PAR-Q & YOU

Yes

No
1
1
1
1
1
1
1
0

1. Has your doctor ever said that you have a heart condition and that you
should only do physical activity recommended by a doctor?
2. Do you feel pain in your chest when you d physical activity?
3. In the past month, have you had chest pain when you were not doing
physical activity?
4. Do you lose you balance because of dizziness or do you ever lose
consciousness?
5. Do you have a bone or joint problem that could be made worse by a change
in your physical activity?
6. Is your doctor currently prescribing drugs for your blood pressure or heart
condition?
7. Do you know of any other reasons why you shold not do physical activity?
7 Total

Start becoming much more physically active - begin slowly and build up gradually. -Take part in a
fitness appraisal- this is and excellent way to determine your basic fitness so that you can plan the
best way for your to live actively.
Delay becoming much more active: -If you are not feeling well beacue of a temprary illness such
and a cold or fever. - If you are or may be pregnant.

Assess your Health status by marking all true statements:

History: Have you Had:
A Heart Attack
0
heart surgery
0
cardiac catheterization
0
coronary angioplaty (PTCA)
0
pacemaker/implantabel cardiac defibrillator/rhythm disturbance
0
heart valve disease
0
heart failure
0
heart transplantation
0
congenital heart disease
0
0
You experience chest discomfort with exertion
0
you experience unreasonable breathlessness
0
you experience dizziness, faithing , or blackouts
0
you experience ankle swelling
0
you experience unpleasant awareness of a forceful or rapid heart rate
0
you take heart medication
0
Other Health Issues:

0
0
0
0
0
0
0
0

you have diabetes

you have asthma or other lung disease
you have burning or cramping sensation in you lower legs when walking short distances
you have musculoskeletal problems that limit your physical activity
you have concerns about the safety of exercise
you take prescription medications
you are pregnant
Total:
You are able to start light Physical Activity.

Cardiovascular risk factors

You are a man 45 yrs or older
0
you are a woman 55 yrs or older
0
you smoke or quit smoking within the previous 6 mo
0
your blood pressure is greater than 140/90 mmHg
0
you do not know your blood pressure
0
your blood cholesterol level is greater than 200 mg/dL
0
you do not know your cholesterol level
0
you have a close blood relative who had a heart attack or heart surgery before age
0
55(father/brother) or 65 (mother/sister)
you are physically inactive
0
you have a body mass index of greater than 30 kg/m^2
0
you have prediabetes
0
you do not know if you have prediabetes
0
Total:
0
You should be able to exercise safely without consulting your physician. You can benefit form using
a facility with a professionally qualified exercise staff.
Please Note: If your health changes so that you then answer Yes to any of the above questions, tell
your fittness or health professional. Ask whether you shold change your physical activity plan.