Physical Activity Readiness Questionnaire printable pdf download

Physical Activity Readiness Questionnaire

Physical Activity Readiness Questionnaire - PAR-Q

PAR-Q & YOU

YES

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 do physical activity?

3. In the past month, have you had chest pain when you were not

doing physical activity?

4. Do you lose your balance because of dizziness or do you ever

lose consciousness?

5. Do you have a bone or joint problem (for example, back, knee

or hip) that could be made worse by a change in your physical

activity?

6. Is your doctor currently prescribing drugs (for example, water

pills) for your blood pressure or heart condition?

7. Do you know of any other reason why you should not do

physical activity?

8. Are you currently pregnant?

If you answered YES to any of the questions above….

• You may not participate in a class due to health concerns.

• Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or

BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered

YES.

• You may be able to do any activity you want — as long as you start slowly and build up gradually. Or, you

may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of

activities you wish to participate in and follow his/her advice.

NAME:________________________________________________________________________________

SIGNATURE:_________________________________________

DATE:_________________________

SIGNATURE OF PARENT OR

GUARDIAN

(for participants under the age of majority) _______________________________________________________________

WITNESS:___________________________________________

Ottawa Pole Fitness Inc.

Confidential

Physical Activity Readiness Questionnaire