Physical activity readiness

(A questionnaire for people aged 15-69)

Regular physical activity is fun and healthy, and more and more people are starting to increase their daily activity levels. Being more active is very safe for most people. However, some people should check with their doctor before they make drastic increases to their activity levels.

If you are planning on becoming much more physically active than you are now,

start by answering the seven questions in the box below.

If you are between the ages of 15 and 69, the PARQ will tell you whether you should check with your doctor before you start. If you are over 69 years of age and you are not used to being very active check with your doctor prior.

Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: check ‘YES’ or ‘NO’.

Name

First NameLast Name

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

Do you feel pain in your chest when you do physical activity?

In the past month, have you had chest pain when you were not doing physical activity?

Do you lose your balance because of dizziness or do you ever lose consciousness?

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 levels?

Is your doctor currently prescribing medication

Have you been diagnosed with Asthma, diabetes or high blood pressure

Have you ever had a Heart attack or a Stroke

Are you currently suffering from COVID-19 symptoms?

Do you know of any other reason why you should not do physical activity?

If you answered yes to the above question please provide details:

Do you give JRC Fitness permission to upload videos (that you may feature in) of class to social media

Do you give JRC Fitness permission to add your number to a Class WhatsApp group

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