Form

Health and Lifestyle Questionnaire
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Physical Activity Readiness Questionnaire

Being physically active is very safe for most people. Some people, however, should check with their doctors before they increase their current level of activity. The PAR-Q has been designed to identify the small number of adults for whom physical activity may be inappropriate or those who should have medical advice concerning the type of activity most suitable for them.
Tick any that apply to you:*

Has your doctor ever said that you have a heart confition 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 do physical activity?Do you lose your balance because of dizziness or do you ever lose consciousness?Do you have bone or joint problem that could be made worse by a change in your physical activity?Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?Do you know any other reason why you should not do physical activity?N/A to all of the above
If you answered yes:

If you answered yes to one or more questions, are older than age 40 and have been inactive or are concerned about your health, consult a physician before taking a fitness test or substantially increasing your physical activity. You should ask for a medical clearance along with information about specific exercise limitations you may have.In most cases, you will still be able to do any type of activity you want as long as you adhere to some guidelines.
If you answered no:

If you answered no to all the PAR-Q questions, you can be reasonably sure that you can exercise safely and have a low risk of having any medical complications from exercise.It is still important to start slowing and increase gradually. It may also be helpful to have a fitness assessment with a personal trainer or coach in order to determine where to begin.
When to delay the start of an exercise program:

· If you are not feeling well because of a temporary illness, such as a cold or a fever, wait until you feel better to begin exercising. · If you are or may be pregnant, talk with your doctor before you start becoming more active. Keep in mind, that if your health changes, so that you then answer "YES" to any of the above questions, tell your fitness or health professional, and ask whether you should change your physical activity plan. Source: Selecting and Effectively Using a Health/Fitness Facility. ACSM Fit Society Page. The American College of Sports Medicine Spring

	Not at all	A little	Quite a bit	Extremely
Difficulty getting to sleep
Memory problems
Attacks of anxiety, panic
Difficulty in concentrating
Feeling tired or lacking in energy
Feeling dizzy or faint
Muscle and joint pains
Hot flushes
Sweating at night
Urinary symptoms
Itchy skin
Dry eyes
Waking multiple times through the night
Constipation
Bloating
Headaches / migraines
Irritability

Health and Lifestyle Questionnaire

Physical Activity Readiness Questionnaire

If you answered yes:

If you answered no:

When to delay the start of an exercise program:

Eating Behaviour

General Health

General Wellbeing