This questionnaire is designed to help assess an adult’s readiness for physical activity and identify potential risks prior to beginning an exercise program.The questions are informed by standard pre-exercise screening guidelines, including those outlined in the Adult Pre-Exercise Screening System (APSS).

Important: This form is for informational purposes only and does not replace professional medical advice. Participants should consult a qualified healthcare professional before starting or changing any exercise program.

IF YOU ANSWERED ‘YES’ to any of the 6 questions, please seek guidance from an appropriate allied health professional or medical practitioner prior to undertaking exercise.

IF YOU ANSWERED ‘NO’ to all of the 6 questions, please proceed to question 7 and calculate your typical weighted physical activity/exercise per week.

Once you have completed and submitted this form, if your responses indicate that a referral may be appropriate, I can assist you through the referral process. I will help connect you with a suitable allied health professional or medical practitioner to ensure you can safely undertake exercise.

Q7. Describe your current physical activity/exercise levels in a typical week by stating the frequency and duration at the different intensities.

If your total is less than 150 minutes per week then light to moderate intensity exercise is recommended. Increase your volume and intensity slowly.

• If your total is more than or equal to 150 minutes per week then continue with your current physical activity/exercise intensity levels.

• It is advised that you discuss any progression (volume, intensity, duration, modality) with an exercise professional to optimise your results.

Q10. Body composition

Any of the below increases the risk of chronic diseases:

BMI ≥ 30 kg/m2

Waist > 94 cm male or > 80 cm female

Either of the below increases the risk of heart disease:

Systolic blood pressure ≥ 140 mmHg

Diastolic blood pressure ≥ 90 mmHg

Any of the below increases the risk of heart disease:

Total cholesterol ≥ 5.2 mmol/L

HDL < 1.0 mmol/L

LDL ≥ 3.4 mmol/L

Triglycerides ≥ 1.7 mmol/L

Fasting blood sugar (glucose) ≥ 5.5 mmol/L increases the risk of diabetes.

Taking medication indicates a medically diagnosed problem. Judgment is

required when taking medication information into account for determining

appropriate exercise prescription because it is common for clients to list

‘medications’ that include contraceptive pills, vitamin supplements and other

non-pharmaceutical tablets. Exercise professionals are not expected to have

an exhaustive understanding of medications. Therefore, it may be important

to use common language to describe what medical conditions the drugs are

prescribed for.

There are positive relationships between illness rates and death versus the

number and length of hospital admissions in the previous 12 months. This

includes admissions for heart disease, lung disease (e.g., Chronic Obstructive

Pulmonary Disease (COPD) and asthma), dementia, hip fractures, infectious

episodes and inflammatory bowel disease. Admissions are also correlated to

‘poor health’ status and negative health behaviours such as smoking, alcohol

consumption and poor diet patterns.

During pregnancy and after recent childbirth are times to be more cautious

with exercise. Appropriate exercise prescription results in improved health

to mother and baby. However, joints gradually loosen to prepare for birth

and may lead to an increased risk of injury especially in the pelvic joints.

Activities involving jumping, frequent changes of direction and excessive

stretching should be avoided, as should jerky ballistic movements.

Guidelines/fact sheets can be found here: 1) www.exerciseismedicine.com.au

2) www.fitness.org.au/Pre-and-Post-Natal-Exercise-Guidelines

Almost everyone has experienced some level of soreness following

unaccustomed exercise or activity but this is not really what this question is

designed to identify. Soreness due to unaccustomed activity is not the same

as pain in the joint, muscle or bone. Pain is more extreme and may represent

an injury, serious inflammatory episode or infection. If it is an acute injury

then it is possible that further medical guidance may be required.