Name *
Name
Date *
Date
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 achange 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? *
If the PAR-Q is being given to a person before he or she participates in a physical activity program or a fitness appraisal, this section may be used for legal or administrative purposes. *
I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction. *