This questionnaire is one of the first steps to take when you are planning to increase the amount of physical activity in your daily schedule.
The PAR-Q will help you decide whether or not you may need written permission from your doctor to engage in physical activity.
Having your doctor involved in your fitness plan is a good idea, as he can prescribe the level and intensity of your program.
Please read the questions carefully and check YES or NO opposite the question if it applies to you. If yes, please explain.
YES NO
____ ____ 1. Has your doctor ever said you have heart trouble?
Yes, __________________________________________
____ ____ 2. Do you frequently have pains in your heart and chest?
Yes, ___________________________________________
____ ____ 3. Do you often feel faint or have spells of dizziness?
Yes, ___________________________________________
____ ____ 4. Has a doctor ever said your blood pressure was too high?
Yes, ___________________________________________
____ ____ 5. Has your doctor ever told you that you have a bone or joint problem(s), such as arthritis that has been aggravated by exercise,
or might be made worse with exercise?
Yes, ___________________________________________
____ ____ 6. Is there a good physical reason, not mentioned here, why you should not follow an activity program even if you wanted to?
Yes, ____________________________________________
____ ____ 7. Are you over age 60 and not accustomed to vigorous exercise?
Yes, ____________________________________________
____ ____ 8. Do you suffer from any problems of the lower back, i.e., chronic pain, or numbness?
Yes, ____________________________________________
____ ____ 9. Are you currently taking any medications? If YES, please specify.
Yes, ____________________________________________
____ ____ 10. Do you currently have a disability or a communicable disease? If
Yes, please specify, _______________________________
____ ____ 11. Do you have poor balance or fall frequently? If
YES please specify, ___________________________
____ ____ 12. Do you currently have memory problems? If
YES, please specify, ___________________________
If you answered NO to all of the questions above, it gives a general indication
that you may participate in physical and aerobic fitness activities and/or fitness evaluation testing.
However, the fact that you answered NO to the above questions, is no guarantee that you will have a normal response to exercise.
If you answered Yes to any of the above questions, then you should have written permission from a physician before participating in physical and aerobic fitness activities and/or fitness evaluation testing.
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