PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)

The PAR-Q is designed to help you help yourself. Many health benefits are associated with regular exercise, and the completion of PAR-Q is a sensible first step to take if you are planning to increase the amount of physical activity in your life.  For most people physical activity should not pose any problem or hazard. PAR-Q has been designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them.

Name:

Surname:

E-Mail:

Common sense is your best guide in answering these few questions. Please read them carefully and select the  YES  or  NO button as it applies to you.

Yes No Yes No Yes No Yes No Yes No Yes No

Has your doctor ever said you have heart trouble?

Do you frequently have pains in your heart and chest?

Do you often feel faint or have spells of severe dizziness?

Has a doctor ever said your blood pressure was too high?

Do you frequently have back pains?

Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise, or might be made worse with exercise?

Yes No Yes No Yes No Yes No

Is there a good physical reason not mentioned here why you should not follow an activity programme even if you wanted to?

Are you over age 65 and not accustomed to vigorous exercise?

Are you pregnant?

Are you currently on medication?

Select any of the following for which you regularly take treatment:

Asthma

High blood pressure Heart disease

Diabetes

Stroke

Rheumatoid arthritis

Osteoarthritis Other arthritis Constipation

Backache

Other:

Consent and Release

I desire to participate in this programme and willingly give my consent for an evaluation of my present level of health and fitness.

I further agree to undergo those health/fitness tests that I have opted to take, which tests may include any or all of the following:

· blood tests

· fitness tests of strength, endurance and flexibility

· cardiovascular fitness tests

· body composition

· other screening tests.

I accept full responsibility for taking any appropriate actions indicated or recommended as a result of health problems or high risk indicators identified during testing.

I understand the risks involved in testing, and assume personal responsibility for my health and safety while participating in this programme.

I accept I do not accept I further release Better Health Ltd. or its agents from all responsibility for any health problems following on or arising from my participation in this programme. I understand that in selecting the "I accept" button below, I have given my consent and release as described above.

Dated: