The Physical Activity Readiness Questionnaire for Everyone

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The health benefits of regular physical activity are clear; more people should engage in physical activity every day of the week. Participating in physical activity is very safe for MOST people. This questionnaire will tell you whether it is necessary for you to seek further advice from your doctor OR a qualified exercise professional before becoming more physically active.

If you are less than the legal age required for consent or require the assent of a care provider, your parent, guardian, or care provider may complete this form on your behalf. Common sense is your best guide when you answer these questions. Please note you should delay becoming much more active if you have a temporary illness (such as a cold or fever). It is best to wait until you feel better. You may also download the print versions of the PAR-Q+ at www.eparmedx.com.

Please read the following seven (7) questions carefully and answer each one honestly: check YES or NO.

Q1: Has your doctor ever said that you have a heart condition OR high blood pressure?(Required)
Q1A: If you answered YES to the Question #1 (above) please select the appropriate condition. Select ALL that apply.
Q2: Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?(Required)
Q3: Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months?(Required)
Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise).
Q4: Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)?(Required)
Q5: Are you currently taking prescribed medications for a chronic medical condition?(Required)
Q6: Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically active?(Required)
Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active.
Q7: Has your doctor ever said that you should only do medically supervised physical activity?(Required)

Since you answered YES to one or more of the questions above we ask that you complete a short series of questions to gain further information prior to providing further recommendations. Please select NO to all questions that do not apply to you.

Follow-up Q1: Do you have Arthritis, Osteoporosis, or Back Problems?(Required)

Follow-up Q1A: Do you have difficulty controlling your condition with medications or other physician-prescribed therapies?
(Answer NO if you are not currently taking medications or other treatments)
Follow-up Q1B: Do you have joint problems causing pain, a recent fracture or fracture caused by osteoporosis or cancer, displaced vertebra (e.g., spondylolisthesis), and/or spondylolysis/pars defect (a crack in the bony ring on the back of the spinal column)?
Follow-up Q1C: Have you had steroid injections or taken steroid tablets regularly for more than 3 months?
Follow-up Q2: Do you currently have cancer of any kind?

Follow-up Q2A: Does your cancer diagnosis include any of the following types: lung/bronchogenic, multiple myeloma (cancer of plasma cells), head, and/or neck?
Follow-up Q2B: Are you currently receiving cancer therapy (such as chemotheraphy or radiotherapy)?
Follow-up Q3: Do you have a Heart or Cardiovascular Condition? This includes Coronary Artery Disease, Heart Failure, Diagnosed Abnormality of Heart Rhythm

Follow-up Q3A: Do you have difficulty controlling your condition with medications or other physician-prescribed therapies?
(Answer NO if you are not currently taking medications or other treatments)
Follow-up Q3B: Do you have an irregular heart beat that requires medical management? (such as atrial fibrillation, premature ventricular contraction)
Follow-up Q3C: Do you have chronic heart failure?
Follow-up Q3D: Do you have diagnosed coronary artery (cardiovascular) disease and have not participated in regular physical activity in the last 2 months?
Follow-up Q4: Do you currently have High Blood Pressure?

Follow-up Q4A: Do you have difficulty controlling your condition with medications or other physician-prescribed therapies?
(Answer NO if you are not currently taking medications or other treatments)
Follow-up Q4B: Do you have a resting blood pressure equal to or greater than 160/90 mmHg with or without medication?
(Answer YES if you do not know your resting blood pressure)
Follow-up Q5: Do you have any Metabolic Conditions? This includes Type 1 Diabetes, Type 2 Diabetes, and Pre-Diabetes.

Follow-up Q5A: Do you often have difficulty controlling your blood sugar levels with foods, medications, or other physician-prescribed therapies?
Follow-up Q5B: Do you often suffer from signs and symptoms of low blood sugar (hypoglycemia) following exercise and/or during activities of daily living? Signs of hypoglycemia may include shakiness, nervousness, unusual irritability, abnormal sweating, dizziness or light-headedness, mental confusion, difficulty speaking, weakness, or sleepiness.
Follow-up Q5C: Do you have any signs or symptoms of diabetes complications such as heart or vascular disease and/or complications affecting your eyes, kidneys, OR the sensation in your toes and feet?
Follow-up Q5D: Do you have other metabolic conditions (such as current pregnancy-related diabetes, chronic kidney disease, or liver problems)?
Follow-up Q5E: Are you planning to engage in what for you is unusually high (or vigorous) intensity exercise in the near future?
Follow-up Q6: Do you have any Mental Health Conditions or Learning Difficulties? This includes Alzheimer’s, Dementia, Depression, Anxiety Disorder, Eating Disorder, Psychotic Disorder, Intellectual Disability, and Down Syndrome.

Follow-up Q6A: Do you have difficulty controlling your condition with medications or other physician-prescribed therapies?
(Answer NO if you are not currently taking medications or other treatments)
Follow-up Q6B: Do you have Down Syndrome AND back problems affecting nerves or muscles?
Follow-up Q7: Do you have a Respiratory Disease? This includes Chronic Obstructive Pulmonary Disease, Asthma, and Pulmonary High Blood Pressure.

Follow-up Q7A: Do you have difficulty controlling your condition with medications or other physician-prescribed therapies?
(Answer NO if you are not currently taking medications or other treatments)
Follow-up Q7B: Has your doctor ever said your blood oxygen level is low at rest or during exercise and/or that you require supplemental oxygen therapy?
Follow-up Q7C: If asthmatic, do you currently have symptoms of chest tightness, wheezing, laboured breathing, consistent cough (more than 2 days/week), or have you used your rescue medication more than twice in the last week?
Follow-up Q7D: Has your doctor ever said you have high blood pressure in the blood vessels of your lungs?
Follow-up Q8: Do you have a Spinal Cord Injury? This includes Tetraplegia and Paraplegia.

Follow-up Q8A: Do you have difficulty controlling your condition with medications or other physician-prescribed therapies?
(Answer NO if you are not currently taking medications or other treatments)
Follow-up Q8B: Do you commonly exhibit low resting blood pressure significant enough to cause dizziness, light-headedness, and/or fainting?
Follow-up Q8C: Has your physician indicated that you exhibit sudden bouts of high blood pressure (known as Autonomic Dysreflexia)?
Follow-up Q9: Have you had a Stroke? This includes Transient Ischemic Attack (TIA) or Cerebrovascular Event.

Follow-up Q9A: Do you have difficulty controlling your condition with medications or other physician-prescribed therapies?
(Answer NO if you are not currently taking medications or other treatments)
Follow-up Q9B: Do you have any impairment in walking or mobility?
Follow-up Q9C: Have you experienced a stroke or impairment in nerves or muscles in the past 6 months?

Follow-up Q10: The following questions relate to other medical conditions not discussed above and whether you currently have two or more medical conditions?

Follow-up Q10A: Have you experienced a blackout, fainted, or lost consciousness as a result of a head injury within the last 12 months OR have you had a diagnosed concussion within the last 12 months?
Follow-up Q10B: Do you have a medical condition that is not listed (such as epilepsy, neurological conditions, kidney problems)?
Follow-up Q10C: Do you currently live with two or more medical conditions?

Thank you for completing the follow-up questions regarding your medical condition(s)!

PLEASE READ, SIGN, AND PRINT OFF (as required by your trustee)

Your answers to this survey indicate that you should seek further information before becoming more physically active or engaging in a fitness appraisal.

It is recommended that you visit a qualified exercise professional (with advanced university training) or your family physician for further information. This does not mean that you cannot perform any physical activities. We recommend that you only engage in low-intensity physical activity until you have received clearance from your physician and/or have met with a qualified exercise professional. Once you receive clearance for unrestricted physical activity, it may be advisable to exercise under the direct supervision of a qualified exercise professional. This will assist in optimizing the health benefits of physical activity while minimizing the risk.

PARTICIPANT DECLARATION

All persons who have completed the PAR-Q+, please read and sign the declaration below.

If you are less than the legal age required for consent or require the assent of a care provider, your parent, guardian, or care provider must also sign this form.

I, the undersigned, have read, understood to my full satisfaction, and completed this questionnaire. I also acknowledge that the community/fitness center may retain a copy of this form for its records. In these instances, it will maintain the confidentiality of the same, complying with applicable law.

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Thank you for completing the first seven questions of the PAR-Q+ Survey!

PLEASE READ, SIGN, AND PRINT OFF (OR SAVE) THIS PAGE (as required by your trustee)

Physical Activity Information

Your Physical Activity Recommendations

Your answers indicated that you are cleared to start becoming more physically active and/or to engage in a fitness appraisal. Follow the global recommendations on physical activity for your age (https://www.who.int/publications/i/item/9789240015128). You are encouraged to start slowly and build up gradually towards 20-60 minutes per session of low to moderate intensity aerobic activities, 3-5 days per week. As you progress, you should aim to accumulate 150 minutes/week of moderate intensity physical activity per week. You should also engage in low to moderate intensity muscular strengthening activities on 2-4 days per week, and flexibility exercises on most days of the week.

You may take part in a health and fitness appraisal. If you are over the age of 45 years and NOT accustomed to regular vigorous to maximal effort exercise, consult a qualified exercise professional before engaging in this intensity of exercise. If you have any further questions, contact a qualified exercise professional.

Delay becoming much more active if:

  • You are not feeling well because of a temporary illness such as a cold or fever: wait until you feel better.
  • You are pregnant - talk to your health care practitioner, a qualified exercise professional, and/or complete the ePARmed-X+ before becoming much more active.

PARTICIPANT DECLARATION

All persons who have completed the PAR-Q+, please read and sign the declaration below.

If you are less than the legal age required for consent or require the assent of a care provider, your parent, guardian, or care provider must also sign this form.

I, the undersigned, have read, understood to my full satisfaction and completed this questionnaire. I acknowledge that this physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if my condition changes. I also acknowledge that the community/fitness center may retain a copy of this form for its records. In these instances, it will maintain the confidentiality of the same, complying with applicable law.

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