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Charneski Power PAR-Q

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PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)

A questionnaire for people age 16-69*

*If younger than 16, to be completed by parent or guardian.


Regular physical activity is fun and healthy, and increasingly more people are starting to become more
active every day. Being more active is very safe for most people. However, some people should check
with their doctor before they start becoming much more physically active.

If you are planning to become much more physically active than you are now, start by answering the
seven questions in the box below. If you are between the ages of 16 and 69, the PAR-Q will tell you if you
should check with your doctor before you start. If you are over 69 years of age, and you are not used to
being very active, check with your doctor. If you are younger than 16 years of age, this document is to be
completed by a parent or guardian.

Common sense is your best guide when you answer these questions. Please read the questions carefully
and answer each one honestly: Circle either YES or NO.

Has your doctor ever said that you have a heart condition and that you should only do physical
activity recommended by a doctor?

YES / NO

Do you feel pain in your chest when you do physical activity?

YES / NO

In the past month, have you had chest pain when you were not doing physical activity?

YES / NO

Do you lose your balance because of dizziness or do you ever lose consciousness?

YES / NO

Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by
a change in your physical activity?

YES / NO

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or
heart condition?

YES / NO

Do you know of any other reason why you should not do physical activity?

YES / NO
IF YOU ANSWERED YES TO ONE OR MORE OF THE
QUESTIONS:
Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or
BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you
answered YES.

You may be able to do any activity you want — as long as you start slowly and build up gradually. Or, you
may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds
of activities you wish to participate in and follow his/her advice.

IF YOU ANSWERED NO TO ALL OF THE QUESTIONS:


If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:
• Start becoming much more physically active – begin slowly and build up gradually. This is the safest and
easiest way to go.
• Take part in a fitness appraisal – this is an excellent way to determine your basic fitness so that you can
plan the best way for you to live actively. It is also highly recommended that you have your blood
pressure evaluated. If your reading is over 144/94, talk with your doctor before you start becoming
much more physically active.

“I have read, understood and completed this questionnaire. Any


questions I had were answered to my full satisfaction.”
FULL NAME:

SIGNATURE:

DATE:

Note: This physical activity clearance is valid for a maximum of 12 months from the date it is completed
and becomes invalid if your condition changes so that you would answer YES to any of the seven
questions.

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