2020PAR-Q+

The Physical Activity Readiness Questionnaire for Everyone

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

GENERAL HEALTH QUESTIONS

Please read the 7 questions below carefully and answer each one honestly: check YES or NO. YES

1) Has your doctor ever said that you have a heart condition OR high blood pressure ?
2) Do you feel pain in your chest at rest, during your daily activities of living, OR when you do
physical activity?
3) C
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Dease an! r NO!a ueb” ess”was iaedwitRoh breathing” un g'oursng ono h x ! '
dt se)
4) Have you ever been diagnosed with another chronic medical condition (other than heart disease
or high blood pressure)? PLEASE LISTCONDITION(S) HERE:
5) Are you currently taking prescribed medications for a chronic medical condition?
PLEASE LIST CONDITION(S) AND MEDICATIONS HERE: o o
6) 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
äCtÎV "? Please answer NO ifyou had a problem in the past, but it does not Timit your current abiTity to be physically active.
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PLEASE LIST CONDITION(S) HERE:

7) Has your doctor ever said that you should only do medically supervised physical activity?
I'm If you answered NO to all of the questions above, you are cleared for physical activity.
Please sign the PARTICIPANT DECLARATION. You do not need to complete Pages 2 and 3.
@ Start becoming much more physically active — start slowly and build up gradually.
@ Follow Global Physical Activity Guidelines for your age (https://a pps.who.int/iris/handIe/10665/44399).
@ You may take part in a health and fit ness app raisal.
If you are over the age of 45 yr 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.
PARTICIPANT DECLARATION
If you are less than the legal age required for consent or require the assent of a care provide r 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 ac knowledge that this physic al 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 a pplica ble law.
NAME DATE
SIGNATURE WITNESS
IGNATUREOF PARENT/GUARDIAN/CARE PROVIDER
L*

G If you answered YES to one or more of the questions above, COMPLETE PAGES 2 AND 3.
Delay becoming more active if:
You have a tempora ry illness such as a cold or fever; it is best to wait until you feel better.
a re pregnant - talk to your health care practitioner, your physician, a qualified exercise professional, and/or complete
the ePARmed-V+ at www.eparmedx.com before becom mg more physically art ive.
Your health changes - answer the questions on Pages 2 and 3 of this doc ument and/or talk to your doctor or a qualified exercise
professional before continuing with any physica I activity program.

Copyright 6 2020 PAR-Q+ Collaboration 1 / 4

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FOLLOW-UP QUESTIONS ABOUT YOUR MEDICAL CONDITION(S)
1. Do you have Arthritis, Osteoporosis, or Back Problems?
If the above condition(s) is/are present, answer questions 1a-1c If NO{_j go to question 2
Do you have difficulty controlling your condition with medications or other physician-prescribed therapies?
YES Q
NO
(Answer NO if you are not currently taking medications or other treatments)
1 b.
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
YES
NO back
of the spinal column)?
1c Have you had steroid injections or taken steroid tablets regularly for more than 3 months?
YES NO

2. Do you currently have Cancer of any kind?

If the above condition(s) is/are present, answer questions 2a-2b If NO go to question 3
2a. Does your cancer diagnosis include any of the following types: lung/bronchogenic, multiple myeloma (cancer of YES {g
NO
plasma cells), head, and/or neck?
2b. Are you currently receiving cancer therapy (such as chemotheraphy or radiotherapy)? YES NO

3. Do you have a Heart or Cardiovascular Condition? This includes Coronary Artery Disease, Heart Failure,
Diagnosed Abnormality of Heart Rhythm
If the above condition(s) is/are present, answer questions 3a-3d If NO go to question 4
3a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies?
YES Q
NO
(Answer NO if you are not currently taking medications or other treatments)
3b. Do you have an irregular heart beat that requires medical management? YES NO
(e.g., atrial flbrillation, premature ventricular contraction)
3c Do you have chronic heart failure? YES NO
3d. Do you have diagnosed coronary artery (cardiovascular) disease and have not participated in reg ular physical YESp
NO
activity in the last 2 months?

4. Do you currently have High Blood Pressure?

If the above condition(s) is/are present, answer questions 4a-4b If NO go to question 5
4a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies?
YES Q
NO
(Answer NO if you are not currently taking medications or other treatments)
4b. Do you have a resting blood pressure equal to or greater than 160/90 mmHg with or without YES NO
medication? (Answer YESif you do not know your resting blood pressure)

5. Do you have any Metabolic Conditions? This includes Type 1 Diabetes,Type 2 Diabetes, Pre-Diabetes
If the above condition(s) is/are present, answer questions 5a-5e If NO go to question 6
5a. Do you often have difficulty controlling your blood sugar levels with foods, medications, or other physician-
YESp
NO
prescribed therapies?
5b. Do you often suffer from signs and symptoms of low blood sugar (hypoglycemia) following exercise and/or

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during activities of daily living? Sig ns of hypoglycemia may include shakiness, nervousness, unusual irritability,
abnormal sweating, dizziness or light-headedness, mental confusion, difficulty speaking, weakness, or sleepiness.
YES NO

5c Do you have any signs or symptoms of diabetes complications such as heart or vascular disease and/or YES NO
complications affecting your eyes, kidneys, OR the sensation in your toes and feet?
5d. Do you have other metabolic conditions (such as current pregnancy-related diabetes, chronic kidney disease, OF YES NO
liver problems)?
5e. Are you planning to engage in what for you is unusually high (or vigorous) intensity exercise in the near future? YES Q NO

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Do you have any Mental Health Problems or Learning Difficulties? This includes Alzheimer‘s, Dementia,
Depression, Anxiety Disorder, Eating Disorder, Psychotic Disorder, Intellectual Disability, Down Syndrome
If the above condition(s) is/are present, answer questions 6a-6b If NO go to question 7
6a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies?YES Q NO
(Answer NO if you are not currently taking medications or other treatments)
6b. Do you have Down Syndrome AND back problems affecting nerves or muscles?
YES NO

7. Do you have a Respiratory Disease? This includes Chronic Obstructive Pulmonary Disease, Asthma,
Pulmonary High Blood Pressure
If the above condition(s) is/are present, answer questions 7a-7d If NO go to question
8
7a. Do you have difficulty controlling your condition with medications or other physician-prescribed YES NO
therapies? (Answer NO if you are not currently taking medications or other treatments)

7b. Has your doctor ever said your blood oxygen level is low at rest or during exercise and/or that you require YES NO
supplemental oxygen therapy?
7c. If as thmatic, do you currently have symptoms of chest tightness, wheezing, laboured breathing, consistent cough
ES
NO
(more than 2 days/week), or have you used your rescue medication more than twice in the last week?

7d. Has your doctor ever said you have high blood pressure in the blood vessels of your lungs?
YES NO
8. Do you have a Spinal Cord Injury? This includes Tetraplegia and Paraplegia
If the above condition(s) is/are present, answer questions 8a-8c If NO |**] go to question 9
8a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies? yES NO
(Answer NO if you are not currently taking medications or other treatments)
8b. Do you commonly exhibit low resting blood pressure sig niflcant enough to cause dizziness, light-
headedness, y ES NO
and/or fainting?
8c Has your physician indicated that you exhibit sudden bouts of high blood pressure (known as Autonomic YES NO
Dysreflexia)?

9. Have you had a Stroke? This includes Transient Ischemic Attack (TIA) or Cerebrovascular Event
If the above condition(s) is/are present, answer questions 9a-9c If NO[**] go to question
10
9a. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies?
Y
(Answer NO if you are not currently taking medications or other treatments) ES

9b. Do you have any impairment in walking or mobility?

YES NO
9c Have you experienced a stroke or impairment in nerves or muscles in the past 6 months?
YES NO

10. Do you have any other medical condition not listed above or do you have two or more medical conditions?
If you have other medical conditions, answer questions 10a-10c If NO{_j read the Page 4 recommendations
10a. Have you experienced a blackout, fainted, or lost consciousness as a result of a head injury within the last 12 YES
NO
months OR have you had a diagnosed concussion within the last 1 2 months?
10b. Do you have a medical condition that is not listed (such as epilepsy, neurological conditions, kidney problems)? YES NO
10c. Do you currently live with two or more medical
conditions? YES NO

PLEASE LISTYOUR MEDICAL CONDITION(S)

AND ANY RELATED MEDIATIONS HERE:

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If you answered NO to all of the FOLLOW-UP questions (pgs. 2-3) about your medical condition,
@It is advised that you consult a qualified exercise professional to help you develop a safe and effective physica
You are encouraged to start slowly and build up gradually - 20 to 60 minutes of low to moderate intensity exercis
@ As you progress, you should aim to accumulate 150 minutes or more of moderate intensity physical activity pe
qualified exercise professional before engaging in this intensity of exercise.

f you an we edES o o e e f thell p questn abou youed aondon

You should seek further information before becoming more physically active or engag ing in a fitness appraisal. You should comp

@ Delay becoming more active if:

You have a temporary illness such as a cold or fever; it is best to wait until you feel better.
You are pregnant - talk to your health care practitioner, your physician, a qualified exercise professional,
and/or complete the ePARmed-X+ at www.eparmedwcoro before becoming more physically active.
Your health changes - talk to your doctor or qualified exercise professional before continuing with any physical
activity program.

G You are encouraged to photocopy the PAR-Q+. You must use the entire questionnaire and NO changes are permitted.
G The authors, the PAR-Q+ Collaboration, partner organizations, and their agents assume no liability for persons who
undertake physical activity and/or make use of the PAR-Q+ or ePARmed-X+. If in doubt after completing the questionnaire,
consult your doctor prior to physical activity.
PARTICIPANT DECLARATION
0 AII persons who have completed the PAR-Q+ please read and sign the declaration below.
GIf 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 2 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 records. In these instances, it will maintain the confidentiality of the same, complying with
applicable law.

NAME DATE
SIGNATURE WITNESS
SIGNATURE OF PARENT/GUARDIAN/CARE PROVIDER

For more information, please contact

The PAR-Q+ was created using rhe evidence-based AGREE process (1) by rhe PAR-Q+
Email:eparmedx@gmalI.œm Collaborarion chaired by Dr. Darren E. R. Warbur ron wirh Dr. Norman Gledhill, Dr. Veronica
Jamnik, and Dr. Donald C. McKenzie (2). Produc rion of rhis document has been made
Watbu t ton DER, J amni k W, B tedi n SSD, and Gled hill N on bert al f of th e PAR-Q+ ColI abota tion possible through financi al con rriburions from rhe Public Heal rh Agency of Canada and rhe
BC Ministry of Heal rh Services. The views expressed herein do nor necessarily represent
rhe views of rhe Public Heal rh Agency of Canada or rhe BC Ministry of Heal rh Services.
J amniL VK, WatbuI ton DER, Ma La tsLi J, M¢k enzie DC, Sheph aid RJ, Stone J, and Gled hill N En han¢ing the effe¢tivenes s of ¢leat an¢e lot physi ¢al a ¢tivup pat ti¢ipa tion, ba¢Lg found and ov et all pt o¢es s APNM 36(SI) 53-513, 2011
2 WaI but ton DER, Gled hill N, J amniL VK, Bred in SSD, M¢Kenzie DC, Stone J, Ch atI eswot th S, and Sheph aid RJ Eviden ¢e-ba sed tisL as ses smenI and ie¢ommend a tions lot physi ¢al a ¢tivup ¢lea tan ¢e, Consensus Do¢umen I APNM

3 Chish olm DM, Coll is ML, Kula LLL, Dayen pot tW, and Gtubet N Physi ¢al a ¢tiyup lead in ess BIlash Columbia Me di¢al Joutn al 1975,17 37S-378

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