1) 醫生曾否說過你的心臟有問題，以及只可進行醫生建議的體能活動？Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

2) 你進行體能活動時會否感到胸口痛？Do you feel pain in your chest when you do physical activity?

3) 過去一個月內，你曾否在沒有進行體能活動時也感到胸口痛？In the past month, have you had chest pain when you were not doing physical activity?

4) 你曾否因感到暈眩而失去平衡，或曾否失去知覺？Do you lose your balance because of dizziness or do you ever lose consciousness?

5) 你的骨骼或關節(例如脊骨、膝蓋或髖關節)是否有毛病，且會因改變體能活動而惡化？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?

6) 醫生現時是否有開血壓或心臟藥物（例如 water pills）給你服用？Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?