Physical Activity Readiness Questionnaire

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Questions

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

Yes

Do you feel pain in your chest when you perform physical activity? *

Yes

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

Yes

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

Yes

Do you have a bone or joint problem that could be made worse by a change in your physical activity? *

Yes

Is your doctor currently prescribing any medication for your blood pressure or for a heart condition? *

Yes

Do you know of any other reason why you should not engage in physical activity? *

Yes

If you have answered “Yes” to one or more of the above questions, consult your physician before engaging in physical activity. Tell your physician which questions you answered “Yes” to. After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition.

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