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The Physical Activity Readiness Questionnaire (PAR-Q)

The PAR-Q is a simple self-screening tool that is typically used by fitness trainers or coaches to determine the safety or possible risks of exercising based on your health history, current symptoms, and risk factors.

It also can help a trainer create an ideal exercise prescription for a client.

The PAR-Q+ was created using the evidence-based AGREE process (1) by the PAR-Q+ Collaboration chaired by Dr. Darren E. R. Warburton with Dr. Norman Gledhill, Dr. Veronica Jamnik, and Dr. Donald C. McKenzie (2). Production of this document has been made possible through financial contributions from the Public Health Agency of Canada and the BC Ministry of Health Services. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.

General Health Questions

Please read the 7 questions below carefully and answer each one honestly

1a

Has your doctor ever said that you have a heart condition?

1b

Has your doctor ever said that you have 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

Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months?

Please answer No if your dizziness was associated with over-breathing (including during vigorous exercise)

4

Have you ever been diagnosed with another chronic medical condition?

(Other than heart disease or high blood pressure)

5

Are you currently taking prescribed medications for a chronic medical condition?

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 active?

Answer No if you had a problem in the past, but it does not limit your current ability to be physically active

7

Has your doctor ever said that you should only do medically supervised physical activity?

Follow up questions about your medical condition(s)

If you answer yes, additional questions regarding that condition will appear

1

Do you have Arthritis, Osteoporosis, or Back Problems?

1a

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)

1b

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)?

1c

Have you had steroid injections or taken steroid tablets regularly for more than 3 months?

2

Do you currently have cancer of any kind?

2a

Does your cancer diagnosis include any of the following types: lung/bronchogenic, multiple myeloma (cancer of plasma cells), head, and/or neck?

2b

Are you currently receiving cancer therapy (such as chemotheraphy or radiotherapy)?

3

Do you have a Heart or Cardiovascular Condition?

This includes Coronary Artery Disease, Heart Failure, Diagnosed Abnormality of Heart Rhythm

3a

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

3b

Do you have an irregular heart beat that requires medical management? (e.g., atrial fibrillation, premature ventricular contraction)

3c

Do you have chronic heart failure?

3d

Do you have diagnosed coronary artery (cardiovascular) disease and have not participated in regular physical activity in the last 2 months?

4

Do you have High Blood Pressure?

4a

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)

4b

Do you have a resting blood pressure equal to or greater than 160/60 mmHg with or without medication?

Answer Yes if 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

5a

Do you often have difficulty controlling your blood sugar levels with foods, medications, or other physician-prescribed therapies?

5b

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 irritibility, abnormal sweating, dizziness or light-headedness, mental confusion, difficulty speaking, weakness, or sleepiness

5c

Do you have any signs of diabetes complications such as heart or vascular disease and/or 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, or liver problems)?

5e

Are you planning to engage in what for you is unusually high (or vigorous) intensity exercise in the near future?

6

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

6a

Do you often have difficulty controlling your condition with medications or other physician-prescribed therapies?

6b

Do you have Down Syndrome AND back problems affecting nerves or muscles?

7

Do you have a Respiratory Disease?

This includes Chronic Obstructive Pulmonary Disease, Asthma, Pulmonary High Blood Pressure

7a

Do you often have difficulty controlling your blood sugar levels with foods, medications, or other physician-prescribed 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 supplemental oxygen therapy?

7c

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?

7d

Has your doctor ever said you have high blood pressure in the blood vessels of your lungs?

8

Do you have a Spinal Cord Injury?

This includes Tetraplegia and Paraplegia

8a

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

8b

Do you commonly exhibit low resting blood pressure significant enough to cause dizziness, light-headedness, and/or fainting?

8c

Has your physician indicated that you exhibit sudden bouts of high blood pressure (known as Autonomic Dysreflexia)?

9

Have you had a Stroke?

This includes Transient Ischemic Attack (TIA) or Cerebrovascular Event

9a

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

9b

Do you have any impairment in walking or mobility?

9c

Have you experienced a stroke or impairment in nerves or muscles in the past 6 months?

10

Do you have any other medical condition not listed above or do you have two or more medical conditions?

10a

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?

10b

Do you have a medical condition that is not listed (such as epilepsy, neurological conditions, kidney problems)?

10c

Do you currently live with two or more medical conditions?

I 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 a Trustee (such as my employer, community/fitness centre, health care provider, or other designate) may retain a copy of this form for their records. In these instances, the Trustee will be required to adhere to local, national, and international guidelines regarding the storage of personal health information ensuring that the Trustee maintains the privacy of the information and does not misuse or wrongfully disclose such information.

I have read the above release and waiver of liability and fully understand its content. I am legally component to sign and voluntarily agree to the terms and conditions states above.

Medical History

Do you experience any sharp pain or extreme tightness in your chest when you are hit with a cold blast of air?

Have you ever experienced rapid heart action or palpitations?

Have you ever had a real or suspected heart attack, coronary occlusion, myocardial infarction, coronary insufficiency, or thrombosis?

Have you ever had rheumatic fever?

Do you have diabetes, hypertension, or high blood pressure?

Does anyone in your family have diabetes, hypertension, or high blood pressure?

Has more than one blood relative (parent, sibling, first cousin) had a heart attack or coronary artery disease before the age of 60?

Have you ever taken medications or been on a special diet to lower your cholesterol?

Have you ever taken digitalis, quinine, or any other drug for your heart?

Have you ever taken nitroglycerine or any other tablets for chest pain—tablets you take by placing under the tongue?

Are you overweight?

Are you under a lot of stress?

Do you drink excessively?

Do you smoke cigarettes?

Do you exercise fewer than three times per week?

Have you ever had a heart attack?

Have you ever had bypass or cardiac surgery?

Have you ever had phlebitis or an embolism?

Have you ever had a history of fainting or light-headedness?

Have you ever had a high blood fat (lipid) level?

Have you ever had a stroke?

Have you recently been hospitalized for any cause?

Do you have any orthopedic problems (including arthritis)?

For any of the conditions checked above, please list the diagnosis and examining physician:

Exercise History

1

Are you currently involved in a regular exercise program?

2

Do you regularly walk or run 1 or more miles continuously?

3

Do you practice weightlifting or calisthenics?

4

Are you involved in an aerobic program?

5

Please select the sports in which you have competed:

Highschool / College Currently

Health History

Are you taking any medications?

Do you have any allergies?

Do you take any supplements?

How would you describe your nutritional habits?

Are you on any specific food/diet plan at this time?

Please list any other food/nutritional issues you want your trainer/nutritionist to be aware of (preferences, mealtimes, foods to avoid, etc.)

Please check the box that describes your smoking habits:

Non-user
Former user
Cigar and/or pipe
15 or less cigarettes per day
16 to 25 cigarettes per day
26 to 25 cigarettes per day
More than 35 cigarettes per day

For any of the conditions below, check the box as they relate to you:

Family Member Personally

Please fill in all the rows that apply:

Do you have any past or current musculoskeletal conditions such as muscle pulls, sprains, fractures, surgery, back pain, or general discomfort?

Check if Yes Details

Do you work more than 40 hours a week?

Please check the box that best describes your exertion levels:

Sedentary Light Moderate Intense

Nutrition Program Liability Waiver

Please read the following carefully so you can answer the next question.

I understand that the role of the Nutrition Coach is not to provide health care, medical or nutrition therapy services; or to diagnose, treat or cure any disease, condition or other physical or mental ailment of the human body. Rather, the Nutrition Coach is a mentor and guide who has been trained to help clients reach their own goals by helping clients devise and implement positive, sustainable lifestyle changes. The Client understands that the Coach is not acting in the capacity of a doctor, licensed dietician-nutritionist, psychologist or other licensed or registered professional, and that any advice given by the Coach is not meant to take the place of advice by these professionals. If the Client is under the care of a health care professional or currently uses prescription medications, the Client should discuss any dietary changes or potential dietary supplements use with his or her doctor and should not discontinue any prescription medications without first consulting his or her doctor.

I have chosen to work with a Nutrition coach and understand that the information received should not be seen as medical advice and is not meant to take the place of seeing licensed health professionals.

It is my responsibility to inform my Nutrition Coach of any physical limitations before beginning a program:

I represent and warrant that I am in good physical health and do not suffer from any medical condition that would limit my participation in nutrition coaching offered through Cleanslate Training. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in nutrition coaching. I understand the risks associated with nutrition coaching offered by Cleanslate Training and I agree to follow all instructions so that I may safely participate in nutrition coaching.

I hereby WAIVE and RELEASE Cleanslate Training, its owners, officers, employees, and instructors from any claim, demand, or cause of action of any kind resulting from or related to my participation in the nutrition coaching offered. In taking part in nutrition coaching, with Cleanslate training, I understand and acknowledge that I am fully responsible for any and all risks, injuries, or damages known, or unknown, which might occur as a result of my participation in nutrition coaching.

Do you have any health limitations that could be aggravated by nutrition coaching?

I have read the Nutrition Program Liability Waiver in its entirety and understand its content. I am legally competent to sign and voluntarily agree to the terms and conditions stated above.

Training Program Liability Waiver

Please read the following carefully so you can answer the next question.

It is my responsibility to inform my trainer of any physical limitations before beginning a training program

I represent and warrant that I am in good physical health and do not suffer from any medical condition that would limit my participation in the training offered through Cleanslate Training. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in personal training, fitness training or group training. I understand the risks associated with the activities offered by Cleanslate Training and I agree to follow all instructions so that I may safely participate in training, workshops, or other activities.

I hereby WAIVE and RELEASE Cleanslate Training, its owners, officers, employees, and instructors from any claim, demand, or cause of action of any kind resulting from or related to my participation in the programs offered. In taking part in personal training, fitness training, or group training, with Cleanslate training, I understand and acknowledge that I am fully responsible for any and all risks, injuries, or damages known, or unknown, which might occur as a result of my participation in personal training, fitness training, or group training.

I have read the above release and waiver of liability and fully understand its content. I am legally component to sign and voluntarily agree to the terms and conditions states above.

Do you have any health limitations that could be aggravated by training?

I have read the Training Program Liability Waiver in its entirety and understand its content. I am legally competent to sign and voluntarily agree to the terms and conditions stated above.

COVID-19 Liability Release Waiver

    Please read the following carefully so you can answer the next question.

    The World Health Organization has declared the novel Coronavirus (COVID-19) a worldwide pandemic, and the spread and risks of Covid-19 have remained. Due to its capacity to transmit from person-to-person through respiratory droplets, the government has set recommendations, guidelines, and some prohibitions which Cleanslate Training adheres to comply.

    In consideration of my participation in the foregoing, the undersigned acknowledge and agree to the following:

    • I am aware that my participation in a program with Cleanslate Training, despite all precautions, may expose me to injury or illness such as, but not limited to: Influenza, MRSA, or COVID-19 that may lead to paralysis or death.
    • This acknowledgement also raises the awareness of potential unknown risks to my own health as a result of a novel virus and my previous exposure to it and any past treatments that could effect the fitness guidelines in which a certified personal trainer abides and my ability to remain in good health throughout. I waive, as per described below in the declaration, all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me when reasonable first-aid efforts are applied and the condition or ailment is uncharacteristic to the cautions and program design, and may have causes that are also related or novel, to the virus and strains of viruses causing COVID-19.
    • I acknowledge that by signing this form, until further notice, should I contract Covid-19 or experience symptoms listed, I will voluntarily communicate the facts if they fall within 5 days of any training session.
    • I have not experienced symptoms of fever, fatigue, difficulty in breathing, or dry cough or exhibiting any other symptoms relating to COVID-19 or any communicable disease within the last 5 days.
    • I have not, nor any member(s) of my household, traveled by sea or by air, internationally from which my return was in the past 7 days.
    • I have not been, nor any member(s) of my household, diagnosed to be infected with COVID-19 virus within the last 10 days.

    Following the pronouncements above I hereby declare the following:

    • I am fully and personally responsible for my own safety and actions while and during may participation and I recognize that I may in any case be at risk of contracting COVID-19. With full knowledge of the risks involved, I hereby release, waive, discharge Cleanslate Training, its board, officers, independent contractors, affiliates, employees, representatives, successors from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19. I agree to indemnify, defend, and hold harmless Cleanslate Training from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19.
    • By signing below I acknowledge that I have read the foregoing Liability Release Waiver and understand its contents; that I am at least eighteen (18) years old, or  the parent/legal guardian of the below listed minor and am and fully competent to give my consent; that I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free act and deed; that I give my voluntary consent in signing this Liability Release Waiver as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation.

    This waiver will remain effective throughout the participant’s inclusion in any training programs.

    I have read and agreed to all statements and declarations in the COVID-19 Liability Release Waiver.

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