2022 PAR-Q+

The Physical Activity Readiness Questionnaire for Everyone

The health benefits of regular physical activity are clear; more people should engage in physical activity every
day of the week. Participating in physical activity is very safe for MOST people. This questionnaire will tell you
whether it is necessary for you to seek further advice from your doctorOR 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 NO

1) Has your doctor ever said that you have a heart condition OR high blood pressure ? NO
2) Do you feel pain in your chest at rest, during your daily activities of living, OR when
you do physical activity? NO
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). NO
4) Have you ever been diagnosed with another chronic medical condition (other than heart
disease or high blood pressure)? PLEASE LIST CONDITION(S) HERE: NO
5) Are you currently taking prescribed medications for a chronic medical condition?
PLEASE LIST CONDITION(S) AND MEDICATIONS HERE: NO
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? Please answer NO if you had a problem in the past, but it does not limit your current ability to
be physically active. PLEASE LIST CONDITION(S) HERE: NO

7) Has your doctor ever said that you should only do medically supervised physical activity? NO

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
([Link] You may take part in a health and !tness
appraisal.
If you are over the age of 45 yr and NOT accustomed to regular vigorous to maximal e"ort exercise, consult a quali!ed
exercise professional before engaging in this intensity of exercise.
If you have any further questions, contact a quali!ed exercise professional.
PARTICIPANT DECLARATION
If 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 12 months from the date it is completed and becomes invalid if my condition changes. I
also acknowledge that the community/!tness center may retain a copy of this form for its records. In these instances, it will maintain
the con!dentiality of the same, complying with applicable law.
NAME: MARC JHUNIE MESA DATE : JAN 17 2024
WITNESS ; MELANIE MESA
SIGNATURE

SIGNATURE OF PARENT/GUARDIAN/CARE PROVIDER

____________________________________________________________

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 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 quali!ed exercise professional, and/or
complete the
ePARmed-X+ at [Link] before becoming more physically active. Your health changes -
answer the questions on Pages 2 and 3 of this document and/or talk to your doctor or a quali!ed exercise professional
before continuing with any physical activity program.
Copyright © 2022 PAR-Q+ Collaboration 1 /4
01-11-2021
Cancer of any kind?

2022 PAR-
Q+
FOLLOW-UP QUESTIONS ABOUT YOUR
MEDICAL CONDITION(S) YES NO
1. Do you have Arthritis, Osteoporosis, or Back Problems?
If the above condition(s) is/are present, answer questions
1a-1c If NO go to question 2 YES NO YES NO

1a. Do you have di!culty controlling your condition with

medications or other physician-prescribed therapies? (Answer
NO if you are not currently taking medications or other
treatments) If the above condition(s) is/are present, answer questions
2a-2b
1b. Do you have joint problems causing pain, a recent fracture or
fracture caused by osteoporosis or cancer, displaced vertebra If NO go to question 3
(e.g., spondylolisthesis), and/or spondylolysis/pars defect (a 2a. Does your cancer diagnosis include any of the following
crack in the bony ring on the back of the spinal column)? types: lung/bronchogenic, multiple myeloma (cancer of plasma
cells), head, and/or neck?
1c. Have you had steroid injections or taken steroid tablets
2b. Are you currently receiving cancer therapy (such as
regularly for more than 3 months? 2. Do you currently have chemotheraphy or radiotherapy)?
YES NO YES NO

3. Do you have a Heart or Cardiovascular Condition? This includes Coronary Artery Disease, Heart Failure,
Diagnosed Abnormality of Heart Rhythm
with medications or other physician-prescribed
If the above condition(s) is/are present, answer therapies? (Answer NO if you are not currently taking
questions 3a-3d medications or other treatments)
If NO go to question 4 4b. Do you have a resting blood pressure equal to or
greater than 160/90 mmHg with or without
3a. Do you have di!culty controlling your condition medication? (Answer YES if you do not know your
with medications or other physician-prescribed resting blood pressure)
therapies? (Answer NO if you are not currently taking
medications or other treatments)

3b. Do you have an irregular heart beat that requires 5. Do you have any Metabolic Conditions? This
medical management? includes Type 1 Diabetes, Type 2 Diabetes,
(e.g., atrial "brillation, premature ventricular Pre-Diabetes
contraction)
YES NO YES NO
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?
If the above condition(s) is/are present, answer
4. Do you currently have High Blood Pressure? questions 5a-5e
YES NO YES NO If NO go to question 6
5a. Do you often have di!culty controlling your blood
YES NO YES NO sugar levels with foods, medications, or other
physician- prescribed therapies?
5b. Do you often su#er from signs and symptoms of
low blood sugar (hypoglycemia) following exercise
If the above condition(s) is/are present, answer and/or during activities of daily living? Signs of
questions 4a-4b hypoglycemia may include shakiness, nervousness,
unusual irritability, abnormal sweating, dizziness or
If NO go to question 5 light-headedness, mental confusion, di!culty
4a. Do you have di!culty controlling your condition speaking, weakness, or sleepiness.
 5c. Do you have any signs or symptoms of diabetes 5e. Are you planning to engage in what for you is
complications such as heart or vascular disease unusually high (or vigorous) intensity exercise in the
and/or complications a#ecting your eyes, kidneys, near future?
OR the sensation in your toes and feet?
YES NO
5d. Do you have other metabolic conditions (such as
current pregnancy-related diabetes, chronic kidney
disease, or liver problems)?
YES NO YES NO YES NO YES NO

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2022 PAR-Q+
6. Do you have any Mental Health Problems or Learning Di!culties? 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 di!culty controlling your condition with YES NO YES NO YES NO YES NO
medications or other physician-prescribed therapies? (Answer
NO if you are not currently taking medications or other
treatments)
If the above condition(s) is/are present, answer questions
6b. Do you have Down Syndrome AND back problems a$ecting 8a-8c
nerves or muscles? If NO go to question 9
8a. Do you have di!culty controlling your condition with
7. Do you have a Respiratory Disease? This medications or other physician-prescribed therapies? (Answer
includes Chronic Obstructive NO if you are not currently taking medications or other
treatments)
Pulmonary Disease, Asthma,
Pulmonary High Blood Pressure 8b. Do you commonly exhibit low resting blood pressure
signi"cant enough to cause dizziness, light-headedness, and/or
YES NO YES NO fainting?
8c. Has your physician indicated that you exhibit sudden bouts of
high blood pressure (known as Autonomic Dysre#exia)?

9. Have you had a Stroke? This includes

If the above condition(s) is/are present, answer questions
7a-7d Transient Ischemic Attack (TIA)
If NO go to question 8 or Cerebrovascular Event
7a. Do you have di!culty controlling your condition with YES NO YES NO YES NO
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 If the above condition(s) is/are present, answer questions
rest or during exercise and/or that you require supplemental
oxygen therapy? 9a-9c
If NO go to question 10
7c. If asthmatic, do you currently have symptoms of chest
tightness, wheezing, laboured breathing, consistent cough (more 9a. Do you have di!culty controlling your condition with
than 2 days/week), or have you used your rescue medication medications or other physician-prescribed therapies? (Answer
NO if you are not currently taking medications or other
more than twice in the last week? treatments)
7d. Has your doctor ever said you have high blood pressure in 9b. Do you have any impairment in walking or mobility?

the blood vessels of your lungs? 8. Do you have a Spinal 9c. Have you experienced a stroke or impairment in nerves or
muscles in the past 6 months?

Cord Injury? This includes YES NO YES NO YES NO

Tetraplegia and Paraplegia

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

GO to Page 4 for recommendations about your current

medical condition(s) and sign the PARTICIPANT
DECLARATION.

Copyright © 2022 PAR-Q+ Collaboration 3/ 4

01-11-2022

2022 PAR-Q+

If you answered NO to all of the FOLLOW-UP questions (pgs. 2-

3) about your medical condition,
you are ready to become more physically active - sign the PARTICIPANT
DECLARATION below: It is advised that you consult a quali"ed exercise professional to help you develop
a safe and e!ective physical
activity plan to meet your health needs.
You are encouraged to start slowly and build up gradually - 20 to 60 minutes of low to moderate intensity
exercise, 3-5 days per week including aerobic and muscle strengthening exercises.
As you progress, you should aim to accumulate 150 minutes or more of moderate intensity physical activity per week.
If you are over the age of 45 yr and NOT accustomed to regular vigorous to maximal e!ort exercise, consult
a quali"ed exercise professional before engaging in this intensity of exercise.

If you answered YES to one or more of the follow-up questions about your medical
condition: You should seek further information before becoming more physically active or engaging in a "tness appraisal. You
should complete the specially designed online screening and exercise recommendations program - the ePARmed-X+ at
[Link] and/or visit a quali"ed exercise professional to work through the ePARmed-X+ and for further information.

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 quali"ed exercise
professional, and/or complete the ePARmed-X+ at [Link] before becoming more
physically active.
Your health changes - talk to your doctor or quali"ed exercise professional before continuing with any
physical activity program.

You are encouraged to photocopy the PAR-Q+. You must use the entire questionnaire and NO changes are permitted.
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
All persons who have completed the PAR-Q+ please read and sign the declaration below.

If 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 12 months from the date it is
completed and becomes invalid if my condition changes. I also acknowledge that the community/"tness center
may retain a copy of this form for records. In these instances, it will maintain the con"dentiality of the same,
complying with applicable law.
________________________________________________
NAME DATE _________________________________________
__________________________________________________ WITNESS ______________________________________

__ SIGNATURE

SIGNATURE OF PARENT/GUARDIAN/CARE PROVIDER

____________________________________________________________________
Key References

The PAR-Q+ was created using the evidence-based AGREE process (1) by the
For more information, please contact PAR-Q+ Collaboration chaired by Dr. Darren E. R. Warburton with Dr. Norman
[Link] Gledhill, Dr. Veronica Jamnik, and Dr. Donald C. McKenzie (2). Production of this
Email: eparmedx@[Link] document has been made possible through "nancial contributions from the Public
Citation for PAR-Q+ Health Agency of Canada and the BC Ministry of Health Services. The views
Warburton DER, Jamnik VK, Bredin SSD, and Gledhill N on behalf of the PAR-Q+ Collaboration. The Physical
Activity Readiness Questionnaire for Everyone (PAR-Q+) and Electronic Physical Activity Readiness Medical expressed herein do not necessarily represent the views of the Public Health
Examination (ePARmed-X+). Health & Fitness Journal of Canada 4(2):3-23, 2011. Agency of Canada or the BC Ministry of Health Services.
1. Jamnik VK, Warburton DER, Makarski J, McKenzie DC, Shephard RJ, Stone J, and Gledhill N. Enhancing the e!ectiveness of clearance for physical activity participation; background and overall
process. APNM 36(S1):S3-S13, 2011. 2. Warburton DER, Gledhill N, Jamnik VK, Bredin SSD, McKenzie DC, Stone J, Charlesworth S, and Shephard RJ. Evidence-based risk assessment and
recommendations for physical activity clearance; Consensus Document. APNM 36(S1):S266-s298, 2011.
3. Chisholm DM, Collis ML, Kulak LL, Davenport W, and Gruber N. Physical activity readiness. British Columbia Medical Journal. 1975;17:375-378.
4. Thomas S, Reading J, and Shephard RJ. Revision of the Physical Activity Readiness Questionnaire (PAR-Q). Canadian Journal of Sport Science 1992;17:4 338-345.
Copyright © 2022 PAR-Q+ Collaboration 4/ 4
01-11-2021