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6 vues4 pages

Par Q

par q assement

Transféré par

caballec
Copyright
© All Rights Reserved
Nous prenons très au sérieux les droits relatifs au contenu. Si vous pensez qu’il s’agit de votre contenu, signalez une atteinte au droit d’auteur ici.
Formats disponibles
Téléchargez aux formats PDF ou lisez en ligne sur Scribd
2023 PAR-Q+ The Physical Activity Readiness Questionnaire for Everyone The health benefits of regular physical activity ae clear more people should engage in physical actvty every day ofthe week. Participating in physical activity ver safe for MOST people. This questionnaiewilltell you whether s necessary for you to seek further advice from your doctor OR qualifed exercise professional before becoming more physically active GENERAL HEALTH QUESTIONS Please read the 7 questions below ly and answer each one honesth 1) Has your doctor ever said that you have a heart condition Q 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) 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)? PLEASE LIST CONDITION(S) HERE: 5) Are you currently taking prescribed medications for a chronic medical condition? PLEASE LIST CONDITION(S) AND MEDICATIONS HERE: 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 ifyou hada problem in the past, butt dees not limit your current ability to be physically activ, PLEASE LIST CONDITION(S) HERE: 7) Has your doctor ever said that you should only do medically supervised physical activity? oh you answered NO toall ofthe 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] int/publications/v/itenn/9789240015128) @ You may take part in a health and fitness appraisal, If youare over the age of 4 yr ane NOT accustomed to regular vigorous to maximal effort exercise, consulta qualified exercise © fessional before engaging in this ntensty ofexerese. " © fyounave any further questions, contact qualified exercise professional PARTICIPANT DECLARATION Ifyou ae less than the legal age required for consent or requite the assent ofa cate provider, your parent, quardian or cae provider must alzosign thi form, |, the undersigned, have read, understood to my full satisfaction andl completed this questionnaire. | acknowledge that this physical activity clearance is valid for a maximum of 12 months rom the date itis completed and Becomes invalid if my condition changes, | also, acknowledge that the community/itness center may retain a copy of this form for its records. In these instances t wil maintain the Confidentiality ofthe same, complying with applicable law. NAME DATE SIGNATURE WITNESS. ‘SIGNATURE OF PARENT/GUARDIAN/CARE PROVIDER @ If you answered YES to one or more of the questions above, COMPLETE PAGES 2 AND 3. ‘Ax Delay becoming more active if: Youhavea temporary lines such asa cold or fever itis best to wait until you fel better. Youre pregnant talk to your health care practitioner, your physician, a qualified exercise professional andor complete the BARI aSaS! won epatmedncom before Becoming more physically adtve c : Your health changes - answer the questions on Pages 2 and 3 ofthis document and/or talk to your doctor ora qualified exercise Brofessinal before continuing with any physical ava program. 2 : Copyngheo ans PARC caoboaton | / 2023 PAR-Q+ FOLLOW-UP QUESTIONS ABOUT YOUR MEDICAL CONDITION(S) Do you have Arthritis, Osteoporosis, or Back Problems? If the above condition(s) is/are present, answer questions 1a-1c If NOL) go to question 2 1. Doyouhave aici controling your candlion with medationsor other physician prescribed therapes? ves) no (Answer NO if you are not currently taking medications or other treatments) OO TB Doyou have jon problems causing pin, arecetfracture or fracture caused by oneoporoiso ance Gapacedveheorstesroponavolithesh andlor spondyiobsilpas ecctatiock Mike bonyanpanthe YES) NOC) back of the spinal column)? Te Have you had steroid injections or taken sterotd tablets regularly for more than 3 months? vesQ) no) 2 Doyou currently have Cancer of any kind? I the above condition(s) is/are present, answer questions 2a-26 NOC) go to question 3 2a Does your cancer diagnosis include any of the following types: lung/bronchogenic, multiple myeloma (cancer of plasma cells), head, and/or neck? vesQ noQ 2b. Areyou currently receiving cancer therapy (such as chemotheraphy or radiotherapy)? YES) NOD) 3. Doyou 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 1fNO 8 g0 to question > Grdeer mo fyouare neteumenty akg medications coterreatnensy enna? Yes) WoC) Be eg oer ir prerue ere te cont ea 3<__Doyouhave chronic hear faire? ves) NOD) 3a Dayautie daqnsed cna ater (erdovaraon diese ndhavenotportcstedinreguarahsal wes) woC) 4, Doyoucurrently have High Blood Pressure? 7 IF the above condition(s) is/are present, answer questions 4a-4b HNO FY go to question 5 4a, Doyou have difficulty contraling your condition with medications or other physician-prescribed therapies? YES) No| (Andwer WOif you are not current) taking medications or other reatments) OO Ze Dayo Faves resting Blood pressure equal oor greater than 16090 rmligwith or without mediesion? (atl WBSiyou So nexangn your esa blood presote vs) wo Doyyou have any Metabolic Conditions? This includes Type 1 Diabetes, Type 2 Pre-Diabetes Ifthe above condition(s) is/are present, answer questions Sa-Se NOE} go to question 6 5a, Doyou often have difficulty controling your blood sugar levels with foods, medications, or other physician- ves) no) prescribed therapies? 3b. Doyou often suffer rom signs and sympioms of ow blood sugar hypoglycemia) flowing exercise and/or

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