Physical Activity Readiness Questionnaire (PAR-Q)
Regular physical activity is fun and healthy, and increasingly more people are starting to become more active
every day. Being more active is very safe for most people. However, some people should check with their
doctor before they start becoming more physically active.
If you are planning to become much more physically active than you are now, start by answering the seven
questions below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with
your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check
with your doctor.
Common sense is your best guide when you answer these questions. Please read the questions carefully and
answer each one honestly: check YES or NO.
YES NO
1. Has your doctor ever said that you have a heart condition and that you should only do
physical activity recommended by a doctor?
2. Do you feel pain in your chest when you do physical activity?
3. In the past month, have you had chest pain when you were not doing physical activity?
4. Do you lose your balance because of dizziness or do you ever lose consciousness?
5. 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. Is your doctor currently prescribing drugs (for example, pills) for your blood pressure or
heart condition?
7. Do you know of any other reason why you should not do physical activity?
If you answered YES to one or more questions:
Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a
fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES.
You may be able to do any activity you want --- as long as you start slowly and build up gradually. Or you may need to restrict your
activities to those which are safe for you. Talk with your doctor about the kinds of activities which you wish to participate in and
follow his/her advice.
If you answered NO to all questions:
If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:
Start becoming much more physical active – begin slowly and build up gradually. This is the safest and easiest way to go.
Take part in a fitness appraisal – this is an excellent way to determine your basic fitness so that you can plan the best way for you to
live actively. It is also highly recommended that you have your blood pressure evaluated. If your reading is over 144/94, talk with
your doctor before you start becoming much more physically active.
DELAY BECOMING MUCH MORE ACTIVE:
If you are not feeling well because of a temporary illness such as a cold or a fever – wait until you feel better; or
If you are or may be pregnant – talk to your doctor before you start becoming more active
PLEASE NOTE: If your health changes so that you then answer YES to any of the above questions, tell your health professional or
notify AMAESHI soonest.
Informed Use of the PAR-Q: The AMA Educational Systems and Holdings, Inc. and their agents assume no liability for persons who
undertake physical activity and if in doubt after completing this questionnaire, consult your doctor prior to physical activity.
“I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.”
NAME: ________________JHUN SYRIELL ACAIN____________________
SIGNATURE:____________________________________________________
DATE:_________________10/01/2018________________________________
SIGNATURE OF PARENT OR GUARDIAN
(FOR PARTICIPANTS UNDER THE AGE OF MAJORITY):______________
Source:
Bryant, C.X., Ph.D., FACSM, & Green, D.J. (2010). ACE personal trainer manual: The ultimate resource for fitness professionals (4th ed.). San Diego,
CA: American Council on Exercise.
Questionnaire used with permission from the Canadian Society for Exercise Physiology. RETRIEVED March 29, 2016 from
http://www.csep.ca/view.asp?ccid=517
Physical Activity Readiness Questionnaire (PAR-Q)
HEALTH HISTORY FORM
Name:__ JHUN SYRIELL ACAIN Date:_______10/01/2018__________
Age:____28________________________________________________ Sex M F
Are you taking any medications, supplements, or drugs? If so, please list medication, dose, and reason.
__I’m taking multivitamins and vitamin C twice a day______________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Does your physician know you are participating in a physical activity course? __YES_____________________
Describe any physical activity you do somewhat regularly.
__Over the past 6 months, I’ve been doing some push -ups, curl ups, dumbbell exercises, some squats, and____
cycling when I have the time and if the weather is suitable.__________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Do you now, or have had in the past: Yes No
1. History of heart problems, chest pain, or stroke
2. Elevated blood pressure
3. Any long or pre-existing illness or condition
4. Difficulty with physical exercise
5. Advice from physician not to exercise
6. Recent surgery (last 12 months)
7. Pregnancy (now or within the last 3 months)
8. History of breathing or lung problems
9. Muscle, joint, or back disorder, or any previous
injury still affecting you
10. Diabetes or thyroid condition
11. Cigarette smoking habit
12. Obesity (BMI > 30 kg/m2)
13. Elevated blood cholesterol
14. History of heart problems in immediate family
15. Hernia, or any condition that may be aggravated
by lifting heavy or other physical activities
If you answered YES to one or more questions:
Talk with your doctor by phone or in person BEFORE you start becoming much more physically active. Tell your doctor about the
Health History Form and which questions you answered YES.
You may be able to do any activity you want --- as long as you start slowly and build up gradually. Or you may need to restrict your
activities to those which are safe for you. Talk with your doctor about the kinds of activities which you wish to participate in and
follow his/her advice.
If you answered NO to all questions:
If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:
Start becoming much more physical active – begin slowly and build up gradually. This is the safest and easiest way to go.
Take part in a fitness appraisal – this is an excellent way to determine your basic fitness so that you can plan the best way for you to
live actively. It is also highly recommended that you have your blood pressure evaluated. If your reading is over 144/94, talk with
your doctor before you start becoming much more physically active.
Source:
Bryant, C.X., Ph.D., FACSM, & Green, D.J. (2010). ACE personal trainer manual: The ultimate resource for fitness professionals (4th ed.). San Diego,
CA: American Council on Exercise.
Questionnaire used with permission from the Canadian Society for Exercise Physiology. RETRIEVED March 29, 2016 from
http://www.csep.ca/view.asp?ccid=517
Physical Activity Readiness Questionnaire (PAR-Q)
Exercise History and Attitude
Name___________JHUN SYRIELL ACAIN________________________ Date____10/01/2018____________
General Instructions: Please fill out this form as completely as possible. If you have any questions, DO NOT
GUESS, feel free to ask through the Forum discussion of this course.
1. Please rate your exercise level on a scale of 1 to 5 (5 indicating very strenuous) for each range through your
present age:
15-20_______ 21-30_3______ 31-40______ 41-50______ 51+______
2. Were you a high school and/or college athlete?
Yes No If yes, please specify __2nd Year taking up BA in English Language__________
3. Do you have any negative feelings toward, or have you had any bad experience with, physical-activity
programs?
Yes No If yes, please explain _______________________________________________
4. Do you have any negative feelings towards, or have you had any bad experience with, fitness testing and
evaluation?
Yes No If yes, please explain _______________________________________________
5. Rate yourself on a scale of 1 to 5 (1 indicating the lowest value and 5 the highest).
Circle the number that best applies.
a. Characterize your present athletic ability.
1 2 3 4 5
b. When you exercise, how important is competition?
1 2 3 4 5
c. Characterize your present cardiovascular capacity.
1 2 3 4 5
d. Characterize your current muscular capacity.
1 2 3 4 5
e. Characterize your present flexibility capacity.
1 2 3 4 5
6. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
7. How much time are you will to devote for this online P.E. Course?
Yes No
8. Are you currently involved in regular endurance exercise (e.g. walking, biking, running)?
Yes No If yes, please specify type of exercise (s)_walking and biking_______________
How many _60 – 90 minutes/day and _Saturdays & Sundays _______days/week?
Rate your perception if the exertion of your exercise program (circle the number):
(1) Light (2) Fairly light (3) Somewhat hard
9. How long have you been exercising regularly?
___6___month/s ______year/s
10. What other exercise, sport, or recreational activities have you participated in?
In the past 6 months? On the second week of August 2018, I went skiing together with some friends in VIC.
In the past 5 years? Over this time span, I have participated in plenty of indoor and outdoor activity, i.e., kayaking,
gym exercises, jogging, bush walking, rocket sports, stationary biking, and doing routine exercises______________
11. What types of exercise interest you?
Walking Jogging Strength Training
Cycling Traditional Aerobics Racquet Sports
Stationary biking Elliptical Striding Yoga/Pilates
Stair Climbing Swimming Other Activities
Source:
Bryant, C.X., Ph.D., FACSM, & Green, D.J. (2010). ACE personal trainer manual: The ultimate resource for fitness professionals (4th ed.). San Diego,
CA: American Council on Exercise.
Questionnaire used with permission from the Canadian Society for Exercise Physiology. RETRIEVED March 29, 2016 from
http://www.csep.ca/view.asp?ccid=517
Physical Activity Readiness Questionnaire (PAR-Q)
Exercise History and Attitude
12. Do you think exercise and physical activity can give great benefits to you?
Yes No
13. Rank your goals in undertaking exercise:
What do you want exercise do for you? __I am undertaking some exercise to keep my body in shape, to
avoid serious health risks, and to keep my mind sharp________________________________________
Use the following scale to rate each goal separately:
Not at all Somewhat Extremely
Important Important Important
1 2 3 4 5 6 7 8 9 10
a. Improve cardiovascular fitness ___8____
b. Lose weight/body fat ___1____
c. Reshape or tone my body ___9____
d. Improve performance for a specific sport ___8____
e. Improve moods and ability to cope with stress ___10___
f. Improve flexibility ___8____
g. Increase strength ___9____
h. Increase energy level ___9____
i. Feel better ___10___
j. Enjoyment ___10___
k. Social Interaction ___7____
14. By how much would you like to change your current weight?
(+)___20____lbs. (-)___________lbs.
15. What is your target or expectation at the end of this course?
__My target at the end of this course is to oriented with the appropriate exercises which should help me to gain
more muscles in order for me to achieve the body that I’ve been dreaming of as well as to have some
knowledge of some exercise that helps me alleviate the stress that I’m dealing with my current job. __________
Source:
Bryant, C.X., Ph.D., FACSM, & Green, D.J. (2010). ACE personal trainer manual: The ultimate resource for fitness professionals (4th ed.). San Diego,
CA: American Council on Exercise.
Questionnaire used with permission from the Canadian Society for Exercise Physiology. RETRIEVED March 29, 2016 from
http://www.csep.ca/view.asp?ccid=517
