2020 PAR-Q+
The Physical Activity Readiness Questionnaire for Everyone
The health beneꢀ ts 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 doctor
OR a qualiꢀ ed 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 ?
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 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:
7) Has your doctor ever said that you should only do medically supervised physical activity?
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 (https://apps.who.int/iris/handle/10665/44399).
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 eꢀ ort exercise, consult a qualiꢀ ed exercise
professional before engaging in this intensity of exercise.
If you have any further questions, contact a qualiꢀ 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
conꢀ dentiality of the 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.
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 qualiꢀ ed exercise professional, and/or complete the
ePARmed-X+ at www.eparmedx.com 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 qualiꢀ ed exercise
professional before continuing with any physical activity program.
Copyright © 2020 PAR-Q+ Collaboration 1 /4
01-11-2019
2020 PAR-Q+
FOLLOW-UP QUESTIONS ABOUT YOUR MEDICAL CONDITION(S)
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
1a. Do you have diꢀ culty controlling your condition with medications or other physician-prescribed therapies? YES NO
(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 YES NO
back of the spinal column)?
1c. Have you had steroid injections or taken steroid tablets regularly for more than 3 months?
YES NO
2. Do you currently have Cancer of any kind?
If the above condition(s) is/are present, answer questions 2a-2b If NO go to question 3
2a. Does your cancer diagnosis include any of the following types: lung/bronchogenic, multiple myeloma (cancer of YES NO
plasma cells), head, and/or neck?
2b. Are you currently receiving cancer therapy (such as chemotheraphy or radiotherapy)? YES NO
3. Do you 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 If NO go to question 4
3a. Do you have diꢀ culty controlling your condition with medications or other physician-prescribed therapies? YES NO
(Answer NO if you are not currently taking medications or other treatments)
3b. Do you have an irregular heart beat that requires medical management? YES NO
(e.g., atrial ꢀ brillation, premature ventricular contraction)
3c. Do you have chronic heart failure? YES NO
3d. Do you have diagnosed coronary artery (cardiovascular) disease and have not participated in regular physical YES NO
activity in the last 2 months?
4. Do you currently have High Blood Pressure?
If the above condition(s) is/are present, answer questions 4a-4b If NO go to question 5
4a. Do you have diꢀ culty controlling your condition with medications or other physician-prescribed therapies? YES NO
(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 160/90 mmHg with or without medication? YES NO
(Answer YESif 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
If the above condition(s) is/are present, answer questions 5a-5e If NO go to question 6
5a. Do you often have diꢀ culty controlling your blood sugar levels with foods, medications, or other physician- YES NO
prescribed therapies?
5b. Do you often suꢂer 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 irritability, YES NO
abnormal sweating, dizziness or light-headedness, mental confusion, diꢀ culty speaking, weakness, or sleepiness.
5c. Do you have any signs or symptoms of diabetes complications such as heart or vascular disease and/or YES NO
complications aꢂecting your eyes, kidneys, ORthe sensation in your toes and feet?
5d. Do you have other metabolic conditions (such as current pregnancy-related diabetes, chronic kidney disease, or YES NO
liver problems)?
5e. Are you planning to engage in what for you is unusually high (or vigorous) intensity exercise in the near future? YES NO
Copyright © 2020 PAR-Q+ Collaboration 2/4
11-01-2019
