STR8 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 doctor OR a qualified exercise professional before becoming more physically active.

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GENERAL HEALTH QUESTIONS

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Please read the 8 questions below carefully and answer each one honestly: Type YES or NO 

1. Has your doctor ever said that you have a heart condition?
2. Has your doctor ever said that you have high blood pressure?
3. Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?
4. 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).
5. Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure? PLEASE LIST CONDITION(S) HERE:
6. Are you currently taking prescribed medications for a chronic medical condition? PLEASE LIST CONDITION(S) AND MEDICATION(S) HERE:
7. Do you currently have (or have you 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:
8. Has your doctor ever said that you should only do medically supervised physical activity?

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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 FOLLOW-UP QUESTIONS SECTION.

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 health and fitness appraisal.

If you are over the age of 45 yrs and NOT accustomed to regular rigorous to maximal effort exercise, consult a qualified exercise professional before engaging in this intensity of exercise.

If you have further questions, contact a qualified exercise professional.

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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, they 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 STR8 Performance LLP may retain a copy of this form for its records. In these instances, it will maintain the confidentiality of the same, complying with applicable law.

Name: {name} Date: {sign_date}

Participant (18+) or Legal Guardian Signature:

Signer Name (If Legal Guardian):  

Signer Relationship:

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If you answered YES to one or more of the questions above, COMPLETE FOLLOW-UP QUESTIONS SECTION.

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Delay becoming more active if:

You have 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 qualified exercise professional, and/or complete the ePARmed-X+ at www.eparmedx.com before becoming more physically active.

Your health changes - answer the follow-up questions below and/or talk to your doctor or qualified exercise professional before continuing with any physical activity program. 

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FOLLOW-UP QUESTIONS ABOUT YOUR MEDICAL CONDITION(S)

Complete only if you answer yes to one or more questions in first section.

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1. Do you have Arthritis, Osteoporosis, or Back Problems? If the above condition(s) is/are present, answer 1a - 1c. If NO go to question 2.
   1. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies?
   2. 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)?
   3. Have you had steroid injections or taken steroid tablets regularly for more than 3 months?
2. Do you currently have Cancer of any kind? If the above condition(s) is/are present, answer 2a - 2b. If NO go to question 3.
   1. Does your cancer diagnosis include any of the following types: lung/bronchogenic, multiple myeloma (cancer of the plasma cells), head, and/or neck?
   2. Are you currently receiving cancer therapy (such as chemotherapy or radiotherapy)?
3. Do you have a Heart or Cardiovascular Condition? This includes Coronary Disease, Heart Failure, and Diagnosed Abnormality of Heart Rhythm If the above condition(s) is/are present, answer 3a - 3d. If NO go to question 4.
   1. Do you have difficulty controlling your condition with medications or other physician-prescribed therapies?
   2. Do you have an irregular heart beat that requires medical management? (e.g. atrial fibrillation, premature ventricular contraction)
   3. Do you have chronic heart failure?
   4. Do you have diagnosed coronary artery (cardiovascular) disease and have not participated in regular physical 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.
   1. 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)
   2. Do you have resting blood pressure equal to or greater than 160/90 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, and Pre-Diabetes. If the above condition(s) is/are present, answer questions 5a - 4e. If NO go to question 6.
   1. Do you have difficulty controlling your blood sugar levels with foods, medications, or other physician-prescribed therapies?
   2. 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 irritability, abnormal sweating, dizziness or light-headedness, mental confusion, difficulty speaking, weakness, or sleepiness.
   3. Do you have any signs or symptoms of diabetes complications such as heart or vascular disease and/or complications affecting your eyes, kidneys, OR the sensation in your toes and feet?
   4. Do you have other metabolic conditions (such as current pregnancy-related diabetes, chronic kidney disease, or liver problems?
   5. 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, and Down Syndrome. If the above condition(s) is/are present, answer questions 6a - 6b. If NO go to question 7.
   1. Do you 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) 
   2. Do you have Down Syndrome AND back problems affecting nerves or muscles?
7. Do you have Respiratory Disease? This includes Chronic Obstructive Pulmonary Disease, Asthma, and Pulmonary High Blood Pressure. If the above condition(s) is/are present, answer questions 7a - 7d. If NO go to question 8.
   1. Do you 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) 
   2. Has your doctor ever said your blood oxygen level is low at rest or during exercise and/or that you require supplemental oxygen therapy?
   3. If asthmatic, do you currently have symptoms of chest tightness, wheezing, labored breathing, consistent cough (more than 2 days/week), or have you used your rescue medication more than twice in the last week?
   4. 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. If the above condition(s) is/are present, answer questions 8a - 8c. If NO go to question 9.
   1. 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)
   2. Do you commonly exhibit low resting blood pressure significant enough to cause dizziness, light-headedness, and/or fainting?
   3. Has your physician indicated that you exhibit sudden bouts of high blood pressure (known as Autonomic Dysrelexia)?
9. Have you had a Stroke? This includes Transient Ischemic Attack (TIA) or Cerebrovascular Event. If the above condition(s) is/are present, answer questions 9a - 9c. If NO go to question 10.
   1. 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)
   2. Do you have any impairment in walking or mobility?
   3. 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? If the above condition(s) is/are present, answer questions 10a - 10c. If NO read the recommendations that follow.
    1. 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?
    2. Do you have a medical condition that is not listed (such as epilepsy, neurological conditions, kidney problems)?
    3. Do you currently live with two or more medical conditions?

PLEASE LIST YOUR MEDICAL CONDITION(S) AND ANY RELATED MEDICATIONS HERE:

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RECOMMENDATIONS AND PARTICIPANT DECLARATION

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If you answered NO to all of the FOLLOW-UP questions about your medical condition,  you are ready to become more physically active - sign the PARTICIPANT DECLARATION below. 

It is advised that you consult a qualified professional to help you develop a safe and effective 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 of moderate intensity physical activity per week.

If you are over the age of 45 yrs and NOT accustomed to regular rigorous to maximal effort exercise, consult a qualified exercise professional before engaging in this intensity of exercise.

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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 fitness appraisal. You should complete the specially designed online screeening and exercise recommendations program - the ePARmed-X+ at www.eparmendx.com and/or visit a qualified exercise professional to work through the ePARmed-X+ and for further information.

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Delay becoming more active if:

You have 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 qualified exercise professional, and/or complete the ePARmed-X+ at www.eparmedx.com before becoming more physically active.

Your health changes - talk to your doctor or qualified exercise professional before continuing with any physical activity program. 

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• You can request a paper copy of the PAR-Q+ for your reference. You must us 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.

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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, they 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 STR8 Performance LLP may retain a copy of this form for its records. In these instances, it will maintain the confidentiality of the same, complying with applicable law.

Name: {name} Date: {sign_date}

Participant (18+) or Guardian Signature:

Signer Name (If Legal Guardian):  

Signer Relationship:

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For more information, please contact:

www.eparmedx.com

Email: eparmedx@gmail.com

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 or the BC Ministry of Health Services.

Citation for PAR-Q+

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 Examination (ePARmed-X+). Health & Fitness Journal of Canada 4(2):3-23, 2011.

Key References

1. Jamnik VK, Warburton DER, Makarski J, McKenzie DC, Shepard RJ, Stone J, and Gledhill N. Enhancing the effectiveness 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, Charleswoth 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 Medial 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 Sports Science 1992;17:4 338-345. 

____________________________________________________________________________ Copyright © 2020 PAR-Q+ Collaboration

11-01-2019