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WR9 0BN
Phone:07800815314
Email: [email protected]

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Physical activity readiness questionnaire (PAR­Q)

Welcome to PMF at Cube International!

Please complete the following form so that you’re cleared to train with PMF’s instructors.  If you have any questions, please get in touch at [email protected]

    Physical activity readiness questionnaire (PAR­Q) and you
    (a questionnaire for people aged 15 ­ 69)

     


    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 much more physically active.
    If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of 15 and 69, the PAR­Q 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: tick YES or 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?

    YesNo

    2. Do you feel pain in your chest when you do physical activity?

    YesNo

    3. In the past month, have you had chest pain when you were not doing physical activity?

    YesNo

    4. Do you lose your balance because of dizziness or do you ever lose consciousness?

    YesNo

    5. Are you pregnant or have you given birth in the last 6 months?

    YesNo

    6. 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?

    YesNo

    7. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart conditions?

    YesNo

    8. Do you know of any other reason why you should not do physical activity?

    YesNo

     

    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 PAR­Q and which questions you answered YES.

    Please note that if you have answered YES to any of the questions, unfortunately you cannot train with PMF at this time. If you would like to be referred to a specialist, please let us know ([email protected]) and we'll be more than happy to help.

    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 you wish to participate in and follow his/her advice to find out which community programmes are safe and helpful for you.

     

    If you answered NO to all questions:
    If you answered NO honestly to all PAR­Q questions, you can be reasonably sure that you can:
    start becoming much more physically 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 fitness or health professional. Ask whether you should change your physical activity plan.

    “I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.”

    *Your Full Name:

    *Your Email Address:

    *Phone Number:

    *Signature:

    *Date:

    Signature of parent or guardian:
    (for participants under the age of majority)

    Witness (PMF use only):

    Note: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes so that you would answer YES to any of the questions.

    How would you describe your current fitness level:

    Optional - which areas are you looking to improve on:
    Overall fitnessWeight LossCore StrengthUpper Body StrengthImproved RunningBetter Cardio FitnessImproved Confidence

    I consent to you contacting me by:

    EmailTextPhoneWhatsAppFacebook/Messenger
    (Please check all that apply - we won't spam you, it's usually just in case of changes to sessions or urgent comms)

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