The Activity Parq form, officially known as the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+), is designed to assess an individual's readiness for physical activity. By answering a series of straightforward questions, individuals can determine if they need to consult a doctor or a qualified exercise professional before increasing their activity levels. To ensure your safety and well-being, fill out the form by clicking the button below.
The Activity Parq form, specifically the 2021 PAR-Q+, is a vital tool designed to assess an individual's readiness for physical activity. Its primary aim is to ensure safety by identifying any potential health risks before engaging in exercise. The form consists of a series of straightforward yes or no questions that cover essential health topics, including heart conditions, chronic diseases, and medication usage. Respondents are prompted to answer honestly, as their responses will determine if they need to consult a healthcare provider or a qualified exercise professional. If all questions are answered negatively, individuals are generally cleared to begin or increase their physical activity levels. However, those who answer affirmatively must complete additional pages for a more detailed assessment. The form emphasizes the importance of gradual progression in physical activity and highlights the necessity of consulting professionals, especially for individuals over 45 or those with existing health concerns. Furthermore, it includes a participant declaration section to ensure understanding and compliance with the guidelines, reinforcing the commitment to maintaining health and safety during physical endeavors.
2021 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.
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 OOR high blood pressure O?
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 listcondition(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 doesnot limit your current ability to be physically active.
PLEASE LIST CONDITION(S) HERE:
o
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.
—I 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://www.who.int/publications/i/item/9789240015128).
You may take part in a health and fitness appraisal.
If you are over the age of 45 yr and NOT accustomed to regular vigorous to maximal effort exercise, consult a qualified exercise professional before engaging in this intensity of exercise.
►If you have any further questions, contact a qualified 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/fitness center 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
DATE
SIGNATURE _____________________________________
WITNESS
SIGNATURE OF PARENT/GUARDIAN/CARE PROVIDER
[i® 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 orfever; 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-XT at www.eparmedx.com before becoming more physically active.
Your health changes - answer the questions on Pages 2 and 3 of this document and/ortalkto your doctor ora qualified exercise professional before continuing with any physical activity program.
J
3
01-11-2020
2021 PAR-Qt
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 la-lc
If noQ go to question 2
la.
Do you have difficulty control ling your condition with medications or other physician-prescribed therapies?
yesQ NOQ
(Answer NO if you are not currently taking medications or other treatments)
lb.
Do you have joint problems causing pain, a recent fracture or fracture caused by osteoporosis or cancer,
YESQ NOQ
displaced vertebra (e.g., spondylolisthesis), and/or spondylolysis/pars defect (a crack in the bony ring on the
back of the spinal column)?
1c.
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 questions 2a-2b
If NO O go to question 3
2a.
Does your cancer diagnosis include any of the following types: lung/bronchogenic, multiple myeloma (cancer of
yes[“) NO t-)
plasma cells), head, and/or neck?
u
2b.
Are you currently receiving cancer therapy (such as chemotheraphy or radiotherapy)?
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 difficulty controlling your condition with medications or other physician-prescribed therapies? (Answer NO if you are not currently taking medications or other treatments)
3 b. Do you have an irregular heart beat that requires medical management? (e.g., atrial fibrillation, premature ventricular contraction)
3c. Do you have chronic heart failure?
3d. 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 O 9° to question 5
4a.
Do you have difficulty controlling your condition with medications or other physician-prescribed therapies?
4b.
Do you have a 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, 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 difficulty controlling your blood sugar levels with foods, medications, or other physician-
YESQ
NOQ
prescribed therapies?
5 b.
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.
5c.
Do you have any signs or symptoms of diabetes complications such as heart or vascular disease and/or
complications affecting 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 liver problems)?
5e. Are you planning to engage in what for you is unusually high (or vigorous) intensity exercise in the near future?
<- VI
in □
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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, Down Syndrome
If the above condition(s) is/are present, answer questions 6a-6b
If NO O go to question 7
6a.
6b.
Do you have Down Syndrome AND back problems affecting nerves or muscles?
7.Do you have a Respiratory Disease? This includes Chronic Obstructive Pulmonary Disease, Asthma, Pulmonary High Blood Pressure
If the above condition(s) is/are present, answer questions 7a-7d
|f NO Q go to question 8
7a. 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)
7 b. Has your doctor ever said your blood oxygen level is low at rest or during exercise and/or that you require supplemental oxygen therapy?
7c. If asthmatic, do you currently have symptoms of chest tightness, wheezing, laboured breathing, consistent cough (more than 2 days/week), or have you used your rescue medication more than twice in the last week?
7d. 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 O go to question 9
8a. 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)
8 b. Do you commonly exhibit low resting blood pressure significant enough to cause dizziness, light-headedness, and/or fainting?
8c. Has your physician indicated that you exhibit sudden bouts of high blood pressure (known as Autonomic Dysreflexia)?
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 Q go to question 10
9a. 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)
9 b. Do you have any impairment in walking or mobility?
9c. Have you experienced a stroke or impairment in nerves or muscles in the past 6 months?
YESQ noQ
yesQ noQ
YESQ NoQ
yesQ NoQ
10.Do you have any other medical condition not listed above or do you have two or more medical conditions?
If you have other medical conditions, answer questions lOa-IOc
If NqQ read the Page 4 recommendations
10a.
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?
10b.
Do you have a medical condition that is not listed (such as epilepsy, neurological conditions, kidney problems)?
NoQ
10c.
Do you currently live with two or more medical conditions?
PLEASE LISTYOUR MEDICAL CONDITION(S)
AND ANY RELATED MEDICATIONS HERE:
GO to Page 4 for recommendations about your current medical condition(s) and sign the PARTICIPANT DECLARATION.
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2021 PAR-Ql-
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 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.
•You are encouraged to photocopy the PAR-Q+. You must use 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.
•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 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/fitness center may retain a copy of this form for records. In these instances, it will maintain the confidentiality of the same, complying with applicable law.
SIGNATURE
----------- For more information, please contact
www.eparmedx.com
Email: eparmedx^gmailxom
Otttfcn for PAR-O+
Warburton DER, Jamnik VK, Bred in 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 Referanees
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.
1.Jamnik VK, Warburton DER, Makarski J, McKenzie DC, Shephard 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,JamnikVK, Bredin SSD, McKenzie DC, Stone J, Charlesworth S, and Shephard RJ. Evidence-based risk assessment and recommendations for physical activity clearance; Consensus Document. APNM 36(S1>:S266-s298,20l1.
3.Chisholm DM, Collis ML, Kulak LL, DavenportW, and Gruber N. Physical activity readiness. British Columbia Medical Journal. 1975;17:375-378.
4.Thomas S, Reading J, and Shephard RJ. Revision of the Physical Activity Rea din ess Questionnaire (PAR-C&. Canadian Journal of Sport Science 1992;17:4 338-345.
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01 -11-2020
Completing the Activity Parq form is a straightforward process that involves answering a series of health-related questions. This information will help determine if further medical advice is necessary before engaging in physical activity. Follow the steps below to ensure accurate completion of the form.
What is the Activity Parq form?
The Activity Parq form, also known as the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+), is designed to help individuals assess their readiness for physical activity. By answering a series of health-related questions, participants can determine if they need to consult a healthcare provider before increasing their activity levels.
Who should complete the Activity Parq form?
Anyone considering starting a new physical activity program should complete the Activity Parq form. It is particularly important for those with existing health conditions or those who have not engaged in regular physical activity for a while. This form helps identify any potential risks associated with increased physical activity.
What happens if I answer "yes" to any of the questions?
If you answer "yes" to any of the questions on the form, it indicates that you may have a medical condition that requires further evaluation. In such cases, you should complete additional pages of the form and consult with a healthcare provider or qualified exercise professional before proceeding with any physical activity.
How long is the clearance from the Activity Parq form valid?
The physical activity clearance obtained from the Activity Parq form is valid for a maximum of 12 months. If your health condition changes during that time, you must complete the form again to ensure your safety while engaging in physical activity.
Can I participate in physical activity if I have a chronic medical condition?
Yes, you can participate in physical activity even if you have a chronic medical condition. However, it is crucial to answer the questions on the form honestly. If you have concerns about how your condition might affect your ability to exercise, consulting with a healthcare provider is recommended.
What should I do if I have temporary illness or am pregnant?
If you have a temporary illness, such as a cold or fever, it is advisable to wait until you feel better before starting or resuming physical activity. If you are pregnant, you should discuss your exercise plans with your healthcare provider or a qualified exercise professional before becoming more active.
Is the information I provide on the Activity Parq form confidential?
Yes, the information you provide on the Activity Parq form is kept confidential. The community or fitness center may retain a copy of the form for their records, but they are required to maintain your privacy in accordance with applicable laws.
What if my condition changes after completing the form?
If your condition changes after you have completed the Activity Parq form, you should not engage in physical activity until you have consulted with a healthcare provider. It is essential to reassess your readiness for physical activity to ensure your safety.
Where can I find more information about physical activity guidelines?
You can find more information about physical activity guidelines tailored to your age by visiting the World Health Organization's website. They provide valuable resources and recommendations to help you stay active safely.
Filling out the Activity ParQ form is an important step toward ensuring your safety as you engage in physical activity. However, many individuals make common mistakes that could lead to misunderstandings about their health status. One significant error is failing to answer questions honestly. The form is designed to assess your readiness for physical activity, and providing inaccurate information can jeopardize your safety.
Another frequent mistake involves skipping questions. Each question on the form is crucial for determining your health risks. Omitting a response can result in incomplete information, which may lead to inappropriate recommendations regarding your physical activity. It's essential to answer every question to the best of your ability.
Some individuals also neglect to list their current medications or medical conditions. This information is vital for healthcare professionals to assess any potential risks associated with physical activity. If you are taking prescribed medications or have chronic conditions, be sure to provide those details in the designated sections.
Additionally, many people misunderstand the instructions regarding dizziness. If you have experienced dizziness related to over-breathing during vigorous exercise, you should answer "NO" to that question. Misinterpreting this can lead to unnecessary delays in your ability to engage in physical activity.
Another common oversight is ignoring the importance of the participant declaration. This section confirms that you have read and understood the questionnaire. Failing to sign this declaration can invalidate your clearance for physical activity, which could hinder your fitness goals.
Some individuals also rush through the form, which can lead to careless errors. Take your time to read each question carefully and consider your responses. A rushed approach may result in misunderstandings that could affect your health.
It is also critical to consult a qualified exercise professional if you answer "YES" to any of the health questions. Many individuals overlook this step, thinking they can proceed without further guidance. Seeking professional advice is essential for ensuring your safety during physical activity.
Finally, not updating the form when health conditions change is a significant mistake. The clearance is only valid for 12 months, and any changes in your health should prompt you to reassess your readiness for physical activity. Keeping the information current is vital for your safety.
The Activity Parq form is essential for assessing an individual's readiness for physical activity. However, several other documents may accompany it to ensure comprehensive evaluation and safety. Below is a list of these forms and their purposes.
Utilizing these forms alongside the Activity Parq ensures a thorough evaluation of an individual's readiness for physical activity, promoting safety and informed participation.
When filling out the Activity Parq form, there are important guidelines to follow. Here’s a list of things you should and shouldn’t do:
This is not true. The Activity Parq form is designed for everyone, regardless of their health status. It helps individuals assess their readiness for physical activity and encourages safe participation.
A "yes" answer does not automatically disqualify someone from exercising. It indicates that further consultation with a healthcare provider may be necessary to ensure safety during physical activity.
The questions on the Activity Parq form are straightforward and meant to be easily understood. They focus on general health and specific conditions that could affect exercise readiness.
The clearance provided by the Activity Parq form is only valid for 12 months. If there are any changes in health status, a new assessment is required.
If you have a chronic condition, it is advisable to consult a healthcare professional before starting any new exercise program, even if the form indicates you are cleared for activity.
The Activity Parq form is applicable to individuals of all ages. It is important for anyone considering a new exercise routine to assess their readiness, regardless of age.
While it may seem optional, completing the Activity Parq form is a critical step for anyone looking to engage in physical activity safely. It helps identify any potential risks and promotes informed decision-making.
Filling out the Activity Parq form is an important step in ensuring that you are ready to engage in physical activity safely. Here are some key takeaways to keep in mind:
By keeping these points in mind, you can ensure that your experience with the Activity Parq form is both safe and beneficial as you pursue a more active lifestyle.