Content Navigation
The Activity Parq form, officially known as the Physical Activity Readiness Questionnaire (PAR-Q+), serves as an essential tool for individuals looking to engage in physical activity safely. Designed for everyone, this questionnaire assesses your readiness for exercise by posing a series of straightforward health-related questions. By answering these questions honestly, you can determine if it is necessary to consult with a healthcare provider or a qualified exercise professional before starting a new physical activity regimen. The form covers critical health aspects, including any existing heart conditions, chronic medical issues, and current medications. It also addresses potential risks associated with physical activity, such as dizziness, joint problems, or other medical conditions that may affect your ability to exercise safely. If you answer 'no' to all questions, you are cleared to begin your physical activity journey. However, a 'yes' response prompts further evaluation, ensuring that you receive the appropriate guidance tailored to your health needs. Completing the Activity Parq form is not just a precaution; it is a proactive step toward a healthier lifestyle.
Activity Parq Example
2021
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
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
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.
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
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
2021
1.Do you have Arthritis, Osteoporosis, or Back Problems?
|
If the above condition(s) is/are present, answer questions |
If noQ go to question 2 |
|
la. |
Do you have difficulty control ling your condition with medications or other |
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? |
YESQ NOQ |
|
2.Do you currently have Cancer of any kind?
|
If the above condition(s) is/are present, answer questions |
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 |
|
|
plasma cells), head, and/or neck? |
|
u |
2b. |
Are you currently receiving cancer therapy (such as chemotheraphy or radiotherapy)? |
YESQ NOQ |
|
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 |
If NO |
go to question 4 |
3a. Do you have difficulty controlling your condition with medications or other
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 |
If NO O 9° to question 5 |
4a. |
Do you have difficulty controlling your condition with medications or other |
|
|
(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? |
|
|
(Answer YES if you do not know your resting blood pressure) |
|
YESQ NOQ
yesQ NOQ
yesQ NOQ
YESQ NOQ
yesQ NOQ
YESQ NOQ
5.Do you have any Metabolic Conditions? This includes Type 1 Diabetes,Type 2 Diabetes,
|
If the above condition(s) is/are present, answer questions |
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, |
YESQ |
NOQ |
|
abnormal sweating, dizziness or
5c. |
Do you have any signs or symptoms of diabetes complications such as heart or vascular disease and/or |
YESQ NOQ |
|
complications affecting your eyes, kidneys, ORthe sensation in your toes and feet? |
|
5d. Do you have other metabolic conditions (such as current
5e. Are you planning to engage in what for you is unusually high (or vigorous) intensity exercise in the near future?
<- VI |
NOQ |
in □ |
|
YESQ NOQ
2021
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 |
If NO O go to question 7 |
|
6a. |
Do you have difficulty controlling your condition with medications or other |
yesQ NOQ |
|
|
(Answer NO if you are not currently taking medications or other treatments) |
|
|
6b. |
Do you have Down Syndrome AND back problems affecting nerves or muscles? |
|
yesQ NOQ |
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 |
|f NO Q go to question 8 |
7a. Do you have difficulty controlling your condition with medications or other
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 |
If NO O go to question 9 |
8a. Do you have difficulty controlling your condition with medications or other
8 b. Do you commonly exhibit low resting blood pressure significant enough to cause dizziness,
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 |
If NO Q go to question 10 |
9a. Do you have difficulty controlling your condition with medications or other
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
yesQ NoQ
yesQ NOQ
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 |
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 |
YESQ |
NOQ |
|
|
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)? |
YESQ |
NoQ |
|
10c. |
Do you currently live with two or more medical conditions? |
|
YESQ |
NOQ |
|
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.
2021
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
Your health changes - talk to your doctor or qualified exercise professional before continuing with any physical activity program.
•You are encouraged to photocopy the
•The authors, the
PARTICIPANT DECLARATION
•All persons who have completed the
•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.
NAME
SIGNATURE
SIGNATURE OF PARENT/GUARDIAN/CARE PROVIDER
www.eparmedx.com
Email: eparmedx^gmailxom
Otttfcn for
Warburton DER, Jamnik VK, Bred in SSD, and Gledhill N on behalf of the
The Physical Activity Readiness Questionnaire for Everyone
Key Referanees
DATE
WITNESS
The
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
2.Warburton DER, Gledhill N,JamnikVK, Bredin SSD, McKenzie DC, Stone J, Charlesworth S, and Shephard RJ.
3.Chisholm DM, Collis ML, Kulak LL, DavenportW, and Gruber N. Physical activity readiness. British Columbia Medical Journal.
4.Thomas S, Reading J, and Shephard RJ. Revision of the Physical Activity Rea din ess Questionnaire
01
File Breakdown
| Fact Name | Description |
|---|---|
| Purpose | The PAR-Q+ is designed to assess an individual's readiness for physical activity, helping to identify if further medical advice is needed before engaging in exercise. |
| Target Audience | This questionnaire is intended for everyone, regardless of fitness level, ensuring that all individuals can determine their readiness for physical activity. |
| Health Questions | The form includes seven general health questions that address various medical conditions, such as heart issues, dizziness, and chronic illnesses. |
| Validity Period | The physical activity clearance obtained through the PAR-Q+ is valid for a maximum of 12 months, after which it must be re-evaluated. |
| Legal Considerations | In the United States, the use of the PAR-Q+ is governed by health and privacy laws, including HIPAA, which ensures confidentiality and proper handling of personal health information. |
Guide to Using Activity Parq
Completing the Activity Parq form is an important step toward ensuring your readiness for physical activity. This form consists of a series of questions designed to assess your health status and identify any potential risks associated with increased physical activity. Follow the steps below to fill out the form accurately.
- Begin by reading the instructions carefully at the top of the form.
- Answer the first seven general health questions by checking either YES or NO for each question. Be honest in your responses.
- If you answered YES to any of the first seven questions, proceed to complete Pages 2 and 3 of the form.
- If you answered NO to all seven questions, you are cleared for physical activity. Proceed to the PARTICIPANT DECLARATION section.
- In the PARTICIPANT DECLARATION section, write your name and date in the provided spaces.
- Sign the form to acknowledge that you have read and understood the questionnaire.
- If you are under the legal age for consent, ensure that a parent, guardian, or care provider signs the form as well.
- Keep a copy of the completed form for your records, as it may be retained by the fitness center.
After filling out the form, you will have a clearer understanding of your readiness to engage in physical activity. If necessary, consult with a qualified exercise professional or your doctor for further guidance based on your responses.
Get Answers on Activity Parq
-
What is the Activity Parq form?
The Activity Parq form, specifically the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+), is designed to help individuals assess their readiness for physical activity. It asks a series of health-related questions to determine if you need to consult a doctor or qualified exercise professional before starting or increasing your physical activity levels.
-
Who should fill out the Activity Parq form?
Anyone considering starting a new exercise program or increasing their physical activity should fill out the Activity Parq form. This is particularly important for individuals over 45 years old or those who have not engaged in regular vigorous exercise recently. It's also essential for those with existing health conditions or concerns.
-
What types of questions are included in the form?
The form includes seven general health questions that cover a range of topics, such as:
- Heart conditions and high blood pressure
- Chest pain during physical activity
- Dizziness or loss of consciousness
- Chronic medical conditions
- Current medications
- Bone or joint problems
- Medical supervision requirements
-
What happens if I answer "yes" to any of the questions?
If you answer "yes" to any question, you will need to complete additional pages of the form. These pages ask follow-up questions about your medical conditions and help determine if you should seek further medical advice before engaging in physical activity.
-
How long is the clearance 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 this period, you should consult a healthcare professional and may need to complete the form again.
-
What should I do if I have a temporary illness?
If you have a temporary illness, such as a cold or fever, it is best to wait until you feel better before engaging in physical activity. Listen to your body and prioritize your health.
-
Can I participate in physical activity if I am pregnant?
If you are pregnant, it’s important to consult your healthcare practitioner or a qualified exercise professional before starting or continuing any physical activity. They can provide guidance tailored to your situation.
-
How is my information kept confidential?
The community or fitness center will retain a copy of your completed form for their records. They are required to maintain the confidentiality of your information in compliance with applicable laws.
-
Where can I find more information or assistance?
If you have further questions about the Activity Parq form or your health status, it is advisable to contact a qualified exercise professional or visit the ePARmed-X website for additional resources and guidance.
Common mistakes
Completing the Activity Parq form is an important step for anyone looking to engage in physical activity. However, there are common mistakes that can lead to misunderstandings or complications. Here are five mistakes people often make when filling out this essential questionnaire.
One frequent error is inaccurate responses to the health questions. It's vital to answer each question honestly and to the best of one's ability. Some individuals may downplay their health issues or forget to mention a chronic condition. This can lead to serious consequences, as the questionnaire is designed to identify potential risks associated with physical activity.
Another mistake is failing to disclose medications being taken for chronic conditions. When asked to list medications, some may overlook this section or assume it’s not necessary. However, medications can significantly impact a person's ability to exercise safely. Being transparent about all medications helps professionals provide tailored advice.
Additionally, individuals sometimes misinterpret the questions themselves. For instance, the wording can be confusing, leading to misinterpretation of what is being asked. It’s crucial to take the time to read each question carefully. If something is unclear, seeking clarification can prevent miscommunication and ensure accurate responses.
Many people also neglect to update their information when their health status changes. The form is valid for a maximum of 12 months, but if a person experiences a significant health change, they should reassess their readiness for physical activity. Failing to do so can lead to engaging in activities that may not be safe.
Lastly, a common oversight is not signing the participant declaration at the end of the form. This signature is a confirmation that the individual has completed the questionnaire and understood its implications. Without this signature, the form may be considered incomplete, potentially delaying access to physical activity programs.
By being aware of these common mistakes, individuals can ensure that they fill out the Activity Parq form accurately, leading to a safer and more effective approach to physical activity.
Documents used along the form
In the realm of physical fitness and health assessments, the Activity Parq form serves as a crucial starting point for individuals looking to engage in physical activity safely. However, several other forms and documents often accompany it, each playing a distinct role in ensuring that participants are adequately prepared and informed. Below is a list of these documents, each described briefly to highlight its significance.
- Informed Consent Form: This document ensures that participants understand the risks associated with physical activity and agree to participate voluntarily. It outlines the nature of the activities involved and any potential hazards.
- Medical History Questionnaire: This form collects detailed information about an individual’s past and current medical conditions, medications, and surgeries. It helps health professionals assess any risks before engaging in physical activity.
- Exercise Prescription: After evaluating the Activity Parq responses, a qualified professional may provide an exercise prescription tailored to the individual's health status and fitness goals. This document outlines recommended activities, duration, and intensity.
- Liability Waiver: This document protects fitness facilities and trainers from legal claims arising from injuries sustained during physical activity. Participants acknowledge the risks and agree not to hold the facility liable.
- Emergency Contact Form: This form allows participants to provide contact information for someone to be notified in case of an emergency during physical activities. It ensures that help can be quickly reached if needed.
- Fitness Assessment Results: Following initial assessments, this document summarizes the results of various fitness tests, such as cardiovascular endurance, strength, and flexibility. It provides a baseline for tracking progress.
- Progress Tracking Log: Participants may use this log to record their physical activity, monitor their progress over time, and set new fitness goals. It serves as a motivational tool and aids in accountability.
- Referral Form: If a participant has specific health concerns that require further evaluation, this form allows trainers or health professionals to refer them to appropriate specialists for additional assessment or treatment.
These documents collectively enhance the safety and effectiveness of physical activity participation. They ensure that individuals are well-informed, adequately prepared, and supported in their fitness journeys. Utilizing these forms alongside the Activity Parq form fosters a comprehensive approach to health and wellness.
Similar forms
- Health History Questionnaire (HHQ): Like the Activity Parq form, the HHQ gathers information about an individual's medical history and current health status. It helps identify any conditions that might affect the ability to participate in physical activities safely.
- Informed Consent Form: This document ensures that participants understand the risks involved in physical activities. Similar to the Activity Parq form, it requires participants to acknowledge their health conditions and the potential need for medical advice.
- Exercise Pre-participation Screening (EPS): The EPS serves a similar purpose by assessing an individual's readiness for physical activity. It includes questions about health status and past medical history, much like the Activity Parq form.
- Medical Clearance Form: This form is used to obtain a doctor's approval before starting a new exercise program. It parallels the Activity Parq form by emphasizing the importance of medical advice based on the participant's health status.
- Fitness Assessment Questionnaire: This document collects information about an individual's fitness level and health history. It shares similarities with the Activity Parq form by evaluating readiness for physical activity and identifying potential health risks.
Dos and Don'ts
When filling out the Activity Parq form, consider the following guidelines:
- Answer all questions honestly to ensure accurate health assessment.
- Consult with a healthcare professional if you have any medical concerns before completing the form.
- Sign the participant declaration only after thoroughly reading and understanding the entire questionnaire.
- Keep a copy of the completed form for your records.
Avoid these common mistakes:
- Do not skip any questions, as each one is crucial for your safety.
- Do not provide vague or incomplete information regarding medical conditions or medications.
- Do not rush through the form; take your time to ensure accuracy.
- Do not ignore changes in your health status after submitting the form.
Misconceptions
- Misconception 1: The PAR-Q form is only for people with existing health issues.
- Misconception 2: Completing the PAR-Q is optional.
- Misconception 3: If I answered "No" to all questions, I can do any physical activity.
- Misconception 4: The PAR-Q form guarantees I won't have health issues while exercising.
- Misconception 5: I can skip the follow-up questions if I have no known conditions.
- Misconception 6: The PAR-Q is only relevant for older adults.
- Misconception 7: I can modify the PAR-Q questions to fit my situation.
- Misconception 8: If I have a temporary illness, I can still exercise without concern.
In reality, the PAR-Q form is designed for everyone, regardless of their health status. It helps identify those who may need further medical advice before starting a new physical activity routine.
While it may seem like a suggestion, completing the PAR-Q is often a requirement for participating in many fitness programs. It ensures safety for all participants.
Answering "No" means you are cleared for activity, but it doesn't mean you should jump into high-intensity workouts immediately. It's important to start slowly and build up gradually.
No form can provide a complete guarantee. The PAR-Q helps assess readiness but does not eliminate all risks associated with physical activity.
Even if you believe you have no conditions, it's wise to answer all follow-up questions. They help ensure a comprehensive understanding of your health status.
This form is applicable to individuals of all ages. Young adults and teens can also benefit from assessing their readiness for physical activity.
It's crucial to use the form as it is. Modifying questions can lead to inaccurate assessments and potentially unsafe exercise practices.
It's best to wait until you feel better before resuming physical activity. Exercising while unwell can lead to further complications.
Key takeaways
Complete the Activity Parq form honestly to ensure your safety during physical activity. Your responses help determine if you need medical advice before starting.
If you answer NO to all questions, you are cleared to begin physical activity. However, it is advisable to start slowly and gradually increase your intensity.
In case of any YES answers, you must complete additional pages of the questionnaire to provide more detailed information about your health conditions.
Remember that the clearance is valid for 12 months. If your health status changes, you should reassess your readiness to engage in physical activity.