Article Guide
The Activity Parq form, officially known as the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+), serves as a crucial tool for individuals considering an increase in physical activity. This form is designed to assess whether participants need to consult a healthcare provider or a qualified exercise professional before engaging in more strenuous activities. It consists of a series of straightforward questions that focus on general health, medical conditions, and any medications currently being taken. Respondents are asked to answer honestly, as their answers will determine their readiness for physical activity. If all questions are answered negatively, individuals can proceed with their fitness plans. However, a positive response to any question prompts the need for further evaluation, ensuring safety during exercise. Additionally, the form includes a participant declaration that emphasizes the importance of understanding one’s health status and the validity of the clearance for up to 12 months. This proactive approach not only promotes safer exercise habits but also encourages individuals to take charge of their health and well-being.
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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 |
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[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
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1.Do you have Arthritis, Osteoporosis, or Back Problems?
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If the above condition(s) is/are present, answer questions |
If noQ go to question 2 |
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la. |
Do you have difficulty control ling your condition with medications or other |
yesQ NOQ |
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(Answer NO if you are not currently taking medications or other treatments) |
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lb. |
Do you have joint problems causing pain, a recent fracture or fracture caused by osteoporosis or cancer, |
YESQ NOQ |
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displaced vertebra (e.g., spondylolisthesis), and/or spondylolysis/pars defect (a crack in the bony ring on the |
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back of the spinal column)? |
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1c. |
Have you had steroid injections or taken steroid tablets regularly for more than 3 months? |
YESQ NOQ |
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2.Do you currently have Cancer of any kind?
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If the above condition(s) is/are present, answer questions |
If NO O go to question 3 |
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2a. |
Does your cancer diagnosis include any of the following types: lung/bronchogenic, multiple myeloma (cancer of |
yes[“) NO |
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plasma cells), head, and/or neck? |
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2b. |
Are you currently receiving cancer therapy (such as chemotheraphy or radiotherapy)? |
YESQ NOQ |
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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? |
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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 |
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(Answer NO if you are not currently taking medications or other treatments) |
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4b. |
Do you have a resting blood pressure equal to or greater than 160/90 mmHg with or without medication? |
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(Answer YES if you do not know your resting blood pressure) |
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YESQ NOQ
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yesQ NOQ
YESQ NOQ
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YESQ NOQ
5.Do you have any Metabolic Conditions? This includes Type 1 Diabetes,Type 2 Diabetes,
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If the above condition(s) is/are present, answer questions |
If NO [~] go to question 6 |
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5a. |
Do you often have difficulty controlling your blood sugar levels with foods, medications, or other physician- |
YESQ |
NOQ |
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prescribed therapies? |
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5 b. |
Do you often suffer from signs and symptoms of low blood sugar (hypoglycemia) following exercise and/or |
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during activities of daily living? Signs of hypoglycemia may include shakiness, nervousness, unusual irritability, |
YESQ |
NOQ |
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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 |
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complications affecting your eyes, kidneys, ORthe sensation in your toes and feet? |
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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 □ |
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YESQ NOQ
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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
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If the above condition(s) is/are present, answer questions |
If NO O go to question 7 |
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6a. |
Do you have difficulty controlling your condition with medications or other |
yesQ NOQ |
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(Answer NO if you are not currently taking medications or other treatments) |
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6b. |
Do you have Down Syndrome AND back problems affecting nerves or muscles? |
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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
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YESQ NoQ
yesQ NoQ
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10.Do you have any other medical condition not listed above or do you have two or more medical conditions?
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If you have other medical conditions, answer questions |
If NqQ read the Page 4 recommendations |
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10a. |
Have you experienced a blackout, fainted, or lost consciousness as a result of a head injury within the last 12 |
YESQ |
NOQ |
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months OR have you had a diagnosed concussion within the last 12 months? |
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10b. |
Do you have a medical condition that is not listed (such as epilepsy, neurological conditions, kidney problems)? |
YESQ |
NoQ |
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10c. |
Do you currently live with two or more medical conditions? |
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YESQ |
NOQ |
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PLEASE LISTYOUR MEDICAL CONDITION(S) |
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AND ANY RELATED MEDICATIONS HERE: |
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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
Form Specifications
| Fact Name | Details |
|---|---|
| Purpose | The PAR-Q+ helps individuals assess their readiness for physical activity. |
| Health Questions | It contains seven health-related questions to identify potential risks. |
| Validity Period | Clearance from the form is valid for a maximum of 12 months. |
| Legal Age Requirement | Minors must have a parent or guardian sign the form for consent. |
| Governing Laws | Compliance with applicable health privacy laws, such as HIPAA. |
Activity Parq: Usage Guidelines
Filling out the Activity Parq form is a straightforward process that helps ensure you are ready for physical activity. Follow these steps to complete the form accurately and efficiently.
- Begin by reading the title and purpose of the form at the top.
- Carefully review the 7 general health questions listed. Answer each question honestly by checking either YES or NO.
- If you answered YES to any question, make sure to complete Pages 2 and 3 as instructed.
- If you answered NO to all questions, proceed to the PARTICIPANT DECLARATION section.
- In the declaration section, fill in your name and date.
- Sign the form to confirm 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 also signs the form.
- Keep a copy of the completed form for your records if needed.
Once you have filled out the form, you are ready to start becoming more physically active. Remember to follow the recommended guidelines and consult a professional if you have any concerns about your health or activity levels.
Your Questions, Answered
What is the purpose of the Activity Parq form?
The Activity Parq form, specifically the Physical Activity Readiness Questionnaire (PAR-Q+), is designed to help individuals assess their readiness for physical activity. It identifies whether a person may need to seek medical advice before starting or increasing their level of physical activity, ensuring safety and well-being during exercise.
Who should complete the Activity Parq form?
Anyone planning to engage in physical activity, especially if they have existing health concerns, should complete the Activity Parq form. This includes individuals who are new to exercise, those who have been inactive for a while, or anyone with a history of medical conditions that could affect their ability to exercise safely.
What should I do if I answer 'YES' to any of the questions?
If you answer 'YES' to any of the questions on the form, it is recommended that you complete additional pages provided in the questionnaire. This information will help assess your health status more thoroughly. You should also 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 completing the Activity Parq form is valid for a maximum of 12 months. If your health condition changes during this time, you will need to reassess your readiness for physical activity by completing the form again.
What if I am under the legal age for consent?
If you are under the legal age for consent, a parent, guardian, or care provider must also sign the Activity Parq form. This ensures that a responsible adult is involved in the decision-making process regarding your participation in physical activity.
Can I participate in physical activity if I have a temporary illness?
If you are experiencing a temporary illness, such as a cold or fever, it is advisable to wait until you feel better before engaging in physical activity. Prioritizing your health will help ensure a safe and effective return to exercise.
What should I do if my health condition changes after completing the form?
If your health condition changes after you have completed the Activity Parq form, you should answer the follow-up questions provided in the additional pages. It's important to consult with your healthcare provider or a qualified exercise professional before continuing with your physical activity program.
Where can I find more information about the Activity Parq form?
For more information regarding the Activity Parq form, you can visit the official website at www.eparmedx.com. This site provides additional resources and contact information for inquiries related to the questionnaire and physical activity readiness.
Common mistakes
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Failing to read the instructions carefully. Many individuals skip the introductory information, which can lead to misunderstandings about how to answer the questions.
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Providing incomplete answers. Some people may forget to list their medical conditions or medications, which can affect their physical activity clearance.
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Answering questions dishonestly. It is crucial to be honest when responding to the health questions, as false information can lead to serious health risks.
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Not seeking clarification. If unsure about a question, individuals often proceed without asking for help, which can result in misinterpretation.
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Overlooking the importance of recent health changes. Many fail to consider their current health status or any recent medical events, which can impact their readiness for physical activity.
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Ignoring the need for a doctor's consultation. Some individuals may answer "NO" to all questions without considering that they should consult a healthcare professional based on their unique circumstances.
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Neglecting to sign the participant declaration. This step is essential, and forgetting it can invalidate the entire questionnaire.
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Misunderstanding the significance of the questionnaire. Some people view it as a mere formality rather than a vital tool for assessing their health and safety.
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Using outdated information. Individuals sometimes rely on past medical conditions or treatments that may no longer be relevant, leading to inaccurate assessments.
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Failing to keep a copy of the completed form. Not retaining a personal copy can lead to confusion or disputes regarding the information provided in the future.
Documents used along the form
The Activity Parq form is an essential tool for assessing an individual's readiness to engage in physical activity. However, it is often accompanied by several other important documents that provide additional context and guidance regarding health and fitness. Below is a list of these documents, each serving a specific purpose in the overall process of ensuring safety and preparedness for physical activity.
- Informed Consent Form: This document outlines the risks associated with physical activity and ensures that participants understand and agree to these risks before engaging in exercise. It protects both the participant and the organization offering the activity.
- Medical History Questionnaire: This form gathers comprehensive information about an individual's past and current health conditions. It helps identify any potential health issues that may affect participation in physical activities.
- Emergency Contact Information: This document provides essential details about whom to contact in case of an emergency during physical activity. It ensures that appropriate measures can be taken quickly if an incident occurs.
- Waiver of Liability: This form releases the organization from liability in case of injury or accident during the activity. Participants acknowledge the inherent risks and agree not to hold the organization responsible for any unforeseen incidents.
- Physical Activity Log: This document allows participants to track their physical activity over time. It helps individuals monitor their progress and can be a valuable tool for both motivation and accountability.
These documents, when used in conjunction with the Activity Parq form, create a comprehensive framework for promoting safe and effective physical activity. Together, they help ensure that individuals are well-informed and prepared to embark on their fitness journeys.
Similar forms
The Activity Parq form shares similarities with several other documents designed to assess health and readiness for physical activity. Below is a list of eight documents that serve similar purposes, along with a brief explanation of their similarities:
- Health History Questionnaire (HHQ): Like the Activity Parq, the HHQ collects information about an individual's medical history and current health status to determine their readiness for physical activity.
- Pre-Participation Physical Evaluation (PPE): This document involves a comprehensive assessment by a healthcare professional to ensure that an individual is fit to engage in sports or exercise, similar to the Activity Parq's goal of identifying potential health risks.
- Informed Consent Form: Both forms require individuals to acknowledge understanding of the risks associated with physical activity. They emphasize the importance of honesty in disclosing health information.
- Exercise Screening Questionnaire: This document serves to identify any medical conditions that may limit an individual's ability to participate in physical activity, paralleling the health questions found in the Activity Parq.
- Medical Clearance Form: Often required by fitness facilities, this form confirms that a healthcare provider has deemed an individual safe to engage in physical activity, akin to the clearance provided by the Activity Parq.
- Physical Activity Readiness Medical Examination (ePARmed-X): This electronic version of the readiness questionnaire provides a detailed assessment and guidance, similar to the Activity Parq's intention of determining the need for further medical advice.
- Chronic Disease Management Plan: This document outlines strategies for managing chronic conditions while engaging in physical activity, much like how the Activity Parq addresses chronic medical issues.
- Fitness Assessment Form: This form evaluates an individual's current fitness level and health status, similar to how the Activity Parq assesses readiness and safety for increased physical activity.
Dos and Don'ts
When filling out the Activity ParQ form, it’s important to approach it thoughtfully. Here’s a list of things to consider doing and avoiding:
- Do read each question carefully before answering.
- Do answer all questions honestly to ensure your safety.
- Do consult a healthcare professional if you have any doubts about your health status.
- Do sign the participant declaration to confirm your understanding of the form.
- Don't rush through the questions; take your time to think about your answers.
- Don't leave any questions unanswered; each one is important.
- Don't provide inaccurate information, as it could impact your health recommendations.
- Don't ignore any changes in your health after completing the form; seek advice if needed.
Misconceptions
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Misconception 1: The PAR-Q+ is only for people with existing health issues.
This form is designed for everyone, regardless of their current health status. While it helps identify individuals who may need to consult a healthcare provider, it is beneficial for anyone planning to increase their physical activity levels.
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Misconception 2: Completing the PAR-Q+ guarantees that I am safe to exercise.
While answering "NO" to all questions indicates that you are likely safe to engage in physical activity, it does not guarantee complete safety. Individual circumstances can change, so it's essential to listen to your body and seek professional advice if any concerns arise.
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Misconception 3: The PAR-Q+ is a one-time requirement.
The clearance obtained from the PAR-Q+ is only valid for a maximum of 12 months. If your health changes during that time, or if you develop new medical conditions, you should complete the questionnaire again and consult a healthcare professional.
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Misconception 4: Only older adults need to fill out the PAR-Q+.
People of all ages can benefit from this questionnaire. It is particularly important for anyone who is planning to start a new exercise routine, regardless of their age or fitness level. Engaging in physical activity should be approached thoughtfully, and the PAR-Q+ helps facilitate that process.
Key takeaways
Filling out the Activity Parq form is an important step in ensuring your safety while engaging in physical activity. Here are some key takeaways to keep in mind:
- Honesty is crucial. Answer each question truthfully to provide an accurate assessment of your health status.
- Consult a professional if needed. If you answer "YES" to any questions, it’s essential to seek advice from your doctor or a qualified exercise professional before increasing your activity levels.
- Understand the purpose. This questionnaire helps identify any potential health risks associated with physical activity, ensuring you can participate safely.
- Sign the declaration. Completing the form includes a participant declaration, confirming your understanding and agreement with the information provided.
- Validity period. The clearance you receive from this form is valid for a maximum of 12 months, so keep that in mind for future activities.
- Keep a copy. It’s advisable to retain a copy of the completed form for your records, as it may be required by fitness centers or health professionals.
- Monitor your health. If your health status changes, you should re-evaluate your readiness for physical activity by filling out the questionnaire again.
By keeping these takeaways in mind, you can ensure that you are making informed decisions about your physical activity and health.