Activity Parq – Fill Out and Use This PDF

The Activity Parq form, short for the Physical Activity Readiness Questionnaire for Everyone, is a tool designed to identify if a person should consult a healthcare provider before starting or increasing physical activity levels. Its main aim is to ensure safety and highlight any health benefits of regular exercise, while also identifying individuals for whom physical activity might require medical supervision. By answering a series of health-related questions, individuals can assess their readiness for physical activity and take necessary precautions based on their health status.

If you're considering becoming more active or changing your exercise routine, it’s important to fill out the Activity Parq form to ensure it’s safe to proceed. Click the button below to start your journey towards a safer and healthier physical activity routine.

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Activity Parq PDF Details

The 2021 Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) serves as a self-screening tool designed to assess the safety and appropriateness of engaging in physical activity for individuals based on their health status. In recognizing the substantial benefits of regular physical activity, this comprehensive questionnaire addresses the necessity for individuals to consult with healthcare providers or qualified exercise professionals before increasing their physical activity levels, especially for those with existing health conditions. By meticulously guiding users through a series of detailed health questions covering a wide array of medical conditions—from cardiovascular diseases, metabolic conditions, mental health issues, respiratory diseases, to musculoskeletal problems—it aims to identify potential risks associated with physical activity. Furthermore, the PAR-Q+ emphasizes the importance of gradual activity enhancement in alignment with global physical activity guidelines, the significance of legal age consent for participation, and the ongoing validity of the clearance provided by the questionnaire, which stands for 12 months or until the participant's health condition changes. With its participant declaration section, the PAR-Q+ also underscores the legal and ethical considerations involved, ensuring that individuals, or their guardians in applicable cases, acknowledge their understanding and agreement to the terms laid out by the questionnaire. Through its structured format, the PAR-Q+ not only aids in promoting safe physical activity engagement but also facilitates an informed dialogue between individuals and healthcare or fitness professionals.

Question	Answer
Form Name	Activity Parq
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	questionnaire par q form, parq acsm, par q form, par q form download

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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:

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.

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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		YESQ NOQ
	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 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)?		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 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?
	(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

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,		YESQ	NOQ

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	YESQ NOQ
	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	NOQ
in □

YESQ NOQ

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2021 PAR-Q+

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.	Do you have difficulty controlling your condition with medications or other physician-prescribed therapies?		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 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

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 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		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.

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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.

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 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

----------- 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

DATE

WITNESS

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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How to Edit Activity Parq Online for Free

Our PDF editor allows you to fill in documents. You should not undertake much to modify par q acsm forms. Only keep up with the following actions.

Step 1: The first task should be to click on the orange "Get Form Now" button.

Step 2: At this point, you're on the file editing page. You may add content, edit current details, highlight certain words or phrases, put crosses or checks, insert images, sign the form, erase unneeded fields, etc.

The next few areas are what you are going to fill out to get the finished PDF document.

entering details in questionnaire par q form step 1

You should enter the appropriate data in the I clearance is valid for a maximum, NAME, SIGNATURE, SIGNATURE OF PARENTGUARDIANCARE, DATE, WITNESS, i If you answered YES to one or, Delay becoming more active if, You have a temporary illness such, You are pregnant talk to your, Your health changes answer the, and Copyright PARQ Collaboration area.

Finishing questionnaire par q form stage 2

Indicate the vital particulars in Do you have Arthritis, If the above conditions isare, If noQ go to question, Do you have difficulty control, Do you have joint problems causing, Have you had steroid injections or, YESQ NOQ, Do you currently have Cancer of, If NO O go to question, a Does your cancer diagnosis, plasma cells head andor neck, b Are you currently receiving, YESQ NOQ, Do you have a Heart or, and go to question segment.

Filling out questionnaire par q form part 3

The Do you have an irregular heart, Do you have chronic heart failure, Do you have diagnosed coronary, Do you currently have High Blood, If NO O to question, yesQ NOQ, YESQ NOQ, Do you have difficulty controlling, yesQ NOQ, Do you have a resting blood, YESQ NOQ, Do you have any Metabolic, If the above conditions isare, If NO go to question, and Do you often have difficulty section will be the place to include the rights and responsibilities of each party.

questionnaire par q form Do you have an irregular heart, Do you have chronic heart failure, Do you have diagnosed coronary, Do you currently have High Blood, If NO O to question, yesQ NOQ, YESQ NOQ, Do you have difficulty controlling, yesQ NOQ, Do you have a resting blood, YESQ NOQ, Do you have any Metabolic, If the above conditions isare, If NO go to question, and Do you often have difficulty fields to insert

Complete the file by reviewing these areas: Are you planning to engage in what, YESQ NOQ, and Copyright PARQCollaboration.

Filling out questionnaire par q form step 5

Step 3: Choose the "Done" button. Now it's possible to export the PDF file to your device. Besides, it is possible to send it via electronic mail.

Step 4: Come up with as much as a few copies of the file to stay clear of all of the possible future concerns.

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