PHYSICAL ACTIVE READINESS QUESTIONNAIRE
If you are planning to take part in physical activity or an exercise class, start by answering the questions below. If you are between the ages of 15 and 69 the questionnaire will tell you if you should talk to your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor. All information will be treated confidentially.
IF YOU ANSWER 'YES' TO ONE OR MORE OF THE QUESTIONS
Talk to your doctor by telephone or in person before you start becoming more physically active and before you have a fitness assessment. Tell your doctor about the questionnaire and which question(s) you answered “yes” to. You may be able to do any activity you want, as long as you begin slowly and build up gradually, or you may need to restrict your activities to those which are safe for you. Talk to your doctor about the kind of activity you wish to participate in and follow his or her advice.
IF YOU ANSWER 'NO' TO ONE OR MORE OF THE QUESTIONS
You can be reasonably sure that you can start to become more physically active and take part in a suitable exercise programme but remember: begin slowly and build up gradually. Please note: If your health changes so that subsequently you answer “yes” to any of the above questions, inform your fitness or health professional immediately. Ask whether you should change your physical activity or exercise plan. Delay becoming more active if you feel unwell because of a temporary illness such as a cold or flu – wait until you are better.
INFORMED CONSENT
The purpose of an exercise programme is to help you achieve your health and fitness goals. Please read the below document and check the box to agree and sign at the bottom of the page.
I desire to participate voluntarily in a progressive exercise program and/or fitness testing in an effort to assess and improve my physical wellbeing.
I understand that these physical activities and/or fitness tests are designed to gradually increase the workload on my circulatory systems as well as my musculoskeletal system, in an effort to improve their function.
The reaction of the system(s) to such activities cannot be predicted with complete accuracy.
The possibility of certain unusual changes during or following the exercise sessions does exist. These changes could include abnormalities in blood pressure or heart rate, ineffective heart function, fainting, muscle soreness, muscle strains, and possibly heart attack or cardiac arrest.The benefits obtained from the exercise program may include a more efficient cardiovascular system, a decreased risk of heart disease and other chronic diseases, improved muscular and skeletal systems, and an increased quality of life.
I realise that it is necessary for me to report, promptly, any signs and/or symptoms indicating abnormalities or distress. I know that if there are any questions about the procedures or methods used during an exercise session or test, I should ask my trainer. If I have any doubts, concerns or questions I should ask for further explanation. I am also aware that I may decide to discontinue a session at any time should I be in any distress.
Please answer the questions below to the best of your knowledge and confirm your consent:
