Questionnaire:
This questionnaire consists of 16 questions and is divided into 5 parts. Please allow at least 10 minutes to complete and note it can't be saved until you have completed the whole form. PLEASE MAKE SURE YOU TAKE YOUR TIME AND FILL IN EVERY QUESTION. SKIPPING QUESTIONS WILL RESULT IN ERROR MESSAGES. Many health benefits are associated with regular exercise, and the completion of PAR-Q is a sensible first step to take if you are planning to increase the amount of physical activity in your life. For most people, physical activity should not pose any problem or hazard. PAR-Q is designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them. Common sense is the best guide in answering these few questions. Clearly mark YES or NO to each of the following questions, delete where appropriate and provide more detail where needed.
Full Name
DOB (yy/mm/dd)
Gender
Number
1. Has your doctor ever said that you have a bone or joint problem, such as arthritis, that has been aggravated by exercise or might be made worse with exercise?
If YES please provide more detail:
2. Do you have high blood pressure?
3. Do you have low blood pressure?
If YES please provide more detail:
4. Do you have Diabetes Mellitus or any other metabolic disease?
If YES please provide more detail:
5. Has your doctor ever said that you have raised cholesterol (serum level above 6.2mmol/L)?
If YES please provide more detail:
6. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by your doctor?
If YES please provide more detail:
7. Have you ever felt pain in your chest when you do physical exercise?
If YES please provide more detail:
8. Is your doctor currently prescribing you drugs or medication?
If YES please provide more detail:
9. Have you ever suffered from unusual shortness of breath at rest or with mild exertion?
If YES please provide more detail:
10. Is there any history of Coronary Heart Disease in your family?
If YES please provide more detail:
11. Do you often feel faint, have spells of severe dizziness or have lost consciousness?
If YES please provide more detail:
12. Do you currently drink more than the average amount of alcohol per week (21 units for men and 14 units for women)?
If YES please provide more detail:
13. Do you currently smoke?
If YES please provide more detail:
14. Do you currently exercise on a regular basis (at least 3 times a week) and work in a job that is physically demanding?
If YES please provide more detail:
15. Are you, or is there any possibility that you might be pregnant?
If YES please provide more detail:
16. Do you know of any other reason why you should not participate in a programme of physical activity?
If YES please provide more detail:
Summary: If you have answered - YES to two or more questions: If you have not recently done so, consult with your doctor by telephone or in person before increasing your physical activity and/or taking a fitness appraisal. Tell you doctor what questions you answered yes to on PAR-Q or present your PAR-Q copy. After medical evaluation, seek advice from your doctor as to your suitability for: 1. Unrestricted physical activity starting off easily and progressing gradually, and 2. Restricted or supervised activity to meet your specific needs, at least on an initial basis. If you have answered - NO to all questions: If you answered PAR-Q accurately, you have reasonable assurance of your present suitability for: 1. A graduated exercise programmes. 2. A fitness appraisal. Assumption of Risk: I hereby state that I have read, understood and answered honestly the questions above. I also state that I wish to participate in activities, which may include aerobic exercise, resistance exercise and stretching. I realise that my participation in these activities involves the risk of injury and even the possibility of death. Furthermore, I hereby confirm that I am voluntarily engaging in an acceptable level of exercise, which has been recommended to me. In addition to the assumption of risk to exercise I hereby also acknowledge the risk in measuring fasting blood glucose and assume full risk in this data collection as part of The Online Gamma Project. Additional note: I have taken medical advice and my doctor has agreed that I should exercise. Notification of cancellation: I hereby acknowledge that cancellation of participation of The Online Gamma Project is only acceptable within the first week of Data collection at the forfeit of The Gamma Project sign up fee. In a month that does not fall into the initial month of subscription I also accept that cancellation of The Online Gamma Project will come at a 50% fee of the Monthly subscription price.