If you are planning to take part in physical activity, please answer the questions below. If you are between the ages of 16-69 this questionnaire will tell you if you should consult with your doctor before you start. If you are over 69 years of age and not used to being very active, you should check with your doctor before participating in physical activity.
Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you ever feel pain in your chest when you do physical activity?
Have you ever experienced pain in your chest when you were not doing physical activity?
Do you ever feel faint or have spells of dizziness?
Do you have a joint problem that could be made worse by exercise?
Have you ever been told that you have high blood pressure?
Are you currently taking any medication that fitness instructors should be made aware of?
Are you pregnant or have you had a baby in the last six months?
Is there any other reason why you should not participate in physical activity?
If you have answered YES to one or more questions:
Talk to your doctor before you start becoming more physically active. Tell your doctor about the questionnaire and which question(s) you have 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 their advice.
If you have answered NO to all questions:
You can be reasonably sure that you can start to become more physically active and take part in a suitable exercise programme. Remember – begin slowly and build up gradually.
Please note: If your health changes so that subsequently you answer “yes” to 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 temporary illness such as a cold or flu – wait until you are better.