ParQ | Muscle Inspires New Empowerment (m.i.n.e)

Has a doctor ever said you have a heart condition and that you should only do doctor-recommended physical activity?

Yes

No

Do you experience an irregular heart rate during rest or exercise?

Yes

No

Do you feel pain in your chest during physical activity?

Yes

No

Do you lose your balance because of dizziness or do you ever lose consciousness?

Yes

No

Do you have a bone or joint problem that can be made worse by physical activity?

Yes

No

Is your doctor currently prescribing drugs for blood pressure or heart condition?

Yes

No

Do you know of any reason why you should not do physical activity?

Yes

No

Are you diabetic?

Yes

No

Are you pregnant?

Yes

No

Are you over 65 and not accustomed to exercise?

Yes

No

Health History Questionnaire