Physical Activity Readiness Questionnaire 2020 (PAR-Q)
This is a tool used to test an individual’s capability to be engaged in a particular Physical Activity; it
will serve as a reference to determine if an individual is fit enough to do the activity, aforementioned.
This can also help in knowing one’s physical strengths, and weaknesses; as well as in seeking medical
assistance, if necessary.
The Physical Activity Readiness Questionnaire for Everyone
The health benefits of regular physical activity are clear; more people should engage in physical
activity everyday of the week . Participating 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.
1. Has your doctor ever said that you have a heart condition or high blood
pressure?
YES
NO
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 overbreathing (including during vigorous exercise)
4. Have you ever been diagnosed with another chronic medical condition (other
than heart disease or high blood pressure) Please list condition(s)
here:_________
5. Are you currently taking prescribed medications for chronic medical condition?
Please list conditions 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 physically active? Please answer NO if you had a problem in the past,
but it does not limit your current ability to be physically active. Please List
conditions here:___________
7. Has your doctor ever said that you should only do medically supervised
physically activity?
I.
International Physical Activity Questionnaire (IPAQ)
We are interested in finding out about the kinds of physical activities that people do as part of
their everyday lives. The questions will ask you about the time you spent being physically active in
the last seven days. Please answer each question even if you do not consider yourself to be an active
person. Please think about the activities you do at work, as part of your house and yard work, to get
from place to place, and in your spare time for recreation, exercise or sport.
Think about all the vigorous activities that you did in the last seven days. Vigorous physical
activities refer to activities that take hard physical effort and make you breathe much harder than
normal. Think only about those physical activities that you did for at least 10 minutes at a time.
1. During the last 7 days, on how many days did you do vigorous physical activities like heavy lifting,
digging, aerobics, or fast bicycling?
_______ days per week
Skip to question 3
No vigorous physical activities
2. How much time did you usually spend doing vigorous physical activities on one of those days?
____ _ _ hours per day
____ _ _ minutes per day
Don’t know/ Not sure
Think about all the moderate activities that you did in the last seven days. Moderate activities refer
to activities that take moderate physical effort and make you breathe somewhat harder than normal.
Think only about those physical activities that you did for at least 10 minutes at a time.
3. During the last seven days, on how many days did you do moderate physical activities like carrying
light loads, bicycling at a regular pace, or doubles tennis? Do not include walking.
_______
days per week
No moderate physical activities
Skip to question 5
4. How much time did you usually spend doing moderate physical activities on one of those days?
____ _ _ hours per day
____ _ _ minutes per day
Don’t know/ Not sure
Think about the time you spent walking in the last seven days. This includes at work and at home,
walking to travel from place to place, and any other walking that you have done solely for recreation,
sport, exercise, or leisure.
5. During the last 7 days, on how many days did you walk for at least 10 minutes at a time?
_______ days per week
Skip to question 7
No walking
6. How much time did you usually spend walking on one of those days?
____ _ _ hours per day
___ _ __ minutes per day
Don’t know/ Not sure
The last question is about the time you spent sitting on weekdays during the last seven days.
Include time spent at work, at home, while doing course work and during leisure time. This may include
time spent sitting at a desk, visiting friends, reading, or sitting or lying down to watch television.
7. During the last seven days, how much time did you spend sitting on a week day?
___ _ __ hours per day
_____ _ minutes per day
Don’t know/ Not sure
II.
PARTICIPANT DECLARATION
● All persons who have completed the PAR-Q+ please read and sign the declaration below.
I, undersigned, have read, understood to my full satisfaction and completed this questionnaire. I
acknowledge that this physical activity clearance is valid for a 5 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 confidentially of the same,
complying with applicable law.
NAME: Peñ a, Mac Haydnn Darren S.
DATE: February 28, 2023
SIGNATURE: ___________________ _ _______
WITNESS: Curitana, John Harris A.
SIGNATURE (PARENT/GUARDIAN/CARE PROVIDER): _______________________
Attached the parent’s picture below (while signing)