P4 VIRTUAL TRAINER
EVALUATION

pfour logo
No Yes
No Yes
No Yes
No Yes
Gym   No gym

PRE-ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)

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 by exercise?
No Yes
2. Do have high blood pressure?
No Yes
3. Do you have low blood pressure?
No Yes
4. Do you have Diabetes Mellitus or any other metabolic disease?
No Yes
5. Has your Doctor ever said you have raised cholesterol?
No Yes
6. Has your Doctor ever said that you have a heart condition?
No Yes
7. Have you ever felt pain in your chest when you do physical exercise?
No Yes
8. Is your Doctor currently prescribing you drugs or medication?
No Yes
9. Are you currently taking any drugs or medication not prescribed by your doctor?
No Yes
10. Have you ever suffered from unusual shortness of breath at rest or mild exertion?
No Yes
11. Do you often feel faint, have spells of severe dizziness or have lost consciousness?
No Yes
12. Is there any history of heart disease in your family?
No Yes
13. Are you or is there a possibility that you might be pregnant?
No Yes
14. Do you know of any other reason why you should not take part in physical activity?
No Yes

If you answered Yes to one 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 fitness appraisal. Tell your doctor what questions you answered ‘yes’ to on PAR-Q or present your PAR-Q copy.

After medical evaluation, seek advise from your doctor as to your suitability for:

1. Unrestricted physical activity starting off easily and progressing gradually.
2. Restricted or supervised activity to meet your specific needs, at least on an initial basis.

If you answered NO to all questions:
If you accurately answered the PAR-Q, you have reasonable assurance of you present suitability for:

1. A graduated exercise programme
2. A fitness appraisal

Assumption of Risk
I hereby state that I have read and understood and answered honestly the questions above. I also state that I wish to participate in activities that may include aerobic exercise, resistance exercise and stretching. I realise that my participation in these activities involves the risk of injury. Furthermore, I hereby confirm that I am voluntarily engaging in an acceptable level of exercise, which has been recommended to me.