Complete this Physical Activity Readiness Questionnaire or PARQ or make one of your own.

HEALTH HISTORY

Do you have or have you had any of these conditions, if you are not sure check with your doctor

1. Have you or a member of your close family have had any heart problems? YES/NO
2. Do you have or have you had high blood pressure? YES/NO
3. Do you have increased or high cholesterol? YES/NO

MEDICAL CONDITIONS

Do you have or have you had any of these conditions, if you are not sure check with your doctor

1. Any chronic illness YES/NO
2. Recent surgery e.g. within the last 12 months YES/NO

RESPIRATORY PROBLEMS

Do you have or have you had any of these conditions, if you are not sure check with your doctor

1. Have you a history of breathing problems e.g. Asthma YES/NO

OTHER CONCERNS

1. Do you have difficulty with regular exercise? YES/NO
2. Do you have a muscle or joint disorder? YES/NO
3. Do you suffer from diabetes YES/NO

EXERCISE HISTORY

Select and tick the line which best describes how active you are

1. I have never been active in sports or exercise
2. I used to play sports and take exercise but not now
3. I am quite active as I play but do not train

I take aerobic (CV) exercise regularly I lift weights regularly

Print Name ___________________________ Signature _______________________

SPORT_______________________________
ASSESS THE AIMS AND REASONS FOR TAKING PART IN YOUR
PERSONAL EXERCISE PROGRAMME (PEP)

The aims/reasons for taking part in my Personal Exercise Programme are to:

Improve my:

1. Cardiovascular Fitness

2. Muscular Endurance

3. Muscular Strength

4. Flexibility

5. Body Composition

These can all help to enhance my performance and help me to win in my sport

Other reasons are to:

Reduce stress