RIO Pre-Activity Readiness Questionnaire (PAR-Q)
This information has to be read and
all patients wishing to use the on-site gym facilities.
activity is fun and healthy, and many people are becoming more active every day.
is not only good for cardiovascular fitness, but any regular physical activity can raise your Metabolic Rate and
assist in accelerated and healthy weight loss.
active is very safe for most people; however, some people should consult their Doctor before increasing the
amount of exercise they take.
If you are
planning to become much more physically active than you are now, start by answering the 7 questions
If you are over
70 years of age, and you are not used to much in the way of exercise, consult your Doctor before completing this
If you are
between the ages of 18 and 70, and answer YES to any of the questions below, you should consult your Doctor
before you start on an exercise programme.
□ □ Has your Doctor ever said that you have a heart
condition and that you should limit your
activity to that recommended by a Doctor?
□ Do you feel pain in your chest when you
undertake physical activity?
□ In the past month, have you had chest pain
when NOT undertaking physical activity?
□ Do you lose balance because of dizziness or do
you ever lose consciousness?
□ Do you have a bone or joint problem (for
example, back, knee or hip) that could be made worse
change in your physical activity?
□ Is your Doctor currently prescribing drugs for
high blood pressure or a heart condition?
□ Do you know of any other reason why you should not undertake physical
In signing this
form I confirm that I have read, understood and completed this questionnaire. I confirm the above answers are true and accurate to the best of my knowledge
and belief. I undertake to notify a member of the RIO staff at once
if any of the answers to the above questions change. I agree not to
use any item of exercise equipment without receiving full instructions beforehand, in its use, from the RIO
Exercise Therapist. I am aware that physical activity can be
hazardous and there is a risk involved.
I have read and understood the contents of this
Questionnaire and Disclaimer.