This form is adapted from :
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY – PHYSICAL ACTIVITY TRAINING FOR HEALTH (CSEP-PATH®)Physical activity improves your physical and mental health. Even small amounts of physical activity are good, and more is better.For almost everyone, the benefits of physical activity far outweigh any risks. For some individuals, specific advice from a Qualified Exercise Professional (QEP – has post-secondary education in exercise sciences and an advanced certification in the area – see csep.ca/certifications) or health care provider is advisable.
This questionnaire is intended for all ages - to help move you along the path to becoming more physically active.
The following questions will help confirm that you can participate in physical activity safely. Please indicate "yes" or "no" on each of the questions. If you are not sure what to answer, check "yes" and we can follow up in a discussion.
Have you had or experienced any of the following:
IF YES, PLEASE READ: Physical activity is likely to be beneficial. If you have been treated for heart disease but have not completed a cardiac rehabilitation program within the past 6 months, consult a doctor – a supervised cardiac rehabilitation program is strongly recommended. If you are resuming physical activity after more than 6 months of inactivity, begin slowly with light- to moderate-intensity physical activity. If you have pain/discomfort/pressure in your chest and it is new for you, talk to a doctor. Describe the symptom to them and what activities bring it on.
IF YES, PLEASE READ: Physical activity is likely to be beneficial if you have been diagnosed and treated for high blood pressure (BP). If you are unsure of your resting BP, consult a health care provider or a Qualified Exercise Professional (QEP) to have it measured. If you are taking BP medication and your BP is under good control, regular physical activity is recommended as it may help to lower your BP. Your doctor should be aware of your physical activity level so your medication needs can be monitored. If your BP is 160/90 or higher, you should receive medical clearance and consult a QEP about safe and appropriate physical activity.
IF YES, PLEASE READ: There are several possible reasons for feeling this way and many are not worrisome. Before becoming more active, consult a health care provider to identify reasons and minimize risk. Until then, refrain from increasing the intensity of your physical activity.
IF YES, PLEASE READ: If you have asthma or other conditions that cause shortness of breath, and this is relieved with medication, light to moderate physical activity is safe. If your shortness of breath is not relieved with medication, consult a doctor.
IF YES, PLEASE READ: Before becoming more active, consult a doctor to identify reasons and minimize risk. Once you are medically cleared, consult a Qualified Exercise Professional (QEP) about types of physical activity suitable for your condition.
IF YES, PLEASE READ: A concussion is an injury to the brain that requires time to recover. Increasing physical activity while still experiencing symptoms may worsen your symptoms, lengthen your recovery, and increase your risk for another concussion. A health care provider will let you know when you can start becoming more physically active, and a Qualified Exercise Professional (QEP) can help get you started.
IF YES, PLEASE READ: If this swelling or pain is new, consult a health care provider. Otherwise, keep joints healthy and reduce pain by moving your joints slowly and gently through the entire pain-free range of motion. Consult a Qualified Exercise Professional (QEP) in follow-up to help you become more active and prevent or minimize future pain.
IF YES, PLEASE READ: First listen to the advice of your health care provider. A Qualified Exercise Professional (QEP) will ask you about any considerations and provide specific advice for physical activity that is safe and that takes your lifestyle and health care provider’s advice into account.
IF YES, PLEASE READ: Some people may worry that if they have a medical or physical condition, physical activity might be unsafe. In fact, regular physical activity can help to manage and improve many conditions. Physical activity can also reduce the risk of complications. A Qualified Exercise Professional (QEP) can help with specific advice for physical activity that is safe and that takes your medical history and lifestyle into account.
If you answered "YES" to any of the questions make sure you read the "IF YES, PLEASE READ" following the question.
Increase your physical activity gradually so that you have a positive experience. Build physical activities that you enjoy into your day (e.g., take a walk with a friend, ride your bike to school or work) and reduce your sedentary behaviour (e.g., prolonged sitting).
If you want to do vigorous physical activity (i.e., physical activity at an intensity that makes it hard to carry on a conversation), consult a Qualified Exercise Professional (QEP) beforehand. This can help ensure that your physical activity is safe and suitable for your circumstances. Physical activity is also an important part of a healthy pregnancy.
Delay becoming more active if you are not feeling well because of a temporary illness.