Are you fit for exercise?
Screening questionnaire
Adapted from the ACSM Health/Fitness Facility Preparticipation Screening Questionnaire
Before you begin an exercise programme, we advise that you use this questionnaire to check whether you are sufficiently healthy to begin exercising regularly.
| MARK ALL TRUE STATEMENTS History - You have had: ___ a heart attack ___ heart surgery ___ cardiac catheterisation ___ coronary angioplasty ___ a pacemaker ___ defibrillator ___ heart valve disease ___ heart failure ___ a heart transplant ___ heart disease Symptoms- You experience: ___ chest pain with exertion ___ unreasonable breathlessness ___ dizziness or fainting ___ heart medication Other issues: ___ you have diabetes ___ you have asthma or COPD ___ you get a burning sensation in the legs when walking short distances ___ you have musculoskeletal problems that limit physical activity ___ you have concerns about exercise safety ___ you take prescribed drugs ___ you are pregnant Risk factors: ___ you are a male over 45 years old ___ you are female over 55 years old ___ you smoke or quit within the last six months ___ your blood pressure is above 140/90 mm hg ___ your total cholesterol is above 5.2 mmol/L ___ you have heart attack or sudden death in the family (male before 55 years, female before 65 years) ___ you are sedentary ___ you are classed as obese |
If you marked any of the statements in this section as true, consult your GP before taking part in an exercise programme. |
| ___ none of the above | You can exercise |
