fitness4less
Has a doctor/medical professional ever diagnosed you with a heart condition and indicated you should restrict your physical activity?
Yes
No
When you perform physical activity, do you feel pain in your chest?
Yes
No
When you are not engaging in physical activity, have you experienced chest pain in the past month?
Yes
No
Do you ever faint or get dizzy and lose your balance?
Yes
No
Do you have an injury or orthopaedic condition (such as a back, hip, or knee problem) that may worsen due to a change in your physical activity?
Yes
No
Do you have high blood pressure or a heart condition in which a
doctor/medical professional is currently prescribing a medication?
Yes
No
Are you pregnant?
Yes
No
Do you have insulin dependent diabetes?
Yes
No
Are you 69 years of age or older and not used to being very active?
Yes
No
Do you know of any other reason you should not exercise or increase your physical activity?
Yes
No

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