Get Active Questionnaire

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) with IPG Wellness Services 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.

Multi choice

I am completing this questionnaire for myself.

I am completing this questionnaire for my child/dependent as parent/guardian.

PREPARE TO BECOME MORE ACTIVE

The following questions will help to ensure that you have a safe physical activity

experience. Please answer YES or NO to each question before you become more

physically active. If you are unsure about any question, answer YES.

Have you experienced ANY of the following (A to F) within the past six months?

A diagnosis of/treatment for heart disease or stroke, or pain/discomfort/pressure in your chest during activities of daily living or during physical activity?

A diagnosis of/treatment for high blood pressure (BP), or a resting BP of 160/90 mmHg or higher?

Dizziness or lightheadedness during physical activity?

Shortness of breath at rest?

Loss of consciousness/fainting for any reason?

Concussion?

NO to all questions: go to Page 3 – ASSESS YOUR CURRENT PHYSICAL ACTIVITY

YES to any question: go to Reference Document on Page 2 – ADVICE ON WHAT TO DO IF YOU HAVE A YES RESPONSE

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Get Active Questionnaire