PRE-ASSESSMENT

Directions: Read and answer the questionnaire honestly.

PAR-Q and YOU Questionnaire (prior to the activity test)
Name: ____________________________________ Date: _______________
Age: _____________ Preferred sports:
________________

Questions Yes No
1. Has your doctor ever said that you have a heart condition and that you should
only do physical activity recommended by a doctor?
2. Do you feel pain in your chest when you do physical activity?
3. In the past month, have you had chest pain when you were not doing physical
activity?
4. Do you loose your balance because of dizziness or have you ever lost
consciousness?
5. Do you have a bone or joint problem (for example, back, knee, hip) that could
be made worse by a change in your physical activity?
6. Is your doctor currently prescribing drugs for your heart condition?
7. Do you know of any other reason why you should not do physical activity?

__________________________ ___________________________
Signature over printed name Parent’s Signature Over Printed Name
Compute your THR (Target Heart Heart) at moderate and at vigorous intensity of physical
activity.

Moderate (40-55%): 220-age= ____________________Personal Maximum Heart Rate (PMHR)

MHR x 0.4 = _______________bpm
MHR x 0.55 =________________bpm
Vigorous (60-85%): MHR x 0.6 = ________________bpm
MHR x 0.85 = _______________ bpm
STATIC STRETCHING EXERCISES DONE

1. Neck Stretches (16 counts)

2. Shoulder Curls (16 counts)
3. Arm Stretches (16 counts )
4. Trunk Stretches (16 counts)
5. Squats (8 times)
DYNAMIC STRETCHING EXERCISES DONE

1. Jogging (16 counts)

2. Butt kicks (16 counts)
3. High Knees (16 counts)
4. Back Pedals (16 counts)
5. Jumping Jacks (16 counts)