UNIVERSITY OF SANTO TOMAS

INSTITUTE OF PHYSICAL EDUCATION AND ATHLETICS

SERVICE PHYSICAL EDUCATION DEPARTMENT

Students Name: _Iñigo Miguel M. Suarez_______. College/ Sec.: ______2M6_______

The Philippine Physical Activity Readiness Questionnaire (PPAR-Q) modified by Bernardo

Bonoan (2006) is a self-guided question-screening tool that is able to quickly identify
conditions or risk factors that require further assessment before commencing exercise. This
questionnaire is adapted from the British Columbia Ministry of Health and the Multidisciplinary
Board on Exercise.

PHILIPPINE PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PPAR-Q)

(Bonoan, Bernardo 2006)

Please read the questions carefully and answer (/) each one honestly.
Basahin nang mabuti ang mga tanong at sagutin (/) nang buong katapatan.

YES No Questions
(Oo) (Hindi) (Tanong)
Has your doctor ever diagnosed you to have a heart condition and that you should only
do physical activity recommended by a doctor?

(Sinabihan ka na ba ng doktor mo na ikaw ay may karamdaman sa puso at ang dapat

mo lang gawing pisikal ay ang rekomendado ng doktor?)
Is your doctor currently prescribing drugs for your blood pressure or heart condition?

(Kasalukuyan ka bang umiinom ng gamot na inireseta ng doktor mo para sa mataas na

presyon ng dugo o karamdaman sa puso?)
Do you experience pain or discomfort in the chest, neck, and jaw area during mild
physical activity or at rest?

(Nakakaramdam ka ba ng sakit o karamdaman sa dibdib, leeg, o gawing panga

habang gumagawa ng malumanay na gawaing pisikal o kaya ay nagpapahinga?)
Do you experience shortness of breath with mild physical exertion?

(Nakakaramdam ka ba ng kahirapan sa paghinga habang gumagawa ng malumanay

na gawaing pisikal?)
Do you get tired frequently even when not doing physical activity or are you frequently
drowsy?

(Madalas ka bang napapagod maski na walang ginagawang pisikal o madalas ka bang

nananamlay?)
Have you lost weight rapidly recently with or without feelings of extreme hunger?

(Namayat o nawalan ka ba ng timbang nang sobrang bilis kamakailan nang hindi

nakakaramdam ng matinding gutom?)
Do you have a bone or joint pain that increases with movement? Is there a sudden
increase in pain when bending or touching the joint?

(Nakakaramdam ka ba ng sakit sa buto o kasu-kasuan na lumalala kapag gumalaw?

May biglang pagtindi ba ng sakit kung binabaluktot o hinahawakan ang kasu-kasuan?)
Do you know of any other reason why you should not do physical activity?

(Meron ka bang alam na iba pang dahilan kung bakit hindi ka dapat gumawa ng kahit
ano mang gawaing pisikal?)

If you answered YES to any question, please see an EIM certified specialist. Thank you.
(Kapag may sinagutan ka ng Oo, maaari lang magpakita sa EIM certified specialist. Salamat.)
 UST-IPEA A.Y. 2021-2022

UNIVERSITY OF SANTO TOMAS

INSTITUTE OF PHYSICAL EDUCATION AND ATHLETICS
SERVICE PHYSICAL EDUCATION DEPARTMENT

I hereby confirm that the information given in this form is true and correct to the best of
my knowledge and belief.

Signature of Parents/ Guardian: ___Leah M. Suarez_______. Date:_Oct 14 2022______

In case of emergency:

Parents/ Guardian Name: ____ Leah M. Suarez. Relation:____Mother___________

Home Address: __L.Cortez St San Nicholas Pob. Concecpcion Tarlac_______________

Contact No.: __09369500725__________Email Address: __None_________________

*Only Registered Physicians or Specialists will fill up the questions below.

Clearance Recommendations: Please put a mark ( / or x) inside the box.

He/She is cleared to participate in unrestricted activity.

He/She is cleared to participate in light to moderate activity only.

He/She should not participate in activity at this time pending further evaluation.

Others: Please specify: _______________________________________________________

__________________________________________________________________________

Signature of Physician: Date:_Oct 14 2022____

*Please attach medical records or certificates if found with any medical conditions upon
submission of this form.

UST-IPEA A.Y. 2021-2022