Self Test

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Name: ___________________________________________

Put a check mark (/) on the box that corresponds to your answer. This questionnaire will
help you check if moderate to vigorous physical activity is safe for you. If you are between ages
15 to 69, the PAR-Q will tell you if you should check with your doctor before you start.
Common sense is your best guide when you answer these questions.

DESCRIPTION YES NO
1. Has your doctor ever told you that you have a heart condition or a
high blood pressure?
2. Do you feel pain in your chest when you are doing daily activities or
when you do physical activities?
3. Do you lose balance because of dizziness or have you lost
consciousness in the past 12 months?
4. Have you ever been diagnosed with a chronic condition other than
heart disease or hypertension (e.g. cancer)?
5. Are you currently taking prescribed maintenance condition?
6. Do you currently have a bone, joint, or other musculoskeletal
condition that can worsen as a result of moderate to vigorous physical
activity?
7. Has your doctor ever told you that you should only engage in
medically supervised physical activity?

If you answer “NO” to all the questions, you are ready to engage in an active lifestyle and
do the task given below. If you answer “YES” to any of the questions, you need to talk to your
physician about your condition. In order for you not to do the task, 4 provide proof such as
medical prescriptions or anything that can be used as proof of your health condition that you
cannot perform the data needed below.
Perform one activity at a time and supply the information by filling-out the table.

Describe the activity Walking around for 5 Brisk walking for 4 3- minute jump jacks
based on the following minutes minutes
How are you feeling?

How is your breathing?

How is your Sweat?

How is your talking


ability?
Instructions: Copy and answer the following in your activity notebook.
Which among the three (walking around, brisk walking, 3-minute jump jacks) is
considered:
a. Light activity:_________________________________________________
Justification: _________________________________________________
b. Moderate activity: _____________________________________________
Justification: _________________________________________________
c. Vigorous activity: _____________________________________________
Justification: ___________________________________________________

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