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Adult Pre-Exercise Screening Questionnaire
Answer Yes or No to the following seven questions for a quick self evaluation of if it's advised you seek guidance from your general practitioner (GP) or another health professional prior to undertaking physical activity/exercise.
1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?
Examples include, but are not limited to:
2. Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?
Unexplained chest pains may be characterised by constriction, burning, knife-like pains and/or a dull ache. 3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?
Examples of dizziness may include, but are not limited to:
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Click on the above image to view/print the questionnaire PDF file. Note: It will open in a new window.
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4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
Medical attention refers to GP or hospital visit immediately following an asthma attack. It does not include the self administration of Ventolin, Becotide or any other inhalant. 6. Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise?
Examples include, but are not limited to the conditions listed below:
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5. If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?
‘Trouble controlling’ usually refers to an inability to maintain a stable blood glucose level, this may also include the diabetic who sustains a hyperglycaemic (hyper) or hypoglycaemic (hypo) event. 7. Do you have any other medical condition/s that may make it dangerous for you to participate in physical activity/exercise?
If you have any other concerns or medical problems not covered in the previous questions select Yes. Examples that might come up include, but are obviously not limited to:
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IF YOU ANSWERED 'YES' to any of the 7 questions, please seek guidance from your GP or appropriate allied health professional, prior to undertaking physical activity/exercise.
IF YOU ANSWERED 'NO' to all of the 7 questions and you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise.
