CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY

GET ACTIVE QUESTIONNAIRE

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 - has post-secondary education in exercise sciences and an advanced certification in the area - see csep.ca/certifications) or health case provider is adviseable. This questionnaire is intended for all ages - to help move you along the path to becoming more physically active.

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

A. 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?

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

C. Dizziness or lightheadedness during physical activity?

D. Shortness of breath at rest?

E. Loss of consciousness/fainting for any reason?

F. Concussion?

2. Do you currently have pain or swelling in any part of your body (such as from an injury, acute flare-up of arthritis, or back pain) that affects your ability to be physically active?

3. Has a health care provider told you that you should avoid or modify certain types of physical activity?

4. Do you have any other medical or physical condition (such as cancer, osteoporosis, spinal cord injury) that may affect your ability to be physically active?

ASSESS YOUR CURRENT PHYSICAL ACTIVITY

Answer the following questins to assess how active you are now.

1. During a typical week, on how many days do you do moderate- to vigorous-intensity aerobic physical activity (such as brisk walking, cycling or jogging)?

2. On days that you do at least moderate-intensity aerobic physical activity (e.g., brisk walking), for how many minutes do you do this activity?

3. For adults, please multiply your average number of days/week by the average number of minutes/day:

DECLARATION

To the best of my knowledge, all of the information I have supplied on this questionnaire is correct. If my health changes, I will complete this questionnaire again.