National Academy of Sports Medicine
PROFESSIONALS NAME: Click here to enter text.
CLIENTS NAME: Click here to enter text.
DATE: Click here to enter text.
PHYSICAL ACTIVITY READINESS QUESTIONNAIRE
Questions Yes No
1 Has your doctor ever said that you have a heart condition and that you
should only perform physical activity recommended by a doctor?
2 Do you feel pain in your chest when you perform physical activity?
3 In the past month, have you had chest pain when you are not performing
any physical activity?
4 Do you lose your balance because of dizziness or do you ever lose
consciousness?
5 Do you have a bone or joint problem that could be made worse by a change
in your physical activity?
6 Is your doctor currently prescribing any medication for your blood pressure
or for a heart condition?
7 Do you know of any other reason why you should not engage in physical
activity?
If you have answered "Yes" to one or more of the above questions, consult your physician before
engaging in physical activity. Tell your physician which questions you answered "Yes" to. After
a medical evaluation, seek advice from your physician on what type of activity is suitable for
your current condition.