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Has your doctor ever said that you have a heart condition and that you should
only do physical activity recommended by a doctor?
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Do you have either high or low blood pressure? If yes, which type?
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Have you ever felt pain in your chest when you do physical exercise?
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In the past month, have you had chest pain when you were not doing physical activity?
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Do you often feel faint, lose your balance because of dizziness or have you ever lost consciousnes
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Have you ever suffered from unusual shortness of breath at rest or with mild exertion?
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Has the doctor ever said that you have a bone or joint problem, such as arthritis, that has been aggravated by exercise or that may be made worse by exercise?
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Are you, or is there any possibility that you might be pregnant, or have you been
pregnant in the last 6 months?
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Are you currently on any prescribed medicines that may affect your ability to exercise?
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Do you know of any other reason that may affect your ability to participate in physical activity?​