Physical Activity Readiness Questionnaire (PARQ)
You may either complete and submit the form below via e-mail, or...
you may click here for a printer-friendly PDF version* that you can complete and mail to:

Dr. Katarina Borer
Division of Kinesiology
3060G CCRB
401 Washtenaw Ave.
Ann Arbor, MI 48109-2214

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Subject Identification Code:
Home Address:
City:    State:    Zip Code:
E-Mail (required):
Phone (Daytime):
Phone (Evening):
Emergency Contact's Name:
And Daytime Phone:
Your Height (in inches):     Weight (in pounds):
Today's Date:     Your Age:
 

The health benefits of regular physical activity include: lowering blood pressure; reduced risks of coronary heart disease and diabetes; and reduced body fat level. PARQ seeks to identify a small number of individuals who may have medical conditions that could make exercise hazardous to their health. Also, it seeks health information necessary for inclusion in the study.

1. Have you entered menopause? Yes No
2. When was your last menstrual period? (mm/dd/year)
3. Do you take replacement hormones? Yes No
4. Which hormones do you use?
5. Do you smoke? Yes No
6. How often and how long do you exercise?
7. Have you ever had heart pains or heart disease? Yes No
8. Have you ever had high blood pressure? Yes No
9. Do you have bone/joint problems? Yes No
10. Do you have asthma? Yes No
11. Do you have diabetes, or a family history of diabetes? Yes No
12. What medications do you take regularly?
13. Is there a reason (not already mentioned) why you should not follow an activity program, even if you wanted to?
14. Are you actively dieting? Yes No
Please use this space to explain any "Yes" answers to the questions above.
Which study/studies are you interested in?
1. Hormone Study And 30 Weeks Of Walking
2. Blood Pressure And 15 Weeks Of Walking Study
3. Blood Pressure Response To Acute Exercise Study
4. Timing Of Meals And Exercise Study



(Adapted from PAR-Q by British Columbia Ministry of Health) DOS138:\PARQ.795