Whether you are a fitness leader or a fitness participant, chances are you’ve come across a medical screening form to be completed before registering for a fitness class or activity. This is done to protect each participant and to ensure the fitness leader knows which clients have any pre-existing health concerns.

The two most common screening tools used are the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and the electronic Physical Activity Readiness Medical Evaluation (ePARmed-X). Many facilities and fitness professionals make these screening tools a mandatory component of their services and programs. BCRPA considers the PAR-Q+ to be the gold standard for exercise screening because of its continual peer-review process and strongly recommends all its registered fitness leaders use them.

What are the PAR-Q+ and ePARmed-X?

The Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and the electronic Physical Activity Readiness Medical Evaluation (ePARmed-X) are internationally renowned, evidence-based pre-participation screening tools.

The questionnaires were created to reduce barriers to physical activity participation and help identify people who may require more screening, and/or health care approval, before increasing their physical activity level.

Why was the PAR-Q+ created?

Before the PAR-Q+ was widely adopted, there were restrictive practices in place for individuals interested in participating in exercise testing and/or prescription.

For example, in North America it was recommended that a stress test with an electrocardiogram be administered for men aged 35 and older who were interested in increasing their physical activity levels. The thought process behind this recommendation was that medically supervised stress testing could predict, and thereby prevent adverse exercise–related events. However, further studies found the efficacy of such stringent and extensive guidelines to be debatable.

In fact, several studies have argued that by restricting physical activity, you are increasing the risk of an adverse event. As one researcher stated, “The need for extensive preliminary screening is particularly questionable, given that moderate exercise decreases rather than increases a person’s overall risk of cardiac death.”

As a result, in the mid- to late- 1970s, a less stringent, more user-¬friendly screening process was sought. Around the same time, the PAR-Q+ was created for British Columbia’s Ministry of Health.

The PAR-Q+ is regularly revised in response to consensus and panel reviews by sector specialists.

How is the Par-Q+ administered?

The PAR-Q+ is a self-administered questionnaire that can be completed electronically or manually on a printed handout. It is designed to assess participants’ readiness to participate in more physical activity. The questionnaire starts with 7 “yes” or “no” questions.

If “no” is selected for all questions, the individual can start to become more physically active.

If “yes” is selected for any of the questions on the first page of the PAR-Q+, the individual must complete the second and third pages. If they answer “no” to all follow-up questions, they are ready to be physically active.

If “yes” is selected for any of the follow-up questions on the second or third page of the PAR-Q+, the individual will need to complete the ePARmed-X+ or speak with a qualified exercise professional, such as a BCRPA registered Fitness Leader.

What is the Goal of the PAR-Q+?

Using the PAR-Q+ is an essential step in promoting safe and effective physical activity and exercise and can help to prevent exercise-related injuries and health problems.

If people understand their exercise tolerance, self-monitoring procedures, and relevant prodromal symptoms, exercise can be prescribed with confidence that the benefits far outweigh any potential risk.

Within any exercise program, patient safety can be achieved by a gradual progression of intensity, during which the individual remains within the limits of exercise tolerance.

A trainer and a client sitting on a yoga mat and talking.

When do I administer PAR-Q+?

There are instances where the PAR-Q+ is not part of the registration process at a facility or centre. If this is the case BCRPA recommends the following promising practices:

Group fitness classes (including Yoga, Pilates, and Aquatics)
For all group classes, the PAR-Q+ should be verbally acknowledged at the beginning of the first class and again in each class if it is open for drop-ins. A poster with the most current versions of the screening forms should be displayed.

Weight rooms
Discuss the PAR-Q+ during weight room orientations and when registering new users. Weight rooms should display a poster with the most current versions of the screening forms.

Personal trainers
Keep a copy of the completed and signed questionnaire. The Par-Q+ should be administered prior to doing any further health or baseline assessments and putting together a contract.

BCRPA recommends you instruct your client to fill out the PAR-Q+ annually along with your contract renewals to stay informed and track any health changes with your client.

Pre- and post-natal clients.
As stated on the PAR-Q+ forms, those who are pregnant should complete the ePARmed-X. Alternatively, there is the Canadian Society for Exercise Physiology (CSEP) Get Active Questionnaire for Pregnancy.

A group yoga class leaning over to stretch with one arm raised in the air
Image via Pexels

Using the ePARmed-X

The ePARmed-X was developed for use by exercise professionals, such as BCRPA registered Fitness Leaders, and physicians to help address medical concerns identified by the PAR‐Q+.

The ePARmed-x is used to provide clearance for physical activity participation or to prompt referral to a medically-supervised exercise program by gathering additional information. The intent is to provide clearance in a way that allows for only a minority (estimated at 1-2%) of respondents to be referred for additional medical testing prior to becoming much more physically active.

Where can I find the PAR-Q+ and ePARmed-X+?

The latest versions of these forms can always be found here.

Since the forms undergo routine updates as the evidence evolves, check back regularly for updated versions.

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