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Adult Pre-Exercise Screening Tool

Standard adult pre-exercise screening tool.

Uploaded by

Ahmad Akbary
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
19 views5 pages

Adult Pre-Exercise Screening Tool

Standard adult pre-exercise screening tool.

Uploaded by

Ahmad Akbary
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Adult Pre-Exercise Screening Tool

Pre-Exercise Screening and Assessment Forms

This screening tool plays a vital role in ensuring the safety and effectiveness of fitness
programs by thoroughly identifying individuals who may require medical clearance before
participating in physical activities. By gathering comprehensive health and lifestyle details,
this tool enables trainers and clients to work collaboratively toward tailored exercise plans.
This process not only minimizes the potential risks associated with physical activities but
also fosters a positive and enjoyable fitness experience for all participants.

1. Pre-Exercise Screening Tool

Personal Details

• Name: ____________________

• Birthdate: _______________

• Phone: ___________________

• Email: ___________________

• Emergency Contact Name: _______

• Relationship to Contact: ____________

• Emergency Contact Phone: _________

Medical History

• Existing Conditions (check all that apply):

o Heart disease

o High blood pressure

o Diabetes

o Asthma

o Joint problems

o Other: ________________

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Adult Pre-Exercise Screening Tool

Lifestyle Details

• Smoking Status:

o Current smoker

o Former smoker

o Never smoked

• Alcohol Consumption:

o Regular

o Occasional

o None

• Activity Level:

o Sedentary (little or no physical activity)

o Active (some physical activity weekly)

o Highly Active (frequent, intense physical activity)

Current Medications

• List any medications you are currently taking: ________________

Past or Current Injuries

• Injury History (check one):

o Yes (Specify): ________________

o No

Medical Clearance

• Has a doctor ever advised you to avoid physical activity?

o Yes

o No

Signature: _______________ Date: _______________

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Adult Pre-Exercise Screening Tool

2. PAR-Q+ (Physical Activity Readiness Questionnaire)

The PAR-Q+ helps determine the individual’s readiness for physical activity by asking the
following critical health-related questions:

1. Do you have a heart condition or high blood pressure?

o Yes

o No

2. Do you experience chest pain during physical activity?

o Yes

o No

3. Have you had chest pain at rest within the last month?

o Yes

o No

4. Do you often feel dizzy or faint?

o Yes

o No

5. Do you have any bone or joint problems that could be worsened by physical
activity?

o Yes

o No

6. Are you currently taking medications for any chronic condition?

o Yes

o No

Signature: _______________ Date: _______________

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Adult Pre-Exercise Screening Tool

3. Fitness Goal Questionnaire

Understanding a client’s fitness goals is critical for developing a customized program. This
section captures the individual's specific aspirations and barriers to success.

Goals

• What are your primary fitness goals? (check all that apply):

o Weight loss

o Muscle gain

o Endurance improvement

o Flexibility enhancement

o General wellness

o Other: ________________

Motivation

• What motivates you to achieve these goals? ________________

Timeline

• Do you have a specific timeline for achieving these goals?

o Yes (Specify): ________________

o No

Obstacles

• What challenges or obstacles might prevent you from reaching your goals?
________________

Signature: _______________ Date: _______________

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Adult Pre-Exercise Screening Tool

4. Informed Consent

Acknowledgment and Agreement

By signing this informed consent form, you acknowledge that the information provided is
accurate to the best of your knowledge. You also accept the inherent risks associated with
physical activity and agree to notify your trainer of any changes in your health status.

• Participant Agreement:

o I understand and accept the risks of participating in a fitness program.

o I agree to provide accurate health information and update my trainer about


any relevant changes in my condition.

Participant Signature: _______________ Date: _______________

Trainer Signature: _______________ Date: _______________

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