Please complete the attached Physical Activity Readiness Questionnaire in order to be approved to access our CancerFit series of videos in partnership with Exercise Prescription. 

Physical Activity Readiness Questionnaire

The health benefits of regular physical activity are clear; more people should engage in physical activity every day of the week. Participating in physical activity is very safe for MOST people. This questionnaire will tell you whether it is necessary for you to seek further advice from your doctor or a qualified exercise professional before becoming more physically active.

General Questions

Please read the 7 questions below carefully and answer each one honestly: Tick YES or NO.

Has your doctor ever said that you have a heart condition or high blood pressure?
Do you feel pain in your chest at rest, during your daily activities of living or when you do physical activity?
Do you lose balance because of dizziness or have you lost consciousness in the last 12 months? Please answer ‘no’ if your dizziness was associated with over-breathing (including during vigorous exercise).
Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)?
Are you currently taking prescribed medications for a chronic medical condition?
Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically active? Please answer no if you had a problem in the past, but it does n
Has your doctor ever said that you should only do medically supervised physical activity?

If you answered NO to all of the questions above, you are cleared for physical activity.

Participant Declaration

  • Start becoming much more physically active - start slowly and build up gradually.

  • Follow International Physical Activity Guidelines for your age  (www.who.int/dietphysicalactivity/en/).

  • You may take part  in a health and fitness appraisal.

  • If you are over the age of 45 and not accustomed to regular vigorous to maximal effort exercise, consult a qualified exercise professional before engaging in this intensity of exercise.

  • If you have any further questions, contact a qualified exercise professional.

I have read and understood to my full satisfaction and completed this questionnaire.  I acknowledge that this physical activitgy clearance is valid for a maximum of 12 months from the date it is completed andbecomes invalid if my condition changes. 

I also acknowledge that the charity may retain a copy of this form for its records.  In these instances, it will maintain the confidentiality of the same, complying with applicable law.