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Physical Activity Readiness Questionnaire (PAR-Q)

Before starting your MummaFit fitness journey, please ensure you answer the questions below to the best of your knowledge, where an answer is “Yes”, please give additional information.


The information provided will help your trainer create a safe and effective training programme.


All information will be kept private and confidential.

Birthday
Day
Month
Year
Has your Doctor completed your 6-8 weeks postnatal check:
Yes
No
Method of delivery of your recent baby:
Caesarean section
Vaginal delivery (no medical intervention)
Vaginal delivery with medical intervention (e.g. forceps)
Did you take part in regular exercise before pregnancy?
Yes
No
Did you have an active pregnancy?
Yes
No
Have you started exercising since having your baby/babies?
Yes
No
Are you interested in Personal Training?
Yes
No
Have you ever experienced any of the following *health conditions* past or present?
Have you ever suffered with Pelvic Girdle Pain, e.g. symphysis pubis dysfunction?
Yes
No
Did you have a lengthy or difficult labour?
Yes
No
If you had a vaginal delivery, did you have stitches to repair an episiotomy or tear?
Yes
No
Do you have any particular concerns or worries about your pelvic floor health? E.g. are you experiencing urine leakage? Have you noticed anything unusual or had a lack of sensation?
Yes
No
Are you breastfeeding?
Yes
No
Do you have any particular concerns or worries about exercise in the postnatal period?
Yes
No
Have you had major surgery in the last 10 years (except Caesarean section)?
Yes
No
Have you had minor surgery in the last two years?
Yes
No
Have you ever been told that you have arthritic joints, osteoporosis or any bone or joint problem that may affect your ability to exercise?
Yes
No
Do you have pain or restricted movement in your neck, back or other joints (e.g. hip, knee, ankle, shoulder)?
Yes
No
Have you been diagnosed as having hypermobile joints (excessive joint movement)?
Yes
No
Is there anything else in your medical history that you feel could affect your ability to exercise?
Yes
No
Are you taking any medications that may affect your ability to exercise?
Yes
No

Declaration

If you ticked YES to one or more of the *health conditions*, you may need to talk to your GP for advice before you start becoming more physically active. Tell your GP about the questionnaire and which question(s) you highlighted/ticked. You may be able to do any activity you want - as long as you begin slowly and build up gradually, or you may need to restrict your activities to those which are safe for you.

If your health changes at all and you develop any health conditions, then please inform Adela and a health professional immediately.

I can confirm that I have read, understood and completed this questionnaire to the best of my knowledge, consulted with my GP if necessary and that it is my responsibility to ensure the safety of myself and my baby/babies when participating in any of MummaFit classes.

Date
Day
Month
Year
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