Physical Activity Readiness Questionnaire Research Articles

Dealing with ambiguity: Israeli physician's attitudes and practices regarding pre-exercise certificates: a questionnaire study.

BackgroundIt has become clear in recent years that a healthy lifestyle, including physical exercise is crucial for health maintenance. Nevertheless, most people do not exercise regularly. Physician intervention is beneficial in increasing patient exercise. In Israel, the 1994 “Sports Law” regarding exercising in a gymnasium requires a physician’s written authorization, but does not direct the physicians what they should ascertain before issuing the certificate. This pre-exercise certificate has been widely discussed in Israel over the last year as the law is to be revised to enable using a modification of the PAR-Q+ (Physical Activity Readiness questionnaire) patient questionnaire as a screening tool. This will leave the requirement for a pre-exercise certificate for a less healthy population, yet without clear instructions to the primary care physician on criteria for ascertaining fitness. Our aim was to evaluate how primary care physicians deal with the ambiguity of defining health criteria for issuing exercise authorization/certificate.MethodsWe used an anonymous ten-item attitude/knowledge multiple choice questionnaire with an additional 13 personal/education and employment questions. We assessed each potential predictor of physician attitude and knowledge in univariate models.Results135 useable questionnaires were collected. Of these, 43.7 % of the doctors will provide the pre-exercise certificate to all their patients; 63 % were aware of their HMO/employers guidelines for issuing certificates; 62 % stated they complied with these guidelines, and 16 % stated they did not follow them. In addition, 70 % of the physicians reported regular exercise themselves, an average of 4.12 h/week. These physicians tended to provide the pre-exercise certificate to all patients unconditionally, as compared to physicians that did not exercise regularly. (46 % vs. 14.5 %, p < 0.01)ConclusionsMost Israeli primary care physicians will provide the required certificate allowing their patients to exercise in the gym. There is a wide variation as to what physicians check before providing the certificate. The modification of the law has made the need for standardization of the nature of what is expected of primary care physicians more urgent. A large portion of physicians exercise on a regular basis – and exercising physicians are more positive regarding pre-exercise certificates.Our study clearly shows a gap in knowledge transfer; and we call for a standardized approach to pre-exercise certificates utilizing computerized patient medical files.

Recruitment, screening, and baseline participant characteristics in the WALK 2.0 study: A randomized controlled trial using web 2.0 applications to promote physical activity.

ObjectiveTo describe in detail the recruitment methods and enrollment rates, the screening methods, and the baseline characteristics of a sample of adults participating in the Walk 2.0 Study, an 18 month, 3-arm randomized controlled trial of a Web 2.0 based physical activity intervention.MethodsA two-fold recruitment plan was developed and implemented, including a direct mail-out to an extract from the Australian Electoral Commission electoral roll, and other supplementary methods including email and telephone. Physical activity screening involved two steps: a validated single-item self-report instrument and the follow-up Active Australia Questionnaire. Readiness for physical activity participation was also based on a two-step process of administering the Physical Activity Readiness Questionnaire and, where needed, further clearance from a medical practitioner.ResultsAcross all recruitment methods, a total of 1244 participants expressed interest in participating, of which 656 were deemed eligible. Of these, 504 were later enrolled in the Walk 2.0 trial (77% enrollment rate) and randomized to the Walk 1.0 group (n = 165), the Walk 2.0 group (n = 168), or the Logbook group (n = 171). Mean age of the total sample was 50.8 years, with 65.2% female and 79.1% born in Australia.ConclusionThe results of this recruitment process demonstrate the successful use of multiple strategies to obtain a diverse sample of adults eligible to take part in a web-based physical activity promotion intervention. The use of dual screening processes ensured safe participation in the intervention. This approach to recruitment and physical activity screening can be used as a model for further trials in this area.

The 2015 Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and electronic Physical Activity Readiness Medical Examination (ePARmed-X+).

The 2015 Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and electronic Physical Activity Readiness Medical Examination (ePARmed-X+).

The ePARmed-X+ Physician Clearance Follow-up

The new Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and the new online electronic Physical Activity Readiness Medical Examination (ePARmed-X+) pre-participation clearance and risk stratification strategy reduces markedly the barriers to physical activity participation.

Qualified Fitness and Exercise as Professionals and Exercise Prescription: Evolution of the PAR-Q and Canadian Aerobic Fitness Test.

Traditional approaches to exercise prescription have included a preliminary medical screening followed by exercise tests of varying sophistication. To maximize population involvement, qualified fitness and exercise professionals (QFEPs) have used a self-administered screening questionnaire (the Physical Activity Readiness Questionnaire, PAR-Q) and a simple measure of aerobic performance (the Canadian Aerobic Fitness Test, CAFT). However, problems have arisen in applying the original protocol to those with chronic disease. Recent developments have addressed these issues. Evolution of the PAR-Q and CAFT protocol is reviewed from their origins in 1974 to the current electronic decision tree model of exercise screening and prescription. About a fifth of apparently healthy adults responded positively to the original PAR-Q instrument, thus requiring an often unwarranted referral to a physician. Minor changes of wording did not overcome this problem. However, a consensus process has now developed an electronic decision tree for stratification of exercise risk not only for healthy individuals, but also for those with various types of chronic disease. The new approach to clearance greatly reduces physician referrals and extends the role of QFEPs. The availability of effective screening and simple fitness testing should contribute to the goal of maximizing physical activity in the entire population.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Exercise as medicine: role in the management of primary hypertension.

Primary hypertension affects ∼1 in 5 Canadians and significantly increases the risk of myocardial infarction, stroke, heart failure, and early mortality. Guidelines for the management of hypertension recommend lifestyle modifications (e.g., increased physical activity, smoking cessation, moderate alcohol consumption, improved dietary choices) as the frontline strategy to prevent and manage high blood pressure (BP). In particular, acute and chronic aerobic exercise has consistently been shown to reduce resting and ambulatory BP, with the largest effects in hypertensive patients. Current guidelines recommend 30-60 min of moderate- to vigorous-intensity aerobic exercise 4-7 days per week, in addition to activities of daily living. The role of resistance training in the management of hypertension is less clear, although available data suggests resistance exercise can be performed safely without risk of increasing BP or adverse events. Presently, resistance exercise (8-10 exercises, 1-2 set(s) of 10-15 repetitions, 2-3 days/week) is advocated only as an adjunct exercise modality. Patients desiring to begin an exercise program should complete the Physical Activity Readiness Questionnaire (PAR-Q or PAR-Q+) or as required, the Electronic Physical Activity Readiness Medical Examination (ePARmed-X) or Physician Clearance Form in consultation with their clinician and (or) trained exercise professional. A greater emphasis on utilizing exercise as medicine will produce positive nonpharmacologic benefits for hypertensive patients and improve overall cardiovascular risk profiles.

The 2014 Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and electronic Physical Activity Readiness Medical Examination (ePARmed-X+).

The 2014 Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and electronic Physical Activity Readiness Medical Examination (ePARmed-X+).

Application of the American Heart Association/American College of Sports Medicine Adult Preparticipation Screening Checklist to a nationally representative sample of US adults aged >=40 years from the National Health and Nutrition Examination Survey 2001 to 2004.

Although the American Heart Association/American College of Sports Medicine's Preparticipation Questionnaire (AAPQ) is a recommended preexercise cardiovascular screening tool, it has never been systematically evaluated. The purpose of this research is to provide preliminary evidence of its effectiveness among adults aged ≥40 years. Under the assumption that participants would respond to AAPQ items as they responded to a general health survey, we calculated the sex- and age-specific proportions of adult participants in the National Health and Nutrition Examination Survey 2001 to 2004 who would receive a recommendation for physician consultation based on AAPQ referral criteria. Additionally, we compared recommended AAPQ referrals to a similar assessment using the Physical Activity Readiness Questionnaire in the study sample. AAPQ referral proportions were higher with older age. Across all age groups ≥40 years, 95.5% (94.3% to 96.8%) of women and 93.5% (92.2% to 94.7%) of men in the United States would be advised to consult a physician before exercise. Prescription medication use and age were the most commonly selected items. When referral based on AAPQ was compared with that of the Physical Activity Readiness Questionnaire, the 2 screening tools produced similar results for 72.4% of respondents. These results suggest that >90% of US adults aged ≥40 years would receive a recommendation for physician consultation by the AAPQ. Excessive referral may present an unnecessary barrier to exercise adoption and stress the healthcare infrastructure.

Feasibility and Acceptability of an Internet-Based, African Dance-Modified Yoga Program for African-American Women with or at Risk for Metabolic Syndrome.

African-American (AA) women are the segment of the population that experiences the highest mortality from metabolic syndrome (MetS). Yoga decreases risk of MetS, yet there have been no yoga studies of AA women with or at risk for MetS. The purpose of this 4-week study was to test the feasibility and acceptability of a culturally tailored, Internet-based intervention, yogic dance (YD), using digital videos in a sample of AA women (ages 35-64) at risk for or with MetS. The investigators examined the rates of accrual, attrition, and reasons for attrition; the feasibility of using the Internet to deliver the intervention; the acceptability of the intervention as structured; and any other benefits and/or limitations of YD. The study used a single-group, mixed-methods design underpinned by social constructivist theory and Pender's Health Promotion Model. Twenty-four women provided consent to enroll in the study. After completing in-person semi-structured interviews and Internet-based measures, including the Physical Activity Readiness Questionnaire, and the modified International Physical Activity Questionnaire, consented participants engaged in 4-weeks of the yogic dance intervention via daily video-based instructions located on the study Web site. After the intervention, four women participated in focus groups to voice their perceptions of barriers to and benefits from YD and the acceptability of using the YD intervention. The investigators analyzed focus group data using content/thematic analysis and validated themes with baseline semi-structured interviews. The majority of the women (79%) found YD acceptable. Themes that emerged from the descriptive data include: (1) Culture is an important aspect of yogic dance; and (2) Increased social support would enhance yogic dance participation. The integrated results from this feasibility study will inform research exploring the complex correlates that influence health behaviors in AA women.

Voluntary muscle and motor cortical activation during progressive exercise and passively induced hyperthermia

This study examined whether central fatigue was exacerbated by an increase in muscle contractile speed caused by passive hyperthermia (PaH) and whether exercise-induced hyperthermia (ExH) combined with related peripheral fatigue influenced this response. The ExH was induced by cycling at 60% of maximal oxygen uptake in 38°C conditions and the PaH by sitting in a 48°C climate chamber. Ten men performed brief (≈ 5 s) and sustained (30 s) maximal voluntary isometric contractions (MVCs) of the knee extensors at baseline (CON, ∼37.1°C) and during moderate (MOD, ≈ 38.5°C) and severe (SEV, ∼39.5°C) hyperthermia. Motor nerve and transcranial magnetic stimulation were used to assess voluntary muscle and cortical activation level, along with contractile properties. Brief MVC force decreased to a similar extent during SEV-ExH (-8%) and SEV-PaH (-6%; P < 0.05 versus CON). Sustained MVC force also decreased during MOD-ExH (-10%), SEV-ExH (-13%) and SEV-PaH (-7%; P < 0.01 versus CON). Motor nerve and cortical activation were reduced on reaching MOD (≈ 3%) and SEV (≈ 5%) ExH and PaH during the brief and sustained MVCs (P < 0.01 versus CON). Peak twitch force decreased on reaching SEV-ExH and SEV-PaH (P < 0.05 versus CON). Following transcranial magnetic stimulation, during the brief and sustained MVCs the peak muscle relaxation rate increased in ExH and PaH (P < 0.01 versus CON). The increase was greatest during the sustained contraction in SEV-PaH (P < 0.01), but this did not exacerbate central fatigue relative to ExH. These results indicate that during fatiguing cycling exercise in the heat, quadriceps peak relaxation rate increases. However, the centrally mediated rate of activation appears sufficient to overcome even the largest increase in muscle relaxation rate, seen during SEV-PaH.

Diagnostic accuracy of pre-exercise screening questionnaire: Emphasis on educational level and cognitive status

The physical activity readiness questionnaire (PAR-Q) has been the most popular simple method of screening for people who intend to engage in exercise programs. Despite of the recommendations indicating that the instrument should be applied in the age range from 15 to 69 years, the questionnaire has been widely used in elderly people. The aim of this study was to assess the diagnostic accuracy of PAR-Q in elderly women with respect to absolute and relative contraindications to exercise and verify the influence of educational level and cognitive status. Eighty-nine subjects (61–89 years) participated in the study and went through clinical exams and exercise testing. The influence of educational status, age and cognitive state (Mini-Mental State Examination, MMSE) on the PAR-Q responses was analyzed by logistic regression. The occurrences of absolute and relative contraindications were respectively 9% and 22%. The Sensitivity and Specificity were 75.0% and 19.8% (absolute) and 77.8% and 19.7% (relative). The PAR-Q results were not influenced by low educational status; age, or cognitive state. In conclusion, although the usefulness and easy applicability of the PAR-Q's questions, the responses to the questionnaire led to a high number of false positive and false negative cases, suggesting that it would not be adequate as a pre-participation screening tool in elder samples.

Triagem pré-participação em exercício físico em pacientes com doença arterial periférica

CONTEXTO: Os indivíduos com doença arterial periférica (DAP) apresentam alto risco de doença cardiovascular. Dessa forma, é imprescindível que os instrumentos de triagem pré-participação em exercício indiquem quais pacientes com DAP devem realizar avaliação cardiovascular antes de iniciar o programa de exercício. OBJETIVO: Comparar a sensibilidade de dois instrumentos de triagem pré-participação em exercício para identificação de indivíduos com DAP. MÉTODOS: Vinte e oito pacientes com DAP de ambos os sexos responderam ao questionário de prontidão para a atividade física (PAR-Q) e um questionário de estratificação do risco cardiovascular (QERC) baseado nas diretrizes do American College of Sports Medicine. RESULTADOS: O PAR-Q mostrou que a questão seis (Algum médico já recomendou o uso de medicamentos para a sua pressão arterial ou condição cardiovascular?) foi a que apresentou maior frequência de respostas positivas (82,1%). Considerando todas as respostas, cinco indivíduos não tiveram nenhuma positiva ao questionário (17,9%), indicando que estariam aptos para a prática de atividade física. Os resultados do QERC mostraram que as questões 11 (Você sente queimação ou sensação de câimbras em suas pernas quando faz caminhada?) e 2 (Algum médico já falou que você tem pressão alta?) apresentaram a maior frequência de respostas positivas (82,1%). CONCLUSÕES: Segundo o QERC, todos os indivíduos da amostra foram considerados com alto risco cardiovascular. O PAR-Q não foi sensível o suficiente para identificar todos os sujeitos, ao passo que o QERC identificou todos os indivíduos. Assim, sugere-se a utilização do QERC para identificação de indivíduos com DAP.

Trends in aerobic fitness among Canadians, 1981 to 2007–2009

Public health surveillance systems often monitor physical activity trends, but fitness assessment is relatively rare. This study investigated secular changes in aerobic fitness among Canadian adults and children. Participants aged 8-69 years were from 2 nationally representative surveys, conducted in-home in 1981 and in mobile examination centers in 2007-2009. In both surveys, submaximal step tests using progressive age- and sex-specific exercise stages were completed after initial screening (Physical Activity Readiness Questionnaire, heart rate, blood pressure). Between surveys, the step-test protocol had been modified to reduce underestimation of fitness among fitter and older individuals. Maximal oxygen uptake was estimated for adults using validated historical and updated prediction equations, adjusted to reflect protocol differences. Because these equations are not validated for young people, maximal aerobic power was predicted at a heart rate of 200 beats·min(-1) by regressing observed heart rates on the oxygen costs of stepping for children and youth who completed at least 2 exercise stages. Overall, despite protocol differences, we found that the aerobic fitness levels of Canadians were lower in 2007-2009 than in 1981, with declines apparent in all age and both sex groups, thereby increasing the number of those at risk of adverse health outcomes. Future work is required to validate prediction equations of aerobic fitness for young people to make it possible to compare fitness levels over the lifespan and across time.

The Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and Electronic Physical Activity Readiness Medical Examination (ePARmed-X+): Summary of Consensus Panel Recommendations

In 2007-2010, a critical evaluation was conducted of evidence-based support for the Physical Activity Readiness Questionnaire (PAR-Q) and the Physical Activity Readiness Medical Evaluation (PARmed-X) to determine whether further revisions of these forms were needed. The result of this process was an enhanced pre-participation screening and risk stratification strategy including the development of the new Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and the online ePARmed-X+. The present article summarizes the consensus panel recommendations (and associated Level and Grade of evidence) that formed the foundation for the new PAR-Q+ and ePARmed-X+. It is anticipated that this process will lead to marked reductions in the barriers to physical activity for the majority of Canadians.

The Physical Activity Readiness Questionnaire for Everyone (PAR-Q+): English North America Version

This contains the new Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) for English North America. This link will also contain the revised, evidence-based, and consensus panel approved PAR-Q+ as it evolves over the years.

Evidence-based risk assessment and recommendations for physical activity clearance: Consensus Document 20111This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

The Physical Activity Readiness Questionnaire (PAR-Q) and the Physical Activity Readiness Medical Evaluation (PARmed-X) are internationally known preparticipation screening tools developed on the basis of expert opinion. The primary purposes of this consensus document were to seek evidence-based support for the PAR-Q and PARmed-X forms, to identify whether further revisions of these instruments are warranted, to determine how people responding positively to questions on the PAR-Q can be safely cleared without medical referral, and to develop exercise clearance procedures appropriate for various clinical conditions across the human lifespan. Seven systematic reviews were conducted, examining physical-activity-related risks and effective risk-stratification procedures for various prevalent chronic conditions. An additional systematic review assessed the risks associated with exercise testing and training of the general population. Two gap areas were identified and evaluated systematically: the role of the qualified exercise professional and the requisite core competencies required by those working with various chronic conditions; and the risks associated with physical activity during pregnancy. The risks associated with being physically inactive are markedly higher than transient risks during and following an acute bout of exercise in both asymptomatic and symptomatic populations across the lifespan. Further refinements of the PAR-Q and the PARmed-X (including online versions of the forms) are required to address the unique limitations imposed by various chronic health conditions, and to allow the inclusion of individuals across their entire lifespan. A probing decision-tree process is proposed to assist in risk stratification and to reduce barriers to physical activity. Qualified exercise professionals will play an essential role in this revised physical activity clearance process.

Evidence-based risk assessment and recommendations for physical activity clearance: an introduction1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

The Physical Activity Readiness Questionnaire (PAR-Q) and the Physical Activity Readiness Medical Evaluation (PARmed-X) are internationally renowned and extensively used preparticipation screening tools. However, recent feedback from end-users has identified limitations to the existing PAR-Q and PARmed-X screening process. As such, a systematic evaluation of the PAR-Q and PARmed-X forms was conducted, adhering to the Appraisal of Guidelines for Research and Evaluation (AGREE) criteria. Recognized experts in physical activity (PA) and prominent health conditions worked with an expert consensus panel to increase the effectiveness of the PAR-Q and PARmed-X PA participation clearance process. The systematic review process established that the health benefits of PA participation far outweigh the risks in the vast majority of asymptomatic and symptomatic individuals. A new risk continuum and decision tree process was created to allow for the effective risk stratification of prominent health conditions, reducing greatly the barriers to PA participation for the majority of individuals. The new PA participation clearance process is available in new paper and online versions (PAR-Q+) and the PARmed-X was replaced with an online interactive computer programme (ePARmed-X+). It is anticipated that this new risk stratification and PA clearance process will reduce markedly the barriers for PA participation for both asymptomatic and symptomatic individuals.

Evidence-based risk assessment and recommendations for physical activity clearance: established cardiovascular disease1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

Physical activity is an effective lifestyle therapy for patients at risk for, or with, documented cardiovascular disease (CVD). Current screening tools--the Physical Activity Readiness Questionnaire (PAR-Q) and the Physical Activity Readiness Medical Evaluation (PARmed-X)--require updating to align with risk/benefit evidence. We provide evidence-based recommendations to identify individuals with CVD at lower risk, intermediate risk, or higher risk of adverse events when participating in physical activity. Forms of exercise and the settings that will appropriately manage the risks are identified. A computer-assisted search of electronic databases, using search terms for CVD and physical activity risks and benefits, was employed. The Appraisal of Guidelines for Research and Evaluation were applied to assess the evidence and assign a strength of evidence rating. A strength rating for the physical activity participation clearance recommendation was assigned on the basis of the evidence. Recommendations for physical activity clearance were made for specific CVD groups. Evidence indicates that those who are medically stable, who are involved with physical activity, and who have adequate physical ability can participate in physical activity of lower to moderate risk. Patients at higher risk can exercise in medically supervised programs. Systematic evaluation of evidence indicates that clinically stable individuals with CVD may participate in physical activity with little risk of adverse events. Therefore, changes in the PAR-Q should be undertaken and a process of assessment and consultation to replace the PARmed-X should be developed. Patients at lower risk may exercise at low to moderate intensities with minimal supervision. Those at intermediate risk should exercise with guidance from a qualified exercise professional. Patients at higher risk should exercise in medically supervised programs.

Validation of the PAR-Q+ and ePARmed-X+

The Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and the electronic Physical Activity Readiness Medical Examination (ePARmed-X+) were created recently to reduce the barriers to physical activity participation for individuals with and without established chronic disease. Our primary purpose was to provide preliminary evidence on the effectiveness of these new forms for pre-participation screening and risk stratification. In particular, we sought to examine the new PAR-Q+ (and ePARmed-X+) risk stratification strategy in comparison to the previous PAR-Q. The new PAR-Q+ and ePARmed-X+ risk stratification and pre-participation strategy reduced significantly the number individuals that were sent for medical referral in comparison to the PAR-Q (i.e., 0.8% vs. 15%, respectively). The reliability of the PAR-Q+ over a three month period was high (r = 0.99). Moreover, the new strategy demonstrated high sensitivity (0.90 (95% CI = 0.77-0.96)) and specificity (1 (95% CI = 0.99-1)) for determining those with and without hypertension, respectively. In conclusion, our preliminary evaluation of the new PAR-Q+ and ePARmed-X+ risk stratification and pre-participation strategy in comparison to the PAR-Q reveals that the new process reduces greatly the barriers to physical activity participation, with a high reliability, sensitivity, and specificity of measurement.