Get Active Questionnaire
For almost everyone, the benefits of physical activity far outweigh any risks. For some individuals, specific advice from a Qualified Exercise Professional (QEP – has post-secondary education in exercise sciences and an advanced certification in the area – see csep.ca/certifications) or health care provider is advisable. This questionnaire is intended for all ages – to help move you along the path to becoming more physically active.
Select the event you are attending: *
I am completing this questionnaire for: *
SECTION 1: PREPARE TO BECOME MORE ACTIVE
The following questions will help to ensure that you have a safe physical activity experience. Please answer YES or NO to each question before you become more physically active. If you are unsure about any question, answer YES.
Have you experienced ANY of the following (A to F) within the past 6 months? *
Yes
No
A diagnosis of/treatment for heart disease or stroke, or pain/discomfort/pressure in your chest during activities of daily living or during physical activity?
A diagnosis of/treatment for high blood pressure (BP), or a resting BP of 160/90 mmHg or higher?
Dizziness or light headedness during physical activity?
Shortness of breath at rest?
Loss of consciousness/fainting for any reason?
Concussion?
Do you currently have pain or swelling in any part of your body (such as from an injury, acute flare-up of arthritis, or back pain) that affects your ability to be physically active? *
Has a health care provider told you that you should avoid or modify certain types of physical activity? *
Do you have any other medical or physical condition (such as diabetes, cancer, osteoporosis,asthma, spinal cord injury) that may affect your ability to be physically active? *
SECTION 2: ASSESS YOUR CURRENT PHYSICAL ACTIVITY
Answer the following questions to assess how active you are now.
During a typical week, on how many days do you do moderate- to vigorous-intensity aerobic physical activity (such as brisk walking, cycling or jogging)? (Days/week)
Your answer
On days that you do at least moderate-intensity aerobic physical activity (e.g., brisk walking),for how many minutes do you do this activity? (Minutes/day)
Your answer
For adults, please multiply your average number of days/week by the average number of minutes/day:
Your answer
GENERAL ADVICE FOR BECOMING MORE ACTIVE
Increase your physical activity gradually so that you have a positive experience. Build physical activities that you enjoy into your day (e.g., take a walk with a friend, ride your bike to school or work) and reduce your sedentary behaviour
(e.g., prolonged sitting).

If you want to do vigorous-intensity physical activity (i.e., physical activity at an intensity that makes it hard to carry on a conversation), and you do not meet minimum physical activity recommendations noted above, consult a Qualified Exercise Professional (QEP) beforehand. This can help ensure that your physical activity is safe and suitable for your circumstances.

Physical activity is also an important part of a healthy pregnancy.

Delay becoming more active if you are not feeling well because of a temporary illness.

DECLARATION
To the best of my knowledge, all of the information I have supplied on this questionnaire is correct.
If my health changes, I will complete this questionnaire again.
Please check the following that applies: *
Required
In the Declaration above, if you chose option 3, please review the Reference Document: http://www.csep.ca/CMFiles/publications/GAQ_ReferenceDoc_2pages.pdf
Your answer
Participant Name (First & Last) *
Your answer
Name of Parent/Guardian (if applicable)
Your answer
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