Pre-exercise questionnaire
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  • Yes No
    1- Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?
    2- Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?
    3- Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?
    4- Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
    5- If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?
    6- Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise?
    7- Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?
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