|A) 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?
|B) A diagnosis of/treatment for high blood pressure (BP), or a resting BP of 160/90 mmHg or higher?||No|
|C) Dizziness or lightheadedness during physical activity?||No|
|D) Shortness of breath at rest?||No|
|E) Loss of consciousness/fainting for any reason?||No|
|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?||No|
|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?
I am comfortable with becoming more physically active on my own without consulting a health care provider or QEP.