健康和體適能評估表集.docVIP

身體狀況安全問卷調查 PAR-Q FORM (為年齡介乎１５至６９人士之問卷) (A Questionnaire for People Aged 15 to 69) 會員姓名Name : __ 會員號碼Membership No.: __ 為閣下安全，請回答以下問題（在適用處(打上(號） For your safety, please answer the following questions by ticking (() the appropriate box (() 沒有 有（或不清楚） NO YES or not sure ( ( 你的醫生有否告訴你，你的心臟有問題，並要求你只能在醫生建議的情況下才能進行運動？ Does your doctor ever said that you have a heart condition and so that you should only do physical activity recommended by a doctor? ( ( 當你進行運動時，胸腔有否感到痛楚？ Do you feel pain in your chest when you do physical activity? ( ( 在過往一個月，你曾否試過在沒有運動情況下出現胸腔痛楚感覺？ In the past month, did you have chest pain when you were not doing physical activity? ( ( 你有否由於頭暈而導致失去平沖，或至失去知感？ Do you lose your balance because of dizziness or do you ever lose consciousness? ( ( 你有否因改變你的運動計畫而導致骨骼或關節問題惡化的情況？ Do you have a bone or joint problem that could be made worse by a change in your physical activity? ( ( 你的醫生現時有否開藥方給你用於血壓或心臟等問題？ Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? ( ( 你是否知道有可因素導致你不運動的原因？ Do you know of any other reasons why you cannot do physical activity? 我已經閱讀、明白及完成這問卷。以上問題的答案均是本人所同意。 I have read, understood and completed this questionnaire. All questions are answered to my full satisfaction. 簽署 日期 Signature Date Instruction of PAR-Q 身體狀況安全問卷調查使用指引 If you answered yes to one or more questions 若「有」的答案有一個彧以上 Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-O and which questions you answered YES. 在你進行運動或體適能評估之前，請親身或透過電話諮詢你的醫生。告訴你的醫生有關PAR-Q的資料及那些問題專案的是「有」。 ? You may be able to do any activity you want - as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.