健康与体适能评估表.docVIP

健康和体适能评估表 Health And Fitness Assessment Kit 私人教练专用 For Personal Trainer NAME____________ Trainer____________ 身体状况安全问卷调查 PAR-Q FORM （年龄15—69岁人士之调查问卷） A Questionnaire for people Aged 15 to 69 姓名NAME____________ 为阁下安全，请回答以下问题（在使用□内打√） For your safety, please answer the following questions by ticking (√) the appropriate box (x) 没有 有（或）不清楚 NO YES or not sure □ □ 您的医生有否告诉你，您的心脏有问题 并要求你只能在医生的建议下，才能参与运动？ Does your doctor ever said that you have a heart condition and s that you should only do physical activity recommended by a doctor? □ □ 当您在运动时胸腔是否感觉疼痛？ Do you feel pain in your chest when you do physical activity? □ □ 再过去的一个月，你是否曾经感觉在没有运动的情况下胸腔感觉痛楚？ in the past month, did you have chest pain when you were not doing physical activity? □ □ 您有否由于头晕，导致恶心 失去平衡或失去知觉？ Do you lose your balance because of dizziness or do you ever lose consciousness? □ □ 您有否由于改变运动计划或运动导致你关节或骨骼疼痛？ Do you have a bone or joint problem that could be made worse by a change in your physical activity? □ □ 您在体检过程中，知道自己有高血压 、高血糖、心脏等问题，并因此而吃药吗？ Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? □ □ 你知道有否因素导致您不运动吗？ Do you know of any other reasons why you cannot do physical Activity? 我已经阅读明白及完成这份问卷，以上问题的答案均是本人同意 I have read, understood and completed this questionnaire. All questions are answered to my full satisfaction. 签署 日期 Signature___________________ Date__________________ Chester Step Test /台阶测试12 (30cm) Step Name Age MaxHR 80% MaxHR _ 姓名___________________ 年龄_____ 最大心率______bpm 最大心率的 80%______bp Heart Rate (beats/minute 220 210 200 190 180 170 160 150 140 130 120 110 100 90 80 70 60 ml/kg/min 14 19 24 29