Exercise Readiness Questionaire

Regular exercise is associated with many health benefits.  Increasing physical activity is safe for most people.  However, some individual should check with a physician before they become more physical active.  Completion of this questionnaire is a first step when planning to increase the amount of physical activity in your life.  Please read each question carefully and answer every question honestly. 

If you answered yes to any of the below questions, talk with your doctor before you become more physically active. Tell your doctor your plan to exercise and to which questions you answer yes.

 

If you honestly answered no to all questions you can be reasonably certain you can safely increase your level of physical activity gradually. 

 

If your health changes, resulting in a yes answer to any of the above questions, seek guidance from a physician.

Has a physician ever diagnosed you with a heart condition and indicated you should restrict your physical activity?
When you perform physical activity, do you feel pain in your chest?
When you were not engaging in physical activity, have you experienced chest pain in the past month?
Do you ever faint or get dizzy and lose your balance?
Do you have an injury or orthopedic condition (such as back, hop or knee problem) that may worsen due to a change your physical activity?
Has a physician ever diagnosed you with a heart condition and indicated you should restrict your physical activity?
When you perform physical activity, do you feel pain in your chest?
When you were not engaging in physical activity, have you experienced chest pain in the past month?
Do you ever faint or get dizzy and lose your balance?
Are you pregnant?
Do you have high blood pressure or a heart condition in which a physician is currently prescribing a medication?
Are you pregnant?
Do you have insulin dependent diabetes?
Are you 69 years of age or older and not used to being very active?
Do you know of any other reason you should not exercise or increase your physical activity?
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© 2023 The Richard E. Workman Sports and Wellness Complex. Created by Rink Management Services Corporation

The Richard E. Workman Sports & Wellness Complex
1301 N. Maple St.
Effingham, IL 62401

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Tel: (217) 342-3481

Facility Hours:
Monday - Friday: 5:00AM - 8:00PM
Saturday: 6:00AM - 8:00PM
Sunday: 9:00AM - 8:00PM

 

Pool Hours:

Monday - Friday: 5:00AM - 8:00PM
Saturday: 6:00AM - 7:30PM
Sunday: 9:00AM - 7:30PM