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Please read carefully: Circle yes or no. If you circle any of the ‘yes’ responses below you may need your doctor’s consent before you participate in Nordic walking.
Has a doctor ever said that you have a heart condition and recommended only medically supervised activity? Yes / No
Do you have chest pain brought on by physical activity? Yes / No
Have you developed chest pain in the past month? Yes / No
Do you lose consciousness or fall over as a result of dizziness? Yes / No
Do you have a bone or joint problem that could be aggravated by physical activity?
Yes / No
Has a doctor ever recommended medication for your blood pressure or a heart condition?
Yes / No
Are you aware through your own experience or from doctor’s advice of any other reason why you should not exercise without medical supervision? Yes / No
Please outline any other relevant information that may affect your ability to exercise.
Pre-existing medical conditions:
I realise that my body’s reaction to exercise is not totally predictable. Should I develop a condition that affects my ability to exercise, I will inform my instructor immediately and stop exercising if necessary. I take full responsibility for monitoring my own physical condition at all times.
IN CASE OF EMERGENCY, PLEASE CONTACT:
Havering Nordic Walkers
Physical Activity Readiness Questionnaire