Stay Healthy by Staying Fit - The Benefits of Strength Training - Handout 1

Please answer the following statements. If you answer "yes" to any of them, you should consult with your doctor before starting an exercise or strength training program.

		Yes	No
1.	I get chest pains while at rest and/or during exertion. (If a doctor has diagnosed these chest pains and told you it is safe for you to exercise, you do not have to answer "yes.")	____	____
2.	I have had a heart attack within the last year.	____	____
3.	I have high blood pressure (or my last blood pressure reading was more than 150/100).	____	____
4.	I have diabetes. (If your diabetes is being treated and your health care team has told you it is safe for you to exercise, you do not have to answer "yes".)	____	____
5.	I am short of breath after extremely mild exertion and sometimes even at rest or at night in bed.	____	____
6.	I have ulcerated wounds or cuts on my feet that don’t seem to heal.	____	____
7.	I have lost 10 pounds or more in the past 6 months without trying.	____	____
8.	I get pain in my buttocks or the back of my legs (thighs or calves) when I walk.	____	____
9.	While at rest, I often have fast irregular heartbeats or very slow heartbeats. (A low heart rate can be a sign of an efficient and well-conditioned heart, but a very low rate can also mean an almost completely blocked blood vessel to the heart.)	____	____
10.	I am currently being treated for a heart or circulatory condition, such as vascular disease, stroke, angina, hypertension (high blood pressure), congestive heart failure, poor circulation to the legs, vascular heart disease, blood clots or pulmonary (lung) disease.	____	____
11.	As an adult, I have fractured my hip, spine or wrist.	____	____
12.	I have fallen more than twice in the past year (for any reason).	____	____

Even if you checked "no" to all 12 questions, the American College of Sports Medicine encourages all persons over age 35 to have a medical examination before beginning a vigorous training effort.

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2000 Volunteer Leader Training Guide Stay Healthy by Staying Fit: The Benefits of Strength Training Screening Questionnaire Handout 1

2000 Volunteer Leader Training Guide
Stay Healthy by Staying Fit: The Benefits of Strength Training
Screening Questionnaire
Handout 1