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1、健康和醴遹能押估表集Hea1thandFitnessAssessmentKit高级私人教穗事用ForAdvancedPersona1Trainer身ft状况安全周卷查PAR-QFORMG年龄介乎15至69人士之R5卷)(AQuestionnaireforPeop1eAged15to69)姓名Name：#M1MembershipNo.：下安全，回答以下冏I1(在遹用虑打上/虢)Foryoursafety,p1easeanswerthefo11owingquestionsbyticking(/)theappropriatebox()i有NO有（或不清楚）YESornotsurei.你的翳生有否告你
2、，你的心朦有冏I1或要求你只能在翳生建的情况下才能i行建勤？Doesyourdoctoreversaidthatyouhaveaheartconditionandsothatyoushou1don1ydophysica1activityrecommendedbyadoctor?2.常你迤行建勤口札胸腔有否感到痛楚？Doyoufee1paininyourchestwhenyoudophysica1activity?3.在谩往一他月，你曾否1遇在没有iS勤情况下出现胸腔痛楚感箕;？Inthepastmonth,didyouhavechestpainwhenyouwerenotdoingphysic
3、a1activity?4.你有否由於而溥致失去平冲，或至失去知感？Doyou1oseyourba1ancebecauseofdizzinessordoyouever1oseconsciousness?5.你有否因改建你的建t十重而醇致骨骼或(W第冏题悲化的情况？Doyouhaveaboneorjointprob1emthatcou1dbemadeworsebyachangeinyourphysica1activity?6.你的瞽生琨日寺有否桀方给你用於血屋或心朦等冏18?Isyourdoctorcurrent1yprescribingdrugs(forexamp1e,waterpi11s)fo
4、ryourb1oodpressureorheartcondition?7.你是否知道有可因素醇致你不建勤的原因？Doyouknowofanyotherreasonswhyyoucannotdophysica1activity?我已明白及完成造冏卷。以上冏题的答案均是本人所同意。Ihaveread,understoodandcomp1etedthisquestionnaire.A11questionsareansweredtomyfu11satisfaction.受署SignatureDa1e日期InstructionofPAR-Q身髓状沆安全卷查使用指引Ifyouansweredyestoon
5、eormorequestions若有的答案有一他或以上Ta1kwithyourdoctorbyphoneorinpersonBEFOREyoustartbecomingmuchmorephysica11yactiveorBEFOREyouhaveafitnessappraisa1.Te11yourdoctoraboutthePAR-OandwhichquestionsyouansweredYES.在你迤行iS*或醴逋能押估之前，M青貌身或透谩甯g你的瞽生。告你的翳生有PAR-Q的资料及那些冏魅事案的是有。Youmaybeab1etodoanyactivityyouwant-as1ongasyo
6、ustarts1ow1yandbui1dupgradua11y.Or,youmayneedtorestrictyouractivitiestothosewhicharesafeforyou.Ta1kwithyourdoctoraboutthekindsofactivitiesyouwishtoparticipateinandfo11owhis/heradvice.你或能谨行任何建勤，但要在始畤招弓金度降低，加逐渐提高。或你可能限制只能参奥封你安全的建勤。言咨前你的翳生有1你希望参奥的建勤，加参考瞽生的意见。Findoutwhichcommunityprogramsaresafeandhe1pf
7、u1foryou.器找封你合逾舆安全的社曾康IfyouansweredNOhonest1ytoa11PAR-Qquestions,youcanbereasonab1ysurethatyoucan：若你真地回答所有的冏题，或所有的答案是装有。你能匆：startbecomingmuchmorephysica11yactive-begins1ow1yandbui1dupgradua11y.Thisisthesafestandeasiestwaytogo.迤行建勤（但要在始畴招强度降低，或逐渐提高。道是最安全及最容易的方法。）,takepartinafitnessappraisa1-thisisane
8、xce11entwaytodetermineyourbasicfitnesssothatyoucanp1anthebestwayforyouto1iveactive1y.迤行通能押估（造是最好的方法测你现在遹能状况，因此你能更有效重你的健康生活。）健康和f1遹能押估表他人资料Persona1Information姓名NameMenbershipno.住址Address男/女MaIe/Fema1e身高(米)BodyHeight(m)年龄Age：测试日期TestDate项目Items*fc1st2nd3rd4th好熊心跳率(每分心率数目)RestingHeartRate(b.p.m.)目襟心跳率(
9、50%-75%)TargetTrainingHeartRate血屋(心编屋和心舒展)B1oodPressure(mnHg)Diasto1ic/Systo1ic髀级C1assificationttt(公斤)BodyWeight(kg)傕直指数BMI解税C1assificationti脂百分比一皮折测量BodyComposition-%BodyFat(Skinfo1d)男胸部MenChest女肱三醺肌WomenTriceps放部Abdomen倦脊上绿Suprai1iua大展Thigh大腿Thigh趣数(毫米)Tota1(mm)估tt脂百分比EstimatedBodyFat呼级C1assificat
10、ion冕子测量%BodyFat(BIA)腰臀比例Waist-hipratio辞级C1assification上身肌力及肌耐力骐!就UpperBodyMuscu1arStrength&Endurance洌弑日期项目TestDateItems*111st2nd3rd4th最多俯5Uf次数MaximumNo.ofpush-ups辞级C1assification20秒卷膜次数No.ofcrunchcomp1etedin20sec辞版C1assification身it柔勒度BodyF1exibi1ity坐式前TrunkForwardF1exion(inch)*FtC1assification肝肠肌(榄举
11、：15。-20)Gastrocnemius(Standard150-20)AMM儒*o-o)Haastring(StandardO0-10o)他腰肌(襟率：低於水平面)I1iopsoas(Standardbe1owhorizonta11eve1)背曲肌(襟举；165)1atissimusDorsi(Standard165*)亚洲运动及体适能专业学院专业体适能教练AsianAcademyforSports&FitnessProfessiona1sProfessiona1FitnessTrainerSUmOfthreeSkinfOIdS18-2223-2728-3233-3738-4243-474
12、8-5253-57=588-121.82.63.44.24.95.76.57.38.113-173.64.45.26.06.87.68.49.19.918-225.46.27.07.88.69.310.110.911.723-277.17.98.79.510.311.111.912.613.428-328.89.610.411.212.012.813.514.315.133-3710.411.212.012.813.614.415.215.916.738-4212.012.813.614.415.215.916.717.518.343-4713.514.315.115.916.717.518.
13、319.019.848-5215.015.816.617.418.118.919.720.521.353-5716.417.218.018.819.620.321.121.922.758-6217.818.519.320.120.921.722.523.324.163-6719.119.920.621.422.223.023.824.625.468-7220.321.121.922.723.524.325.125.826.673-7721.522.323.123.924.725.526.327.027.878-8222.723.524.325.025.826.627.428.229.083-8723.824.625.326.126.927.728.529.330.188-9224.825.626.427.228.028.829.630.331.193-9725.826.
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