Guest Forms

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Before visiting Kia Ora Fitness as a guest, there are a few forms that need to be completed.

First, share a little about yourself.

Personal details:

Get Active Questionnaire

Physical activity improves your physical and mental health. Even small amounts of physical activity are good, and more is better.

For almost everyone, the benefits of physical activity far outweigh any risks. For some individuals, specific advice from a health care provider is advisable. This questionnaire is intended for all ages – to help move you along the path to becoming more physically active.

PREPARE TO BECOME MORE ACTIVE

The following questions will help to ensure that you have a safe physical activity experience. Please answer YES or NO to each question before you become more physically active. If you are unsure about any question, answer YES.

1

Have you experienced ANY of the following (A to F) within the past six months?

A

A diagnosis of/treatment for heart disease or stroke, or pain/discomfort/pressure in your chest during activities of daily living or during physical activity?

Physical activity is likely to be beneficial. If you have been treated for heart disease but have not completed a cardiac rehabilitation program within the past 6 months, consult a doctor – a supervised cardiac rehabilitation program is strongly recommended. If you are resuming physical activity after more than 6 months of inactivity, begin slowly with light- to moderate-intensity physical activity. If you have pain/discomfort/pressure in your chest and it is new for you, talk to a doctor. Describe the symptom and what activities bring it on.

B

A diagnosis of/treatment for high blood pressure (BP), or a resting BP of 160/90 mmHg or higher?

Physical activity is likely to be beneficial if you have been diagnosed and treated for high blood pressure (BP). If you are unsure of your resting BP, consult a health care provider or a Personal Trainer to have it measured. If you are taking BP medication and your BP is under good control, regular physical activity is recommended as it may help to lower your BP. Your doctor should be aware of your physical activity level so your medication needs can be monitored. If your BP is 160/90 or higher, you should receive medical clearance and consult a Personal Trainer about safe and appropriate physical activity.

C

Dizziness or lightheadedness during physical activity?

There are several possible reasons for feeling this way and many are not worrisome. Before becoming more active, consult a health care provider to identify reasons and minimize risk. Until then, refrain from increasing the intensity of your physical activity.

D

Shortness of breath at rest?

If you have asthma and this is relieved with medication, light to moderate physical activity is safe. If your shortness of breath is not relieved with medication, consult a doctor.

E

Loss of consciousness/fainting for any reason?

Before becoming more active, consult a doctor to identify reasons and minimize risk. Once you are medically cleared, consult a Personal Trainer about types of physical activity suitable for your condition.

F

Concussion?

A concussion is an injury to the brain that requires time to recover. Increasing physical activity while still experiencing symptoms may worsen your symptoms, lengthen your recovery, and increase your risk for another concussion. A health care provider will let you know when you can start becoming more physically active, and a Personal Trainer can help get you started.

2

Do you currently have pain or swelling in any part of your body (such as from an injury, acute flare-up of arthritis, or back pain) that affects your ability to be physically active?

If this swelling or pain is new, consult a health care provider. Otherwise, keep joints healthy and reduce pain by moving your joints slowly and gently through the entire pain-free range of motion. If you have hip, knee or ankle pain, choose low-impact activities such as swimming or cycling. As the pain subsides, gradually resume your normal physical activities starting at a level lower than before the flare-up. Consult a Personal Trainer in follow-up to help you become more active and prevent or minimize future pain.

3

Has a health care provider told you that you should avoid or modify certain types of physical activity?

Listen to the advice of your health care provider. A Personal Trainer can help by asking you about any considerations and providing specific advice for physical activity that is safe and that takes your lifestyle and health care provider's advice into account.

4

Do you have any other medical or physical condition (such as diabetes, cancer, osteoporosis, asthma, spinal cord injury) that may affect your ability to be physically active?

Some people may worry if they have a medical or physical condition that physical activity might be unsafe. In fact, regular physical activity can help to manage and improve many conditions. Physical activity can also reduce the risk of complications. A Personal Trainer can help with specific advice for physical activity that is safe and that takes your medical history and lifestyle into account.

Get Active Questionnaire

ASSESS YOUR CURRENT PHYSICAL ACTIVITY

Answer the following questions to assess how active you are now.

During a typical week, on how many days do you do moderate- to vigorous-intensity aerobic physical activity (such as brisk walking, cycling or jogging)?

DAYS/
WEEK

On days that you do at least moderate-intensity aerobic physical activity (e.g., brisk walking), for how many minutes do you do this activity?

MINUTES/
DAY

Multiplying your responses yields:

MINUTES/
WEEK

Physical Activity Guidelines for Americans recommend for substantial health benefits, do one of the following: 150 minutes (2 hours and 30 minutes) each week of moderate-intensity aerobic physical activity (such as brisk walking or tennis), 75 minutes (1 hour and 15 minutes) each week of vigorous-intensity aerobic physical activity (such as jogging or swimming laps), or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity. Do aerobic physical activity in episodes of at least 10 minutes and, if possible, spread it out through the week.

For even greater health benefits, do one of the following: Increase moderate-intensity aerobic physical activity to 300 minutes (5 hours) each week, increase vigorous-intensity aerobic physical activity to 150 minutes (2 hours and 30 minutes) each week. Doing more will lead to even greater health benefits.

Do muscle-strengthening activities (such as lifting weights or using resistance bands) that are moderate or high intensity and involve all major muscle groups on 2 or more days a week.

For more information go to https://health.gov/paguidelines/guidelines/

Get Active Questionnaire

GENERAL ADVICE FOR BECOMING MORE ACTIVE

Increase your physical activity gradually so that you have a positive experience. Build physical activities that you enjoy into your day (e.g., take a walk with a friend, ride your bike to school or work) and reduce your sedentary behavior (e.g., prolonged sitting).

If you want to do vigorous-intensity physical activity (i.e., physical activity at an intensity that makes it hard to carry on a conversation), and you do not meet minimum physical activity recommendations noted above, consult a health care provider beforehand. This can help ensure that your physical activity is safe and suitable for your circumstances.

Physical activity is also an important part of a healthy pregnancy.

Delay becoming more active if you are not feeling well because of a temporary illness.

Get Active Questionnaire

DECLARATION

To the best of my knowledge, all of the information I have supplied in this questionnaire is correct. If my health changes, I will complete this questionnaire again.

I answered NO to all of the health questions.

I answered YES to at least one of the health questions above.

Check the box below that applies to you:

I have consulted a health care provider who has recommended that I become more physically active.

I am comfortable with becoming more physically active on my own without consulting a health care provider.

Waiver