Pre-exercise Questionnaire | THE RUNNING KLUB

Name *

First

Last

Email *

Date of Birth *

Gender

Height

Weight

Country

City

Phone number

Has your medical practitioner ever told you that you have a heart condition or have you ever suffered a stroke? *

Yes
No

Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity/exercise? *

Yes
No

Do you ever feel faint, dizzy or lose balance during physical activity/exercise? *

Yes
No

Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months? *

Yes
No

If you have diabetes (type 1 or 2) have you had trouble controlling your blood sugar (glucose) in the last 3 months? *

Yes
No

Do you have any other conditions that may require special consideration for you to exercise? *

Yes
No

Describe your current physical activity/exercise levels in a typical week by stating the frequency and duration at the different intensities. For intensity guidelines consult figure 2. *

How many hours do you sit per day? *

What does your weekly schedule look like? *

What shoe do you currently use? *

What shoes do you mainly wear for day to use? *Please be specific *

How many hours do you wear shoes per day? *

What system, application or watch do you use to monitor your activity? *

What device do you use mainly at home? *