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Existing Members Login User Name Password Forgot Password? Andrew Cotton Instructions Eat Well Plate Exercise and Children The Elderly Who We Are Walking is a Great Exercise Nordic Walking Nordic Walking Course Nordic Walking Rate Sheet Health and Safety Questionnaire Pre-Exercise Questionnaire Book your Nordic Walking Training Program Healthy Heart and Heart Disease Your Diet The GI Diet High Protein Diets Cholesterol Exercise Where and When you Choose Order Status Feedback Virtual Personal Training VIRTUAL PERSONAL TRAINING From Only £ 19.99 per month For the fraction of the cost of Personal Trainer, your VPT will: Recommend an appropriate fitness program. Advise on diet. Contact you with regular email exercise reminders. Evaluate your feedback and update your program. Carry out regular health screening to ensure safe and effective exercise prescription. Plus much much more. For more information or to sign up to a healthier and fitter life Call now on 0844 8806779 Or send an email to: info@blueskyacademy.co.uk Subscribe for Newsletter Name: Email:	Pre-Exercise Questionnaire Name *  Address *  Age (years) *  Sex * Male   Female  Phone (work)    Phone (home)    Phone (mobile)      Note: Answers of Questions 1-14 are Mandatory     Yes No 1 Has your doctor ever said you have a heart condition and you should only participate in medically supervised activity? 2 Do you have or feel chest pain during physical exercise? 3 Do you experience loss of balance due to dizziness or do you ever lose consciousness? 4 Are you taking medication for your blood pressure or a heart condition? 5 Do you have an existing bone or joint problem that is likely to be made worse by physical activity? 6 Do you ever experience shortness of breath with MILD exertion? 7 Do you suffer palpitations? 8 Are you pregnant or given birth during the last 6 weeks? 9 Do you have diabetes mellitus? 10 Are you aware of any other reason why you should not exercise without medical supervision? Notes   Risk Factors to CAD   11 Are you aware if your blood pressure is too high? 12 Is your cholesterol level high? 13 Do you smoke? 14 Is there any history of heart disease in your immediate family, specifically heart attack or sudden death before the age of 55 in any male members of the family or 65 in any female members of your family? QUESTIONS 11-14 If you answered YES to two or more of the questions your exercise program will be restricted to a very moderate intensity for safety reasons, unless consent has been given by your doctor that you are able to work at a higher intensity. Moderate intensity is a level that you can sustain exercise comfortably up to 60 minutes
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