as le Directions: Please read the question carefully and answer each one honestly: Put an (D) mark if your answer is NO and (v) mark if your answer is YES. 1. Has your doctor ever said that you have a heart condition and that you should only do physical activities based on his/her recommendations? 2. Do you feel pain in your chest when you do any physical activity? 3. In the past month, did you feel any chest pain even if you were not doing a physical activity? 4. Do you lose your balance because of digziness or do you ever lose consciousness? 5. Do you have a bone or joint problem that could be made worse by a change in your physical activity? 6. Is your doctor currently prescribing drugs (like water pille) for your blood pressure or heart condition? 7. Do you know of any other reason why you should not do any physical activity? ​