Acute Exercise and Emotion Study

Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly.

1. Has your doctor every said that you have a heart condition and that you should only do physical activity recommended by a doctor?
2. Do you feel pain in your chest when you do physical activity?
3. In the past month, have you had chest pain when you were not doing physical activity?
4. Do you lose your balance because of dizziness 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 (for example, water pills) for your blood pressure or heart condition?
7. Do you know of any other reason why you should not do physical activity?

In addition:

• If you are or may be pregnant do not participate.
• If you are not feeling well because of a temporary illness such as a cold or fever, wait until you feel better.
• If your health changes so that you answer YES to any of the above questions do not participate.
• Only males between the ages of 18 and 44 and females between the ages of 18 and 54 are eligible to participate in this study.

Physical Activity Readiness-Questionnaire, Canadian Society for Exercise Physiology, Inc. (1994).

ACSM Risk Stratification (ACSM, 2000)

Do you have any of the following conditions?

_________  1.  Family history of Heart disease: Heart attack, heart surgery, or sudden death before age 55 (father/brother/son) or 65 (mother/sister/daughter)

_________  2.  Cigarette Smoker: current or have quit within the past 6 months

_________  3.  High Blood Pressure: SBP > 140 or DBP > 90 (confirmed on 2 occasions or on Blood Pressure medication)

_________  4.  High cholesterol: total >200 (or HDL < 35, or > 130, or on medication for high cholesterol)

_________  5.  Diabetes (adult or juvenile) or Glucose Intolerance 

_________  6.  Obesity (Body Mass Index > 30, or waist circumference > 39 inches)

_________  7.  Sedentary Lifestyle (less than 30 minutes total �physical activity� most days)

Do you have any of the following? 

_________ Pain, discomfort, tightness, or heaviness in the chest, neck, jaw, arms, or other areas

_________ Shortness of breath at rest or with mild exertion

_________ Dizziness or loss of consciousness

_________ Difficulty breathing when lying down or any difficulty breathing during physical exertion

_________ Swelling at the ankles

_________ Irregular or fast heart rate

_________ Intermittent leg pain or limping especially upon exertion

_________ Known heart murmur

_________ Unusual fatigue or shortness of breath with usual activities

Stratification (only persons considered as low risk may participate in this study)

Low Risk:   Younger individuals (males: younger than 45, females: younger than 55) who have no signs/symptoms and no more than 1 risk factor.

Moderate Risk: Older individuals (males: 45 and older, females: 55 and older) or those who have 2 or more risk factors.

High Risk: Individuals with 1 or more signs/symptoms or known cardiovascular, pulmonary or metabolic disease.