PAR-Q+ and ePARmed-X+: new risk stratification and physical activity clearance strategy for physicians and patients alike.

The Physical Activity Readiness Questionnaire and You (PAR-Q) and the Physical Activity Readiness Medical Examination (PARmed-X) were Canada’s primary front-line pre-participation screening tools for physical activity. The PAR-Q contains a simple 7question battery designed to determine whether individuals are able to become more physically active or engage in a fitness appraisal.1 When a person responds positively to 1 or more questions on the PAR-Q, he or she is advised to consult a physician for physical activity participation clearance. The PARmed-X was designed for use by physicians to address medical concerns about physical activity participation for persons answering yes to 1 or more of the 7 questions on the PAR-Q.2 Although the original PAR-Q is used extensively in Canada and worldwide, barriers in this physical activity participation clearance process have been identified by physicians, physical activity participants, fitness professionals, and various organizations.1-5 For instance, the PAR-Q is purposely conservative, leading to many false positive results and causing considerable unnecessary medical referrals4; the age restrictions of the PAR-Q (ie, 15 to 69 years) create an unnecessary barrier to physical activity participation for children and elderly people; and there is often inconsistent or improper use of the clearance forms.4 Also, the PAR-Q is often a barrier for individuals who need increased physical activity the most (such as those living with chronic medical conditions).1,2 Moreover, physicians commonly complain that the PARmed-X is too long, is very difficult to use, and is not evidence-based. The College of Family Physicians of Canada has not formally endorsed the PARmed-X. The medical community has recently challenged the validity of both the PAR-Q and the PARmed-X owing to their lack of evidence-based support. Because of this criticism, our research team conducted a series of systematic reviews together with an evidence-based consensus process to establish best practices in risk stratification for physical activity participation. The result of this process was the creation of a new pre-participation risk stratification strategy: the new Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and the electronic Physical Activity Readiness Medical Examination (ePARmed-X+).3,4 This article will briefly summarize the features of the new PAR-Q+ and ePARmed-X+ and highlight how these tools can be incorporated into daily clinical practice to facilitate risk stratification, physical activity clearance, and exercise prescription for both asymptomatic individuals and persons living with chronic medical conditions.