5.1 PAR-Q, Health History, Lifestyle Questionnaire, and Documentation

Intake Is the First Assessment

For the NASM Certified Personal Trainer (CPT7) exam, assessment does not start when the client squats, steps, or lifts. It starts with subjective information gathered before any physical test. NASM teaches a deliberate sequence: collect subjective data (readiness screen, health history, lifestyle questionnaire), then objective physiological data (heart rate, blood pressure, body composition), then movement and performance assessments. Skipping the subjective stage to "just start training" is a classic exam trap, because the screen is what tells the trainer whether a physical assessment is even safe to administer.

The goal of intake is threefold: safety (rule out conditions that make exercise risky today), scope (decide what the trainer may handle versus refer), and assessment selection (choose tests that fit the client's age, history, and goals). A 58-year-old desk worker with knee surgery history and a 22-year-old recreational runner should not receive identical assessment batteries, and intake is where that branching decision is made.

The PAR-Q+ Readiness Screen

The PAR-Q+ (Physical Activity Readiness Questionnaire for Everyone) is the standardized pre-participation screen NASM uses. It is a short, self-report questionnaire of yes/no general health questions (heart condition, chest pain at rest or with activity, dizziness/loss of balance, bone or joint problems, blood-pressure or heart medications, and any other reason not to exercise). Key points the exam tests:

• It is a screen, not a diagnosis. A "yes" does not mean the client cannot exercise; it means more information or clearance is needed first.
• If the client answers "no" to all questions, they are generally cleared to begin gradually.
• A "yes" routes them to the follow-up pages (ePARmed-X+) and, when indicated, to physician clearance before moderate-to-vigorous activity.
• A client who reports chest discomfort during activity and wants to start hard intervals "today" should be held back: defer vigorous testing, recommend medical clearance, and start conservatively only after clearance.

The PAR-Q+ protects both the client and the trainer's legal/professional standing. It is documented, dated, and signed.

Health History, Lifestyle, and Medications

Beyond the readiness screen, NASM collects a broader health-history and lifestyle questionnaire. This captures:

• Occupation — sitting vs. standing, repetitive motions, dress shoes/heels, overhead work. A desk worker's prolonged hip flexion and rounded posture directly predict overhead-squat compensations, so this item guides posture and movement assessment.
• Lifestyle/recreation — hobbies, sport, sleep, stress, tobacco, alcohol, and prior exercise experience.
• Medical history — past injuries, surgeries, chronic conditions, and family history.
• Medications and supplements — because several common drugs change cardiovascular responses.

Medications that affect heart rate and blood pressure are heavily tested. Beta-blockers blunt the heart-rate response, lowering both resting and exercise HR, so HR-based intensity formulas become unreliable and the trainer should lean on RPE and the talk test. Calcium channel blockers and diuretics can also alter HR/BP and hydration. The exam wants the trainer to recognize that a "normal" target-HR number may be meaningless for a medicated client.

Why intake drives test choice

• Occupational sitting → expect overhead-squat compensations; prioritize posture/movement screens.
• Knee surgery history → avoid high-impact cardio tests; choose low-impact options.
• Beta-blocker use → use RPE/talk test instead of %HRmax targets.

Documentation and Informed Consent

Professional documentation is part of the assessment, not an afterthought. NASM expects the trainer to obtain informed consent (explaining what each test involves and its risks, and confirming the client agrees to participate voluntarily) and to keep clear, dated records. Consent should be obtained before any physical testing, and the client should understand they may stop at any time. Good documentation captures: the data collected, the date, the client's own report in their words, the trainer's action (e.g., "recommended physician clearance"), and any referral or clearance status.

An appropriate documentation entry is factual and scope-conscious — for example: "6/12: Client reports occasional chest tightness with stairs. PAR-Q+ "yes" to chest discomfort. Deferred cardio testing; advised physician clearance before vigorous exercise." An inappropriate entry would diagnose ("client has angina") or prescribe treatment, both outside CPT scope. The trainer records what was observed and reported, not a clinical interpretation.

Good records protect the client, support program decisions, create a baseline for reassessment, and document that the trainer acted within scope and standard of care. They are kept confidential and stored securely, consistent with the trainer's professional and legal obligations. The exam frequently rewards the answer that documents conservatively and refers, over the answer that pushes ahead and records a self-made diagnosis.

The intake sequence at a glance

1. PAR-Q+ readiness screen (with informed consent).
2. Health-history and lifestyle questionnaire (occupation, medical, medications).
3. Objective vitals and body-size measures (HR, BP, BMI, circumference).
4. Movement and performance assessments — only if screening clears the client.
5. Document everything and define the next safe step.