The PAR-Q+ and ePARmed-X+: As easy as 1, 2, 3.

Authors

  • Shannon S. D. Bredin Indigenous Health & Physical Activity Program, University of British Columbia; Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia https://orcid.org/0000-0003-0651-3950
  • Veronica K. Jamnik School of Kinesiology and Health Science, York University
  • Norman Gledhill School of Kinesiology and Health Science, York University
  • Darren E. R. Warburton Indigenous Health & Physical Activity Program, University of British Columbia; Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia https://orcid.org/0000-0002-2842-9170

DOI:

https://doi.org/10.14288/hfjc.v18i1.863

Keywords:

Physical Activity, Pre-Participation Screening, Risk Stratification, PAR-Q , e-PARmed-X

Abstract

In 2007, an international collaboration (PAR-Q+ Collaboration) launched the PAR‑Q+ and ePARmed‑X+ to modernize pre‑participation screening, lower barriers to physical activity, and ensure safety across all ages and health statuses. Grounded in systematic reviews of over 540,000 citations and more than 1,000 key studies, the tools incorporate 60+ evidence‑based recommendations spanning pregnancy and eight clinical domains—cardiovascular, metabolic, orthopaedic, cancer, psychological, respiratory, spinal cord injury, and stroke—developed according to AGREE Instrument standards. The resulting tools feature no age restrictions, self‑administration, and a three‑step risk‑stratification process that integrates the role of qualified exercise professionals. Step One: Clients complete seven general health questions on the PAR-Q+; all “No” responses clear them for unrestricted activity with general exercise guidelines and a signed Participant Declaration. Any “Yes” leads to follow‑up. Step Two: Clients with a “Yes” response on Page 1 complete the follow-up questions on Pages 2–3 concerning chronic conditions; all “No” responses allow self‑clearance with tailored exercise advice, while any “Yes” directs clients to the ePARmed‑X+ and/or a qualified exercise professional. Step Three: Through the ePARmed‑X+ and/or professional consultation, clients are stratified into low, intermediate, or high risk—guiding supervision level or physician referral. This streamlined approach reduces physician referrals to approximately 1% (versus 15% under the original PAR‑Q), emphasizes that physical inactivity poses greater risk than exercise, and empowers individuals of all ages and health statuses to participate safely in physical activity. Anticipated to reach millions around the globe, the PAR-Q+ and ePARmed-X+ have significantly reduced barriers to physical activity participation for individuals across the lifespan.

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References

AGREE Collaboration. (2001). Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. https://www.agreetrust.org/

AGREE Collaboration. (2003). Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: The AGREE project. Quality and Safety in Health Care, 12(1), 18–23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12571340

Bredin, S. S. D., Gledhill, N., Jamnik, V. K., & Warburton, D. E. R. (2013). PAR-Q+ and ePARmed-X+: New risk stratification and physical activity clearance strategy for physicians and patients alike. Canadian Family Physician, 59(3), 273–277. https://www.cfp.ca/content/59/3/273

Bredin, S., Warburton, D., Warburton, A., Jamnik, V., Gledhill, N., & Warburton, D. (2025). The PAR-Q+ and ePARmed-X+: Knowledge mobilization resources for clients and practitioners. Health & Fitness Journal of Canada, 18(1), 80–88. https://doi.org/10.14288/hfjc.v18i1.75

Bredin, S. S. D., Jamnik, V., Gledhill, N., & Warburton, D. E. R. (2016). Effective pre-participation screening and risk stratification. In D. E. R. Warburton (Ed.), Health-related exercise prescription for the qualified exercise professional (6th ed., pp. 1–30). Health & Fitness Society of BC.

Lee, I. M., Shiroma, E. J., Lobelo, F., Puska, P., Blair, S. N., Katzmarzyk, P. T., & Lancet Physical Activity Series Working Group. (2012). Effect of physical inactivity on major non-communicable diseases worldwide: An analysis of burden of disease and life expectancy. Lancet, 380(9838), 219–229. https://doi.org/10.1016/S0140-6736(12)61031-9

Maiorana, A. J., Williams, A. D., Askew, C. D., Levinger, I., Coombes, J., Vicenzino, B., Davison, K., Smart, N. A., & Selig, S. E. (2018). Exercise professionals with advanced clinical training should be afforded greater responsibility in pre-participation exercise screening: A new collaborative model between exercise professionals and physicians. Sports Medicine, 48(6), 1293–1302. https://doi.org/10.1007/s40279-018-0888-2

Min, J. Y., & Min, K. B. (2016). Excess medical care costs associated with physical inactivity among Korean adults: Retrospective cohort study. International Journal of Environmental Research and Public Health, 13(1), 136. https://doi.org/10.3390/ijerph13010136

Shephard, R. J. (2000). Does insistence on medical clearance inhibit adoption of physical activity in the elderly? Journal of Physical Activity and Health, 8, 301–311.

Warburton, D. E., & Bredin, S. S. (2016). Reflections on physical activity and health: What should we recommend? Canadian Journal of Cardiology, 32(4), 495–504. https://doi.org/10.1016/j.cjca.2016.01.024

Warburton, D. E. R., & Bredin, S. S. D. (2017). Health benefits of physical activity: A systematic review of current systematic reviews. Current Opinion in Cardiology, 32(5), 541–556. https://doi.org/10.1097/HCO.0000000000000437

Warburton, D. E. R., & Bredin, S. S. D. (2021). Cardiovascular health benefits of physical activity: Time to focus on strengths. Cahiers de Nutrition et de Diététique, 56(1), 40–50. https://doi.org/10.1016/j.cnd.2020.12.001

Warburton, D. E. R., Bredin, S. S. D., Jamnik, V., & Gledhill, N. (2011). Validation of the PAR-Q+ and ePARmed-X+. Health & Fitness Journal of Canada, 4(2), 38–46. https://doi.org/10.14288/hfjc.v4i2.151

Warburton, D. E. R., Gledhill, N., Jamnik, V. K., Bredin, S. S. D., McKenzie, D. C., Stone, J., Charlesworth, S., & Shephard, R. J. (2011). Evidence-based risk assessment and recommendations for physical activity clearance: Consensus document 2011. Applied Physiology, Nutrition, and Metabolism, 36(S1), S266–S298.

Warburton, D. E. R., Gledhill, N., Jamnik, V. K., Bredin, S. S. D., McKenzie, D. C., Stone, J., Charlesworth, S., Shephard, R. J., & on behalf of the PAR-Q+ Collaboration. (2011). The Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and electronic Physical Activity Readiness Medical Examination (ePARmed-X+): Summary of consensus panel recommendations. Health & Fitness Journal of Canada, 4(2), 26–37.

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Published

2025-03-30

How to Cite

Bredin, S., Jamnik, V., Gledhill, N., & Warburton, D. (2025). The PAR-Q+ and ePARmed-X+: As easy as 1, 2, 3. The Health & Fitness Journal of Canada, 18(1), 75–79. https://doi.org/10.14288/hfjc.v18i1.863

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EXPERT OPINION