Name: ____________________________

Course/Yr. Level: ____________________

Age: __________
Sex: __________

Test Items Test Results Final Rating

BMI _______

Standing Long Jump _______ cm.

(Power)

Sit and Reach _______ cm.

(Flexibility)

Stork Balance Left: _______

(Balance) secs/minutes

Right: _______
secs/minutes

Hexagonal Step _______ secs/minutes

(Agility and Reaction
Time)

3-Minute Step Test _____ pulse rate

(Cardiovascular)

INDIVIDUAL RECORD
FORM Photo

Final Rating:
Excelle Very Above Avera Below Poor Very
nt Good Average ge Average Poor
5 4.5 4 3.5 3 2 1.5

PHYSICAL ACTIVITY READNIESS QUESTIONNAIRE (PAR-Q)

The DOH recommends that Filipinos participate in moderate to vigorous physical
activities for at least 30 minutes for most days of the week. Physical activity is good for
the heart and strengthens the body. Since physical activity is safe for most people,
everyone is encouraged to pursue an active lifestyle.
This questionnaire will help you check if moderate to vigorous physical activity is
safe for you.
Instructions: Put a check mark on the box that corresponds to your answer. If you answer
“NO” to all the questions, you are ready to engage in an active lifestyle. Start an exercise
program that has low to moderate intensity activities and build your intensity gradually.
If you answer “YES” to any question, you need to talk to your physician about your
condition before participating in an exercise program.
 Question Ye N
s o
1. Has your doctor ever told you that you have
a heart condition or a high blood pressure?
2. Do you feel pain in your chest when you are
doing your daily activities or when you do
physical activities?
3. Do you lose balance because of dizziness or
have you lost consciousness in the past 12
months?
4. Have you ever been diagnosed with chronic
condition other than heart disease or
hypertension (i.e., cancer)?
5. Are you currently taking prescribed
maintenance medications?
6. Do you currently have a bone, joint, or other
musculoskeletal condition that can worsen
as a result of moderate to vigorous physical
activity?
7. Has your doctor ever told you that you
should only engage in medically supervised
physical activity?

Body Mass Index

equipment required: scales and stadiometer as for weight and height.
procedure: BMI is calculated from body mass (M) and height (H). BMI = M / (H x H), where M = body
mass in kilograms and H = height in meters. The higher the score usually indicating higher levels of
body fat.
scoring: Use the table below to determine your BMI rating. The table shows the World Health
Organization BMI classification system. The rating scale is the same for males and females. You can
also use the reverse lookup BMI table for determining your ideal weight based on height.

classification BMI (kg/m2) sub-classification BMI (kg/m2)

underweight < 18.50 Severe thinness < 16.00

Moderate thinness 16.00 - 16.99

Mild thinness 17.00 - 18.49

normal range 18.5 - 24.99 normal 18.5 - 24.99

overweight ≥ 25.00 pre-obese 25.00 - 29.99

Obese obese class I 30.00 - 34.99

(≥ 30.00)

obese class II 35.00 - 39.99

obese class II ≥ 40.00

Procedure:
Standing Long Jump
The student stands behind a line marked on the ground with feet slightly apart. A
two foot take-off and landing is used, with swinging of the arms and bending of the
knees to provide forward drive. The subject attempts to jump as far as possible, landing
on both feet without falling backwards. Three attempts are allowed. The measurement is
 taken from take-off line to the nearest point of contact on the landing (back of the heels).
Record the longest distance jumped, the best of three attempts.

RESULT PROCEDURE

Sit and Reach

Place the ruler/tape measure on the ground between your legs or on the top of the
step. Place one hand on top of the other, then reach slowly forward. At the point of your
greatest reach, hold for a couple of seconds, and measure how far you have reached.
PROCEDURE
RESULT

Stork Balance Test

Remove the shoes and place the hands on the hips, then position the non-
supporting foot against the inside knee of the supporting leg. The subject is given one
minute to practice the balance. The subject raises the heel to balance on the ball of the
foot. The stopwatch is started as the heel is raised from the floor. The stopwatch is
stopped if any of the follow occur:

 The hand(s) come off the hips

 The supporting foot swivels or moves (hops) in any direction

 The non-supporting foot loses contact with the knee.

 The heel of the supporting foot touches the floor.

Rating Score (seconds)

Excellent > 50

Good 40 - 50

Average 25- 39

Fair 10 - 24

Poor < 10
Scoring: The total time in seconds is recorded. The score is the best of three attempts.
The table lists general ratings for this test.

Hexagonal Agility Te

test layout: Using athletic tape, mark a hexagon (six sided shape) on the floor. The
length of each side should be 24 inches (60.5 cm), and each angle should work out to be
120 degrees.

procedure: The participant begins with both feet together in the middle of the hexagon
facing the front line. On the command 'go', they jump ahead across the line, then back
over the same line into the middle of the hexagon. Then, continuing to face forward with
the feet together, they jump over the next side and back into the hexagon. Continue this
pattern for three full revolutions, continuing to face forwards throughout the test.
Perform the test both clockwise and anti-clockwise.

scoring: The athletes score is the time taken to complete three full revolutions. The best
score from two trials is recorded. Comparison of the anti-clockwise and clockwise
directions will show if any imbalances exist between left and right movement skills.

3-minute Step Test

A 12 inch high bench (or a similar sized stair or sturdy box), a watch for timing
minutes. Step on and off the box for three minutes. Step up with one foot and then the
other. Step down with one foot followed by the other foot. Try to maintain a steady four
beat cycle. It's easy to maintain if you say "up, up, down, down". Go at a steady and
consistent pace. This is a basic step test procedure.
PROCEDURE
 At the end of three minutes, remain standing while you immediately check your
heart rate. Take your pulse for one minute (e.g. count the total beats from 3 minutes
after starting the test).
RESULT