Notes: If the member answers YES to any of the above questions, they should NOT do the step test. ii. 疾病史情况 Your Medical History 医生是否诊断您患以下疾病或者是否因以下疾病

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1 体能测试问卷 Vitality Health and Fitness Questionnaire i. 体育运动情况 Physical Activity Readiness Questions 医生是否曾诊断过您有心脏病, 只能做一些医生推荐的体育活动? Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? 运动时, 您是否感到胸口疼痛? Do you feel pain in your chest when you do physical activity? 上个月, 没有运动时, 您是否感到过胸口疼痛? In the past month, have you had chest pain when you were not doing physical activity? 您是否曾因为眩晕而失去平衡, 或者曾失去过知觉? Do you lose your balance because of dizziness or do you ever lose consciousness? 您是否患有骨或关节病变 ( 比如背部膝盖臀部 ), 并且在 5 运动后会变得更严重? Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by participating in physical activity? 您目前是否在服用医生开的控制血压或心脏病的药 ( 比如利 6 尿剂 )? Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? 7 您是否有其他原因无法进行体育运动? Do you know of any other reason why you should not do physical activity? 注意 : 如果上述问题中的任何一项回答是, 则不应进行踏阶测试

Notes: If the member answers YES to any of the above questions, they should NOT do the step test. ii. 疾病史情况 Your Medical History 医生是否诊断您患以下疾病或者是否因以下疾病给您开过药?

2 Notes: If the member answers YES to any of the above questions, they should NOT do the step test. ii. 疾病史情况 Your Medical History 医生是否诊断您患以下疾病或者是否因以下疾病给您开过药? Have you ever been diagnosed with any of the following medical conditions by a doctor or have you been prescribed medicine for any of them? 过敏 Allergies 关节炎 Arthritis 哮喘 Asthma 背痛 Back pain 5 癌症 Cancer 6 慢性肺病 Chronic lung disease 7 慢性疼痛 Chronic pain 8 更年期 Climacterium 9 抑郁 Depression 高血压 High blood pressure 若是, 您目前是否服药来控制血压? 0 If yes, are you currently taking medicine to control your blood pressure? 高胆固醇 High cholesterol 若是, 您目前是否服药来控制胆固醇? If yes, are you currently taking medicine to control your cholesterol? 偏头痛 Migraine headaches

3 若是, 你是否在接受偏头痛治疗? If yes, are you currently on treatment for migraine headaches? 骨质疏松 Osteoporosis 若是, 您目前是否在接受骨质疏松治疗? If yes, are you currently on treatment for osteoporosis? 糖尿病 Diabetes 若是, 您患的哪一型糖尿病? If yes, what type of diabetes do you have? 您目前是否服药来控制血糖? Are you currently taking medicine to manage your diabetes? 失眠 Insomnia 若是, 你是否在接受失眠治疗? If yes, are you currently on treatment for insomnia? 胃烧灼痛或胃反酸 Heartburn or acid reflux 若是, 您是否在接受胃病治疗? If yes, are you currently on treatment for stomach disease? 中风 Stroke 若是, 您是否在接受中风治疗? If yes, are you currently on treatment for a stroke? 心脏病 Heart disease 若是, 您是否在接受心脏病治疗? If yes, are you currently on treatment for heart disease? 甲状腺疾病 Thyroid disease 若是, 您是否在接受甲状腺疾病治疗? If yes, are you currently on treatment for thyroid disease? Ⅰ 型 Type Ⅱ 型 TypeⅡ 0 您是否还有其他疾病? 若是, 请在下面详细描述 Do you have any other diseases? If yes, please provide more

4 details about the condition(s). 您现在是否怀孕? Are you currently pregnant? 注意 : 如果怀孕, 建议不要进行体能测试 Note:If the member is pregnant, she should NOT do the test. iii. 运动量情况 Physical Activity 您平均每周运动几天? On average how many days a week do you exercise? 天 days 在运动的那几天, 您平均 :On the days you exercise, on average: 每天运动多少分钟?How many minutes do you exercise for? 分钟 minutes 您每次的运动强度有多大?How intense are your exercise sessions? 低 Low 适中 Moderate 高 High 备注 : 说话测试 (talk test) 是测试运动强度的一个很简单的指标 Note: The talk test is an easy indicator of the intensity at which you are exercising 低强度运动时, 您可以在没有呼吸困难的情况下唱出一首歌的几句歌词 Low intensity if you can sing the lyrics of a song without breathing hard. 适中强度运动时, 您可以与人交谈且呼吸顺畅 Moderate intensity - if you can talk with others without breathing rapidly. 高强度运动时, 您每说一个词就必须呼吸一次 High intensity - if you have to take a breath between every word you say.

5 您多久做一次力量练习, 比如俯卧撑引体向上仰卧起坐或通过器械来进行力量练习? How often do you do strength exercises like push-ups, pull-ups, sit-ups or using weight machines? 很少或从不 Rarely or never 每周一至两次 Once or twice a week 每周三至五次 Three to five times a week 每周六至七次 Six or seven times a week 平日里, 您每天花多长时间做以下事情? On an average day, how many hours a day do you spend doing the following activi 坐下来开会 Sitting in meetings 坐在电脑前 Sitting in front of your computer 看电视 Watching television 会员姓名 Member Name: 证件类型 ID Type: 证件号码 ID No.: 会员号 Party Number: 填写日期 Date: 年 (YY) 月 (MM) 日 (DD) 5

UTI (Urinary Tract Infection) - Traditional Chinese

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