Screening Questionnaire

This survey is a pre-screening questionnaire for our Muscle Strength Study. Please complete the survey as accurate as possible. All information will be kept in confidential. The eligibility status of your study participation will be notified by email 

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* 1. Are you 60 years of age or older?

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* 2. What is your email address?

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* 3. Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?

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* 4. Do you feel pain in your chest when you perform physical activity?

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* 5. In the past month, have you had chest pain when you were not performing any physical activity?

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* 6. Do you lose your balance because of dizziness or do you ever lose consciousness?

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* 7. Do you have a bone or joint problem that could be made worse by a change in your physical activity?

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* 8. Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?

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* 9. Do you know of any other reason why you should not engage in physical activity?

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* 10. Do you have any history of heart disease, cancer, or stroke?

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