SoalActive

Get SelidikQuestionnaire
Hidup Aktif - Dokumen Rujukan
– Reference Document
Get Active Questionnaire – Reference Document
NASIHATON
ADVICE TENTANG APA
WHAT TO DOYANG HARUS
IF YOU A YES RESPONSE
DILAKUKAN
HAVE JIKA
ADVICE ON WHAT TO DO IF YOU HAVE A YES RESPONSE
ANDA MEMPUNYAI JAWAPAN YA

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UseGunakan dokumen
this reference rujukan if
document iniyou
jikaanswered
anda menjawab
YES toYA
anykepada mana-mana
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have not anda beluma
mendapatkan
health nasihat
care provider seorang penyedia
or Qualified khidmat penjagaan
Exercise Professional kesihatan
(QEP) about atau Pakar
becoming moreSenaman Berkelayakan
physically active.
(QEP) tentang menjadi lebih aktif secara fizikal.

2
2 Adakah anda mengalami
Do you currently rasa
have pain sakit atau
or swelling inbengkak
any part di
of mana-mana bahagian
your body (such as tubuh YA
YES
2 Doan you currently
acutehave painof
orarthritis,
swelling in any part of yourakut,
bodyatau
(such as

Borang Soal
anda
from (seperti daripada
injury, kecederaan,
flare-up kejadian
or radang
back pain) sendi
that affects yoursakit YES
fromtoanbeinjury,
belakang),
ability yang acuteactive?
menjejas
physically flare-up of arthritis,
keupayaan or back
anda untuk pain) that
menjadi aktifaffects
secarayour
fizikal?
ability to be physically active?
Jika bengkak atau rasa sakit ini baru terjadi, dapatkan nasihat seorang penyedia khidmat penjagaan kesihatan. Jika tidak,
If thiskesihatan
jaga swelling or painanda
sendi is new,
danconsult a health
kurangkan care provider.
kesakitan Otherwise, keep
dengan menggerakkan joints
sendi healthy
anda secaraand reduce pain by
perlahan-lahan moving
melalui
yourIf joints
this swelling
keseluruhan slowly or pain
and
jangkauan
is new,
gently consult
through
pergerakan
aentire
healthpain-free
thebebas
yang
care provider. Otherwise,
rangeJika
dari rasa sakit. of motion. Ifkeep
you joints
anda mengalami have healthy
hip,
sakit kneeand
pinggul,
reduce
orlutut
ankle painchoose
pain,
atau
by moving
buku lali, pilih
yourberimpak
aktiviti
low-impact joints slowly
activities andseperti
rendah
such gently throughorthe
berenang
as swimming atauentire pain-free
berbasikal.
cycling. As range
Apabila
the pain of motion.
rasa
subsides,sakit If you
semakin
gradually have hip,
yourknee
berkurangan,
resume or ankle
sambung
normal pain, choose
aktiviti
physical fizikal
activities
low-impact
normal
starting anda activities
secara
at a level lower suchbermula
ansuran
than as swimming
before pada
the or cycling.
tahap
flare-up. yangAs
Consult the
lebih pain subsides,
rendah
a Qualifiedberbanding
Exercise gradually resume
sebelum
Professional your
bengkak
(QEP) normal
inatau rasaphysical
follow-up sakit activities
terjadi.
to help you

Selidik Hidup
Dapatkan
starting nasihat
at a Pakar
level Senaman
lower than Berkelayakan
before the (QEP)Consult
flare-up. dalam rawatan
a susulan
Qualified untuk
Exercise membantu(QEP)
Professional anda menjadi
in lebihtoaktif
follow-up help dan
you
become more
mencegah atau active and prevent
mengurangkan or minimize
kesakitan pada future
masa pain.
hadapan.
become more active and prevent or minimize future pain.

3
3 Pernahkah
Has a healthseorang penyedia
care provider khidmat
told penjagaan
you that kesihatan
you should avoid ormemberitahu anda
modify certain YA
YES
3 Hasof
bahawa
types a anda
health care
harus
physical provider told atau
mengelakkan
activity? you that you should beberapa
mengubahsuai avoid or modify certainfizikal?
jenis aktiviti YES
types of physical activity?

Listen tonasihat
Dengar the advice of your
penyedia health penjagaan
khidmat care provider. A Qualified
kesihatan anda.Exercise
SeorangProfessional
Pakar Senaman(QEP) will ask you(QEP)
Berkelayakan aboutakan
any

Aktif ini untuk

Listen to the
menanyakan
considerations advice
anda
andtentangof your
provide health
sebarang
specific care provider.
pertimbangan
advice A Qualified
dan
for physical memberikan
activity Exercise
that safeProfessional
is nasihat
andkhusus (QEP)
untuk
that takes will ask
aktiviti
your you
fizikal
lifestyle about
yang
and any dan
selamat
health
considerations
mengambil and
kiraadvice
care provider’s provide
nasihatinto
penyediaspecific advice for physical activity
khidmat penjagaan kesihatan anda.
account. that is safe and that takes your lifestyle and health
care provider’s advice into account.

4
4 Adakah anda any
Do you have menghidap sebarang
other medical masalahcondition
or physical kesihatan atau fizikal lain YA
YES
4 Do as
(such you
(seperti have any
kencing
diabetes, other
manis, medical
barah,
cancer, or physical
osteoporosis,
osteoporosis, condition
semput,
asthma, spinalkecederaan
cord injury)saraf tunjang) YES
(such
yang
that may asaffect
boleh diabetes,
menjejas cancer,
keupayaan
your ability osteoporosis,
to beanda untuk
physicallyasthma,
menjadi
active? spinal
aktifcord injury)
secara fizikal?
that may affect your ability to be physically active?

Keselamatan
Sesetengah
Some people orang
may mungkin merasa
worry if they havebimbang
a medical jika
ormereka
physicalmenghidap masalah
condition that kesihatan
physical activityatau fizikal
might be yang boleh
unsafe. membuat
In fact,
aktiviti
Some fizikal menjadi
people maybahaya.
worry if Sebaliknya,
they a aktiviti fizikal secara kerap dapat membantu menangani dan memperbaiki
regular physical activity can help tohave
manage medical or physical
and improve manycondition that
conditions. physicalactivity
Physical activity might
can alsobe unsafe.
reduce theInrisk
fact,
berbagai masalah
regular physical kesihatan. Aktiviti fizikal juga boleh mengurangkan risiko komplikasi. Seorang Pakar Senaman
of complications.
Berkelayakan A activity
(QEP) Qualified
boleh
canExercise
help toProfessional
membantu
manage and(QEP)
memberikan
improve
nasihat can many conditions.
helpuntuk
with specific Physical activity
adviceyang
for can activity
physical also reduce
that isthe risk
safe
andofthat
complications.
takes yourdan A Qualified
medical Exercise
history Professional
and lifestyle (QEP) can help with specific advice for physical activity that iskira
into account.
khusus aktiviti fizikal selamat dan mengambil safe
sejarah perubatan gaya hidup anda.
and that takes your medical history and lifestyle into account.

Selepas membaca
After reading the NASIHAT untuk
ADVICE for jawapan
your YA anda,go
YES response, pergi ke Muka
to Page 2 ofSurat
the 2 Soal

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AKTIVITI
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MASAACTIVITY
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Get Active Questionnaire – ASSESS YOUR CURRENT PHYSICAL ACTIVITY

I N G I NW DAANPAT
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csep.ca/certifications
csep.ca/certifications csep.ca/guidelines
csep.ca/guidelines
csep.ca/certifications csep.ca/guidelines
Ahli CSEP
CSEP Bertauliah
Certified boleh
members membantu
can help you Garis Panduan
Canadian Aktiviti
Physical Fizikal
Activity Kanada untuk
Guidelines for allsemua
ages.
CSEP
anda Certified
dengan members
matlamat can
aktiviti helpanda.
fizikal you Canadian
peringkat Physical Activity Guidelines for all ages.
usia.
with your physical activity goals.
with your physical activity goals.
An Initiative by

© Persatuan Kanada for

Canadian Society untuk Fisiologi
Exercise Senaman,
Physiology, 2017.
2017. AllSemua hak terpelihara.
rights reserved. PAGE 2 OF42
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 Get
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SelidikQuestionnaire
Hidup Aktif SoalActive
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Hidup Aktif Soal SelidikQuestionnaire
Hidup Aktif - Dokumen Rujukan
Get Active Questionnaire
Active Get Get Active
GetGet
Active Questionnaire –
– Reference
Reference Document
Document
Questionnaire
CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY –
PHYSICAL ACTIVITY TRAINING FOR HEALTH (CSEP-PATH ®
)
Get Active Questionnaire NASIHAT
ADVICE
ADVICE
Active
TENTANG
ON
ON
ADVICE
WHAT
WHAT
ON
Questionnaire
APA
TO
TO
WHAT
DO
DOYANG
IF
TO DO YOU
– Reference
HARUS
IF YOU HAVE
IF YOU A YES
HAVEYES
Document
DILAKUKAN
HAVE A JIKA
RESPONSE
RESPONSE
A YES RESPONSE
ANDA MEMPUNYAI JAWAPAN YA
PERSATUAN
CANADIAN KANADA
SOCIETY UNTUK
FOR FISIOLOGI
EXERCISE SENAMAN
PHYSIOLOGY –-
CANADIAN
PHYSICAL SOCIETY
LATIHAN AKTIVITI
ACTIVITY FOR UNTUK
FIZIKAL EXERCISE
TRAINING FOR PHYSIOLOGY
KESIHATAN
HEALTH –
(CSEP-PATH
(CSEP-PATH ® ®)
)
PHYSICAL ACTIVITY TRAINING FOR HEALTH (CSEP-PATH ) ®

ASSESS YOUR CURRENT PHYSICAL ACTIVITY

M E N I L A I A K T I V I T I F I Z I K A L A N D A PA D A M A S A I N I Use YES
Aktiviti fizikal meningkatkan kesihatan fizikal dan mental anda. Meskipun sedikit, aktiviti fizikal Use this
this reference
Gunakan
reference document
dokumen if
if you
rujukan
document answered
ini jika
you YES to
to any
anda menjawab
answered YA question
any and
and you
you have
kepada mana-mana
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soalan
have consulted
notdan a
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Answersoalan-soalan
the followingberikut untuk
questions menilaihow
to assess sejauh manakah
active you areanda
now.aktif pada masa ini. healthmendapatkan
health care providernasihat
care provider or seorang
or Qualified penyedia
Exercise khidmat penjagaan
Professional (QEP) kesihatan
(QEP) about atau Pakar
becoming more Senaman Berkelayakan
more physically active.
adalah
Physicalbaik, dan improves
activity apabila lebih
yourbanyak
physicaldilakukan,
and mental lebih baik manfaat
health. Even small yang akan diraih.
amounts of physical activity Answer the following questions to assess how active you are now. Qualified Exercise Professional about becoming physically active.
Physical activity improves your physical and mental health. Even small amounts of physical activity HARI/
(QEP) tentang menjadi lebih aktif secara fizikal.
are good, and more is better. 1 Dalam
During minggu
a typicalyang
week,biasa, berapa
on how manyharikah
days doanda
youmelakukan aktiviti
do moderate- fizikal aerobik berintensiti
to vigorous-intensity sederhana
aerobic physical DAYS/
are good, and more MINGGU
orang,is better. 1 During a typical week, on how many days do you do moderate- to vigorous-intensity aerobic physical DAYS/
WEEK
Bagi hampir setiap manfaat daripada aktiviti fizikal jauh melebihi sebarang risiko. Bagi sesetengah individu, nasihat khusus hingga tinggias
activity (such (seperti berjalancycling
brisk walking, pantas,orberbasikal
jogging)? atau berlari-lari anak)? WEEK
daripada Pakar Senaman activity (such as brisk walking, cycling or jogging)?
For almost everyone, the Berkelayakan (QEP - activity
benefits of physical mempunyai pendidikan
far outweigh any pos-menengah
risks. For some dalam bidang
individuals, sains senaman
specific advice fromdanapensijilan
For almost everyone, the
ini benefits of physical activity far outweigh any from aSoal selidik 2 Pada
On dayshari-hari di mana
that you do atanda
least melakukan sekurang-kurangnya
moderate-intensity aktiviti
aerobic physical fizikal(e.g.,
activity aerobik
briskberintensiti
walking), sederhana MINIT/
MINUTES/ 1 Pernahkah
1 Have anda mengalami
you experienced MANA-MANA
ANY of the followingyang
(A toberikut (A the
F) within hingga
pastF)six
dalam tempoh enam
months?
lanjutan
Qualified dalam bidang
Exercise - lihat(QEP
Professional csep.ca/certifications)
– has post-secondaryatau penyedia
education inrisks.
khidmat For
exercise some
penjagaanindividuals,
scienceskesihatan specific advice
adalah dinasihatkan.
and an advanced certification in the 2 On days that you do at least moderate-intensity aerobic physical activity (e.g., brisk walking), HARI
MINUTES/
DAY
ini adalah
Qualified
area untuk semua
– seeExercise peringkat
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csep.ca/certifications) usia
(QEP
or – -has
untuk
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provider isanda
post-secondary
care memulakan
education
advisable. hidupsciences
in exercise
This yang lebih
questionnaire isandaktif secara
an advanced
intended fizikal.
for all certification
ages in move
– to help the (contohnya,
for how many berjalan
minutes pantas),
do youberapa
do thisminitkah
activity? anda melakukan aktiviti ini? DAY bulan yangyou
1 Have lepas?
experienced ANY of the following (A to F) within the past six months?
for how many minutes do you do this activity?
MINIT/
areaalong
– see the
csep.ca/certifications)
path to becoming or health active. is advisable. This questionnaire is intended for all ages – to help move
care provider MINUTES/
you more physically Untuk orang
For adults, dewasa,
please multiply your average
sila darabkan puratanumber
jumlah of days/weekanda
hari/minggu by the average
dengan number
purata of minutes/day:
jumlah minit/hari: MINGGU
MINUTES/
you along the path to becoming more physically active. For adults, please multiply your average number of days/week by the average number of minutes/day: WEEK A diagnosis of/treatment
A Diagnosis/rawatan
A for
bagi penyakit Physical activity
Aktiviti fizikal is likelybermanfaat.
mungkin to be beneficial. If youtelah
Jika anda havedirawat
been treated for heart
bagi penyakit jantung
WEEK
Saya melengkapkan soal selidik ini untuk diri saya sendiri. A diagnosis
A disease
heart of/treatment
or stroke, pain/for disease
or atau Physical
but have activity is likely to be
not completed beneficial.
a cardiac If you have
rehabilitation been treated
jantungprogram within for
the heart
Garis Panduan
Canadian Aktiviti
Physical Fizikal
Activity Kanadarecommend
Guidelines mengesyorkan thatagar
adults orang dewasaatmelakukan
accumulate sejumlah
least 150 minutes ofsekurang-kurangnya 150 minit
moderate- to vigorous-intensity jantung atau angin ahmar, tetapi belum melengkapkan program pemulihan dalam tempoh 6 bulan
I am completing this questionnaire for myself. heart disease or stroke, or pain/ disease but have not completed a cardiac rehabilitation program within
diawasithe
Saya melengkapkan thissoal selidik ini untuk anak/tanggungan saya sebagai seorang ibu bapa/penjaga. Canadian
aktiviti Physical Activity Guidelineshingga
recommend that adults accumulate at least 150 minutes of moderate- to vigorous-intensity rasa sakit/tidak selesa/tekanan
discomfort/pressure in your past
yang6lepas,
months, consultnasihat
dapatkan a doctor – a supervised
doktor - program cardiac
pemulihanrehabilitation
jantung yang program
I am completing questionnaire for myself. physicalfizikal berintensiti
activity per week.sederhana tinggiat
For children and youth, setiap
least 60minggu.
minutesBagi kanak-kanak
daily dan belia,
is recommended. disyorkan sekurang-kurangnya
Strengthening muscles and bones at discomfort/pressure in your past recommended.
6 months, consult a doctor – a supervised cardiac rehabilitation program
physical
60 minit activity per week.
setiap hari. For children
Menguatkan otot and
danyouth,
tulangatsekurang-kurangnya
least 60 minutes daily duais recommended. Strengthening
kali seminggu untuk muscles
orang dewasa, andtiga
dan bones
kali at di dada
chest andaactivities
during semasa kegiatan
of daily amat
is disyorkan.
strongly Jika anda ingin
If you menyambung
are resuming semula
physical aktiviti
activityfizikal
afterselepas
more than tidak
I am completing this questionnaire for my child/dependent as parent/guardian. least two times per week for adults, and three times per week for children and youth, is also recommended (see csep.ca/guidelines).
I am completing this questionnaire for my child/dependent as parent/guardian. seminggu untukper
least two times kanak-kanak dan belia,
week for adults, juga times
and three disyorkan (lihatfor
per week csep.ca/guidelines).
children and youth, is also recommended (see csep.ca/guidelines). kehidupan
chest
living or harian
during
during atau
physical semasa
activities of daily 6
activity? aktif is strongly
selama
months of lebih recommended.
dari begin
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slowly withare
mulakan resuming
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light- to physical
perlahan dengan activity
moderate-intensity after
aktiviti more than
fizikal
physical
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fizikal?
or during physical activity?berintensiti
6 months
activity. ringan
If you have hingga
of inactivity,sederhana. Jika anda
begin slowly withinlight-
pain/discomfort/pressure mengalami
yourto rasa sakit/tidak
moderate-intensity
chest selesa/
and it is new forphysical
you,
YES tekanan di dada anda danpain/discomfort/pressure
ini adalah sesuatu yang baru untuk anda, berjumpalah
talk toactivity.
a doctor. If you have
Describe the symptom and what activities in your chest
bring and
it on.it is new for you,
P R E PA R E T O B E C O M E M O R E A C T I V E YA YES dengan doktor. Terangkan simptomnya dan aktiviti apakah yang menyebabkannya.
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BERSEDIA UNTUK MENJADI LEBIH AKTIF
The following questions will help to ensure that you have a safe physical activity Tingkatkan aktiviti fizikal anda gradually
sedikit demi sedikit
YES NO Increase your physical activity so that youuntuk
have pengalaman yang positif.
a positive experience. Lakukan
Build aktiviti
physical fizikalthat
activities yang
youanda nikmati
enjoy A diagnosis of/treatment
B Diagnosis/rawatan
B bagi tekanan Physical activity
Aktiviti fizikal is likelybermanfaat
mungkin to be beneficial if youtelah
jika anda have didiagnosis
been diagnosed and treated
dan dirawat bagi for
Increase
setiap your
hari physical activity gradually
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a positive experience. Build atau
physical activities
kerja) that you enjoy A diagnosis of/treatment Physical activity(BP).
is likely toare
be beneficial if youresting
have been diagnosed andcare
treated for
YES NO The following
experience. questions
Please answerwillYES
helportoNO
ensure thatquestion
to each you havebefore
a safeyou
physical
becomeactivity
more into your day (e.g., takeberjalan-jalan
a walk with a bersama
friend, ride berbasikal
your bike to school ke sekolah
or work) and reduce tempat
your sedentary dan kurangkan
behaviour forBhigh
darah blood
tinggi pressure
(BP), atau BP high blood
tekanan pressure
darah tinggi (BP).IfJika you andaunsure of your
tidak pasti bacaan BPBP, consult
semasa a health
rehat anda,
YA TIDAK Soalan-soalan berikut akan membantu memastikan anda mempunyai pengalaman into your day
tabiatprolonged (e.g.,
sedentari anda take a walk with a friend, ride
(contohnya, duduk terlalu lama). your bike to school or work) and reduce your sedentary behaviour for high blood pressure high blood pressure (BP). If youpenjagaan
are unsure oftoyour resting BP, consult a health
are care
experience.
physically Please
active. If answer
you are YES or NO
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eachquestion,
questionanswer
before YES.
you become more (e.g., sitting). semasa rehat 160/90of
(BP), or a resting BP mmHg provider
dapatkan ornasihat
a Qualified
penyediaExercise Professional
khidmat (QEP) have
kesihatan it measured.
atau Pakar If you
Senaman
aktiviti fizikal yang selamat. Sila jawab YA atau TIDAK bagi setiap soalan sebelum (e.g., prolonged sitting).
Jika aktiviti fizikal berintensiti tinggi atau
160/90 (BP),
lebih
mmHgor aor
resting
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higher? provider
Berkelayakan
taking or a Qualified
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mengukur
and your Professional
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good control, to
anda have physical
it measured.
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BP
activity
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anda menjadi active. If you
lebih aktifare unsure
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Jika question,
anda answer
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an intensity yang menyukarkan
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on a
If you want
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anda tidak memenuhi physical
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dinyatakan di atas,itdapatkan
hard to carry on a
nasihat 160/90 mmHg or higher? dan
is BPtaking
anda BP
recommended medication
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as it may andto your
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adalah regular
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should bephysical
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1
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Have you experienced ANY of the following (A to F) within the past six months?
conversation), and you do not meet minimum physical activity recommendations noted above, consult a Qualified Exercise
Pakar Senamanand
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you do not(QEP)meet dahulu.
minimum Iniphysical
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a Qualified untuk YA
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is recommended BP
activity levelasanda.
it may
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help toanda
medication lowerharus
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doctor should aktiviti
be aware
If your BP of
Professional (QEP) beforehand. This can help ensure that your physical activity is safe and suitable for your circumstances. YES fizikal anda
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Have you experienced ANY of the following (A to F) within the past six months?
1
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a QEP about
adalahis160/90 atau lebih tinggi, andareceive
harus disahkan sihat olehanddoktor dahulu danabout
1
Pernahkah mengalami MANA-MANA
andaof/treatment yang berikutor hingga F) dalam tempoh enam bulan
(Apain/discomfort/pressure Physical activity
Aktiviti fizikal is also
juga an important
merupakan part ofpenting
sebahagian a healthy pregnancy.
kehamilan yang sihat. safe and 160/90 or higher,
appropriate you should
physical activity. medical clearance consult a QEP
A A diagnosis for heart disease or stroke, Physical activity is also an important part of a healthy pregnancy. dapatkan nasihat QEP tentang aktiviti fizikal yang selamat dan sesuai.
yang lepas? safe and appropriate physical activity.
A in your chestof/treatment
A diagnosis during activities of daily
for heart livingor
disease orstroke,
duringor physical activity?
pain/discomfort/pressure Delay becoming more activelebih
if you arejika
notanda
feeling well kurang
because of adisebabkan
temporary illness.
A Diagnosis/rawatan Delay becoming more active if you are not feeling well becausesihat
Tangguhkan untuk menjadi aktif berasa sakit yang sementara.
of a temporary illness.
in your chest duringbagi penyakit
activities jantung
of daily atau
living or angin
duringahmar,
physicalatau rasa sakit/tidak selesa/tekanan di
activity?
B A diagnosis of/treatment for high blood pressure (BP), or a restingfizikal?
dada anda semasa kegiatan kehidupan harian atau semasa aktiviti BP of 160/90 mmHg or higher? C Pening
C Dizzinessatauor pitam semasa
lightheadedness There arebeberapa
Terdapat several possible reasons
sebab yang for membuat
boleh feeling thisanda
way merasa
and many are not
seperti ini dan
C Dizziness
aktiviti
during fizikal or lightheadedness
physical activity ThereBefore
worrisome.
kebanyakannya are adalah
several possible
becoming
tidak morereasons
active,for
membimbangkan. feeling
consult a this
Sebelum way
health andprovider
care
menjadi many aretonot
lebih aktif,
B A diagnosis of/treatment for high blood pressure (BP), or a resting BP of 160/90 mmHg or higher?
B Diagnosis/rawatan bagi tekananduring
darah tinggi (BP),activity?
atau BP semasa rehat 160/90 mmHg atau lebih tinggi? PE
D ENCLGAI SRYAT
T IIH
OANR A N during physical activity worrisome.
dapatkan nasihatandBefore
penyedia becoming
khidmat more active,
penjagaan consult
fromauntuk
kesihatan health carethe
provider
mengenal pasti to
C Dizziness or lightheadedness physical D E C L A R AT I O N YA
YES
identify reasons minimize risk. Until then, refrain increasing intensity
C Dizziness or lightheadedness during physical activity? Sepanjang
To the best pengetahuan saya,all
of my knowledge, semua
of themaklumat yang
information sayasupplied
I have berikan dalam
on thissoal selidik ini adalah
questionnaire betul.
is correct. of youridentify
sebabnya dan reasons
physical activity.and minimize
mengurangkan risiko. risk. Until then,
Sementara refrain from
itu, jangan increasing the intensity
meningkatkan
C Pening
D Shortnessatau
of pitam
breathsemasa
at rest?aktiviti fizikal*? To the best of my knowledge, all of the information I have supplied on this questionnaire is correct. YES intensiti
of aktiviti fizikal anda.
your physical activity.
If my health
Sekiranya changes,saya
kesihatan I willberubah,
complete thisakan
saya questionnaire again.soal selidik ini sekali lagi.
melengkapkan
D Shortness of breath at rest? If my health changes, I will complete this questionnaire again.
D Sesak
E Loss ofnafas semasa rehat?
consciousness/fainting for any reason? D Shortness of breath at rest If you have asthma and this is relieved with medication, light to moderate
Saya jawab TIDAK
I answered kepada
NO to semua soalan
all questions on di m.s. 11
Page ISaya jawab YAYES
answered kepada sebarang
to any soalan
question ondiPage
m.s. 11 D Sesak nafas semasa rehat? Jika anda menghidap penyakit semput dan memerlukan ubat untuk melegakan-
E Loss of consciousness/fainting for any reason? D Shortness of breath at rest If you
physical have asthma
activity and this is relieved with medication, light to moderate
E Pengsan/tidak I answered NO to all questions on Page 1 I answered YES to any question on Page 1 nya, aktiviti fizikalisyang
safe. ringan
If your shortness
hingga of breath
sederhana is not selamat.
adalah relieved with
Jika medication,
sesak nafas
F Concussion? sedarkan diri atas sebarang sebab? YES physical activity is safe. If your ubat,
shortness of breath is not relieved with medication,
YA consult
anda tidaka doctor.
dapat dilegakan dengan dapatkan nasihat doktor.
F Concussion? Tandakan
Check kotak
the box di bawah
below yang berkenaan
that applies to you: dengan anda; YES consult a doctor.
F Gegaran otak? Check the box below that applies to you:
2 Do you currently have pain or swelling in any part of your body (such as from an injury, ISaya
havetelah mendapatkan
consulted nasihat
a health care penyedia
providerkhidmat penjagaan
or Qualified kesihatan
Exercise atau
Professional
Pakar
haveSenaman
2 acute
Do you flare-up of arthritis,
currently have pain oror
back pain) in
swelling that
anyaffects
part of your
yourability
bodyto be physically
(such as from anactive?
injury, I(QEP) who hasBerkelayakan
consulted recommended yang
a health care mengesyorkan
provider
that I become agar saya
or Qualified
more menjadi
Exercise
physically lebih aktif
Professional
active. E Loss of consciousness/
E Pengsan/tidak sedarkan diri Before
Sebelum becoming more aktif,
menjadi lebih active, consult anasihat
dapatkan doctordoktor
to identify
untukreasons
mengenalandpasti
2 Adakah anda mengalami sakit atau bengkak di mana-mana bahagian tubuh anda (seperti daripada Tandatangan
Sign and datedan
theisikan tarikh Deklarasi secara who
fizikal.has recommended that I become more physically active. Before
acute flare-upkejadian
of arthritis, or back Declaration below (QEP) E Loss
fainting
atas forof
sebarang
consciousness/
any reason
sebab? minimize risk.becoming
Once
danyou
more active, consult
are medically a doctor
cleared, consult to identify reasons
a Qualified
disahkan Exercise
and
kecederaan, radang sendipain)
akut,that
atauaffects
sakit your ability yang
belakang), to bemenjejas
physicallykeupayaan
active? anda untuk Sign
di and date the Declaration below
bawah ISaya selesa menjadiwith
am comfortable lebihbecoming
aktif secaramore
fizikalphysically
sendiri tanpa mendapatkan
active on my own nasihat
fainting for any reason
sebab-sebabnya
minimize risk.
mengurangkan
Once you are
risiko.
medically
Setelah
cleared,
anda
consult a
sihat oleh
Qualified Exercise
menajdi aktif secara fizikal? penyedia
Iwithout khidmat penjagaan
am comfortable
consulting with kesihatan
becoming
a health moreatauphysically
care provider QEP.
or QEP. active on my own
Professional (QEP)nasihat
doktor, dapatkan about Pakar
types Senaman
of physicalBerkelayakan
activity suitable
(QEP)fortentang
your condition.
jenis aktiviti
3 Has a health care provider told you that you should avoid or modify certain types of physical activity? YES
YA Professional (QEP)keadaan
about types of physical activity suitable for your condition.
without consulting a health care provider or QEP. fizikal yang sesuai untuk anda.
3 Has a health care provider told you that you should avoid or modify certain types of physical activity? YES
3 Pernahkah seorang penyedia khidmat penjagaan kesihatan memberitahu anda bahawa anda harus
4 mengelakkan
Do you have any atauother
mengubahsuai
medical or beberapa jenis aktiviti
physical condition (suchfizikal*?
as diabetes, cancer, osteoporosis,
F Concussion A concussion
otak is an injury to the brain that requires time to recover.
masaIncreasing
4 asthma, spinalany
Do you have cord injury)
other that may
medical affect your
or physical ability (such
condition to beas physically
diabetes,active?
cancer, osteoporosis, Nama
Name (+ Nama
Name of
of Ibu Bapa/Penjagaifjika
Parent/Guardian berkenaan)
applicable) [Sila print]
[Please cetak] Tandatangan
Signature (or(atau Tandatangan
Signature Ibu Bapa/Penjaga
of Parent/Guardian jika berkenaan) Tarikh
if applicable) Date ofLahir
Birth F Gegaran otak? Gegaran adalah kecederaan pada otak yang memerlukan untuk
4 Adakah anda menghidap sebarang masalah kesihatan atau fizikal lain (seperti kencing manis, barah,
asthma, spinal cord injury) that may affect your ability to be physically active?
Name (+ Name of Parent/Guardian if applicable) [Please print] Signature (or Signature of Parent/Guardian if applicable) Date of Birth F Concussion pulih. A
physical concussion
activity while
Meningkatkan isaktiviti
an injury
still to the
experiencing
fizikal brain
ketika thatmengalami
symptoms
masih requires time
may worsen toyour
simptomrecover. Increasing
symptoms,
ini boleh
osteoporosis, semput, kecederaan saraf tunjang) yang boleh menjejas keupayaan anda untuk aktif YES
YA physical
memburukkan
lengthen activity while
and still
lagi simptom,
your recovery, experiencing
memanjangkan
increase symptoms
for anothermay
your riskpemulihan, dan worsen your
meningkatkan
concussion. symptoms,
risiko
A health
secara fizikal? YES lengthen your
NO to all questions: go to Page 2 – ASSESS YOUR CURRENT PHYSICAL ACTIVITY Tarikh
Date Emel
Email (terpulang)
(optional) Telefon (terpulang)
Telephone (optional)
andaprovider
care mendapat will let recovery,
gegaran otak and
you know sekali
when increase
lagi. canyour
you Penyedia risk
start for another
khidmat
becoming moreconcussion.
penjagaanphysically A health
kesihatan
Date Email (optional) Telephone (optional) akan memberitahu
care
and provider anda bila
willExercise
let youanda
knowboleh
when mula
you menjadistartlebih
can can aktifyou
becoming secara
more fizikal,
physically
NO to allkepada
TIDAK questions: go to Page 2 – ASSESS YOUR CURRENT PHYSICAL ACTIVITY
semua soalan: pergi ke Muka Surat 2 – MENILAI AKTIVITI FIZIKAL
active,
dan Pakar
a Qualified
Senaman Berkelayakan
Professional
(QEP)
(QEP)
boleh membantu
help get
anda untuk
started.
Dengan perancangan dan sokongan, anda the
boleh nikmati active, and a Qualified Exercise Professional (QEP) can help get bermula.
you started.
ANDA PADA MASA INI With planning and support you can enjoy benefits ofmanfaat daripada
becoming menjadi lebih
more physically aktif
active. secara
A QEP canfizikal.
help.
YES to any question: go to Reference Document – ADVICE ON WHAT TO DO IF YOU HAVE A YES RESPONSE Seorang QEP boleh
With planning membantu.
and support you can enjoy the benefits of becoming more physically active. A QEP can help.
After reading
Selepas the ADVICE
membaca NASIHATfor yourjawapan
untuk YES response,
YA anda,go to Page
pergi 2 of Surat
the 2 Soal
YES
YA to anymana-mana
kepada question: go to Reference
soalan: pergi ke Document – ADVICE
Dokumen Rujukan ON WHAT
– NASIHAT TO DO IFAPA
TENTANG YOU HAVEHARUS
YANG A YES DILAKUKAN
RESPONSE Tandakan
Check thiskotak
Check this box ifini jikawould
box if you
you anda like
would ingin
like
tomendapatkan
to consult a QEPnasihat
consult a QEP about seorang
about becomingQEP
becoming berkenaan
more
more menjadi
physically
physically
active. lebih aktif secara fizikal.
active. Get After
Active reading the ADVICE
Questionnaire for your YES response, goketoMuka
Page 2 of the
(Soal selidik yangquestionnaire
(This completed dilengkapkanwillini help
akan the
membantu
QEP getQEP mengenali
to know anda
you and dan memahami
understand keperluan anda.)
your needs.) Selidik Hidup Aktif - MENILAI AKTIVITI
– ASSESS FIZIKAL
YOUR ANDA PADA
CURRENT MASA
PHYSICAL INI
ACTIVITY
JIKA ANDA MEMPUNYAI JAWAPAN YA (This completed questionnaire will help the QEP get to know you and understand your needs.) Get Active Questionnaire – ASSESS YOUR CURRENT PHYSICAL ACTIVITY
© Canadian Society for Exercise Physiology, 2017. All rights reserved. PAGE 1 OF 2
Persatuan Society
© Canadian Kanadafor
untuk Fisiologi
Exercise Senaman,
Physiology, 2017.
2017. AllSemua hak terpelihara.
rights reserved. PAGE 1 OF42
MUKA SURAT 1 DARIPADA © Persatuan Kanada for
Canadian Society untuk Fisiologi
Exercise Senaman,
Physiology, 2017.
2017. AllSemua hak terpelihara.
rights reserved. MUKA SURAT 2 PAGE 2 OF 2
DARIPADA 4 Persatuan Society
© Canadian Kanadafor
untuk Fisiologi
Exercise Senaman,
Physiology, 2017.
2017. AllSemua hak terpelihara.
rights reserved. MUKA SURAT 3PAGE 1 OF 24
DARIPADA
© Canadian Society for Exercise Physiology, 2017. All rights reserved. PAGE 2 OF 2 © Canadian Society for Exercise Physiology, 2017. All rights reserved. PAGE 1 OF 2
© Canadian Society for Exercise Physiology, 2017. All rights reserved. PAGE 1 OF 2 © Canadian Society for Exercise Physiology, 2017. All rights reserved. PAGE 1 OF 2