| 1.
Are you 45 years old or older? |
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| 2.
Have you been inactive for the past 12 months? |
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| 3.
Has a blood relative has suffered heart disease? |
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| 4.
Do you have elevated cholesterol levels? |
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| 5.
Are you a Type II diabetic? |
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| 6.
Do you have high blood pressure? |
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| 7.
Are you dieting or fasting? |
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| 8.
Have you ever experienced chest pains when exercising? |
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| 9. Have you ever experienced chest pains when NOT exercising? |
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| 10. Do you feel dizzy / lose your balance / ever lost conciousness? |
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| 11. Do you suffer from any joint problems? |
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| 12. Do you take prescribed drugs for health reasons? |
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