Peer‑Reviewed Publications
Publications developed for the official PAR‑Q+ and ePARmed‑X+ tools
Scope & citation guidance |
Systematic reviews (APNM 2011;36(S1)) |
PAR‑Q+ & ePARmed‑X+ instrument papers |
Summary papers |
Key early PAR‑Q papers
Scope of evidence (important — read before citing)
The peer‑reviewed systematic reviews and subsequent papers listed on this page were produced as part of an evidence‑based consensus process used to develop, describe, evaluate, and/or translate the new PAR‑Q+ and ePARmed‑X+ pre-participation clearance and risk stratification strategy under the direction of the PAR‑Q+ Collaboration and its investigators.
This work (including the associated systematic reviews and knowledge-mobilization resources, published in various forums) was supported through diverse funding awarded to the PAR-Q+ Collaboration lead investigators: Dr. Darren Warburton, Dr. Shannon Bredin, Dr. Veronica Jamnik, Dr. Roy Shephard, and Dr. Norman Gledhill. The lead investigators secured funding from the Canadian Institutes of Health Research, the BC Ministry of Health, and the Public Health Agency of Canada to support this initiative. Additional laboratory-related funding was used to support the full initiative. Staff, trainees, and volunteers from across Canada, the United States, and the United Kingdom contributed to this work.
The special open-access series published in Applied Physiology, Nutrition, and Metabolism (APNM) was made possible by direct funding from Dr. Norman Gledhill and Dr. Veronica Jamnik (York University), who covered the full costs of open-access publication for the APNM special-issue article series. This open-access series would not have been made possible without Dr. Gledhill and Dr. Jamnik’s financial support.
Foundational publications related to the original and revised PAR-Q are also highlighted below.
These PAR-Q/PAR-Q+ associated publications do not evaluate, validate, compare, or endorse any third‑party screening questionnaire or alternative proprietary pre‑participation screening and/or risk stratification process (including modified “PAR‑Q‑like” forms).
What these papers support
- The evidence base and clinical decision recommendations implemented in the official PAR‑Q+ and ePARmed‑X+ strategy.
What these papers do NOT support
- Claims that any other screening tool or modified questionnaire has been validated, examined, endorsed, or approved by this review series, consensus process, or by the PAR‑Q+ Collaboration.
Existence and Ongoing Updates of the PAR-Q+ and ePARmed-X+
- The PAR-Q+ and ePARmed-X+ are maintained by the PAR-Q+ Collaboration and are reviewed by an international panel on a recurring schedule (at least every six months). Official updates are published on this website.
- Claims that the PAR-Q+ and/or ePARmed-X+ have been “replaced,” “retired,” or are no longer maintained are incorrect. To verify the current official version, use the forms and publications linked on eparmedx.com.
Permitted use (to ensure accurate representation):
These publications may be cited as general background information related to condition-specific considerations for physical activity participation. The publications were developed through an international evidence-based and consensus panel approved process associated with the PAR-Q+ and ePARmed-X+ pre-participation screening and risk-stratification framework and should not be represented as providing validation, endorsement, or formal support for other screening questionnaires or tools.
How to cite correctly (examples)
✓ Appropriate: “We use the official PAR‑Q+ and/or ePARmed‑X+ tools (PAR‑Q+ Collaboration) and cite the associated peer‑reviewed publications listed here.”
✓ Appropriate: “We reference condition-specific systematic reviews as background literature to inform general considerations related to physical activity participation.”
✗ Not Recommended: “Describing a separate screening questionnaire as having been validated or directly supported by publications developed specifically and solely for the PAR-Q+ and ePARmed-X+.”
The PAR-Q+–related publications may be referenced to support general understanding of condition-specific considerations for physical activity. Publications developed as part of the PAR-Q+ and ePARmed-X+ initiative are most appropriately cited in relation to those tools. If you have any questions, please contact us via the Contact page on this website.
Systematic Reviews (Appl. Physiol. Nutr. Metab. 2011;36(S1))
Section scope note: These condition-specific evidence reviews were commissioned to inform the development of the PAR-Q+ and ePARmed-X+ forms and the associated pre-participation screening and risk-stratification framework. The 2011 article series was not designed or intended to serve as validation or support for other screening questionnaires developed outside this evidence-based and consensus-driven process.
- Charlesworth S, Foulds H, Burr J, Bredin SSD. Evidence-based risk assessment and recommendations for physical activity clearance: pregnancy. Appl. Physiol. Nutr. Metab. 2011;36(S1):S33-S48.
- Chilibeck P, Vatanparast H, Cornish SM, Charlesworth S. Evidence-based risk assessment and recommendations for physical activity clearance: arthritis, low back pain & osteoporosis. Appl. Physiol. Nutr. Metab. 2011;36(S1):S49-S79.
- Eves ND, Davidson WJ. Evidence-based risk assessment and recommendations for physical activity clearance: respiratory disease. Appl. Physiol. Nutr. Metab. 2011;36(S1):S80-S100.
- Goodman JM, Thomas SG, Burr J. Evidence-based risk assessment and recommendations for physical activity and exercise testing. Appl. Physiol. Nutr. Metab. 2011;36(S1):S14-S32.
- Jones LW. Evidence-based risk assessment and recommendations for physical activity: cancer. Appl. Physiol. Nutr. Metab. 2011;36(S1):S101-S112.
- Rhodes RE, Temple VA, Tuokko HA. Evidence-based risk assessment and recommendations for physical activity clearance: cognitive and psychological conditions. Appl. Physiol. Nutr. Metab. 2011;36(S1):S113–S153.
- Riddell MC, Burr J. Evidence-based risk assessment and recommendations for physical activity clearance: metabolic disorders and related co-morbidities. Appl. Physiol. Nutr. Metab. 2011;36(S1):S154-S189.
- Thomas SG, Goodman JM, Burr J. Evidence-based risk assessment and recommendations for physical activity clearance: established cardiovascular disease. Appl. Physiol. Nutr. Metab. 2011;36(S1):S190-S213.
- Warburton DER, Bredin SSD, Charlesworth S, Foulds H, McKenzie DC, Shephard RJ. Evidence-based risk recommendations for best practices in the training of qualified exercise professionals working with clinical populations. Appl. Physiol. Nutr. Metab. 2011;36(S1):S232-S265.
- Zehr P. Evidence-based risk assessment and recommendations for physical activity clearance: stroke and spinal cord injury. Appl. Physiol. Nutr. Metab. 2011;36(S1):S214-S231.
Scope note: Evidence reviews supporting PAR‑Q+ / ePARmed‑X+ recommendations; not validation or support of other tools.
The New PAR‑Q+ and ePARmed‑X+
Section scope note: These papers describe and/or evaluate the official PAR‑Q+ and ePARmed‑X+ tools themselves.
- Bredin SS, Gledhill N, Jamnik VK, Warburton DE. PAR‑Q+ and ePARmed‑X+: New risk stratification and physical activity clearance strategy for physicians and patients alike. Canadian Family Physician. 2013;59(3):273-7.
- Jamnik VJ, Warburton DER, Makarski J, McKenzie DC, Shephard RJ, Stone J, Gledhill N. Enhancing the effectiveness of clearance for physical activity participation; background and overall process. Appl. Physiol. Nutr. Metab. 2011;36(S1):S3-S13.
- Warburton DER, Bredin SSD, Jamnik V, Gledhill N. Validation of the PAR‑Q+ and ePARmed‑X+. Health & Fitness Journal of Canada. 2011;4(2):38-46.
- Warburton DER, Jamnik VK, Bredin SSD, Burr J, Charlesworth S, Chilibeck P, Eves N, Foulds H, Goodman J, Jones L, McKenzie DC, Rhodes R, Riddell M, Shephard RJ, Stone J, Thomas S, Zehr P, Gledhill N. Executive summary: the 2011 Physical Activity Readiness Questionnaire for Everyone (PAR‑Q+) and the Electronic Physical Activity Readiness Medical Examination (ePARmed‑X+). Health & Fitness Journal of Canada. 2011;4(2):24-25.
- Warburton DER, Jamnik VK, Bredin SSD, Gledhill N. Enhancing the effectiveness of the PAR‑Q and PARmed‑X screening for physical activity participation. Journal of Physical Activity and Health. 2010;7(Suppl 3):S338-S340.
- Warburton DER, Gledhill N, Jamnik VK, Bredin SSD, McKenzie DC, Stone J, Charlesworth S, Shephard RJ. Evidence-based risk assessment and recommendations for physical activity clearance: Consensus Document 2011. Appl. Physiol. Nutr. Metab. 2011;36(S1):S266-S298.
- Warburton DER, Jamnik VK, Bredin SSD, McKenzie DC, Stone J, Shephard RJ, Gledhill N. Evidence-based risk assessment and recommendations for physical activity clearance: an introduction. Appl. Physiol. Nutr. Metab. 2011;36(S1):S1-S2.
- Warburton DER, Jamnik VK, Bredin SSD, Gledhill N. The ePARmed‑X+ Physician Clearance Follow‑up. Health & Fitness Journal of Canada. 2014;7(2):35-38.
- Warburton DER, Jamnik VK, Bredin SSD, Gledhill N. The 2014 Physical Activity Readiness Questionnaire for Everyone (PAR‑Q+) and electronic Physical Activity Readiness Medical Examination (ePARmed‑X+). Health & Fitness Journal of Canada. 2014;7(1):80-83.
Summary Papers
Section scope note: These are summary/clinical interpretation papers related to risk assessment and clearance. They are not validation or support studies of third‑party questionnaires.
- Bredin SS, Foulds HJ, Burr JF, Charlesworth SA. Risk assessment for physical activity and exercise clearance: in pregnant women without contraindications. Can Fam Physician. 2013 May;59(5):515-7.
- Burr JF, Shephard RJ, Zehr EP. Physical activity after stroke and spinal cord injury: evidence-based recommendations on clearance for physical activity and exercise. Can Fam Physician. 2012 Nov;58(11):1236-9.
- Burr JF, Shephard RJ, Jones LW. Physical activity for cancer patients: clinical risk assessment for exercise clearance and prescription. Can Fam Physician. 2012 Sep;58(9):970-3.
- Burr JF, Davidson W, Shephard RJ, Eves N. Physical activity in chronic respiratory conditions: assessing risks for physical activity clearance and prescription. Can Fam Physician. 2012 Jul;58(7):761-4.
- Burr JF, Shephard RJ, Riddell MC. Physical activity in type 1 diabetes mellitus: assessing risks for physical activity clearance and prescription. Can Fam Physician. 2012 May;58(5):533-5.
- Burr J, Shephard R, Cornish S, Vatanparast H, Chilibeck P. Arthritis, osteoporosis, and low back pain: evidence-based clinical risk assessment for physical activity and exercise clearance. Can Fam Physician. 2012 Jan;58(1):59-62.
- Goodman J, Thomas S, Burr JF. Physical activity series: cardiovascular risks of physical activity in apparently healthy individuals: risk evaluation for exercise clearance and prescription. Can Fam Physician. 2013 Jan;59(1):46-9, e6-e10.
- Shephard R. J. (2015). Qualified Fitness and Exercise as Professionals and Exercise Prescription: Evolution of the PAR-Q and Canadian Aerobic Fitness Test. Journal of physical activity & health, 12(4), 454–461.
Key Early Papers Related to the PAR‑Q (Historical Background)
Section scope note: These papers relate to earlier PAR‑Q history.
- Bailey DA, Shephard RJ, Mirwald RL. Validation of a self-administered home test for cardio-respiratory fitness. Can. J. Appl. Sport Sci. 1976;1:67-78.
- Chisholm DM, Collis ML, Kulak LL, Davenport W, Gruber N. Physical activity readiness. British Columbia Medical Journal. 1975;17:375-378.
- Chisholm DM, Collis ML, Kulak LL, Davenport W, Gruber N, Stewart G. PAR-Q validation report: The evaluation of the self-administered pre-exercise screening questionnaire for adults. British Columbia Ministry of Health, 1978.
- Gledhill N. The revised PAR‑Q. York University, 2002.
- Shephard RJ. PAR‑Q, Canadian Home Fitness Test and exercise screening alternatives. Sports Medicine. 1988;5:185-195.
- Thomas S, Reading J, Shephard RJ. Revision of the Physical Activity Readiness Questionnaire (PAR‑Q). Canadian Journal of Sport Science. 1992;17:338-345.