Part 1. Clinical Safety and Symptoms (Red Flag Triage)

Q1. Time Since Event: When was your most recent heart event, stroke, or major surgery?

1. < 1 month ago

2. 1–3 months ago

3. 3–6 months ago

4. 6+ months ago

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Q2. Symptom During Activity: Do you experience chest tightness, irregular heartbeats, or significant shortness of breath during light daily activity (e.g., getting dressed)?

1. Yes, frequently

2. Yes, sometimes

3. Rarely

4. No, never

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Q3. Blood Pressure Status: What is your usual blood pressure range (as confirmed by your doctor)?

1. > 160/100 mmHg

2. 140–159/90 mmHg

3. 120–139/85 mmHg

4. < 120/80 mmHg

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Q4 Orthostatic Dizziness: Do you feel faint or dizzy when changing positions (e.g., standing up quickly from a chair)?

1. Yes, often

2. Yes, sometimes

3. Rarely

4. No, never

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Part 2. Functional Capacity and Movement Barriers (Current Baseline)

Q5. Walking Endurance: Can you walk unaided for 10 consecutive minutes (at a gentle pace) without needing to stop and rest?

1. No, I must rest

2. Yes, but I feel significant fatigue

3. Yes, with mild effort

4. Yes, easily and comfortably

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Q6. Balance & Stability: Can you maintain balance while standing (without holding onto anything) for 30 seconds? (Crucial for stroke recovery)

1. No, I feel unsteady

2. Yes, but with intense focus

3. Yes, with mild unsteadiness

4. Yes, easily and securely

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Q7. Physical Barriers: Does joint pain, muscle weakness, or lingering neuropathy (after stroke) prevent you from attempting light movement?

1. Yes, it stops me completely

2. Yes, it limits me significantly

3. Sometimes, but I push through

4. No, it is not a major barrier

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Part 3. Mindset and Behavioral Readiness (Adherence Potential)

Q7. Safety Knowledge: Are you confident you know your doctor-approved safe heart rate zone for exercise?

1. No, I have no idea

2. I have a rough idea

3. I know and track it occasionally

4. I know and track it consistently

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Your Next Step: Unlock Your Safe Movement Blueprint

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