Phase six of eight 66% Medical Questionnaire 6 – Heart/Vascular Problems Family Is your mother older than 50 years? * Yes No Is your father older than 50 years? * Yes No Do you have immediate family who have suffered from a heart attack or stroke? * Yes No Age and Weight Are you younger than 50 years? * Yes No Do you have a normal weight (BMI less than 28)? * Yes No Power Supply Do you eat mostly vegetables? * Yes No Do you eat at least 3 portions of fruit daily? * Yes No Do you eat fish at least twice a week? * Yes No Do you consume low-saturated lipids (in sausages, cheese, butter and lard)? * Yes No Physical Fitness Do you feel fit? * Yes No Do you get 40 min or more of activity daily e.g. walking, cycling? * Yes No Can you easily walk up flights of stairs without puffing? * Yes No Can you walk without any pain in your legs? * Yes No Do you experience pain in the chest or left arm after exercise? * Yes No Other Risk Factors Do you have a normal blood pressure? * Yes No Do you have a normal blood lipids values? * Yes No Do you suffer from diabete Mellitus? * Yes No Do you suffer from narrowing of the coronary artery? * Yes No Do you suffer from bleeding disorders? * Yes No Do you have a stress-free life? * Yes No Do you smoke? * Yes No Do you take contraceptive pills? * Yes No
