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Exercise Planning Form


Exercise Planning Form

Setting goals

Bring this sheet with you when you visit your doctor. Working together, you can use this sheet to develop your exercise program.

Special tests I need before begin an exercise program (if any):

My chronic health conditions are:

Exercises to help with these conditions are:

Exercises I should not do include:

Community resources and contacts (like the local YMCA) that might be useful to me:

Community resource

Contact information

Personal supports (like family members or exercise partners) who might help me include:

Other questions I have about beginning an exercise program are:

Warning signs I need to watch for are:

Other questions I have about beginning an exercise program:

Steps to take to get started include:

Exercise goals

The three things I want to accomplish most by exercising are:

Physical activities I enjoy:

Physical activities I would like to try:

My initial exercise program will be:

Aerobic exercises I will do:

How often:_______________

How long:________________

Strength and balance exercises I will do:

How often:_______________

How long:________________

Flexibility exercises I will do:

How often:_______________

Credits

ByHealthwise Staff
Primary Medical ReviewerAdam Husney, MD - Family Medicine
Last RevisedJuly 11, 2011

eMedicineHealth Medical Reference from Healthwise

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