Exercise Planning Form Template - Healthwise

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Exercise Planning Form
You can complete the highlighted fields on this form online and then print the form for easy reference. Only
text that is visible on the form is printed; scrolled text will not print. Any text you enter into these fields will be
cleared when you close the form; you cannot save it.
Bring this sheet with you when you visit your doctor. It can help you and your doctor plan your exercise
program.
A personal trainer or fitness expert can help you set your exercise goals.
Special tests I need before I begin an exercise program (if any):
My chronic health conditions:
Exercises to help with my chronic health conditions:
Should I change the time I take my medicines?
Should I take my pulse when I exercise? If so, what range (target heart rate) is best for me?
Exercises I should not do:
Community resources and contacts (like the local YMCA) that might be useful to me:
Personal supports (like family members or exercise partners) who might help me:
Other questions I have about starting an exercise program:
Warning signs I need to watch for:
Steps to get started:
1
Exercise Planning Form
You can complete the highlighted fields on this form online and then print the form for easy reference. Only
text that is visible on the form is printed; scrolled text will not print. Any text you enter into these fields will be
cleared when you close the form; you cannot save it.
Bring this sheet with you when you visit your doctor. It can help you and your doctor plan your exercise
program.
A personal trainer or fitness expert can help you set your exercise goals.
Special tests I need before I begin an exercise program (if any):
My chronic health conditions:
Exercises to help with my chronic health conditions:
Should I change the time I take my medicines?
Should I take my pulse when I exercise? If so, what range (target heart rate) is best for me?
Exercises I should not do:
Community resources and contacts (like the local YMCA) that might be useful to me:
Personal supports (like family members or exercise partners) who might help me:
Other questions I have about starting an exercise program:
Warning signs I need to watch for:
Steps to get started:
1
Exercise goals
Physical activities I enjoy:
Physical activities I would like to try:
In the beginning, my exercise program will be:
Aerobic exercises I will do (how often and how long):
Strength and balance exercises I will do (how often and how long):
Flexibility exercises I will do (how often):
Long-term goals: In the next 6 months I will:
1.
2.
3.
Short-term goals: In the next few weeks I will:
1.
2.
3.
As you reach your short-term goals, add new ones.
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Healthwise, Incorporated.
This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this
information.
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