Exercise Planning FormCurrent as of: November 20, 2015 Author: Healthwise Staff Medical Review: Adam Husney, MD - Family Medicine |
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Exercise Planning FormSetting goalsBring 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 goalsThe 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:_______________ Current as of: November 20, 2015 Author: Healthwise Staff Medical Review: Adam Husney, MD - Family Medicine |
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