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:_______________
| Author: | Caroline Rea, RN, BS, MS | Last Updated: August 3, 2007 |
| Medical Review: | Caroline S. Rhoads, MD - Internal Medicine Matthew I. Kim, MD - Endocrinology & Metabolism | |
 | ||
| |