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San Juan Island Fitness Community HEALTHY WEIGHT Challenge “CHWC”
Personal Cardio and Strength Training Program Questionnaire
NAME___________________________________________________________
Did you talk with you doctor about your increaseing daily exercise?
What are his recommendations about this challenge physically for you?
Are you willing to journal your physical activities?
Do you have any physical limitations?
________________________________________________________________
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What time do you get up in the morning?
Do you know your resting heart rate?
Do you know your cardio training and fat burning heart rate range is?
What time of day do you have the MOST energy?
what do you do with the energy?
what time of day do you have the LEAST energy?
what do you do at this time?
What would you change in your day?
what time do you laydown for the night?
Is working out generally "boring" for you?
Does working out creat energy or deplete energy?
CARDIO TRAINING:
Do you currently cardio train?
How often currently (per week)? 1day_____ 2days_____ 3days_____ 4days_____ 5days_____ 6days_____ 7days_____
What DAYS do you cardio train? Mon_____ Tues_____ Wed_____ Thur_____ Fri_____ Sat_____ Sun_____
What time duration? 10 to 30 min_____ 30 to 45 min_____ 20 to 60 min_____ other______________
Are you willing to incorporate a NEW program?
When is the best time for COMMITTED work outs?
early morning (before 8)______ morning______
early afternoon (before 12)______ afternoon______
early evening (before5) ______ evening______ late evening (after 8)______
How often willing to cardio train (per week)? 1day_____ 2days_____ 3days_____ 4days_____ 5days_____ 6days_____ 7days_____
What DAYS willing to cardio train? Mon_____ Tues_____ Wed_____ Thur_____ Fri_____ Sat_____ Sun_____
What time willing to duration? 10 to 30 min_____ 30 to 45 min_____ 20 to 60 min_____ other______________
What cardio activities do you enjoy and ARE WILLING TO ADD?
aerobics______ bicycling road______ bicycling off road______ elliptical machines______ jump rope______ power walking______ rowing______
yoga______ running______ stair climbing______ swimming______ court sports______ kick boxing______ trail walking/hiking______ pilates______
paddling______ other______
What cardio activities WILL YOU NOT DO?
aerobics______ bicycling road______ bicycling off road______ elliptical machines______ jump rope______ power walking______ rowing______
yoga______ running______ stair climbing______ swimming______ court sports______ kick boxing______ trail walking/hiking______ pilates______
paddling______ other______
What do you normally eat before a work out?
How much time before?
What do you normally eat after a workout?
How much time after?
Do you do events like walk-a-thons, marathons, triathlons or other?
Would you like to train for an upcoming event?
Do you know which event?
What was the last activity you did?
How often do you do this activity?
Do you prefer to work out alone?
STRENGTH TRAINING:
Do you currently strength train?
How often currently strength train (per week)? 1day_____ 2days_____ 3days_____ 4days_____ 5days_____ 6days_____ 7days_____
What DAYS do you strength train? Mon_____ Tues_____ Wed_____ Thur_____ Fri_____ Sat_____ Sun_____
What time duration? 10 to 30 min_____ 30 to 45 min_____ 20 to 60 min_____ other______________
Are you willing to incorporate a NEW program?
How often willing to strength train (per week)? 1day_____ 2days_____ 3days_____ 4days_____ 5days_____ 6days_____ 7days_____
What DAYS willing to strength train? Mon_____ Tues_____ Wed_____ Thur_____ Fri_____ Sat_____ Sun_____
What time willing to duration? 10 to 30 min_____ 30 to 45 min_____ 20 to 60 min_____ other______________
If you are weight training, indicate what type of equipment you are using.
None
Free Weights
Machines
Small Home Equipment
Other
What muscles fatigue quickly while weight training? Circle all that apply.
Abdominals
Hamstrings
Quadriceps (thighs)
Calves
Chest
Neck
Upper back
Mid back
Low back
Shoulders
Biceps
Triceps