Personal Facts

Personal Facts

September 2nd

December 19th

Name: ___________________

Name: ___________________

Date: ___________________

Date: ___________________

Height: ___________________

Height: ___________________

Weight (optional): ___________

Weight (optional): ___________

BMI: ___________________

BMI: ___________________

Target Heart Rate: _________

Target Heart Rate: _________

My Fitness Goals

Steps to Achieve my Goals

1. Short-term (1 week):

1.

Short-term:

2. Medium-term (1 month):

2.

Medium-term:

3. Long-term (lifetime):

3.

Long-term:

Nutritional Habits - Sample

Date: September 2 Mon Tue Wed Thurs Fri Sat Sun

Nutritional Habits
In this section you will be required to
record and analyze your food intake
for 5 consecutive days.

Time
9:00 am
(breakfast)

Food/Beverage
Milk
Instant Oatmeal
Mandarin Orange

Amount
1 cup
1 pack
1 whole

Calories
100
160
64

10:30 am
(snack)

Peach
Cottage Cheese

1 whole
1 cup

33
162

12:00 pm
(lunch)

Bread
Turkey Breast
Cheddar Cheese
Alfalfa Sprouts
Banana
Peanut Butter

2 slices
2 oz.
1 in. cube
1 cup
1 whole
2 tbsp

136
50
110
4
120
190

Tilapia Fish
Brown Rice
Salad
Salad Dressing
Broccoli
Milk

5 oz.
1 cup
1 cup
2 tbsp
1 cup
1 cup

138
170
40
30
7
100

Totals:

1614

1:30 pm
(snack)

5:00 pm
(dinner)

7:30 pm
(snack)

Weight: 125lbs
Notes
Maple kind

Im full

Whole wheat
Fat Free
Delicious!

Mixed vegies

Check off Cups of Water:

Physical Activity
Phys Ed Basketball

How I felt today:

Minutes
38

Fabulous

Great

Intensity L/M/H
M

Okay

Calories Burned
300

Not so Good

Notes:
Today after eating really well and exercising in gym class I felt like I had more energy to
do stuff at night. Tomorrow I hope to add to my exercise by walking home after school.

Nutritional Habits
Date: _____
Time

Mon

Tue

Wed

Thurs

Food/Beverage

Fri

Sat

Amount

Sun

Weight:_____

Calories

Notes

Totals:
Check off Cups of Water:
Physical Activity

How I felt today:

Minutes

Fabulous

Great

Intensity L/M/H

Okay

Calories Burned

Not so Good

Notes: _________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

Exercise Diary
Date

Physical Activity Minutes

Distance

Sets & Reps

Intensity

Feelings before/after

Reflections

Date: ____________

Here you will record items such as reminders,

feelings after working out or eating, and
factors that influenced your fitness.

__________________________________

Date: ____________

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Exercise Diary - Sample

Exercise Diary

Physical
Activity

Date

In this section you will be required to

record and analyze your activity for at
least 5 consecutive days.

09/02

09/03

09/04

09/05

09/06

Basketball
Walk

Minutes

38
15

Distance

Sets
&
Reps

Intensity

High
Low

Feelings
before/
after
Tired
before,
energized
after

Heart Rate

Steps Reached

September 8

September 9

September 18

September 16

September 25

September 25

October 9

October 7

November 13

November 20

November 18 -

November 28

November 21 -

December 2 -

November 30

December 15

December 1 -

December 16

December 15

December 18 -

December 16
December 18 -