EXERCISE  PLAN

1 MY REASONS
 I have high blood pressure, and want better control on fewer medicines.
 I have diabetes and don't want to take insulin.
 I have high blood sugars and don't want to develop "full blown diabetes".
 I have a family history and want to minimize my chances of developing problems.
 I want to lower my risk of developing heart disease or having a stroke.
 I want to minimize my chances of developing arthritis or similar problems.
 I want to look better.
 I want to feel better.
 I feel my social or job status will improve.
 Please list your own personal reasons:

 

2  WHAT  I  ENJOY  DOING

  Walking                      Jogging                      Bicycling                      Swimming
  Tennis                        Racquetball                  Handball                     Basketball
 Volleyball                   Weight Lifting             Other

3  HOW MUCH TIME CAN YOU DEVOTE TO YOUR PROGRAM

____ minutes a day, ____ days each week

4  OTHER  FACTORS

  I enjoy exercising with a partner
  I enjoy exercising in a group situation
  I would like to join a health club or have a personal trainer.
  I have a treadmill at home
  I have an exercise bike or other equipment at home
  I have a mall or other indoor facility available nearby for walking, particularly in inclement weather.
  I have a swimming pool available at home or in my area

5  THE FOLLOWING MAKES A  PROGRAM  MORE DIFFICULT

  I have difficulty traveling to places to exercise
  I have financial limitations in regards to health clubs, home treadmills, etc.
  I live in a rural area, and traveling to a facility is difficult
  Physical limitations (please explain):

  ©COPY;1997 HeartPoint    Updated April 18,2000.



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