Assessment Form for Mandie
PAGE CONTENTS
First Name: Mandie
Gender: Female
Age: 26
Height: 5 feet, 6 inches
Weight: 212 pounds
MEDICAL HISTORY
1.
| YES | NO | � |
| � | X | Has your doctor ever said you have heart trouble? |
| � | X | Do you frequently have pains in your heart and chest? |
| � | X | Do you often feel faint or have spells of severe dizziness? |
| � | X | Has a doctor ever said your blood pressure was too high? |
| � | X | Are you over age 65 and unaccustomed to vigorous exercise? |
| � | X | Are you pregnant? |
| � | X | Do you have any of the following conditions?
|
| � | X | Are you taking any medications that could affect your capabilities and levels of exercise? |
| � | X | Is there another health reason not mentioned here why you should not follow an exercise program? |
2. What daily medications and vitamins do you take? None
3. Do any blood relatives have diabetes, heart trouble or high blood pressure?Yes
4. If yes, please specify: Diabetes
5. Do you drink alcohol? Yes If yes, how often? 2 times a week
6. List any food allergies: Penicillin
7. List foods you dislike: �
8. List foods you crave: Chocolate, peanut butter
9. What do you typically snack on? Sweets, candy, ice cream, buttered popcorn
10. Describe how often snack and when: Three to four times a day, while driving and at home at night
11. Describe your mood and/or situation when you snack: Bored, nervous, angry, PMS, depressed, lonely, frustrated, social situations, when cooking, while watching TV
12. What do you attribute your weight problems to? Bad snacking habits; high fat diet; using food as therapy; poor meal planning; eating when not hungry; lack of self-control
EXERCISE HISTORY
13. Have you been exercising regularly (minimum two times per week) for at least the past eight weeks? No
14. If yes, briefly describe your routine:
15. How many days per week can you realistically devote to exercise? Three to four
16. How many minutes can you realistically devote per exercise session?One hour
17. What physical activities are you interested in doing and have easy access to? Street biking, stationary bike, walking, plan to rejoin a gym
18. What is your resting heart rate? 78 beats per minute
(To determine resting heart rate, get into a sitting position. Place two fingers on your wrist and feel for your pulse. Count the number of pulses in 30 seconds.)
19. Provide the following measurements: Waist 40; Hip 45
20. What is your waist-to-hip ratio? .88
21. If female, what is your dress size? 18
22 . If male, what is your pants size at waist?
23. What is your primary reason(s) for participating in an exercise and nutrition program? My body does not look or function as it was meant to; taking care of your body shows you respect your life. I need more energy, so weighing less will make me feel better, look better and improve my self esteem.
DIET HISTORY
| Typical Breakfast | Typical Lunch | Typical Dinner |
| Lance peanut butter crackers or Tastykakes, soda | Hoagie or tuna sandwich, chips or fries | 1 serving of white meat potatoes, bread |
| Snack | Snack | Snack |
| Candy | Candy | Buttered popcorn, ice cream |
Hello, Mandie! First of all, I think it’s great that you are taking these steps to improve your health and physical fitness. You seem to understand why it’s important for you to make changes in your lifestyle. Remember, the key to making these changes permanently is to integrate healthy eating habits along with regular exercise into your day-to-day schedule.
You need to commit to a plan that is realistic and suitable, so that you don’t fall into a stop-and-start pattern that doesn’t produce the desired results. So think long term – rather than be overzealous at the start, adopt a mindset that says “I’m in this for the long haul. I’m going to start slow, stay with the plan, and see results little by little.” Then your goals will be met!
Your Program
Focus on cardiovascular exercise — While addressing three core components of fitness — cardiovascular, muscular and flexibility –your program will emphasize cardiovascular exercises, such as walking, jogging, stationary cycling, stepping and rowing. These exercises are imperative for weight loss and overall health.
Cardiovascular Exercise:
- Choose one or two forms of exercise per session — walking, bicycling, stepping, or group aerobic classes.
- Frequency — three times per week.
- Amount — 45 minutes total.
Target heart rate — 136 to 166 beats per minute. Exercise at intensity levels that get your heart rate into its target heart rate zone.
Warm up and cool down — Start exercising gradually to warm-up the muscles prior to your workout. After your workout, gradually decrease the pace to cool-down your body. Never start or stop exercising abruptly.
Vary your exercise — To help you stay motivated and to challenge your body in different ways, try to vary the form of exercises you do. For instance, you may want to jog on Monday, bicycle on Wednesday, and step on Friday.
Muscular Fitness Exercise:
1. Pushups – After your cardiovascular workout, it’s time to do some toning and strengthening work. The first exercise to perform is the pushup. Old-fashioned, but effective pushups are a terrific and easy way to strengthen and tone the pectoral (chest) muscles as well as the triceps (back of arms) and deltoids (shoulders). This exercise doesn’t require equipment; instead, you use your body weight for resistance. Below is a description of the modified pushup:
Traditional Pushup – Lie face down on the floor with your hands at shoulder level, your palms flat on the floor slightly more than shoulder width apart, and your toes tucked under. Keeping your body parallel with the floor, straighten your arms while exhaling. Then lower your body again until it practically touches the floor. Do as many as you can, making sure to follow proper form. Try to add one or two repetitions each week.
Modified Pushup – A less challenging variation involves placing your knees on the floor so that only your upper body is providing the resistance. Be sure to keep your back flat during the movement.
2. Abdominal curls: Now it?s time to tighten the tummy! The abdominal curl, also known as the abdominal crunch, is the best exercise for strengthening and toning the abdominal muscles that surround your tummy. Abdominal curls are modified sit-ups in which you raise your shoulders slightly off the ground while keeping your legs bent and your feet flat on the floor. Below is a description of the basic curl:
Basic curl – Lie on the floor with your knees bent and your feet 12 inches to 18 inches from the buttocks. Lightly clasp your hands behind your head with your elbows wide open. Next, press your lower back into the floor, and lift your upper back off the floor while keeping your eyes focused on the ceiling. Be careful not to pull on your neck. Then return slowly to the floor. Start with one set of 10 to 15 repetitions every other day. Try to add one or two repetitions each week until you reach 40.
Flexibility Exercise:
Perform the Basic 10 Stretches – Always end your workout with stretching. Stretching is a great way to both increase your flexibility and relax your muscles.
Do not bounce when you stretch. Instead, hold each stretch for 10-30 seconds to the point of mild discomfort or where you “feel” the stretch. The muscles should be stretched so that the pull is felt in the center of the muscle, not at the joints. Take it slow, relaxing and exhaling as you go into a stretch, then breathing normally.
