Assessment Form for Jim
First Name: Jim
Height: 6 feet, 0 inches
Weight: 185 pounds
|�||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?|
|�||�||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? Daily multi-vitamin, puravate, thermogenic support
3. Do any blood relatives have diabetes, heart trouble or high blood pressure?Yes
4. If yes, please specify: Parents – high blood pressure do to obesity, brother – diabetes due to birth defect
5. Please describe your typical daily food & beverage intake including snacks and amounts:
|Typical Breakfast||Typical Lunch||Typical Dinner|
|English muffin with butter
cereal with 2% milk
|2-3 pieces broailed chicken with sin
steamed vegetables with small amount of butter, salted with low fat dressing and cheese
|Chicken Caesar salad or Lean Cuisine frozen dinner|
|Typical Snack||Typical Snack||Typical Snack|
|n/a||Fruit||Popcorn – micro – with butter
6. How many meals do you eat out per week typically? five – lunches
7. What type of restaurants do you frequent? Broiled chicken and salad places
8. Do you drink alcohol? Yes If yes, how often? Very little – one to two mixed drinks every two weeks
9. List any food allergies: none
10. List foods you crave: Salt, potato chips, French fries
11. Describe your mood and/or situation when you snack: When I’m stressed
12. What do you attribute your weight problems to? Low self esteem
13. In the past, what ways have you tried to lose weight? Metabolife, and dexatrim
14. Have you been exercising regularly (minimum two times per week) for at least the past eight weeks? Yes
15. If yes, briefly describe your routine: Mon arms, 20 mins of cardio and abs, tues 45 mins walk uphill/downhill, wed legs 20 mins cardio and abs, thur 45 min walk up/down hill fri back/shoulders, 20 mins cardio and abs
16. How many days per week can you realistically devote to exercise? five
17. How many minutes can you realistically devote per exercise session? 60 minutes
18. What physical activities are you interested in doing and have easy access to? Hiking with my dog
19. What is your resting heart rate? 60 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.)
20. Provide the following measurements: Waist 32 inches; Hip 34 inches
21. What is your waist-to-hip ratio?
22. If female, what is your dress size? n/a
23. If male, what is your pants size at waist? 32
24. What is your primary reason(s) for participating in an exercise and nutrition program? To lose the last 20 pounds and tighten my stomach.
Welcome to the Four Get Fit program. Congratulations on your tremendous health and fitness accomplishments over the past year. I know how much work, effort and commitment you had to put forth in order to achieve those results. You truly are, and can continue to be, an inspiration to others who wish to make dramatic positive changes in their health.
Now let’s see if I can “fine tune” your exercise program so you can achieve all your fitness goals. First, I’m not sure I would recommend that you try to lose an additional 25 pounds, which you said you want to do. I believe that too much of that weight loss would come from your lean body mass, and that is not healthy. Besides, it lowers your metabolic rate, which means you would be burning fewer calories at rest — and that’s not what you want!
Instead of having a goal of a set number of pounds to lose, I recommend that your goal be to decrease your waist measurement at the belly button while increasing your chest size and arm size. If these numbers change, then we know you have lost body fat and increased lean body mass. Since you goal is also to firm up your muscles, these changes will indicate you are on the right track.
My plan for you is as follows: On Friday or Saturday of each week, send me a detailed log and journal of your exercise for the past seven days. The more information you provide, the better feedback I can give you.
- Perform five sessions per week, each at least 30 minutes in duration. If you can extend the workouts to 45 minutes you will enjoy added benefits.
- Walking and hiking is fine.
- Your target heart rate zone is between 120 and 150 beats per minute.
- Be sure to warm up (start slowly) and cool down (stop gradually) each time.
Strengthening and Toning Exercises
- Three times per week on nonconsecutive days (for example, Monday, Wednesday and Friday), perform a resistance exercise routine after your cardiovascular exercise. This is imperative for toning and strengthening your muscles.
- The weight of the dumbbell or weighted object (milk jug filled with sand, etc.) should be such that it is an effort to complete the desired number of repetitions (reps).
- Perform the exercises in a controlled manner and in the order listed below. With each repetition, take two seconds to lift and three seconds to lower the resistance. For all of the exercises, except pushups, abdominal curls and prone flip-flops, begin with one set of 10 to 15 reps. When you can perform 15 reps easily, increase the weight.
Targeted muscles: chest, shoulders and back of arms
- Extend your legs straight out behind you.
- While maintaining a straight body, bend your elbows, lowering your chest to four inches off the floor.
- Straighten your elbows, raising your body off the floor.
- Your legs and torso must remain 180 degrees relative to the other.
- Allow no more than a two-second pause between each pushup.
- Begin with one set of eight to 12 reps.
- Increase by one or two reps per week, building up to 25 to 30 reps.
- Add a second set after performing the 25 to 30 reps for two weeks.
Targeted muscles: shoulders
- While standing, hold a dumbbell or weighted object in each hand near your thighs.
- Keep your elbows and knees slightly bent.
- Extend your arms out from your sides until they are slightly higher than parallel with the ground.
- Return to starting position.
Targeted muscles: front of upper arms
- While standing, with elbows at your side, grip the dumbbells or weighted objects with your palms up.
- Lift the dumbbells up to your shoulders.
- Lower to starting position.
Overhead Triceps Extensio
Targeted muscles: back of upper arms
- While standing, cup the head of the dumbbell or weighted object with both hands.
- Keep your elbows no wider apart than your shoulders.
- Raise the dumbbell from between your shoulder blades to over your head.
- Lower them to the starting position.
Targeted muscles: upper and lower back, and buttocks
- Lie on your stomach, flat on the floor.
- Fully extend your arms and legs.
- Raise your left arm and right leg off the floor simultaneously, keeping your head on floor. Lower them to the starting position.
- Raise your right arm and left leg off the floor in same manner.
- Begin with one set of 10 to 12 reps.
- Work up to 30 reps.
Targeted muscles: abdominals
- Lie on the floor with your knees bent and your feet 12 to 18 inches from the buttocks.
- Lightly clasp your hands behind your head with your elbows wide open.
- 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.
- Return slowly to the floor.
- Start with one set of 10 to 15 reps.
- Add one or two reps each week until you reach 40.
- Add a second set after performing 40 reps for two weeks.
- This exercise can also be performed using an abdominal training device.
- After each exercise session, whether you are doing just cardiovascular exercise or both cardiovascular and resistance exercise, perform the Basic 10 Stretches.
- These stretches are very important for optimum flexibility and posture. They also decrease the risk of injury as well as promote relaxation.
- Do not bounce when you stretch. Instead, hold each stretch for 10 to 30 seconds to the point of mild discomfort or to the point 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.