PERSONAL FITNESS PLAN

1. My specific Goals/Objectives to be measured on the next fitness assessment:

A. Balance:_______________________________________________________________________________________

B. Strength:_______________________________________________________________________________________

C. Flexibility:______________________________________________________________________________________

2. Activities I will do regularly for five weeks:

Activity Minutes Where Days/ Week Time of Day With Whom

A. Balance __________ __________ __________ __________ __________

B. Strength _________ __________ __________ __________ __________

C. Flexibility _________ __________ __________ __________ __________

3. Other activities I plan to do & resources I plan to use. (ie. Fitness video, use of stairs, etc.):

__________________________________________________________________________________________________

__________________________________________________________________________________________________

4. My greatest potential barriers and how I will overcome them: _____________________________________________

__________________________________________________________________________________________________

5. How others can support me: ________________________________________________________________________

__________________________________________________________________________________________________
6. One reward I will give myself when I succeed: ___________________________________________________________

__________________________________________________________________________________________________

I agree to follow the above fitness plan for five weeks.

____________________________________________
Signature Date

____________________________________________
Name (Print)