Moving Forward With Life

Topics:

Welcome to the Home Log Page. Enter the information on your Exercise Home Log from the past week(s). Your health educator will review this log before your next scheduled call. If your calls are on a bi-weekly schedule, please make sure you enter information for two weeks.

: ID: Your ID is your first three letters of your first name and the first three letters of your last name; (example: Jane Smith would be JANSMI )
: If you are on a 2 week schedule, enter the second week's data below the first

	Date (_ _/_ _/_ _)	Duration (Min)	Type of Exercise	Digiwalker	Heart Rate ?	RPE (6-20) ?
Sunday Activity #1
Activity #2
Monday Activity #1
Activity #2
Tuesday Activity #1
Activity #2
Wednesday Activity #1
Activity #2
Thursday Activity #1
Activity #2
Friday Activity #1
Activity #2
Saturday Activity #1
Activity #2

Second Week:

	Date (_ _/_ _/_ _)	Duration (Min)	Type of Exercise	Digiwalker	Heart Rate ?	RPE (6-20) ?
Sunday Activity #1
Activity #2
Monday Activity #1
Activity #2
Tuesday Activity #1
Activity #2
Wednesday Activity #1
Activity #2
Thursday Activity #1
Activity #2
Friday Activity #1
Activity #2
Saturday Activity #1
Activity #2
	Date (_ _/_ _/_ _)	Duration (Min)	Type of Exercise	Digiwalker	Heart Rate ?	RPE (6-20) ?

Recent Changes Have you had any changes in your medications? yes no
If yes, specify:

Have you noticed any changes in your health? yes no
If yes, specify:

Are you recovering from any illness/injury? yes no
If yes, specify:

Health ProblemsDo you have any of the following health problems related to physical activity:
Muscle soreness
Pain in back, hips, knees, feet or joints
General discomfort or injury related to walking program
Excessive fatigue following walking program
Dizziness or lightheadedness
Chest pain or discomfort
Irregular or abnormally fast / fluttering heart beat (during or after exercise)
Shortness of breath or trouble breathing
Other:

RoadblocksDid you experience any roadblocks in your exercise routine? If so check all that apply:

Not enough time	Bored
Pain or discomfort	Sick
Inconvenience	Lack of Support
Weather Conditions	Holidays
Fatigue	Didn't feel like it
Family / Work demands	Visitor
Other:

Goals What has kept you motivated to continue to exercise or be physically active this week?

What questions or concerns do you have for your health educator?

How many days do you plan to exercise next week(s)?

What type of activity?

How many minutes per session?

What questions or concerns do you have for your health educator?

Date (_ _/_ _/_ _)

Duration (Min)

Type of Exercise

Digiwalker

Heart Rate ?

RPE (6-20) ?

Sunday Activity #1

Activity #2

Monday Activity #1

Activity #2

Tuesday Activity #1

Activity #2

Wednesday Activity #1

Activity #2

Thursday Activity #1

Activity #2

Friday Activity #1

Activity #2

Saturday Activity #1

Activity #2

Date (_ _/_ _/_ _)

Duration (Min)

Type of Exercise

Digiwalker

Heart Rate ?

RPE (6-20) ?

Sunday Activity #1

Activity #2

Monday Activity #1

Activity #2

Tuesday Activity #1

Activity #2

Wednesday Activity #1

Activity #2

Thursday Activity #1

Activity #2

Friday Activity #1

Activity #2

Saturday Activity #1

Activity #2

Date (_ _/_ _/_ _)

Duration (Min)

Type of Exercise

Digiwalker

Heart Rate ?

RPE (6-20) ?

Date
(_ _/_ _/_ _)

Duration
(Min)

Heart Rate

?

RPE
(6-20)
?

Sunday
Activity #1

Monday
Activity #1

Tuesday
Activity #1

Wednesday
Activity #1

Thursday
Activity #1

Friday
Activity #1

Saturday
Activity #1

Date
(_ _/_ _/_ _)

Duration
(Min)

Heart Rate

?

RPE
(6-20)
?

Sunday
Activity #1

Monday
Activity #1

Tuesday
Activity #1

Wednesday
Activity #1

Thursday
Activity #1

Friday
Activity #1

Saturday
Activity #1

Date
(_ _/_ _/_ _)

Duration
(Min)

Heart Rate

?

RPE
(6-20)
?