Overview

Use this sheet to list what you enjoy and what is hard for you. You and your doctor can use this information to come up with an activity plan.

How active are you? Describe what you do to stretch, strengthen, and move your body. Write down how often and how long you do each activity.

What would you like to do? List ways you might like to get more active. And think of someone you can buddy up with for exercise.

What gets in your way? Which of the problems below are you worried about when it comes to getting more active? How might you handle these problems? Who can help you?

What medical problems are you dealing with? List all of the health problems you are having.

Some questions for your doctor:

• Do I need any special tests before I begin a new activity?
• What is safe for me to do? What should I avoid?
• Should I take my pulse when I exercise? If so, what range is best?
• Should I make any medicine changes?

Write down any other questions you might have about getting more active. Talk to your doctor about them at your next visit.

What is your plan for getting more active over the next week? People tend to have more success with long-term goals that are broken into small, short-term goals. You can boost your chances of success in two more ways: include friends and family you can count on for support and reward yourself for the positive changes you are making.

What is your plan for being active 3 months from now?