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Current Exercise Regimen
On a regular basis, how many days a week do you devote to cardiovascular exercise, strength training, and/or flexibility? Please expand below.
Cardiovascular:
Strength:
Flexibility:
Which of the following cardiovascular exercises/machines have you used? (please check)
Treadmill
UBE
Elliptical
Rower
Aerobics
Stair Stepper
Nu-Step (Seated)
Swimming
Recumbent Bike
Spinning
Water Aerobics
Upright Bike
Sports
Which of the following resistance training methods have you used?
Free Weights
Weight/Selectorized Machines
Bodyweight Exercises
Have you participated in a structured exercise program in the past?
Yes
No
If you answered YES, how long have you participated?
Do you have any physical limitations that might prevent you from doing resistance or cardiovascular training? (Please list any exercises or machines that aggravate existing conditions or those you prefer to avoid in your program)
How many days per week and how much time per session do you have to devote to resistance training? (Please check appropriate days per week and time per session)
1day/week
2days/week
3days/week
4days/week
5days/week
6+days/week
20 min
30 min
40 min
50 min
60 min
60+ min
How many days per week and how much time per session do you have to devote to cardiovascular training? (Please check appropriate days per week and time per session)
1day/week
2days/week
3days/week
4days/week
5days/week
6+days/week
20 min
30 min
40 min
50 min
60 min
60+ min
What benefits do you want to achieve from your exercise program? (Check all that apply)
Weight Loss
Decrease Body Fat
Improve Endurance
Improve Balance
Lower Cholesterol
Sport Performance
Improve Flexibility
Blood Pressure
Decrease Medications
Improve Muscle Tone
Improve Self-Esteem
Increase Motivation to Exercise
Improve Athletic Performance
Increase Muscle Strength
Increase Muscle Size
Reduce Stress
Other
Are there any specific areas you would like to target in your workout?
If you like to work with a specific personal trainer for your 8-week program please put their name here
Additional Comments:
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