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Module 3 Exercise Prescription

This document is an exercise prescription form that allows a user to design their own fitness plan. It includes sections for cardiovascular conditioning exercises, muscular resistance training exercises, and a cool down. For cardiovascular conditioning, the user has listed push ups for 3 minutes with 4 reps and 4 sets. The form requests information on exercise duration, reps, and sets to design a full workout schedule, frequency and intensity. It also specifies low, moderate, and high risk exercise guidelines based on a user's risk stratification.

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jaynee jacob
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102 views2 pages

Module 3 Exercise Prescription

This document is an exercise prescription form that allows a user to design their own fitness plan. It includes sections for cardiovascular conditioning exercises, muscular resistance training exercises, and a cool down. For cardiovascular conditioning, the user has listed push ups for 3 minutes with 4 reps and 4 sets. The form requests information on exercise duration, reps, and sets to design a full workout schedule, frequency and intensity. It also specifies low, moderate, and high risk exercise guidelines based on a user's risk stratification.

Uploaded by

jaynee jacob
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Name: Date:

Section: Schedule:

Exercise Prescription Form


Instruction: Design your own fitness plan by filling out this form.
Exercise 1: Push Ups Duration : 3 mins. Reps: 4 Sets: 4

 Cardiovascular Conditioning
 Warm-Up:
Exercise 1:______________________ Duration :_____mins. Reps:______ Sets:______
Exercise 2:______________________ Duration :_____mins. Reps:______ Sets:______
Exercise 3:______________________ Duration :_____mins. Reps:______ Sets:______
Exercise 4:______________________ Duration :_____mins. Reps:______ Sets:______

 Muscular Resistance Training


 Conditioning:
Exercise 1:______________________ Duration :_____mins. Reps:______ Sets:______
Exercise 2:______________________ Duration :_____mins. Reps:______ Sets:______
Exercise 3:______________________ Duration :_____mins. Reps:______ Sets:______
Exercise 4:______________________ Duration :_____mins. Reps:______ Sets:______
Exercise 5:______________________ Duration :_____mins. Reps:______ Sets:______
Exercise 6:______________________ Duration :_____mins. Reps:______ Sets:______
Exercise 7:______________________ Duration :_____mins. Reps:______ Sets:______
Exercise 8:______________________ Duration :_____mins. Reps:______ Sets:______
Exercise 9:______________________ Duration :_____mins. Reps:______ Sets:______
Exercise 10:______________________ Duration :_____mins. Reps:______ Sets:______

a. Frequency: _______x a week (put check on the day/s below)


Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday

This document is the property of PHINMA


EDUCATION
Name: Date:
Section: Schedule:

b. Intensity: (check your risk stratification)


______Low Risk -> Moderate to High Intensity
______Moderate Risk -> Low to Moderate Intensity
______High Risk -> Low Intensity

c. Time: _____min/session ______min/week

d. Type: (check the exercises you will include in your program)


Cardiovascular Muscular Strength
_____Walking _____Push Ups
_____Brisk Walking _____Curl Up
_____Running _____Lunges
_____Biking _____Squat
_____Dancing _____Lifting Weights

Others:______________________________________________________________________

 Cool Down:
Exercise 1:______________________ Duration :_____mins. Reps:______ Sets:______
Exercise 2:______________________ Duration :_____mins. Reps:______ Sets:______
Exercise 3:______________________ Duration :_____mins. Reps:______ Sets:______
Exercise 4:______________________ Duration :_____mins. Reps:______ Sets:______

This document is the property of PHINMA


EDUCATION

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