My Fitness Plan printable pdf download

My Fitness Plan

RARELY = (1 POINT)

USUALLY = (3 POINTS)

Answer each question using the point scale >

SOMETIMES = (2 POINTS)

ALWAYS = (4 POINTS)

THREE

SIX

NINE

TWELVE

Mobility and Daily Activities

START

MONTHS

1. I find it easy to walk up or down two or more flights

of stairs.

2. I have no trouble taking out the trash.

3. I easily do such chores as vacuuming and dusting.

4. I can do other sorts of housework on my own

without difficulty.

5. I don’t need help from family or friends with daily

activities.

THREE

SIX

NINE

TWELVE

Mood, Energy Level and Mental Health

START

MONTHS

6. I feel younger than my age.

7. I feel independent.

8. I feel energetic.

9. I live an active life.

10. I feel strong.

11. My arms and legs work as well as they used to.

12. I am as active as other people my age.

TOTAL

If you scored below 35, don’t be discouraged. Just

What Your Score Means

begin working in short 5- to 10-minute sessions

15-24 points:

Low fitness level

of activity throughout your day until you reach

your goal of 30 minutes of daily moderate activity

25-34 points:

Low-to-moderate fitness level

at least five days a week. Then work toward 60

35-44 points:

Moderate fitness level

minutes of moderate activity or 30 minutes of

vigorous activity every day. (For help, see the

45 and above:

Advanced fitness level

Additional Resources in AICR’ s “Start Where

You Are” brochure or talk w ith your health care

Chart adapted from Growing Stronger: Strength Training for

provider.)

Older Adults, published by the Centers for Disease Control and

Prevention and Tufts University, 2002.

If you scored above 35 points, you are on the right

track! Evaluate your activities to ensure that you

are including the basic components of fitness and

are challenging yourself.

AMERICAN

INSTITUTE for

CANCER

RESEARCH

My Fitness Plan

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