Activity Log Tips
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1CHAMPS
Community Healthy Activities Model Program for Seniors
Appendix 10: Activity Log Tips
The following is a list of tips to help you fill out the activity logs effectively so that we obtain the
research information needed.
A.
B.
C.
D.
Monday – Date: ____/____/____
Class
Time
Effort
(min.)
Activity#1: ____________________________
N
Y
_______
_______
Activity#2: ____________________________
N
Y
_______
_______
Activity#3: ____________________________
N
Y
_______
_______
Comments:
A) Activity:
•
Specify exact activity (e.g. walking, stretching, stationary bike). Please do not write in
just the word “exercise”.
•
Even though these activities may be tiring do not record the following:
Shopping / Errands
Work
Meditation / Stress management
Driving
•
Do record walking to and from the grocery store, work, or to lunch if it is clearly stated
and does not include time spent shopping, working, or eating lunch.
•
Physical therapy:
♦ Only record the times when you are doing the actual exercises by yourself.
♦ Do not record the physical therapy sessions with your physical therapist.
•
Do not group unrelated activities together such as gardening and housework, write as
two separate activities since we need to code each activity separately.
•
Do group similar activities together such as vacuuming and cleaning windows as
housework. If you are unclear then state the activities separately.
B) Class:
•
Please remember to circle Y=yes or N=no for whether the activity is a class you are
taking or not. Exercising to a video or TV program is not considered a class.
C) Time:
•
Remember to fill in the amount of time in minutes doing a particular activity.
♦ Avoid writing in all day.
•
Estimate the time to the best of your ability.
Work Effort
D)
Remember to:
•
Use scale
•
Estimate work effort for overall activity instead of giving ranges.
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