Personal Physical Fitness Plan Page 3
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10Laguna Middle School
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Physical Education Department
PERSONAL FITNESS QUESTIONNAIRE
Name ________________________________
Period 1 2 3 4 5 6
Date ___________
INSTRUCTIONS: Please answer all questions by placing an “X” in the appropriate box
or
X
write your response on the lines provided. Please put quality thought and effort into your answers.
1. Rate your overall activity level:
Very Active
Active
Moderately Active
Sedentary
2. What exercise, if any, do you currently do outside of PE class? Please give a detailed answer.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
3. How would you rate your current muscular strength/endurance level?
Very Strong
Strong
Moderately Strong
Not very strong
4. How would you rate your current cardiovascular fitness level? Basically, when you perform
cardiovascular activities like running, cycling, swimming, etc. how is your fitness?
Excellent
Good
Average
Fair
Very low
5. How flexible are you?
Very Flexible
Somewhat
Not at all
6. How would you rate your experience with exercise?
Advanced
Intermediate
Beginner
7. Do you exercise regularly?
I exercise regularly
I used to exercise regularly and am starting back on a program
I am currently starting a program
I have never exercised regularly
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