Module Four Wellness Plan

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Fill in all logs and answer the reflection questions completely with supporting details for sections 1-5. After completing
all sections, submit this file as your Module Four Wellness Plan assignment.

Section 1: Goals
If you have already created goals for your wellness plan, please copy and paste them from your Module 1 Wellness Plan
into the space below.

If you have not created your personal health goals yet, please refer to the samples to create your wellness goals.

Sample Goals:

1. Physical—I will walk non-stop for at least 30 minutes five days a week over the next three weeks.
2. Social—I will join a club at school before this week ends, and I will attend all meetings this semester.
3. Emotional—I will journal every evening for the next two weeks as a way to reduce stress and anxiety.
4. Academic—I will work with a study partner once a week for at least a month to help improve my geometry grade.

Section 1: Your Goals

Answer:
1. Physical—
2. Social—
3. Emotional—
4. Academic—

Section 2: Fitness Assessments

Complete the following on the chart below:
Complete column B. Use your current results from the Module 4 Wellness Plan Fitness Assessments.

Column A Column B

Activity Module 4

Wellness Plan Results

Mile Run/Walk

Body Mass Index

Aerobic Capacity

Curl-ups

Push-ups

Trunk Lift

Sit and Reach

Fitness Assessment Reflection Questions:

What areas of these fitness assessments are you hoping to see the most improvement in over the next few weeks? What
 specific actions will you take to help improve in these areas?

Answer:

Section 3: Flexibility Workout Log

Perform and log stretching exercises for all eight muscles listed below at least two days per week, but you may stretch
every day. Module Two suggests starting with two repetitions held for 15 seconds for a total of 30 seconds for each
exercise. Refer to the yellow highlighted example below.

Please refer to Video Gallery in the course for demonstrations of how to perform the stretching exercises.
Flexibility Exercises/Muscle Stretched Day 1 Day 2

# of # of
Flexibility Exercises Muscle Stretched Dates Time Dates Time
Repetitions Repetitions

EXAMPLE EXAMPLE 8/3 2 15 seconds 8/5 2 15 seconds

Lying Quad Stretch Quadriceps

Modified Hurdler's Stretch Hamstrings

Flexibility Exercises/Muscle Stretched Day 1 Day 2

Upper Back & Torso Stretch Trapezius

Calf Stretch Gastrocnemius

Lower Back Stretch Latissimus Dorsi

Chest/ Bicep Stretch Pectoralis/ Biceps

Shoulder/ Tricep Stretch Trapezius/ Deltoids

Lying Abdominal Stretch Abdominal

Flexibility Reflection Questions:

Explain how the stretches become easier each time that you perform them. How do these stretches affect your muscles
during physical activities completed after stretching?

Answer:
Section 4: Muscular Strength and Endurance Log
Complete the chart below. Remember:

 Exercises listed should show an increase from your previous plan to show your growth. If you completed 3
sets of 8 for the last Wellness Plan, then 3 sets of 10 would be an increase for this plan.
 Complete muscular exercises on nonconsecutive days.

 Do not work the same muscle groups more than once within a 48-hour period.

 You may select a different exercise than what is listed.

 Module Two suggests starting with 2 or 3 sets.

 The suggested number of repetitions is 8-10 for challenging weights and exercises.

 If you are using very light weight or bodyweight, you can complete as many as 18 repetitions depending on your
current ability level.

Please refer to Video Gallery in the course for demonstrations of how to perform the muscle exercises.

Sample:
Exercise Muscle Worked Dates # of sets # of reps Resistance (Weight)

Squats Quadriceps 8/3 3 8 20 lbs.

 Day 1 Day 2

Exercise Muscle Worked Dates # of # of Resistance Dates # of # of Resistance

sets reps (Weight) sets reps (Weight)

Squats Quadriceps

Push-ups Pectoralis

Bridges Hamstrings

Pull-ups Latissimus Dorsi

Calf Raises Gastrocnemius

Chair Dip Triceps

Curls Biceps

Crunches Abdominal

Muscular Strength and Endurance Reflection Questions:

What muscle groups are the most uncomfortable or difficult for you to work out? What are two additional activities that you
can incorporate into next week’s physical activity to help work those muscles?
Answer:

Section 5: Physical Activity Log

Include all moderate and vigorous physical activity in the table below. You need at least three different moderate to
vigorous activities that add up to 420 minutes. Activities need to add up to 420 minutes without your warm-ups. Keep
adding rows to show all of your activities. The first five rows are completed as a sample only.

Date Warm-up Physical Activity Activity Minutes

without Warm-up
12/25 5-min stretch 2-mile kayak 30 minutes

12/26 5-min jog 4-mile run 45 minutes

12/27 5-min stretch Basketball practice 60 min

12/28 5-min jog Badminton 2 hours

12/29 5-min stretch Skateboarding 1 hour

 Date Warm-up Physical Activity Activity Minutes
without Warm-up

TOTAL Activity Minutes 

Remember the 420-minute minimum

Physical Activity Reflection Questions:

It is important to use proper etiquette, take care of equipment, show respect for facilities, and use safe behaviors when
participating in physical activities.

1. Thinking of the activities you participated in this week, what is the most important safety precaution or rule that you
followed? Explain why you think it is so important.

Answer:

2. Describe one way that you showed respect for equipment, facilities, or teammates in your activities this week.
 Answer:

3. Based on the total number of minutes, how do you feel about your level of activity? What specific changes can you
make to continue to improve the average daily movement?

Answer:

Module Four Wellness Plan Grading Rubric

Excellent Good Needs Improvement Poor

Section 1: 9-10 points 8 points 7 points 0-6 points

Goals
All goals are measurable, Most goals are Some goals are Goals are not
attainable, and deadline measurable, attainable, measurable, attainable, measurable,
driven. Reflection and deadline driven. and deadline driven. attainable, and
question responses are Reflection responses Reflection responses deadline driven.
complete and are adequately are complete but Reflection responses
supported. detailed and lacking detail and are incomplete or
supported. support. inaccurate.

Section 2: 36-40 points 32-35 points 25-31 points 0-24 points

Fitness
 Excellent Good Needs Improvement Poor

Assessment  Fitness assessment  Fitness assessment  Fitness assessment  Fitness

Results for: results are recorded. results are recorded. results are assessment
 Reflection question  Reflection recorded. results are
Module 4
responses responses are  Reflection recorded.
are complete and adequately responses are  Reflection
supported. detailed and complete but responses are
supported. lacking detail and incomplete or
support. inaccurate.

Section 3: 45-50 points 40-44 points 30-39 points 0-29 points

Flexibility Log
 At least two days of  More than one day  At least one day of  Less than
stretching are of stretching is stretching is one day of
recorded. recorded. recorded. stretching is
 All eight stretching  At least six  At least four recorded.
activities are recorded stretching activities stretching activities  Less than four
each day. are recorded each are recorded each stretching
 All stretches are held day. day. activities are
an appropriate length  Most stretches are  Some stretches are recorded each
of time. held an appropriate held an appropriate day.
 Reflection question length of time. length of time.  Few stretches are
responses  Reflection  Reflection held an
are complete and responses are responses are appropriate length
supported. adequately complete but of time.
detailed and lacking detail and
 Excellent Good Needs Improvement Poor

supported. support.  Reflection

responses are
incomplete or
inaccurate.

Section 4: 45-50 points 40-44 points 30-39 points 0-29 points

Muscular
Strength and  All eight muscles are  At least six muscles  At least four  Less than four
Endurance exercised at least two are exercised at muscles are muscles are
Log days. least two days. exercised at least exercised at least
 All muscles are rested  All muscles are two days. two days.
for at least 48 rested for at least 48  Most muscles are  Few muscles are
hours between hours between rested for at least rested 48 hours
workouts. workouts. 48 hours between between workouts.
 Appropriate reps, sets,  Appropriate reps, workouts.  Appropriate reps,
and resistance are sets, and resistance  Appropriate reps, sets, and
used for all are used for most sets, and resistance resistance used
exercises. exercises. are used for some for few exercises.
 Reflection question  Reflection exercises.  Reflection
responses responses are  Reflection responses are
are complete and adequately responses are incomplete or
supported. detailed and complete but inaccurate.
supported. lacking detail and
support.
 Excellent Good Needs Improvement Poor

Section 5: 63–70 points 54–62 points 43–53 points 0–42 points

Physical
Activity Log  All exercises are  Most exercises are  Some exercises are  Few exercises are
YOU ARE moderate to vigorous moderate to moderate to moderate to
REQUIRED TO
intensity. vigorous intensity. vigorous intensity. vigorous intensity,
LOG EACH
 At least 420 activity  At least 385 activity  At least 350 activity or intensity is not
WEEK YOU
ARE IN THE minutes are recorded. minutes are minutes are indicated.
COURSE  All exercises are recorded. recorded.  At least 315
dated as daily or every  All exercises are  Some exercise activity minutes
other day. dated as daily or dates listed are not are recorded.
 At least three different every other day. in an effective  Few exercise
exercises have been  Most exercise dates pattern. dates listed are in
logged, including are listed and are  At least two an effective
specific exercises not in an effective different exercises pattern.
when required. pattern. have been logged,  One type of
 At least three including specific exercise has been
Reflection question responses different exercises exercises when logged, including
are complete and have been logged, required. specific exercises
supported. including specific when required.
exercises when Reflection responses are
required. complete but lacking Reflection responses are
detail and support. incomplete or
Reflection responses are inaccurate.
adequately detailed and
supported.
Total Points Possible: 220 points