Star瑩ng a Community Exercise Program
99 l Page
Basic Class Structure
Emergency Planning
This is important for any facility that has groups of people meeting.  An emergency plan needs to be developed in case there is a 
fall, serious accident, or a cardiovascular event.  An emergency can happen at any time so it is important to have a plan in place.  
Phone numbers for the police, fire department, and emergency personnel should be posted near the phone.  Everyone should 
know how to dial 911.  Ideally an automatic external defibrillator (AED) should be housed in a facility where there are a number 
of people gathering, especially older adults.   An exercise leader should be trained in first aid and basic life support (BLS) or 
cardiopulmonary resuscitation (CPR).  This type of training can be obtained from the American Red Cross or the local YMCA. 
An exercise class should last approximately 60 minutes.  
It is always nice to have some type of music playing while 
exercising, however, make sure the music is appropriate 
for the audience.  Spend about 5-10 minutes warming up.  
This can be done by walking or marching in place or if 
using chairs moving the feet and arms while seated.  After 
the warm-up spend about 20-30 minutes with activities 
that use the large muscle groups (aerobic activities) to 
elevate the heart rate.  Make sure you give opportunities 
for participants to go at their own pace whether standing or 
sitting.  Incorporating arm movements can really increase 
the heart rate.  After the aerobic exercise spend another 
20 minutes conducting strengthening activities.  Strength 
training activities can use participants’ own body weight, 
such as, standing up and sitting down from a chair or doing 
leg lifts while seated.  Depending on your budget you can 
purchase hand weights or resistance bands (see appendix).  
If you do not have any money to purchase equipment, 
participants can bring in milk jugs which can be filled with 
water or sand depending on the strength of the participant. 
Soup cans, rice bags, sand bags, or bean bags can also be 
used as weights for strength training.  The last 10 minutes 
should include a cool down consisting of stretching and 
relaxing. 
Classes do not necessarily have to be completed inside.  For 
example, walking groups can be established at local high 
school and middle school tracks, parks, or the mall.
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Star瑩ng a Community Exercise Program
100 l Page
Assessments
It is always nice to have some basic assessments to allow participants to see improvements.  Again some equipment is relatively 
inexpensive and some you may even have at home.  
• A Scale to measure body weight
• Tape Measure to measure circumferences such as waist, hip, or abdominal areas
• Blood Pressure Cuff and Stethoscope
 Stop Watch or Timer to measure performance for balance tasks or other tests that you may come up with (See 
Active 
Aging Toolkit 
and
Performance and Body Mass Index Evaluation,
located in the Appendix for more examples of 
assessments)
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Appendix
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Appendix
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Appendix
102 l Page
a heart attack
heart surgery
cardiac catheterization 
coronary angioplasty (PTCA)
pacemaker/implantable cardiac defibrillator
rhythm disturbance
heart valve disease
heart failure
heart transplantation
congenital heart disease
Have you experienced chest discomfort at rest or                  
with exertion?
Have you experienced unreasonable breathlessness at 
rest or with exertion?
Have you experienced dizziness, fainting, or 
blackouts?
Do you take heart medications?
Do you get palpitations or a racing heart beat?
Do you get swelling in your ankles?
Do you have difficulty breathing when lying down or diffi-
culty breathing that wakes you up when you are asleep?
Do you have diabetes?
Do you have asthma or other lung disease?
Do you have burning or cramping sensations in your lower 
legs when walking short distances or climbing stairs?
Do you have musculoskeletal problems that limit your        
physical activity?
Do you have concerns about the safety of exercise?
Do you take prescription medications?
If you marked any of these statements in this section, consult your physician or other appropriate health care provider before engaging 
in exercise.
American Heart Association/American College of Sports Medicine
Health/Fitness Health Risk Assessment
Facility Preparticipation Screening Questionnaire for Older Adults
Assess your health status by marking all true statements.
History
Have you ever had 
Symptoms
Other health issues
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Appendix
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Are you a man older than 45 years?
Are you a woman older than 55 years, have had a 
hysterectomy, or are postmenopausal?
Do you smoke, or have you quit smoking within the 
previous six months?
Is your blood pressure greater than 140/90 mmHg?
You do not know your blood pressure?
Do you take blood pressure medication?
Is your total cholesterol level greater than 200 mg/dl?
You do not know your total cholesterol level?
Do you have a close blood relative who had a heart attack 
or heart surgery before age 55 (father or brother) or age 65 
(mother or sister)?
Are you physically inactive (i.e. you get less than 30 minutes 
of physical activity on most days of the week)?
Are you greater than 20 pounds overweight?
I have none of the above conditions
You may need to use a facility with a medically qualified staff
Cardiovascular risk factors
If you marked two or more of the statements in this section you should consult your physician or other appropriate health care provider 
before engaging in exercise.  You might benefit from using a facility with a professionally qualified exercise staff to guide your exercis
program.
You should be able to exercise safely without consulting your physician or other appropriate health care provider in a self-guided pro-
gram or almost any facility that meets your exercise programs needs.
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Appendix
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Physical Activity Readiness Questionnaire (PAR-Q)
PAR-Q is designed to help you help yourself.  Many health benefits are associated with regular exercise, and the completion of PAR-Q is a sen-
sible first step to take if you are planning to increase the amount of physical activity in your life.
For most people, physical activity should not pose any problems or hazard. PAR-Q has been designed to identify the small number of adults for 
whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them.
Common sense is your best guide in answering these few questions.  Please read the carefully and check YES or NO opposite the question if it 
applies to you.  If yes, please explain.
YES      NO
____    ____    1.  Has your doctor ever said you have heart trouble?
Yes,  _____________________________________________
____     ____    2. Do you frequently have pains in your heart and chest?
Yes,  _____________________________________________
____     ____    3. Do you often feel faint or have spells of severe dizziness?
Yes,  _____________________________________________
____     ____    4. Has a doctor ever said your blood pressure was too high?
Yes,  _____________________________________________
____     ____    5. Has your doctor ever told you that you have a bone or joint problem(s), such as arthritis that has been aggravated by 
exercise,  or might be made worse with exercise?
Yes,  _____________________________________________
____     ____    6. Is there a good physical reason, not mentioned here, why you should not follow an activity program even if you
wanted to?
Yes,  _____________________________________________
____     ____    7. Are you over age 60 
and
not accustomed to vigorous exercise?
Yes,  _____________________________________________
____     ____    8. Do you suffer from any problems of the lower back, i.e., chronic pain, or numbness?
Yes,  _____________________________________________
Appendix
105 l Page
YES      NO
____     ____    9. Are you currently taking any medications?  If YES, please specify.
Yes,  _____________________________________________
____     ____   10. Do you currently have a disability or a communicable disease?  If YES, please specify.
Yes,  _____________________________________________
If you answered NO to all questions above, it gives a general indication that you may participate in physical and aerobic fitness activities and/or fit-
ness evaluation testing.  The fact that you answered NO to the above questions, is no guarantee that you will have a normal response to exercise.  
If you answered YES to any of the above questions, then you may need written permission from a physician before participating in physical and 
aerobic fitness activities and/or fitness evaluation.
____________________________        _____________________________        _____________________
Print Name 
Signature                                                   Date
Appendix
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Appendix
107 l Page
My Goals   
Target Date: __________ Start Date: ________ 
Date Achieved: ________
Goal:_________________________________________________________________________________________________
______________________________________________________________________________________________________
Making your goal SMART:
Specific What exactly will you accomplish?
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Measurable: How will you know when you have achieved your goal?
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Adjustable: In case of a setback or progression, how will you adjust your goal?
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Realistic, yet challenging: Is your goal moderately difficult? If not, please adjust it.
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Time-based: When will your goal be achieved?
______________________________________________________________________________________________________
______________________________________________________________________________________________________
This goal is important to me because…
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Appendix
108 l Page
Potential Obstacles/setbacks 
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
Potential Solutions 
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
Person
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
How they will help
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
Step
_________________________________
_________________________________
_________________________________
Expected Completion Date
_________________________________
_________________________________
_________________________________
Completed
_________________________________
_________________________________
_________________________________
The benefits of achieving this goal are… 
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Plan for success!
Seek Social Support:  
Who will you ask to help you achieve your goal and how will you ask them to help? 
The more people you tell about your goal, the more likely you are to achieve it!
Stepping Stones:
What steps need to be taken in order to achieve your goal?
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