Appendix
109 l Page
Benefits of Exercis
Will this 
Benefit Me
How will I specfically Benefit
Flexibility can improve the range of motion of your joints
Example: combing hair, getting dressed, picking up objects 
from the floor
Ability to perform daily activities
Prevention and management of most chronic diseases & disabilities
Bone density, which may lead to a risk for osteoporosis
Blood pressure with aerobic training
Improved glucose and insulin metabolism- 
helps with diseases like 
diabetes
Improved cholesterol profiles
Triglyceride levels
Improved body composition (reduction in fat with an increase in muscle)
Improvements related to cardiovascular disease risk factors
Strength- 
helps you stay or become more independent
Energy to do the things you would like to- playing with 
grandchildren, walking the dog, going to the mall, sightseeing
Improved balance- 
may    the risk of falls or reduce the severity of a fall
Exercise Benefits Analysis
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Appendix
110 l Page
Benefits of Exercis
Will this 
Benefit Me
How will I specfically Benefit
Mood enhancement and     depression
Cognitive function
Feelings of personal control
Well-being
Stress reduction
Insomnia
Improved quality of life
Pain reduction/prevention
Chances of injury
Enhanced immunity
Mobility & gait
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Appendix
111 l Page
6-Week Aerobic Activity Log
For the next six weeks, it is important to keep track of the time walked or any aerobic activity is done. The goal is to increase your 
physical activity consistently. It is recommended that everyone over the age of 2 should get 30 minutes of activity on most days of 
the week.  Whether the goal is to move thirty minutes a day, or to lose five pounds, the goal is better achieved it if is written down.
Record the time 
and activity each 
day.
Week 1
Week 2
Week 3
Week 4
Week 5 5 Week 6
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
TOTALS
Goals
By writing goals on the lines 
below you will have a constant 
reminder of what you have set out 
to do.
Daily goal: 
______________________________
______________________________
6-Week Goal: 
______________________________
______________________________
Overall Goal:
______________________________
______________________________
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Appendix
112 l Page
6-Week Pedometer Log
For the next six weeks, keep track of the number of steps you take. The goal is to slowly increase physical activity. The first week is 
used to get a baseline so keep your normal routine and do not change your activity the first week.  After week 1 or 2, increase the 
number of steps by 10% (multiply your average by 0.10)
Record the 
number of steps 
per day.
Week 1
Week 2
Week 3
Week 4
Week 5 5 Week 6
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Averages for 
the week
Goals
By writing your goals on the lines 
below you will have a constant 
eminder of what you have set out 
to do.
Daily goal: 
___________________________
___________________________
6-Week Goal: 
___________________________
___________________________
Overall Goal: 
___________________________
___________________________
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Appendix
113 l Page
Name of Exercise
Week #   1
Week #   2
Day 1
Day 2
Day 1
Day 2
Set
1
2
1
2
1
2
1
2
1
Biceps Curl
Wt
2lbs
2lbs
2lbs
2lbs
2lbs
2lbs
2lbs
2lbs
Reps
8
8
10
10
10
11
12
12
2
Chest Press
Wt
2lbs
2lbs
2lbs
2lbs
2lbs
2lbs
5lbs
5lbs
Reps
8
9
10
11
12
12
8
9
3
Leg Extension
Wt
12lbs
12lbs
10lbs
10lbs
10lbs
10lbs
15lbs
15lbs
Reps
8
9
10
11
12
12
8
8
4
Hamstring Curl
Wt
10lbs
10lbs
10lbs
10lbs
10lbs
10lbs
10lbs
10lbs
Reps
9
9
10
11
11
12
12
12
5
Wt
Reps
Date
4/11
4/11
4/15
4/15
4/18
4/18
4/21
4/21
Strength Training 
Log
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Appendix
114 l Page
Name of Exercise
Week #
Week #
Day 1
Day 2
Day 1
Day 2
Set
1
2
1
2
1
2
1
2
1
Wt
Reps
2
Wt
Reps
3
Wt
Reps
4
Wt
Reps
5
Wt
Reps
Date
Strength Training 
Log
Appendix
115 l Page
Name of Exercise
Week #
Week #
Day 1
Day 2
Day 1
Day 2
Set
1
2
1
2
1
2
1
2
6
Wt
Reps
7
Wt
Reps
8
Wt
Reps
9
Wt
Reps
10
Wt
Reps
Date
Strength Training 
Log
Appendix
116 l Page
Performance and Body Mass Index Evaluation
Chair Stand
For this task you will need a stable chair and something to count seconds.
• Instruct the older adult to sit in the chair with both feet on the floor and arms crossing the chest.
• Have the older adult stand up straight and then sit down. 
• Repeat this for 30 seconds.
• Count the number of stands.
• The older adult’s score is the total number of stands.
Sit and Reach
For this task you will need a stable chair and a ruler.
• Instruct the older adult to sit on the edge of the chair.
• One leg should be extended out in front of the chair. The heel should 
be on the floor and the ankle flexed towards the body.
• The other leg should be bent with the foot on the floor (Figures 67 and
68).
•    Instruct the older adult to reach with one hand towards the toes. 
• Repeat, switch which leg is extended and which leg is bent.
• Measure the distance between the older adult’s fingertips and toes. If 
the older adult doesn’t reach the toes give them a minus score. If the 
older adult reaches past toes give them a positive score. 
Figure 67
Figure 68
Appendix
117 l Page
Biceps Curl
For this task you will need a stable chair, something to count seconds, and a dumbbell.
• Instruct the older adult to sit in the chair with both feet on the floor.
• Once the older adult is in the chair have him/her hold the dumbbell with one hand to the side.
• Have the older adult curl the arm up to the shoulders and then lower the arm back down to side.
• Make sure the older adult is only moving the lower arm.
• Repeat this for 30 seconds.
• The older adult’s score is the number of curls completed.
• Repeat on opposite side.
Shoulder Flexibility 
For this task you will need a ruler.
• Instruct the older adult to reach over his or her shoulder towards the middle 
of the back.
• Then have the older adult use the other hand to reach up towards the middle 
of the back.
• Measure the distance between the middle fingers (Figure 69).
• If the older adult’s fingers do not touch, give a minus score.  If the fingers 
touch/overlap, give a positive score.
Figure 69
Appendix
118 l Page
2-Minute March
For this task you will need something to count seconds, a tape measure and masking tape.
• Place a piece of masking tape on the wall that is as high as the older adult’s hip.
• Use the masking tape as a marker for the height of the older adult’s steps.
• Instruct the older adult to begin stepping in place. Make sure the older adult is raising the 
knee as high as the masking tape on the wall (Figure 70).
• The score is the number of full steps completed in 2 minutes. (1 step is counted when the 
 right knee is lifted) 
6-Minute Walk 
For this task you will need a tape measure, something to count minutes, and items to mark off the course.
• Mark off a course with a distance you can measure.
• Instruct the older adult to start walking as fast as he or she can.
• Count how many laps that are completed within 6 minutes.
• The score is the distance the older adult walks.
Figure 70
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