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— I will try to decrease my time for a mile run to 7:30 instead of 8:06

2. Social— I will make 1 more friend by the end of the week

3. Emotional— I will walk with my mom around the neighborhood for 30-45 minutes.
 4. Academic— I will submit all my assignments are submitted on time on this semester.

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 11

Body Mass Index 23.33

Aerobic Capacity 41.37

Curl-ups 20

Push-ups 20
Column A Column B

Trunk Lift 13

Sit and Reach 9

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: I really hope to see improvement in my mile run and aerobic capacity.

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  1/25 2  20 seconds  1/27 2 20 seconds

Modified Hurdler's Stretch Hamstrings 1/25 2 20 seconds 1/27 2 20 seconds

Upper Back & Torso Stretch Trapezius 2 2

1/25 20 seconds 1/27 20 seconds

Calf Stretch Gastrocnemius 1/25 2 20 seconds 1/27 2 20 seconds

Lower Back Stretch Latissimus Dorsi 2 2

1/25 20 seconds 1/27 20 seconds

Chest/ Bicep Stretch Pectoralis/ Biceps 1/25 2 20 seconds 1/27 2 20 seconds

Shoulder/ Tricep Stretch Trapezius/ Deltoids 1/25 2 20 seconds 1/27 2 20 seconds

Lying Abdominal Stretch Abdominal 2 2

1/25 20 seconds 1/27 20 seconds
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: Stretches should make your muscles more grounded and more adaptable to build portability.

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)

1/25 3 10 5Ibs 1/26 3 12 5Ibs

Squats Quadriceps

1/25 3 8 Resistance bands 1/26 3 12 Resistance bands

Push-ups Pectoralis

1/25 3 10 Resistance bands 1/26 3 12 Resistance bands

Bridges Hamstrings

1/25 3 12 Resistance bands 1/26 3 12 Resistance bands

Pull-ups Latissimus Dorsi

1/25 3 10 Resistance bands 1/26 3 12 Resistance bands

Calf Raises Gastrocnemius

1/25 3 13 Resistance bands 1/26 3 12 Resistance bands

Chair Dip Triceps

Curls Biceps 1/25 3 10 5 pounds 1/26 3 12 5 lbs

 Day 1 Day 2

1/25 3 10 Resistance bands 1/26 3 12 Resistance bands

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: I don’t really like to stretch my calves due to me constantly hurting myself because they are always sore
from marching but I would do a stretch with a partner or a soccer stretch my friend taught me.
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
1/18 5-min stretch Swimming 45 laps. 30 minutes

1/19 5-min jog 4-mile run 45 minutes

1/20 5-min stretch Football practice 60 min

1/21 5-min jog Tennis Match 2 hours

1/22 5-min stretch Bike riding 1 hour

1/23 4-min Jog Long run 50 minutes

1/24 6-min walk Jogging 30 minutes

1/25 2-min stretch 30 push-ups/1 mile jog 45 min

1/26 300-meter jog 100-meter sprint 40 min

 Date Warm-up Physical Activity Activity Minutes
without Warm-up
1/27 5-minutes of Jogging with Family around the 160 min
breathing neighborhood
techniques

1/28 10-minutes of 400-meter walk/ 100-meter sprint 90

jumping jacks

1/29 200-meter jog 100-meter sprint 55 min

TOTAL Activity Minutes 

Remember the 420-minute minimum
430 minutes
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: Never lock your knees when you walk or you WILL drop.
2. Describe one way that you showed respect for equipment, facilities, or teammates in your activities this week.

Answer: I place my loads down cautiously so I don't harm them, myself, or any other individual around me.

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: I have an inclination that I have an extraordinary speed going for me and I might want to keep it
the equivalent or I would be over endeavoring and that is not generally something worth being thankful for.

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

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

Flexibility Log
 At least two days  More than one  At least one  Less than
of stretching are day of stretching is day of stretching is one day of
 Excellent Good Needs Improvement Poor

recorded. recorded. recorded. stretching is

 All eight stretchin  At least six  At least four recorded.
g activities are stretching activities stretching activities  Less than
recorded each day. are recorded each are recorded each four stretching
 All stretches are day. day. activities are
held an appropriate  Most stretches  Some stretches recorded each
length of time. are held an are held an day.
 Reflection appropriate length appropriate length  Few stretches
question responses of time. of time. are held an
are complete and  Reflection  Reflection appropriate length
supported.  responses are responses are of time.
adequately complete but  Reflection
detailed and lacking detail and responses are
supported.  support. incomplete or
inaccurate. 

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

Muscular
Strength and  All eight muscles  At least six  At least four  Less than
Endurance are exercised at least muscles are muscles are four muscles are
Log two days. exercised at least exercised at least exercised at least
 All muscles are two days. two days. two days.
rested for at least 48  All muscles are  Most muscles  Few muscles
hours between rested for at least are rested for at are rested 48
workouts. 48 hours between least 48 hours hours between
 Appropriate reps, workouts. between workouts. workouts.
 Excellent Good Needs Improvement Poor

sets, and resistance  Appropriate reps  Appropriate  Appropriate

are used for all , sets, and reps, sets, and reps, sets, and
exercises.   resistance are used resistance are used resistance used
 Reflection question for most exercises. for some exercises. for few exercises.
responses  Reflection  Reflection  Reflection
are complete and responses are responses are responses are
supported.  adequately complete but incomplete or
detailed and lacking detail and inaccurate. 
supported. support. 

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  Few exercises are
YOU ARE moderate to vigorous moderate to are moderate to moderate to
REQUIRED TO
intensity. vigorous intensity. vigorous intensity. vigorous intensity,
LOG EACH
WEEK YOU or intensity is not
 At least 420 activity  At least 385 activity  At least 350 activity indicated.
ARE IN THE
minutes are recorded. minutes are minutes are
COURSE
recorded. recorded.  At least 315
 All exercises are activity minutes
dated as daily or  All exercises are  Some exercise are recorded.
every other day. dated as daily or dates listed are not
every other day. in an effective  Few exercise
 At least three pattern. dates listed are in
different exercises  Most exercise an effective
have been logged, dates are listed and  At least two
 Excellent Good Needs Improvement Poor

including specific are not in an different exercises pattern.

exercises when effective pattern. have been logged,
required. including specific  One type of
 At least three exercises when exercise has been
Reflection question different exercises required. logged, including
responses are complete and have been logged, specific exercises
supported. including specific Reflection responses are when required.
exercises when complete but lacking
required. detail and support. Reflection responses are
incomplete or
Reflection responses are inaccurate.
adequately detailed and
supported.

Total Points Possible: 220 points