ACTIVITY 3

Form 3 -A
PHYSICAL FITNESS TEST SCORE CARD
Name: Kurtney Iane Dialoma Sex: Female Age: 19 yo

CLASS #: PED001 Section: M2FEM Date: 11- 04 - 21

Direction: Perform the following activities to assess your fitness level. Make sure to
observe social distancing and other health and safety precautions.

Task 1: Health-Related Fitness Test

A. Body Composition: Body Mass Index (BMI)
Body Mass Index (BMI)
Height (meters) Weight (Kilograms) BMI Classification
157 m 49 kg 19.9 Normal

B. Cardiovascular Endurance: 3-Minute Step

Heart Rate per Minute
Before the Activity After the Activity
68 112

C. Muscular Endurance D. Muscle Strength

1. Push up 2. Basic Plank
Number of Push ups Time
10 42 .61 seconds

E. Flexibility
1. Zipper Test
Overlap/Gap (centimetres)
Right Left
9.5 cm 2 cm
Task 2: Skill-Related Fitness Test

A. Coordination:
1. Juggling Score: 1st trial:__2______
2nd trial:__3______
3rd trial:__4______

B. Agility:
2. Hexagon Agility Test
Clockwise: Time (00:00) Counter clockwise: Time (00:00)

C. Speed:
3. 40 Meter Sprint Time: _____________

D. Power: Standing Long Jump E. Balance: Stork Balance Stand Test

Distance (centimetres Right Foot: Time (00:00) Left Foot: Time(00:00)
First Trial Second Trial 57.22 sec 10.39 sec

F. Reaction Time: Stick/Ruler Drop Test

1st Trial 2nd Trial 3rd Trial
20 cm 4 cm 29 cm

G. Balance: Stork Stand

1st Trial 2nd Trial 3rd Trial
57.22 sec 10.39 sec 13.14 sec

Evaluator’s Name: _________________________

ACTIVITY 3
Form 3- B
INDIVIDUAL SCORE CARD(PRETEST) 

Name: Kurtney Iane Dialoma Gender: Female_Age: 19

Height: ______ m Body Weight: 49 kg BMI: ______MHR: 201

Resting Pulse Rate (RPR): __68__ bpm (Before Step Test) 

Exercise Pulse Rate (EPR): __112_ bpm (After Step Test) 
Recovery Pulse Rate: ___87__ bpm (After 3 min) 
Target Heart Rate: 
Low Intensity 60-70 % ___________ to ____________ bpm 
Moderate Intensity 70-80% ___________ to ____________ bpm 
High Intensity 80-90% ___________ to ____________ bpm 
Very High Intensity 90-100% ___________ to ____________ bpm 
___________________________________________________________________________________
RESULTS OF THE TESTS 
Station Test PRE-TEST
Score Remarks Tester Date
1 3-Minute Step
2 Stork Balance Stand
3 Zipper Test
4 Planking
5 Push up
6 Hexagon Agility Test
7 Standing Long Jump
8 Juggling
9 40 Meter Sprint
10 Stick/Ruler Drop Test
ACTIVITY 4
Directions: Create your own fitness program using the F.I.T.T principle. Ask your family
members to participate in performing the exercise. Before you start, make sure that your
cellular phone is ready to record your video.
INDIVIDUAL EXERCISE WORK OUT FORM
NAME: __________________ SECTION/DAY: ______ BMI: ____AGE: ____ GENDER: __________
TYPE INTENSITY TIME FREQUENCY

COMPONENTS 1ST 2ND WEEK 3RD WEEK 4TH

OF EXERCISE WEEK WEEK
EXERCISE No. set and
Repetition Sec./min
M W F M W F M W F M W F
1.CARDIO
VASCULAR
ENDURANCE

2.BALANCE

3.FLEXIBILITY

4.MUSCULAR
ENDURANCE

5. MUSCULAR
STRENGTH

6.AGILITY

7.POWER

8.COORDINATI
ON

9. SPEED

10. REACTION
TIME