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Ped Worksheet
Ped Worksheet
HEALTHY MONDAY
Total
Monday Tuesday Wednesday Thursday Friday Saturday Sunday (If applicable)
Frequency Total Days:
Did you exercise today? Yes No Yes No Yes No Yes No Yes No Yes No Yes No 2 DAYS
GOAL: 3-5 days every week
Symptom Free
No chest pain, Yes No Yes No Yes No Yes No Yes No Yes No Yes No
dizziness, etc.
Progress Frequency: Frequency: 1x Frequency: 1x Frequency: Frequency: Frequency: Frequency: Next week’s
Each time you exercise Intensity: Intensity: M Intensity: M Intensity: Intensity: Intensity: Intensity: goal?
increase one of the
Time: Time: 6:30AM Time: 7AM Time: Time: Time: Time:
components, what did CONTINUE
you increase? Type: Type:JOGGING Type:WALKING Type: Type: Type: Type: EXERCISE