Module Four Wellness Plan

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 run 3 miles 4 times a week for 4 weeks
2. Social— I will be more outgoing from now on.
3. Emotional— I will write down my how my day was every day for the next 2 weeks
4. Academic— I will study at least 3 times a week for a hour
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Goals Reflection Question:
Select one of the four goals to reflect on. On which goal are you reflecting (1, 2, 3, or 4)? What has influenced or
helped your progress in meeting this goal? What has been a challenge in the progress of meeting the goal? How
can you overcome this challenge?
Answer:
I am reflecting on goal 2. What helped me progress in meeting this goal is putting the mindset that I only live once and I
should make the most out of it. A challenge that has slowed me down from meeting this goal is me being scared of being
embarrassed. I can overcome this challenge by changing my mindset of only living once.
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 7:34
Body Mass Index 18.81
Column A Column B
Aerobic Capacity 49.82
Curl-ups 40
Push-ups 45
Trunk Lift 11 inches
Sit and Reach 11.5
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:
What I want to see most improvement in the next few weeks is my sit and reach. I need to really work on my flexibility in
order to improve my sit and reach.
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
2 15 2
EXAMPLE EXAMPLE 8/3 8/5 15 seconds
seconds
Lying Quad Stretch Quadriceps 2 2

7/7 20 seconds 7/9 20 seconds
Modified Hurdler's Stretch Hamstrings 2 2

Upper Back & Torso Stretch Trapezius 2 2

Calf Stretch Gastrocnemius 2 2

Lower Back Stretch Latissimus Dorsi 2 2

Flexibility Exercises/Muscle Stretched Day 1 Day 2
Chest/ Bicep Stretch Pectoralis/ Biceps 2 2

Shoulder/ Tricep Stretch Trapezius/ Deltoids 2 2

Lying Abdominal Stretch Abdominal 2 2

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:
They got easier because my muscles got used to the movement. These stretches affected my muscles during my physical
activities by making my muscles more used to the movement so it didn’t have to do as much work if I haven't done the
stretches.
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. (There should be at least one day between exercise
sessions)
● 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)
Day 1 Day 2
Squats Quadriceps 3 12 2 14 15 ibs
Push-ups Pectoralis 3 11 2 15 bw
Bridges Hamstrings 3 9 3 10 bw
Pull-ups Latissimus Dorsi 3 15 3 13 bw
Calf Raises Gastrocnemius 2 15 3 12 10 ibs
Chair Dip Triceps 2 10 3 15 bw
Curls Biceps 3 8 3 10 15 ibs
Crunches Abdominal 2 10 3 10 15 ibs
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:
The muscle group that is the most difficult is my Biceps. I can do diamond push-ups and I can also do more pull-ups.
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.
Activity Minutes
Date Warm-up Physical Activity
without Warm-up
12/25 5-min stretch 2-mile kayak 30 minutes
12/26 5-min jog 4-mile run 45 minutes
12/27 5-min stretch Basketball practice 60 min
Activity Minutes
without Warm-up
12/28 5-min jog Badminton 2 hours
12/29 5-min stretch Skateboarding 1 hour
Activity Minutes
without Warm-up
7/1 10 min soccer game 90 min
7/2 30 min two soccer games 180 min
7/3 15 min soccer game 90 min
7/5 20 min gym workout 40 min
7/6 10 min basketball 30 min
7/7 20 min soccer practice 60 min
7/8 5 min 3 mile jog 15 min
TOTAL Activity Minutes 🡪 505 minutes

Remember the 420-minute minimum
Activity Minutes
without Warm-up
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:
The most safety precautions that I followed was wearing shin guards while playing soccer. I think that is the most
important because there have been many occasions that if I wasn’t wearing shin guards my shins could have been
broken.
2. Describe one way that you showed respect for equipment, facilities, or teammates in your activities this week.
Answer:
I showed respect to teammates when they missed a shot or they felt sad because we lost I told them to keep their
head up and it’s fine everyone makes mistakes
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 think my activity level was very good this week and I don’t think there were really to much changes I could have done to improve
my daily movement.
4. After looking at your current levels of fitness and physical activity, do you think you will be able to reach your goals?
If your answer is no, what adjustments can you make to make your goals more obtainable?
After looking at my fitness and physical activities, I will be able to reach my goal.
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 assessment ● Fitness assessment ● Fitness assessment ● Fitness
Results for: results are recorded. results are results are assessment
● Reflection question recorded. recorded. results are
Module 4 recorded.
responses ● Reflection ● Reflection
are complete and responses are responses are ● Reflection
supported. adequately complete but responses are
detailed and lacking detail and incomplete or
supported. support. inaccurate.

Flexibility Log
● At least two days of ● More than one day ● At least one day of ● Less than
stretching are of stretching is stretching is one day of
recorded. recorded. recorded. stretching is
● All eight stretching ● At least six ● At least four recorded.
activities are recorded stretching activities stretching activities ● Less than four
each day. are recorded each are recorded each stretching
● All stretches are held day. day. activities are
an appropriate length ● Most stretches are ● Some stretches are recorded each
of time. held an appropriate held an appropriate day.
● Reflection question length of time. length of time. ● Few stretches are
responses 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.

Muscular
Strength and ● All eight muscles are ● At least six ● At least four ● Less than four
Endurance exercised at least two muscles are muscles are muscles are
Log days. exercised at least exercised at least exercised at least
● All muscles are rested two days. two days. two days.
for at least 48 ● All muscles are ● Most muscles are ● Few muscles are
hours between rested for at least 48 rested for at least rested 48 hours
workouts. hours between 48 hours between between
● Appropriate reps, sets, workouts. workouts. workouts.
and resistance are ● Appropriate reps, ● Appropriate reps, ● Appropriate reps,
used for all sets, and resistance sets, and resistance sets, and
exercises. are used for most are used for some resistance used
● Reflection question exercises. exercises. for few exercises.
responses ● Reflection ● Reflection ● Reflection
are complete and responses are responses are responses are
supported. adequately complete but incomplete or
lacking detail and
detailed and support. inaccurate.

supported.
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 are ● Few exercises are
YOU ARE moderate to vigorous moderate to moderate to moderate to
REQUIRED TO intensity. vigorous intensity. vigorous intensity. vigorous intensity,
LOG EACH ● At least 420 activity ● At least 385 activity ● At least 350 activity or intensity is not
WEEK YOU minutes are recorded. minutes are minutes are indicated.
ARE IN THE ● All exercises are recorded. recorded. ● At least 315
COURSE dated as daily or every ● All exercises are ● Some exercise activity minutes
other day. dated as daily or dates listed are not are recorded.
● At least three every other day. in an effective ● Few exercise
different exercises ● Most exercise dates pattern. dates listed are in
have been logged, are listed and are ● At least two an effective
including specific not in an effective different exercises pattern.
exercises when pattern. have been logged, ● One type of
required. ● At least three including specific exercise has been
● Reflection question different exercises exercises when logged, including
responses are have been logged, required. specific exercises
complete and including specific ● Reflection when required.
supported. exercises when responses are ● Reflection
required. responses are
● Reflection complete but lacking incomplete or

responses are detail and support. inaccurate.
adequately detailed
and supported.
Total Points Possible: 220 points

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Module Four Wellness Plan

GO TO FILE – Choose SAVE AS – Save a copy of this to your computer!

Section 1: Your Goals

Section 2: Fitness Assessments

Wellness Plan Results

Mile Run/Walk 7:34

Body Mass Index 18.81

Aerobic Capacity 49.82

Trunk Lift 11 inches

Sit and Reach 11.5

Fitness Assessment Reflection Questions:

Lying Quad Stretch Quadriceps 2 2

Modified Hurdler's Stretch Hamstrings 2 2

Upper Back & Torso Stretch Trapezius 2 2

Calf Stretch Gastrocnemius 2 2

Lower Back Stretch Latissimus Dorsi 2 2

Chest/ Bicep Stretch Pectoralis/ Biceps 2 2

Shoulder/ Tricep Stretch Trapezius/ Deltoids 2 2

Lying Abdominal Stretch Abdominal 2 2

Flexibility Reflection Questions:

Section 4: Muscular Strength and Endurance Log

Squats Quadriceps 8/3 3 8 20 lbs.

Exercise Muscle Worked Dates # of # of Resistance Dates # of # of Resistance

Squats Quadriceps 3 12 2 14 15 ibs

Pull-ups Latissimus Dorsi 3 15 3 13 bw

Calf Raises Gastrocnemius 2 15 3 12 10 ibs

Chair Dip Triceps 2 10 3 15 bw

Curls Biceps 3 8 3 10 15 ibs

Crunches Abdominal 2 10 3 10 15 ibs

Section 5: Physical Activity Log

12/25 5-min stretch 2-mile kayak 30 minutes

12/26 5-min jog 4-mile run 45 minutes

12/27 5-min stretch Basketball practice 60 min

12/28 5-min jog Badminton 2 hours

12/29 5-min stretch Skateboarding 1 hour

7/1 10 min soccer game 90 min

7/2 30 min two soccer games 180 min

7/3 15 min soccer game 90 min

7/5 20 min gym workout 40 min

7/6 10 min basketball 30 min

7/7 20 min soccer practice 60 min

7/8 5 min 3 mile jog 15 min

TOTAL Activity Minutes 🡪 505 minutes

Physical Activity Reflection Questions:

Module Four Wellness Plan Grading Rubric

Excellent Good Needs Improvement Poor

Section 1: 9-10 points 8 points 7 points 0-6 points

Section 2: 36-40 points 32-35 points 25-31 points 0-24 points

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

are complete and ● Reflection ● Reflection appropriate length

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

detailed and support. inaccurate.

Section 5: 63–70 points 54–62 points 43–53 points 0–42 points

● Reflection complete but lacking incomplete or

Total Points Possible: 220 points

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