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—
2. Social—
3. Emotional—
4. Academic—

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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:

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

Body Mass Index

Aerobic Capacity

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Column A Column B

Curl-ups

Push-ups

Trunk Lift

Sit and Reach

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:

Section 3: Flexibility Workout Log

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 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

Modified Hurdler's Stretch Hamstrings

Upper Back & Torso Stretch Trapezius

Calf Stretch Gastrocnemius

Lower Back Stretch Latissimus Dorsi

Chest/ Bicep Stretch Pectoralis/ Biceps

Shoulder/ Tricep Stretch Trapezius/ Deltoids

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Flexibility Exercises/Muscle Stretched Day 1 Day 2

Lying Abdominal Stretch Abdominal

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:

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.

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  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)

Squats Quadriceps

Push-ups Pectoralis

Bridges Hamstrings

Pull-ups Latissimus Dorsi

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 Day 1 Day 2

Calf Raises Gastrocnemius

Chair Dip Triceps

Curls Biceps

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:

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.

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 Date Warm-up Physical Activity Activity Minutes
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

12/28 5-min jog Badminton 2 hours

12/29 5-min stretch Skateboarding 1 hour

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 Date Warm-up Physical Activity Activity Minutes
without Warm-up

TOTAL Activity Minutes 

Remember the 420-minute minimum

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:

2. Describe one way that you showed respect for equipment, facilities, or teammates in your activities this week.

Answer:

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:
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?

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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 Most goals are Some goals are Goals are not
measurable, attainable, measurable, attainable, measurable, measurable,
and deadline driven. and deadline driven. attainable, and attainable, and
Reflection question Reflection responses deadline driven. deadline driven.
responses are complete are adequately Reflection responses Reflection responses
and supported. detailed and are complete but are incomplete or
supported. lacking detail and inaccurate.
support.

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
responses  Reflection  Reflection recorded.
are complete and responses are responses are  Reflection
supported. adequately complete but responses are
detailed and lacking detail and incomplete or

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 Excellent Good Needs Improvement Poor

supported. support. inaccurate.

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

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  Reflection  Reflection held an
are complete and responses are responses are appropriate length
supported. adequately complete but of time.
detailed and lacking detail and  Reflection
supported. support. responses are
incomplete or
inaccurate.

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

Muscular
Strength and  All eight muscles are  At least six  At least four  Less than four

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 Excellent Good Needs Improvement Poor

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 rested for at least rested 48 hours
workouts. 48 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 sets, and
exercises. are used for most resistance are used resistance used
 Reflection question exercises. for some for few exercises.
responses  Reflection exercises.  Reflection
are complete and responses are  Reflection responses are
supported. adequately responses are incomplete or
detailed and complete but inaccurate.
supported. lacking detail and
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
YOU ARE moderate to vigorous moderate to are moderate to are moderate to
REQUIRED TO
intensity. vigorous intensity. vigorous intensity. vigorous intensity,
LOG EACH
WEEK YOU  At least 420 activity  At least 385 activity  At least 350 or intensity is not
ARE IN THE minutes are activity minutes are

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 Excellent Good Needs Improvement Poor

COURSE minutes are recorded. recorded. recorded. indicated.

 All exercises are  All exercises are  Some exercise  At least 315
dated as daily or dated as daily or dates listed are not activity minutes
every other day. every other day. in an effective are recorded.
 At least three  Most exercise pattern.  Few exercise
different exercises dates are listed and  At least two dates listed are in
have been logged, are not in an different exercises an effective
including specific effective pattern. have been logged, pattern.
exercises when  At least three including specific  One type of
required. different exercises exercises when exercise has been
 Reflection question have been logged, required. logged, including
responses are including specific  Reflection specific exercises
complete and exercises when responses are when required.
supported. required. complete but  Reflection
 Reflection lacking detail and responses are
responses are support. incomplete or
adequately detailed inaccurate.
and supported.

Total Points Possible: 220 points

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