Name:

Teacher:

Sport:

Personal Exercise Plan

(PEP)

Introduction

Who am I:

What are my intended aims:

What am I going to do:

Physical Activity Readiness Questionnaire (PARQ)

1. Have you or a member of your close family ever had any heart problems.

YES NO

2. Do you have or have you had high blood pressure?

YES NO

3. Do you have increased or high cholesterol?

YES NO

4. Have you had any recent surgery within the last 12 months?

YES NO

5. Do you have a history of breathing problems e.g. Asthma?

YES NO

6. Do you smoke?

YES NO

7. Do you have difficulty with regular exercise?

YES NO

8. Do you have a muscle or joint problem?

YES NO

9. Do you suffer from diabetes?

YES NO

SMART TARGETS

SMART Target One:

Why have you chosen this as your target?:

How will it help improve your sporting performance?:

SMART Target Two:

Why have you chosen this as your target?:

How will it help improve your sporting performance?:

SMART Target Three:

Why have you chosen this as your target?:

How will it help improve your sporting performance?:

Fitness Test Results

Test NameWhat is it testing?

Protocol(How to do it)

Score before PEP

Score after PEP

Why did you choose this test?

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