Free ANNUAL PHYSICAL ACTIVITY RECORD, DPH 40074 - Wisconsin

DEPARTMENT OF HEALTH AND FAMILY SERVICES Division of Public Health DPH 40074 (11/04)

STATE OF WISCONSIN

ANNUAL PHYSICAL ACTIVITY RECORD

Name

Year Goal

Month January February March April May June July August September October November December Total Average or %

Days of Activity per Month No. of days No. of days Total active for active for year to the month the month date (last year*) (this year)

+ or ­ versus last year

No. of points for the month (last year)

Points per Month No. of points Total for the year month (this to date year)

+ or ­ versus last year

No. of calories for the month (last year)

Calories per Month No. of calories for Total/ the month year (this year)

+ or ­ versus last year

Instructions: The Annual Physical Activity Record records monthly totals and also allows you to compare your totals from past months and previous years. You can track the information listed above or create your own column headings to track miles run, weight lifting sessions, and other physical activity. The columns above allow you to record your totals for each month, for the number of days you participated in physical activities, the number of activity points earned in a month and the estimated calories burned as a result of the activities. Set goals such as exercising 20 days per month or registering 100 points per month and then see how you do. Adjust your goals as needed and track your progress over time. *You will need to track your activity for a year before you can compare monthly data.