Free Monthly Physical Activity Sheet, dph 40073 - Wisconsin


File Size: 93.3 kB
Pages: 1
Date: December 22, 2005
File Format: PDF
State: Wisconsin
Category: Health Care
Author: dhfs/dph/bchp/nutrition
Word Count: 356 Words, 2,555 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://dhs.wisconsin.gov/forms/DPH/dph40073.pdf

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DEPARTMENT OF HEALTH AND FAMILY SERVICES Division of Public Health DPH 40073 (12/05)

STATE OF WISCONSIN

MONTHLY PHYSICAL ACTIVITY SHEET
Point Goal ______
1 Point/12 min Badminton Basketball ­ shooting Construction/remodel Dancing Golf ­ without cart Health Club ­ general Housework ­ vigorous Hunting Kayaking Mowing lawn ­walking Play w/kids ­ vigorous Skate/Roller blade Softball or Baseball Volleyball ­ vigorous Yard work, raking etc. 1 Point/15 min Archery Auto Repair Bicycling <10 mph Bowling Canoeing ­ light Golf ­ using motor cart Home repair­carpentry, Plumbing, etc. Horseback riding Housework ­ cleaning Music­vigorous, drums Play w/kids ­ moderate Sailing/sail board Snowmobiling Stretching, Yoga Table tennis Walk ­ moderate 3 mph Water Aerobics Weight Lift ­ moderate 1 Point/20 min Billiards/pool Cooking Fishing Mowing lawn ­ riding Music playing ­general Playing catch Play w/kids ­ light Walking ­ slow 2 mph Yard games ­ Croquet, frisbee, darts, etc

Month ___________
1 Point/4 min Bicycling >16 mph Handball, Squash, Racquetball Rowing-vigorous Running > 7 mph X-C skiing ­ racing 1 Point/5 min Boxing/sparring Football Martial arts Rope jumping Running, 6 mph Soccer -vigorous Swimming - vigorous X-C skiing ­ vigorous 1 Point/6 min Basketball ­ game Bicycling 12-15 mph Bicycling stationary Calisthenics-vigorous Carrying heavy loads Circuit training Hockey Rock climbing Running, 5 mph X-C skiing­moderate Snow shoeing Swimming­moderate Tennis, singles Volleyball, beach Walking upstairs 1 Point/10 min Aerobic ­ general Backpacking/hiking Bicycling 10-12 mph Canoeing - moderate Dancing ­ aerobic, fast Jet-skiing, water Jogging < 5 mph Moving boxes Rowing ­ moderate Shoveling snow Skating ­ vigorous Skiing-moderate Sledding Soccer ­ moderate Swimming-leisure Tennis ­ doubles Weight lifting-vigorous Walking ­ brisk, 4 mph

Name _______________________________________________
Length of Time

Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Activity

Points

Sub-total

Total Points
Approximate calories burned during activity 1 point = 40 calories for a 105 pound person 1 point = 50 calories for a 130 pound person 1 point = 60 calories for a 155 pound person 1 point = 70 calories for a 180 pound person 1 point = 80 calories for a 210 pound person 1 point = 90 calories for a 235 pound person 1 point = 100 calories for a 260 pound person Resting Metabolic Rate = about 1 to 2 points/hr

Multiply by calories/point (see weight chart) x ______ Total calories burned this month