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: Measurable, attainable, and deadline driven-MAKE NEW GOALS, DIFFERENT FROM MOD 1 WELLNESS
PLAN
1. Physical—
2. Social—
3. Emotional—
4. Academic—
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 - run or walk a minutes

mile and list how long it takes you
to complete it. There are free
apps (like Run tracker) that will
track your time and distance

Body Composition/BMI - Use

the BMI/Aerobic Capacity
Calculator on page 3 of Lesson
1.03 in your online textbook.

Aerobic Capacity - Use the

BMI/Aerobic Capacity Calculator
on page 3 of Lesson 1.03 in your
online textbook.

Sit and Reach - there is a

video on page 5 of the lesson that
shows how to do the sit and reach
 inches

Curl-Ups - this is just like a sit-

up except that your arms should
be on the ground beside your
body. List how many you can do
in 1 minute

Trunk Lift -there is a video on

page 8 of the lesson that shows
how to do trunk lifts inches

Push-ups - list how many you

can do in 1 minute. You can do
them on your knees or against a
wall to help you build up your
strength.

**Please save these results, as you will need to include them for future Wellness Plans in the course.**

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

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
Dates Date
Flexibility Exercises Muscle Stretched Repetition Time Repetition Time
s
s s
2 15 2 15
EXAMPLE EXAMPLE 8/3 8/5
seconds seconds

REMEMBER TO CHANGE YOUR DATES TO CURRENT DATE

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        

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.
● 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
REMEMBER TO CHANGE YOUR DATES TO CURRENT DATE
Exercise Muscle Worked Dates # of # of Resistance Dates # of # of Resistance
sets reps (Weight) sets reps (Weight)

2 0R 3 8-20 2 OR 3 8-20

Squats Quadriceps

Push-ups Pectoralis

Bridges Hamstrings
 Pull-ups Latissimus Dorsi

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.
 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

12/28 5-min jog Badminton 2 hours

12/29 5-min stretch Skateboarding 1 hour

Start Entering Your Information Here-Above is only an example...Use current dates-NO

REPEATED DATES
 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:

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 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
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
Endurance exercised at least two muscles are muscles are muscles are
days. exercised at least exercised at least exercised at least
Log
● 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
detailed and lacking detail and inaccurate. 
supported. 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 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
different exercises exercises when logged, including
Reflection question
have been logged, required. specific exercises
responses are complete and
supported. including specific when required.
Reflection responses are
exercises when
complete but lacking Reflection responses are
required. detail and support. incomplete or
inaccurate.
Reflection responses are
adequately detailed and
supported.

Total Points Possible: 220 points