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— I will jog with my dad everyday at 4:40 AM
2. Social— I will make 3 more friends by the end of next week
3. Emotional— I will self reflect in my room for 30 minutes a day to lower my stress.
4. Academic— I will change my C into a B by the end of this week

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 18 minute walk around my neighbor hood

Body Mass Index 23.48

Aerobic Capacity 40.35

Curl-ups 20

Push-ups 20

Trunk Lift 14 inches

Sit and Reach 8 inches

 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: I actually like where I am at now but I want to be able to maintain a healthy lifestyle so in order to do that
I will maintain a constant state of exercise and activity.

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
Flexibility Exercises Muscle Stretched Dates Time Dates Time
Repetitions Repetitions

EXAMPLE EXAMPLE 8/3 2 15 seconds 8/5 2 15 seconds

Flexibility Exercises/Muscle Stretched Day 1 Day 2

Lying Quad Stretch Quadriceps 9/10 2 15 seconds 9/11 2 15 seconds

Modified Hurdler's Stretch Hamstrings 9/10 2 15 seconds 9/11 2 15 seconds

Upper Back & Torso Stretch Trapezius 2 2

9/10 15 seconds 9/11 15 seconds

Calf Stretch Gastrocnemius 9/10 2 15 seconds 9/11 2 15 seconds

Lower Back Stretch Latissimus Dorsi 2 2

9/10 15 seconds 9/11 15 seconds

Chest/ Bicep Stretch Pectoralis/ Biceps 9/10 2 15 seconds 9/11 2 15 seconds

Shoulder/ Tricep Stretch Trapezius/ Deltoids 9/10 2 15 seconds 9/11 2 15 seconds

Lying Abdominal Stretch Abdominal 2 28

9/10 15 seconds 9/11 15 seconds

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: Stretches are supposed to make your muscles stronger and more flexible to increase mobility.

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

Exercise Muscle Worked Dates # of # of Resistance Dates # of # of Resistance

sets reps (Weight) sets reps (Weight)

Squats Quadriceps 9/10 2 10 Resistance bands 9/11 2 12 Resistance bands

Push-ups Pectoralis 9/10 2 10 Resistance bands 9/11 2 12 Resistance bands

Bridges Hamstrings 9/10 2 10 Resistance bands 9/11 2 12 Resistance bands

Pull-ups Latissimus Dorsi 9/10 2 10 Resistance bands 9/11 2 12 Resistance bands

Calf Raises Gastrocnemius 9/10 2 10 Resistance bands 9/11 2 12 Resistance bands

Chair Dip Triceps 9/10 2 10 Resistance bands 9/11 2 12 Resistance bands

Curls Biceps 9/10 2 10 25 pounds 9/11 2 12 25 lbs

Crunches Abdominal 9/10 2 10 Resistance bands 9/11 2 12 Resistance bands

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: I don’t really like to stretch my calves due to me constantly hurting myself because they are always sore
from marching but I would do a stretch with a partner or a soccer stretch my friend taught me.

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.

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

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

5/27 2-min stretch 30 push-ups/1 mile jog 45 min

5/28 300 meter jog 100 meter sprint 55 min

5/29 5-minutes of Basketball outside w/ friends 185 min

breathing
techniques

3/30 10-minutes of 500-meter walk/ 100-meter sprint/ 90

stretching and
jumping jacks

3/31 300 meter jog 100 meter sprint 55 min

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

TOTAL Activity Minutes 

Remember the 420-minute minimum
430 minutes

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: Never lock your knees when you march or you WILL pass out.

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

Answer: I place my weights down carefully so I don’t damage them, myself, or anyone else around me.
 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: I feel like I have a great pace going for me and I would like to keep it the same or I would be over
exerting myself and that’s not always a good thing.

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
 Excellent Good Needs Improvement Poor

Module 4  Reflection question recorded. recorded. results are

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
 Excellent Good Needs Improvement Poor

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
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 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  Few exercises are
 Excellent Good Needs Improvement Poor

YOU ARE moderate to vigorous moderate to are 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  All exercises are  Some exercise activity minutes
every 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 pattern. dates listed are in
have been logged, dates are listed and  At least two an effective
including specific are not in an different exercises pattern.
exercises when effective 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 including specific when required.
supported. exercises when Reflection responses are
required. complete but lacking Reflection responses are
detail and support. incomplete or
Reflection responses are inaccurate.
adequately detailed and
supported.

Total Points Possible: 220 points