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G sitting playing video games 920 minutes (Phase/Mth 1) Activities
G surfing on the internet 930 minutes (Phase/Mth 2)
G ________________.
940 minutes (Phase/Mth 3) 950 minutes (Phase/Mth 4) 960 minutes (Phase/Mth 5) Adapted from: Green Prescription, Hillary Commission, Ministry of Health, Wellington, NZ,, Canada's Physical Activity Guide for Youth, 2002, with information from the Canadian Fitness and Lifestyle Research Inst.i.tute 2001 Physical Activity Monitor information from the Canadian Fitness and Lifestyle Research Inst.i.tute 2001 Physical Activity Monitor On a computer program log of your own design, on a calendar, or in your school planner, record the total On a computer program log of your own design, on a calendar, or in your school planner, record the total time that you partic.i.p.ate in each of the above categories and describe how you feel during each activity time that you partic.i.p.ate in each of the above categories and describe how you feel during each activity session. session.
Bring in your completed scheduler to your doctor on : ___________________ (Appt date) Signed: _______________________________ Signed: _______________________________ Date: __________ Doctor's Signature: _______________________ Feel Free to Copy this Sheet [image]
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Patient Information Sheet (Appendix 7) Name:__________________________________________ D.O.B.: _____ /_________/____________.
Phone No.: (_____) - ____________________________
L PEDOMETER EXERCISE PRESCRIPTION L.
I want you and your family to work with me to make sure you are getting enough physical activity to keep you healthy, happy, and doing well in school. This tool is a physical activity to keep you healthy, happy, and doing well in school. This tool is a fun way to discover how much activity you are getting and to measure increases in fun way to discover how much activity you are getting and to measure increases in your activity level toward an even healthier YOU! This is how it works. your activity level toward an even healthier YOU! This is how it works.
1. For this experiment, you will need a pedometer, available at local fitness equipment stores, sporting goods stores, the Running Room retail stores, or through an AVON representative (inquire about a A goods stores, the Running Room retail stores, or through an AVON representative (inquire about a A Bally Kids pedometer $14.99). Bally Kids pedometer $14.99).
2. Clip the pedometer to your waist and wear it from the time you get up until the time you go to bed.
3. The pedometer will measure every step that you take all day long: going to school, playing at recess, at lunch, after school, and after supper. lunch, after school, and after supper.
4. At the end of each At the end of each day, record the number that is displayed on the pedometer on your Health Canada day, record the number that is displayed on the pedometer on your Health Canada Physical Activity Chart (available free with stickers from Health Canada 1-888-334-9769). Physical Activity Chart (available free with stickers from Health Canada 1-888-334-9769).
5. To set your starting point (Level), measure and record the number of steps you take each day for 3 days.
If that number is below 10,000 steps, start at Level 1. For any number of steps higher than 10,000, start at the closest level (e.g. if your total is 12, 342 steps for any one day, start at level 8) at the closest level (e.g. if your total is 12, 342 steps for any one day, start at level 8) 6. When you the steps you take in a day matches the goal for your level, put a sticker on your calendar and 6. When you the steps you take in a day matches the goal for your level, put a sticker on your calendar and share this information with your parents. share this information with your parents.
7. Don't forget to reset the pedometer to 0 (zero) each night before going to bed, so it will be ready to put on the following morning. on the following morning.
8. Challenge your family to try to keep up with you!
Pedometer Prescription Recommendations Level Beginning of week End of week
1.
10,000.
10,500.
2.
10,500.
11,000.
3.
11,000.
11,500.
4.
11,500.
12,000.
5.
12,000.
12,500.
6.
12,500.
13,000.
7.
13,000.
13,500.
8.
13,500.
14,000.
9.
14,000.
15,000.
10.
15,000.
16,000 Congratulations !!!
Bring in your completed poster with all the information on the following date: ______________________, 200_____ 200_____ Signature of doctor: _________________________________ Date of prescription: ______________________, 200_____ Feel Free to Copy this Sheet