Exercise History Form

Exercise Questions

Please complete the form below to assist us in designing your customised training program.

1. Are you currently doing any exercise? ^*

Yes

No

If Yes go to question 2, If No go to question 6.

2. If yes, what is your current exercise regime?

3. How long have you been doing this?

4. How many times a week?

5. How long do you exercise for (minutes/hours)?

6. If no, have you done regular exercise in the past and what type? Why did you stop?

7. Is there any type of exercise you don’t enjoy or are unable to do due to health reasons? ^*

8. Do you have any mobility restrictions due to previous injury, surgery? e.g. back pain, shoulder, knees ^*

9. What are your main goals in starting an exercise program? Please tick any that apply to you: ^*

Improve cardiovascular fitness

Improve strength and general mobility

Increase lean muscle mass and tone

Lose weight

Increased flexibility

Increased energy levels and reduce stress

Postural correction

Improve core strength

Maintain or improve general health

Reduced pain

Prevention of diseases e.g. Diabetes, cardiovascular disease, stroke, osteoporosis, cancers

Recaptcha

Note: Please consult your healthcare professional prior to commencing any exercise program