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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:
5. Physical— gain 25 pounds on my max bench
6. Social—make some more friends
7. Emotional— try and become stronger mentally by talking to a lot of people
8. Academic— make better grades
Goals Reflection Question:
Select one of the four goals to reflect on. On which goal are you reflecting (1, 2, 3, or
4)? What has influenced or helped your progress in meeting this goal? What has been
a challenge in the progress of meeting the goal? How can you overcome this
challenge?
Answer: o am reflecting on my academic goal. I have been challenged by the amount
of effort I have put in. Just put in more effort.
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 7:30
Body Mass Index 19.6
Aerobic Capacity 48.31
Curl-ups 40
Push-ups
30
Trunk Lift 7
Sit and Reach 7
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 would like to improve in the pushups because I know I can do more.
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 Day 1 Day 2
Stretched
Flexibilit Muscle # of # of
y Stretche Dates Repetitio Time Dates Repetitio Time
Exercises d ns ns
EXAMPL EXAMPL 2 15 2 15
8/3 8/5
E E seconds seconds
Lying
Quadrice
Quad 12/5 4 30s 12/6 4 30s
ps
Stretch
Modified 4
Hamstrin
Hurdler's 12/5 30s 12/6 4 30s
gs
Stretch
Upper 4
Back & 4
Trapezius 12/5 30s 12/6 30s
Torso
Stretch
Calf Gastrocne 4
12/5 30s 12/6 30s
Stretch mius 4
Lower 4
Latissimu
Back 12/5 4 30s 12/6 30s
s Dorsi
Stretch
Chest/ 4
Pectoralis
Bicep 12/5 4 30s 12/6 30s
/ Biceps
Stretch
Shoulder
Trapezius
/ Tricep 12/5 4 30s 12/6 4 30s
/ Deltoids
Stretch
Lying
Abdomin
Abdomin 12/5 4 30s 12/6 4 30s
al
al Stretch
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:they become already prestressed out and becomes musclememory.
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 Dates # of sets # of reps Resistance
Worked (Weight)
Squats Quadriceps 8/3 3 8 20 lbs.
Day 1 Day 2
Exerc Muscl Dates # of # of Resist Date # of # of Resis
ise e sets reps ance s sets reps tance
Work (Weigh (Weig
ed t) ht)
12/7 12/8
Squat Quadr
3 10 10 3 10 10
s iceps
pounds
12/7 10 8
Push- Pector
3 8 pounds 12/8 3 10
ups alis
Bridge Hamst 12/7 20 12/8 4
s rings 3 4 pounds 3 20
Latissi 3 20
Pull-
mus 12/7 4 20 12/8 3 4
ups pounds
Dorsi
Calf Gastr 6 8 20
Raise ocne 12/7 3 20 12/8 3
s mius pounds
12/7 3 30 12/8 3
Chair Tricep
4 pounds 4 30
Dip s
10 30 12/8 10
Bicep
Curls 12/7 3 pounds 3 30
s
3 4 4
Crunc Abdo
12/7 40 12/8 3 40
hes minal
pounds
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: the triceps and biceps became most sore overall. Add some stretching
and maybe more things involving the legs.
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 60 min
practice
12/28 5-min jog Badminton 2 hours
12/29 5-min stretch Skateboarding 1 hour
12/5 Stretch for 5 Weight lifting 1 hour and 30 miniutes
Running some poles 2 hours
12/6 and stretches (10 min) Baseball practice
12/7 Stretches for 5 minutes Biking with friends on a
trail. 5 hours
TOTAL Activity Minutes 🡪
510 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.
9. 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: Biking is probably wearing a helmet because you can get seriously hurt.
10. Describe one way that you showed respect for equipment, facilities, or
teammates in your activities this week.
Answer: I stayed after practice to help pick up equipment with my coach.
11. 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 great that I am getting out and working with my friends and
teammates. I made some changes in my warmup routines.
Module Four Wellness Plan Grading Rubric
Excellent Good Needs Poor
Improvement
Section 1: 9-10 points 8 points 7 points 0-6 points
Goals All goals are Most goals are Some goals Goals are not
measurable, measurable, are measurable,
attainable, and attainable, and measurable, attainable, and
deadline deadline attainable, and deadline
driven. driven. deadline driven.
Reflection Reflection driven. Reflection
question responses are Reflection responses are
responses are adequately responses are incomplete or
complete and detailed and complete but inaccurate.
supported. supported. lacking detail
and support.
Section 2: 36-40 points 32-35 points 25-31 points 0-24 points
Fitness Fitness Fitness Fitness Fitness
Assessment assess assess assess assess
Results for: ment ment ment ment
Module 4 results results results results
are are are are
recorde recorde recorde recorde
d. d. d. d.
Reflecti Reflecti Reflecti Reflecti
on on on on
question respons respons respons
respons es are es are es are
es are adequa comple incomp
comple tely te but lete or
te and detailed lacking inaccur
support and detail ate.
ed. support and
ed. support
.
Section 3: 45-50 points 40-44 points 30-39 points 0-29 points
Flexibility Log At least More At least Less
two than one day than
days of one day of one day
stretchin of stretchin of
g are stretchin g is stretchin
recorde g is recorde g is
d. recorde d. recorde
All d. At least d.
eight At least four Less
stretchin six stretchin than
g stretchin g four
activitie g activitie stretchin
s are activitie s are g
recorde s are recorde activitie
d each recorde d each s are
day. d each day. recorde
All day. Some d each
stretche Most stretche day.
s are stretche s are Few
held an s are held an stretche
appropri held an appropri s are
ate appropri ate held an
length ate length appropri
of time. length of time. ate
Reflecti of time. Reflecti length
on Reflecti on of time.
question on respons Reflecti
respons respons es are on
es are es are comple respons
comple adequa te but es are
te and tely lacking incomp
support detailed detail lete or
ed. and and inaccur
support support ate.
ed. .
Section 4: 45-50 points 40-44 points 30-39 points 0-29 points
Muscular All At least At least Less
Strength and eight six four than
Endurance muscles muscles muscles four
Log are are are muscles
exercise exercise exercise are
d at d at d at exercise
least least least d at
two two two least
days. days. days. two
All All Most days.
muscles muscles muscles Few
are are are muscles
rested rested rested are
for at for at for at rested
least 48 least 48 least 48 48
hours hours hours hours
between between between between
workout workout workout workout
s. s. s. s.
Appropri Appropri Appropri Appropri
ate ate ate ate
reps, reps, reps, reps,
sets, sets, sets, sets,
and and and and
resistan resistan resistan resistan
ce are ce are ce are ce used
used for used for used for for few
all most some exercise
exercise exercise exercise s.
s. s. s. Reflecti
Reflecti Reflecti Reflecti on
on on on respons
question respons respons es are
respons es are es are incomp
es are adequa comple lete or
comple tely te but inaccur
te and detailed lacking ate.
support and detail
ed. support and
ed. support
.
Section 5: 63–70 points 54–62 points 43–53 points 0–42 points
Physical All Most Some Few
Activity Log exercise exercise exercise exercise
YOU ARE s are s are s are s are
REQUIRED moderat moderat moderat moderat
TO LOG e to e to e to e to
EACH WEEK vigorous vigorous vigorous vigorous
YOU ARE IN intensity intensity intensity intensity
THE COURSE . . . , or
At least At least At least intensity
420 385 350 is not
activity activity activity indicate
minutes minutes minutes d.
are are are At least
recorde recorde recorde 315
d. d. d. activity
All All Some minutes
exercise exercise exercise are
s are s are dates recorde
dated dated listed d.
as daily as daily are not Few
or every or every in an exercise
other other effective dates
day. day. pattern. listed
At least Most At least are in
three exercise two an
different dates different effective
exercise are exercise pattern.
s have listed s have One
been and are been type of
logged, not in logged, exercise
includin an includin has
g effective g been
specific pattern. specific logged,
exercise At least exercise includin
s when three s when g
required different required specific
. exercise . exercise
Reflection s have Reflection s when
question been responses are required
responses are logged, complete but .
complete and includin lacking detail Reflection
supported. g and support. responses are
specific incomplete or
exercise inaccurate.
s when
required
.
Reflection
responses are
adequately
detailed and
supported.
Total Points Possible: 220 points
