Lifestyle Questionnaire

This lifestyle questionnaire will assess your level of activity. The purpose of this questionnaire is to find out what level of program to start with. Add up all of the points and figure out your score to see where you fit in.

1. In the past year, how often have you been involved in physical activity?
3+ times per week (6pts)
Once per week (4pts)
Once per month (2pts)
Once per 6 months (1 pt)

2. How often have you worked with resistance training? I currently train....

4-6 days/week (9 pts)	1ce/Month (3 pts)
3 days/week (6 pts)	I use to train 1+ year ago (2pts)
1ce/week (4 pts)	I dont train (1 pt)

3. Rate your stress level. ___________ (Value 1-5 pts) (5 being NO stress)

4. How many meals do you have per day?
5+ meals (smaller meals) (5 pts)
3-4 meals (3 pts)
2 meals (1 pts)
0-1 meal (0 pts)

5. Do you feel you eat healthy “most of the time?” (55% carbs, 20% pro, 25% fat)

Enter a number 1-10 ___________ (use this value) (10 being healthy)

6. Is your Body Mass Index in the healthy zone? (BMI Calculator)
Yes (5 pts)
No (-4 pts)

TOTAL: ______________

Now add up your total score, this score will be used for the upcoming pages.

(-1 to 10) Moderate health risks (10 to 15) Mild health risks (15 to 20) Your lifestyle is healthy (20 to 25) You have a very healthy lifestyle (25 to 39) optimal lifestyle

If you have scored high on this questionnaire and feel confident on what you are doing when resistance training you could start at an indermediate program.

If you have scored low, you might need to make some small changes