TRI-SUCCESS FITNESS FEEDBACK FORM #2
Stretching, Misc. Activities, and Nutrition. Tally three day totals and send form:

Name: 
Week: 

 

STRETCHING:

Upperbody and Trunk:
 
Time spent stretching arms, shoulders, chest, and back:
Goal:  Mins. / Day


Actual:
Day 1: 
Day 2: 
Day 3: 

 Time spent stretching neck:
 

Goal:  Mins. / Day


Actual:
Day 1: 
Day 2: 
Day 3: 
 

 Time spent stretching lowerback and gluts:
Goal:  Mins. / Day


Actual:
Day 1: 
Day 2: 
Day 3: 

 Time spent stretching obliques (side bends) and waist (seated or standing twists):
Goal:  Mins. / Day


Actual:
Day 1: 
Day 2: 
Day 3: 

Total time spent stretching upperbody:
Goal: -  Mins./Day


Actual:  Mins.

Lowerbody:
 
Time spent stretching hamstrings (back of thighs):
Goal: 
Mins. / Day


Actual:
Day 1: 
Day 2: 
Day 3: 

 Time spent stretching quadricepts (front of thighs):
Goal: 
Mins. /  Day
Actual:
Day 1: 
Day 2: 
Day 3: 		 Time spent stretching calves:
Goal: 
Mins. /  Day
Actual:
Day 1: 
Day 2: 
Day 3: 

Total Time spent stretching Lowerbody:
Goal:  Mins
Actual: 

GRAND TOTAL Time spent stretching total body: (Total all sets throughout day, you should stretch 4-5 times / day):
Goal:  Mins./Day
Actual: 

Misc. Activities:

Many of our daily activities COUNT toward exercise/fitness time, if they are strenuous enough to work the major muscle groups, and endure long enough to significantly raise the target heart rate zone (then they are considered aerobic exercise)! Some are even overly strenuous, and are anaerobic, but COUNT as resistance exercise!

Put the # of mins. you did each:
 
 
  Vacuuming
  Gardening
  Lawn Work
  Shopping
  Moving
  Carrying kids (at least   15 mins.)
  Scraping/painting
  Sweeping/cleaning
 
  Ironing (at least 15 mins.)
  Weedeating
  Hand washing the car
  Dog walking (big, or medium size)
  Bicycling
  Hiking
  Stairs (at least 15 mins.)
  Water/snow sports    (skiing, waverunner)		   Golf (18 holes without   cart!)
  Basketball
  Volleyball
  Softball
  Football
  Tennis 
  Rope jumping
  Other sports
 

...List all other activities:
 




Total Time spent on misc. Activities:
Day 1: 
Day 2: 
Day 3: 

 

Nutritional Fitness Form:

List everything you ate  and  drank with the amount! Put sup.  if a supplement.  Drinks are 8 oz. servings.
 
Day 1:
Breakfast: 
,
,
,
,
,
Approximate # of total Carbs.,
(From simple/sugar carbs.) ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice.

Day 1:
Snack #1
,
,
,
Approximate # of total Carbs.,
(From simple/sugar carbs.) ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice .
 

 
Day 1:
Lunch
,
,
,
,
,
Approximate # of total Carbs.,
(From simple/sugar carbs.) ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice .
Day 1:
Snack #2
,
,
,
Approximate # of total Carbs.,
(From simple/sugar carbs.) ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice .
 

 
Day 1:
Dinner
,
,
,
,
,
Approximate # of total Carbs.,
(From simple/sugar carbs.) ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice .		 Day 1:
Snack #3
,
,
,
Approximate # of total Carbs.,
(From simple/sugar carbs.) ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice .

 

TOTALS DAY 1:
Total Carbs. ,
Simple carbs. ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice .


 
Day 2:
Breakfast: 
,
,
,
,
,
Approximate # of total Carbs.,
(From simple/sugar carbs.) ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice .
Day 2:
Snack #1
,
,
,
Approximate # of total Carbs.,
(From simple/sugar carbs.) ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice .
 
 
 
Day 2:
Lunch
,
,
,
,
,
Approximate # of total Carbs.,
(From simple/sugar carbs.) ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice .
Day 2:
Snack #2
,
,
,
Approximate # of total Carbs.,
(From simple/sugar carbs.) ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice .
 

Day 2:
Dinner
,
,
,
,
,
Approximate # of total Carbs.,
(From simple/sugar carbs.) ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice . 		 Day 2:
Snack #3
,
,
,
Approximate # of total Carbs.,
(From simple/sugar carbs.) ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice .
 
 

TOTALS DAY 2:
Total Carbs. ,
Simple carbs. ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice .

Day 3:
Breakfast: 
,
,
,
,
,
Approximate # of total Carbs.,
(From simple/sugar carbs.) ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice .
Day 3:
Snack #1
,
,
,
Approximate # of total Carbs.,
(From simple/sugar carbs.) ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice .
 
 
 
 
Day 3:
Lunch
,
,
,
,
,
Approximate # of total Carbs.,
(From simple/sugar carbs.) ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice .
Day 3:
Snack #2
,
,
,
Approximate # of total Carbs.,
(From simple/sugar carbs.) ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice .
 
 
 
Day 3:
Dinner
,
,
,
,
,
Approximate # of total Carbs.,
(From simple/sugar carbs.) ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice .		 Day 3:
Snack #3
,
,
,
Approximate # of total Carbs.,
(From simple/sugar carbs.) ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice .

TOTALS DAY 3:
Total Carbs. ,
Simple carbs. ,
Complex carbs. ,
Fiber , Protein ,
Saturated Fat , Unsaturated fat ,
Water , Juice .

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