Take this Healthy Lifestyle Survey Today!
It will be a great way to monitor your progress as you stay active, healthy and fit in 2012! Re-Take this as soon as every 6 weeks or wait 6 months to see dramatic results
Lifestyle Habits
1) Do you smoke? ____
2) Do you drink more than one alcoholic beverage per day? _____
3) Do you hydrate well (6 to 8 twelve ounce glasses)? _____
4) How many caffeinated beverages do you consume per day? _____
5) How many sodas / sugary drinks do you consume per day? _____
Nutritional Habits
1) How many meals do you eat per day? _____
2) How many between meal snacks per day? _____
3) Do you know how many calories you consume on an average day? _____
Active Lifestyle Habits
1) Are You Regularly Active (30 min per day most days of the week)? _____
2) Is your job physically demanding? ____
3) Do you participate in a regular exercise program? _____
4) How many days per week are you doing Cardiovascular exercise (20 min+)? _____
5) How many days per week are you doing Strength Training? _____
6) How many days per week are you stretching? _____
7) How many days per week do you practice balance training? _____
8) How many days per week do you practice good posture exercises? _____
9) How many days per week are you active with your family, kids, etc? _____
General Fitness
1) On a 10 scale (1=Complete Exhaustion, 10= Not even Breathing Hard) How do you feel after climbing 1 flight of stairs? _____
2) On a 10 scale, how do you feel after climbing 5 flights? _____
3) Weight ____
4) BMI (calculate here: http://www.nhlbisupport.com/bmi/ )_____
5) Waist Circumference (take this 2 finger tips above your navel) ____
6) Hip Circumference (take this at the widest part of your booty) ____
Stress
1) On a 10 scale (1=mentally overwhelmed & exhausted, 10 = stress free), how much stress do you feel in everyday life? _____
2) On the same 10 scale, how much stress do you feel in your professional / work life? _____
3) How many days per week do you do something good (specifically) for your mental health? ___
