Health Goal and Basic Assessment

Dearest  Role Models,

This is the most important step in becoming active and healthy!  Congratulations on getting started. This information will help us support you in reaching your goal.  It will also be used to create your personalized web page.  Please be honest.  You will be shocked at what you can achieve in the next few months.  After you meet your goal, you will take this assessment again.  Let's get started.  Press the submit button at the bottom when you are finished.

Basic Info

1.  First and Last Name:1a.  Nickname (You can make it up!):

2.  Why did you decide to get active?

3.  How old are you? (you must be 18 or older to continue..)

4.  Where are you from?

5.  Where do you live now?

6.  What is your race/ethnicity?

7.  Contact Information. (Used by GirlTrek staff to send motivation, your address will not be shared with 3rd parties.)

    a.  What is your email address? 

Ambitious Fitness Goal

Drum roll please!  Now it's time to set your ambitious fitness goal.  While weight, BMI and waist size management are great indictors of health, GirlTrek believes that these things are secondary to changing your lifestyle and working hard toward a fun goal.  Therefore, YOUR GOAL SHOULD BE INSPIRATIONAL, and something that you look forward to. The best goals are public events or group activities.  It should be a long-term goal, 5 to 8 months, and ambitious for you.  It should be accomplished before August 1, 2009.  Be sure your goal has an active verb and a clear "finish line" or measure of success.

Examples of Inspiring Goals/Event: finish the Los Angeles Revlon 10K Run/Walk, , hike to the top of Machu Picchu with my girlfriends, finish the NYC Five Boro Bike Tour, become a WiiFit master by charting 150 calendar days of play, compete in the Chicago DanceSport Amateur Challenge, master 20 new karate kata, log 50 hours of yoga, complete a 7-day sea kayaking trip, hike to the top of Mount Whitney, participate on a speed walk team at the Annual NW Regional Racewalk Retreat in Portland, bike the entire McKenzie River Trail, etc.  Several GirlTrek woman are running the Chicago Half Marathon this September.  If you are interested, email Vanessa, the team leader. Here are some other activities to consider:

Examples of Not-So-Inspiring Goals: lose weight, start swimming, run a mile every day, learn salsa, eat more vegetables, look better in my clothes, get fit, start dancing again, get my college body back.....

Wellness Survey

Basic Health Assessment

GirlTrek's mission is to empower everyday women to take control of the physical health, positively impacting mental health, disease risk and overall wellness.  There are HUNDREDS of comprehensive health assessments out there and we encourage you to take one with your physician or trainer.  We want to make this experience easy and immediately informative - so we chose 3 easy and very informative qualitative measures to help you better understand your health.

1.  Body Mass Index (BMI): the measurement of choice for most health professionals(1).  It is a simple, mathematical formula, based on height and weight, that is used to determine weight categories and associated health risks of being overweight (a BMI of 25 or over).underweight (18.5 or lower).  Click here to learn your BMI. Enter your BMI, your weight category below.

2.  Waist Size: Latest research says that weight is not nearly as important as waist size(2).  Belly fat, or "abdominal obesity, is a leading indicator of health risks.  To learn your waist size measure the narrowest part of your middle—which isn’t necessarily around your belly button. Find the smallest area between the top of the hipbone and the bottommost rib(3). Enter your waist size, your disease risk below.

3.  Resting Heart Rate (RHR): represents the number of times your heart beats each minute when you are at rest. The better shape you are in the fewer beats per minute. Your RHR tells you lots about your cardiovascular health. Cardiovascular Disease  is the #1 killer in the United States. Since a strong cardiovascular system allows your heart to pump more blood with every beat, a lower RHR tends to correspond with higher aerobic fitness. Your RHR is a useful marker your progress, as it will drop as you get fitter.(4)  Okay, let's measure your RHR while you are sitting here. You'll need to get a stopwatch, or a clock or watch with a second hand, then find your pulse. You can locate your pulse either in your radial artery on your wrist or at your carotid artery in your neck. Choose the spot that works best for you. The only trick to measuring your heart rate is that you must use the correct fingers to do the measuring. Your thumb has a light pulse and can create some confusion when you are counting your beats. It's best to use your index finger and middle finger together.  After you find the beat, and your body is at a normal relaxed heartbeat, you need to count how many beats occur within 60 seconds.(5)  Enter your RHR, your aerobic fitness below.

Commitment

I hereby release and discharge, on behalf of myself, my heirs, executors, personal representatives, and assigns, GirlTrek, their directors, officers, volunteers, and successors, from any and all actions, causes of action, claims, damages, demands, injuries and liabilities of any nature whatsoever, arising out of or in any way connected with my participation in the program overall, and specifically as an active role model in the 2008-2009 program year.   I am aware of the risks of associated with a vigorous level of physical activity and I agree to consult my physician prior to initiating any training program or diet.  I understand that participation in this program is strictly voluntary and I freely chose to participate.  I understand that GirlTrek does not provide medical coverage.  I verify that I will be responsible for any medical costs I incur as a result of my participation.

.

1.  I will look at myself and my life honestly, thoroughly and without judgement.

2.  I promise to work hard and make the necessary changes in my lifestyle to reach my goal.

3.  I will document my journey to share with others by journaling, blogging, and taking/posting pictures.

4.  I will surround myself with people who support my healthier lifestyle

5.  I believe that my goals are realistic and that I can achieve them.

6.  I will reward myself when I reach my goals.

Click the submit button below to agree to all terms above.   Congratulations! You are on your way to a healthier you!  Welcome to the GirlTrek Movement.

1. http://www.webmd.com/diet/features/how-accurate-body-mass-index-bmi

2. http://women.webmd.com/news/20080408/belly-fat-doesnt-bode-well-for-women?src=RSS_PUBLIC

3. http://www.realage.com/WorkoutCenter/bmi.aspx

4. http://www.realbuzz.com/en-us/Ten_DIY_ways_to_test_your_fitness/index?local=en-us&pageID=938&listItem=466

5. http://www.dummies.com/WileyCDA/DummiesArticle/Determining-Your-Resting-Heart-Rate.id-489.html

b.  Mailing Address:

City:

Zip:

c.  Phone:

8. My GirlTrek Goal will MOSTLY help me manage:

6.

Emotional: What is your general mood?

Physical: How often do you break a sweat exercising?

Self Esteem: Do you give yourself credit for being great?

Spiritual: How often do you have quiet time, meditation, prayer, etc.?

Diet: Do you have healthy eating habits?

Stress: Are you stressed?

Energy: Do you have energy?

Body Image: What do you think about your body?

Sleep: Do you feel well rested?

Relationships: How many fulfilling relationships/friendships do you have?

Joy: How often do you indulge in purely fun activities?

Overall Heath:  I rate my overall heath as...

My BMI is:My BMI 

My Waist Size is:

My RHR is:

1.  Tell us about your goal. What is your goal - ultimate event or outcome?

2.  How will you measure your success.  How will you (and any girl watching your journey) know you're successful in reaching your goal? What evidence will illustrate your success. (such as: earn a certificate, cross the finish line, get to a specific target weight, take weekly pictures, or keep a health journal...etc.)

3.  When is your specific deadline or event date (xx/xx/xxxx)?

4.  Briefly describe your training strategy.

5.  What hurdles do you anticipate? What are your challenges/weaknesses?

1. Generally happy and tranquil2. Generally balanced and stable3. Generally overwhelmed and anxious4. Generally sad or onhappy5. Depressed

1.  I'm a  monster,  7 or more times per week.2.  I'm no joke, 5-6 times per week.3.  I'm doing it, 3-4 times per week.4. I'm trying, 1-2 times per week.5. I'm out of the game, 0 times per week.

1.  Several times per day2.  Every day3.  Several times per week4.  About once per week5.  Never

1.  Yes.  Just Call Me Omega 3.2.  Good.  I know the food groups and shop accordingly.3.  Average.  There is fresh produce in my house.4.  Not Good.  I know better, but I love fried food and soda.5.  Terrible.  I don't know where to start. Are jelly beans a food group?

1.  Never2.  Not much3.  Sometimes4.  A lot5.  All of the time

1.  Very high energy2.  High energy3.  Moderate energy4.  Low energy5.  Very low energy

1.  I love it2.  I like it3.  It's okay4.  I don't like it5.  I hate it

1.  Yes2.  Mostly3.  Sometimes4.  Rarely5.  Never

1.  Many2.  Enough3.  Some4.  Few5.  None

1.  All of the time2.  Often3.  Sometimes4.  Rarely5.  Never

1.  All of the time2.  Often3.  Sometimes4.  Rarely5.  Never

18.5 or lower - Underweight/Moderate to High Health Risk18.5 to 24.9 - Healthy Weight 25 to 29.9 - Overweight/ Moderate Health Risk30 or above - Very Overweight/High Health Risk

35 inches or smaller (normal disease risk range)
36 inches or larger (increased disease risk range)

35-40 beats per minute: Ridiculously Fit (Lance Armstrong’s RHR was 32 at the peak of his fitness!) 40-50 beats per minute: Athletic Level Aerobic Fitness50-60 beats per minute: Above Average Aerobic Fitness61–80 beats per minute: Average Aerobic Fitness 81 – 100 beats per minute: Below Average Aerobic Fitness, Still Acceptable 101 or more beats per minute: Dangerously Low Level of Aerobic Fitness, Consult a Physician

I have read and agree to the liability terms above

I am 18 years of age or older.

I have access to a digital camera to document my health story.
I need GirlTrek to provide a disposable digital camera (supplies are limited)

I commit to become an GirlTrek Active Role Model by completing the goal that I establish. Specifically:

1.  Excellent2.  Above Average3.  Average4.  Below Average5.  Poor

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