Task One
The first part of the programme will be to design a lifestyle questionnaire, which can be given
to the client that is taking part in the programme. Once you have created the questionnaire
you will then complete it with the client in a fact-face session.
Design and use a lifestyle questionnaire to describe the strengths and areas for
P2
improvement in the lifestyle of a selected individual
Requirements:
You need to design an appropriate health screening questionnaire.
You need to hand in one blank copy and one completed copy with your assignment.
Your questionnaire needs to collect information from for the following key areas:
o Activity history
o Current physical activity levels
o Injuries
o Personal Training Goals
o Alcohol Consumption
o Smoking
o Stress Levels
o Dietary Habits
o Informed Consent.
You need to go through each area of the questionnaire listed below:
o Describe whether the information that they have given you is strength or an
area to improve on.
o Describe your reasons why.
M Explain the strengths and areas for improvement in the lifestyle of a selected
2 individual
Requirements:
You need to use this questionnaire on a client and write a report on the following
areas:
o Activity history
o Current physical activity levels
Injuries
Personal Training Goals
Alcohol Consumption
Smoking
Stress Levels
Dietary Habits
You need to go through each area of the questionnaire listed below:
o Explain whether the information that they have given you is strength or an
area to improve on.
o Explain your reasons why.
, Health Screening Questionnaire
Name James Jeffrey
Gender Male
Age 18
Date of Birth 28/09/02
Email Address jjeffrey12345@gmail.com
Contact Number 07825559122
Please state your activity history here I have played rugby since I was 6 years old.
including any sports you have played and I have been running for 5 days a week for
how long you have been doing cardio work the past year.
and gym work I have been doing gym work for the past 3
years for 3 days a week split into chest and
back, arms and legs.
Please state your current physical activity 10 hours a week
levels in hours per week
Please state any previous or current injuries I have dislocated my thumb twice in the
that you have past and pulled my hamstring but they are
both fully healed now.
Please state your Personal Training goals, I want to build more muscle and improve
so what you want to get out of the sessions my body fat percentage from 25% to 15%
so I can become a better rugby player.
Please state your weekly alcohol 0 units
consumption per week in units of alcohol
Please state whether you have smoked I have never smoked before
before and if so, whether it is currently,
quit in last six months or quit over a year
ago
Please state your current stress levels on a 2
scale of 1-10
Please state your food and drink intake Breakfast- 5 egg omelette, 1 glass of orange
from the last 24 hours juice
Snack- Muffin
Lunch- 2 chicken wraps with perinase
Snack- Protein Shake- 2 scoops of powder,
Wotsits
Dinner- Steak Pie with chips and beans
Water- 2 litres of water
Informed Consent For Taking Part In Physical Activity
The purpose of an exercise programme is to help you to achieve health and fitness goals.
Your programme will be based upon your present activity/exercise levels and the goals that
you wish to achieve. You will experience some feelings of exertion during each activity
session and will become hot and uncomfortable at times. Your breathing and heart rate will
, increase as a result of these activities as would be expected from physical exercise of this
type. As your fitness improves, you will participate in more vigorous levels of activity, if this
is part of your goal, but these should remain within your capabilities. All activities will be
explained and demonstrated to you but please feel free to ask questions about anything you
wish. Any exercise programme carries with it an element of risk. Your sessions are designed
to minimise the risks whilst providing an effective exercise/activity programme. Please
inform your trainer if, for any reason (such as illness or injury which might be aggravated by
exercise, or eating certain foods), you should not participate in an activity. During your
sessions with your trainer present you will be closely supervised. During your sessions
where your trainer is not present you will be responsible for your own safety. If, at any time,
you feel undue pain or excessive discomfort stop the activity and inform your trainer of your
symptoms. You are free to withdraw from any activity at any time you wish. I have read,
understood and completed the PAR-Q. All questions have been answered to the best of my
knowledge. I agree to take part in the programme described to me by my trainer. The
nature, purpose, risks and benefits have been explained to me and I understand what is
required of me and that I may withdraw at any time.
Payment and Cancellation Policy
Payments must be made in advance and can be made either by cash or by cheque made
payable to: G.Alexander
24 hour notice of cancellation is required otherwise full payment will be incurred.
I accept the Terms & Conditions regarding payment and cancellation.
Client Name: James Jeffrey
Client Signature: J.Jeffrey Date: 23/02/21
Trainer Name: George Alexander
Trainer Signature: G.Alexander Date: 23/02/21
Activity History:
I would say that overall, James’ activity history is one of his biggest strengths as it shows us
that he is very experienced with exercise and he roughly understands what he needs to do
to improve his fitness. James has been playing rugby since he was 6 years old which shows
us that he has always had a good level of exercise from a very young age. It also tells us that
he has something that he wants to work towards which will give him the motivation that he
needs to keep on working towards his goals. James will also have a very good
cardiorespiratory system from running 5 days a week for the past year. This is something
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