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"ONLINE FITNESS ASSESSMENT AND PROGRAM DESIGN" PROFILE Recreational Activity Profile: Do you currently participate in any recreational activities (such as any recreational sports, swimming, dancing, martial arts): Yes No How many days on average per month do you participate in these recreational activities? Does not apply 1-4 times per month 5-9 times per month 10 or more times per month On average, how many hours per month are you participating in recreational activities? Does not apply Less than 4 hours per month More than 4 hours but less than 10 hours per month More than 10 hours per month Lifestyle Survey: Do you have a stressful job and/or lifestyle? Yes No Do you do something regularly for stress relief? Yes No Please indicate which of the following best describes your sleep patterns: Good Average Poor Please indicate which of the following best describes your energy levels: Energy is highest first thing in the morning Energy is highest in the afternoon Energy is highest in the evening Compare your current body weight today to what you weighed 10 years ago: I currently weigh less than I did 10 years ago I am about the same weight I weigh more than I did 10 years ago, but I am less than 20lbs (9kg) heavier than I was back then I am over 20lbs (9kg) heavier today than I was 10 years ago Nutrition Survey: How many times per year do you diet? None 1-2 3-4 5+ Are you currently on or about to start a calorie restrictive nutritional program or diet? Yes No How many 8oz (250ml) glasses of water per day (not including caffeinated beverages such as coffee, tea or colas) do you drink daily? Less than 6 glasses daily More than 6 but less than 10 glasses daily More than 10 glasses daily Exercise Profile: Please select which of the following most accurately describes your current exercise level (not including recreation activities)? Sedentary to Light Activity [?] Active [?] Very Active [?] Please identify your knowledge/experience level with respect to exercise (not including recreational activities): Beginner [?] Intermediate [?] Advanced [?] Fitness Programming Survey: How long has it been since you last followed a regular exercise program (not including recreational activities)? I have been exercising regularly over the past 3 months or longer I have not exercised regularly in the past 3 months to 1 year I have not exercised regularly for over 1 year I have never followed a regular exercise program Please select from the following your foremost fitness goal. Loss weight (Fat loss) Improved Muscle Tone & Strengthen Build Muscle & Strengthen Cardiovascular Improvement How many times per week would you like to commit to your exercise programming? 2 days per week 3 days per week 4 days per week 5 days per week Based on where you typically store your body fat which of the following best describes your body shape? Apple Shape [?] Pear Shape [?] Ruler Shape [?] Hourglass [?] Body Mass Index (BMI) and Waist-to-Hip Ratio (WHR) Calculation. Please enter your physical profile in either: English System (weight in pounds, height/waist/hip in inches) Metric System (weight in kilograms, height/waist/hip in meters) Weight: Height: Waist: (at the navel) Hip: (at the widest point) Gender: Male Female Health Disclaimer This Website provides fitness and weight loss management, physical condition and information applications and content published over the Internet and is intended only to assist users in their personal weight loss and/or exercise efforts. FABS™ INC. is not a medical organization and our staff cannot give you medical advice or diagnosis. Nothing contained in this Website should be construed as such advice or diagnosis. The information and reports generated by us should not be interpreted as a substitute for physician consultation, evaluation, or treatment. You are urged and advised to seek the advice of a physician before beginning any exercise and/or weight loss effort or regimen. This Website is intended for use only by healthy adult individuals. The Website is not intended for use by minors, pregnant women, or individuals with any type of health condition. Such individuals are specifically warned to seek professional medical advice prior to initiating any form of exercise and/or weight loss effort or regimen. The information provided on this site is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional. As a Subscriber, YOU acknowledge that the use of this Website and/or any of the fitness videos, programming and/or any content thereof shall be at my sole/own risk. YOU further represent to FABS™ that: YOU have either discussed this exercise program with YOUR physician or intentionally have not done so. YOU are at least 18 years of age. I agree to the above Health Disclaimer terms and conditions.

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