Fitness Appraisal Results Form # 3 - Section 103 -Mq

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Fitness Appraisal Results # 3 - Section 103 –MQ
(2011)
(Bring this form with you to the Fitness Appraisal)
Teacher’s Name: ____________________
Name: ____________________
Class: ____________________
Class Day & Time: ___________________
Refer to Chapter 12 for verbal ratings and testing instruction and information.
Test
Test 1 Results
Verbal Rating
Fitness App.
Verbal Rating
Baseline
Results
Resting Heart Rate
____ bts/min
____ bts/min
( take in am – 30 sec. x 2)
____ bts/min
____ bts/min
Pre-exercise Heart
(10sec. x 6)
Rate
BODY COMPOSITION
BMI =
BMI =
Body Mass Index
____________
____________
Find your weight in
pounds and your height
Wt.=______lbs
Wt.=______lbs
in feet and inches.
Ht = _______ ft
Ht = _______ ft
Waist to Hip Ratio
WHR = Waist ÷ Hip
WHR = Waist ÷ Hip
______________
______________
Find your waist and hip
circumference.
Waist _____cm
Waist _____cm
Hip _____ cm
Hip _____ cm
Waist
Use measurement
Use measurement
from above to get
from above to get
Circumference
verbal rating
verbal rating
MUSCLE STRENGTH / ENDURANCE / AGILITY / BALANCE
Jump = ______
Jump = ______
Vertical Jump
Push-Ups
# = ___________
# = ___________
Curl-Ups (1 minute)
# = ___________
# = ___________
Front Plank
# = ___________
# = ___________
Chair Dips
# = ___________
# = ___________
Wall Squat
# = ___________
# = ___________
Side Hops (1 min.)
# = ___________
# = ___________
Balance
# = ___________
# = ___________
CARDIOVASCULAR ENDURANCE
12 minute Run
# of laps =
# of laps =
Take your heart rate after the
________X 160m
________X 160m
run (Post HR) -
Total distance=
_______________
Total distance=
_______________
Then 3 minutes after the run
_____________m
Post HR = ______
_____________m
Post HR = ______
= 3 min. HR recovery e
(see chart)
(see chart)
(Take HR for 10 sec x 6 = bts
3 min.HR = _____
3 min.HR = _____
/ min)
FLEXIBILITY
__________ cm
__________ cm
SIT–REACH-HOLD

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