Endocrine, Nutrition & Obesity
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Physical Activity Prescription

Member name:
[text name="variable_1" default=""]
Date of birth:
[date name="variable_2" default=""]
Date of prescription:
[date name="variable_3" default="01/11/2020"]


Aerobic Activity

Type:
[checklist name="variable_4" value="option A|option B|option C"]

Frequency:
[select name="variable_5" value="choice A|choice B|choice C"] days/week

Intensity:
[select name="variable_6" value="choice A|choice B|choice C"]

Time:
[select name="variable_7" value="choice A|choice B|choice C"] min/day

Make it fun:
[select name="variable_8" value="choice A|choice B|choice C"]


Weightlifting & Strength Training

Frequency:
[select name="variable_9" value="choice A|choice B|choice C"]

Muscle groups: do exercises to strengthen all major muscle groups including legs, hips, back, chest, abdomen, shoulders and arms

Repetitions: 8-12 repetitions per set for each exercise

Sets: 3 sets for each exercise

Exercise location: home or gym, use resistance bands or body-weight exercises at home
Physical Activity Prescription

Member name:

Date of birth:

Date of prescription:



Aerobic Activity

Type:


Frequency:
days/week

Intensity:


Time:
min/day

Make it fun:



Weightlifting & Strength Training

Frequency:


Muscle groups: do exercises to strengthen all major muscle groups including legs, hips, back, chest, abdomen, shoulders and arms

Repetitions: 8-12 repetitions per set for each exercise

Sets: 3 sets for each exercise

Exercise location: home or gym, use resistance bands or body-weight exercises at home

Result - Copy and paste this output:

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