Exercise Assessment Sheet

Exercise assessment sheet

Instructions

View each of the exercises (type, sets and reps) and record the heart rate for the cardiovascular exercises. Listen or look at the client's feedback as the exercises are being performed. Based on this feedback determine and record the client's rating of perceived exertion (RPE) using the 1- 10 point scale. Record any comments on problems or issues the client has in performing the exercises at each of the indicated levels.

Save this sheet as it will be useful in determining the exercises you will include in the clients exercise program.

Clients name:
Trainer’s name (your name):
Resistance training exercises / Sets / Reps / RPE
(1-10) / Comments / Appropriate /
Yes / No /
1 arm Tricep Extension / 2 / 15
45 degree leg press / 3 / 12
Alt superman / 3 / . 15
Assisted Chin-ups / 3 / max
Assisted Chin-ups / 4 / max
Bar Bell Bench Press / 3 / 10
Bar Bell Bench Press / 4 / 10
Chin-ups / 3 / max
DB Flye / 2 / 15
DB Flye / 3 / 15
DB Hammer Bicep Curl / 2 / 10
DB Incline Bench Press / 2 / 12
DB Incline Bench Press / 4 / 12
Resistance training exercises / Sets / Reps / RPE
(1-10) / Comments / Appropriate /
Yes / No /
DB Lateral Raise / 1 / 15
DB Lateral Raise / 2 / 15
DB Lateral Raise / 2 / 25
DB Standing Shoulder Press / 3 / 12
Dumb bell lunge / 4 / 15
EZ bicep curl / 2 / 15
Leg curl / 3 / 15
Leg extension / 3 / 15
Machine Seated Row / 2 / 15
Machine Seated Row / 3 / 15
Standing calf raise / 3 / 20
Swiss ball side crunch / 3 / 10
Swiss ball straight crunch / 3 / 12
Tricep Pushdown / 2 / 10
Underhand Lat Pulldown / 2 / 12
Underhand Lat Pulldown / 4 / 12
Wide grip Lat Pulldown / 2 / 12
Cardiovascular exercises / Sets / Reps / HR
(bpm) / RPE
(1-10) / Comments / Appropriate /
Yes / No /
Walking on treadmill 25 min @6.5k/h grad 10%
Walking on treadmill 20 min @6.5k/h grad 10%
Walking on treadmill 20 min @6.5k/h grad 10%
Cardiovascular exercises / HR
(bpm) / RPE
(1-10) / Comments / Appropriate
Yes / No
Running 15 min @ 10.2 kph
Running 20 min @ 10.2 kph
Running 25 min @ 10.2 k/h
Running 20 min @ 10.4 k/p
Running 25 min @ 10.7 k/h
Running 20 min @ 11 k/p
Running 25 min @ 11 k/h
Bike 15 min @ 60% - 80%
Bike 15 min @ 65%- 85% max
Bike 20 @ 65%- 85% max
Bike 15 @ 70%- 90% max
Bike 15 min @ 60% - 80%

Program Evaluation

Once you have assessed each of the exercises, determine which set of exercises are appropriate for your client. Check if the set has only appropriate exercises for each session and the duration of the session will allow for warm up and cool down exercises to fit with in each hour session. You may like to print off this form. You may also complete it and save it to your computer or a disk.

Session / Exercise Set 1 / Exercise Set 2
All exercises are
appropriate / Session durations / All exercises are
appropriate / Session durations
Day 1 -
Upper body / Yes No / minutes / Yes No / minutes
Day 2 -
Cardiovascular / Yes No / minutes / Yes No / minutes
Day 3 –
Lower body / Yes No / minutes / Yes No / minutes
Day 4 -
Cardiovascular / Yes No / minutes / Yes No / minutes
Session / Exercise Set 3 / Exercise Set 4
All exercises are
appropriate / Session durations / All exercises are
appropriate / Session durations
Day 1 -
Upper body / Yes No / minutes / Yes No / minutes
Day 2 -
Cardiovascular / Yes No / minutes / Yes No / minutes
Day 3 –
Lower body / Yes No / minutes / Yes No / minutes
Day 4 -
Cardiovascular / Yes No / minutes / Yes No / minutes
Page 4 / THIS FORM IS FOR TRAINING PURPOSES ONLY.