Behavior Change Contract PDF

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Behavior Change Contract...

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KINS 1902 Personal Wellness Behavior Change Contract Student’s Name:

Course & Section #: 1902.03_

* USE S.M.A.R.T. principle! 1) What is the problem/condition that is affecting your quality of life (refer to step 1, pg. 2)? I feel weak because I cannot lift and carry heavy things. I sometimes struggle to open heavy doors. 2) What is the Behavior Change that you plan to implement? I will go to the gym 5 days a week and focus on weight lifting. 3) Final 6-Week Behavior-Change Goal. Choose only (1) goal for this project: Go to the gym 5 days a week for 50 minutes each time for a total of 250 minutes a week. 4) 6-Week Progressive Plan to achieve your final goal. Choose only (1) goal: Pre Week: __Starting point. Where are you now with no changes? I currently go to the gym 2-3 times a week for 40 minutes each time. Wk1: Go to the gym 3 days a week for 45 minutes each time for a total of 135 minutes a week. Wk 2: Go to the gym 4 days a week for 40 minutes each time for a total of 160 minutes a week. Wk 3: Go to the gym 4 days a week for 45 minutes each time for a total of 180 minutes a week. Wk 4: Go to the gym 5 days a week for 40 minutes each time for a total of 200 minutes a week. Wk 5: Go to the gym 5 days a week for 45 minutes each time for a total of 225 minutes a week. Wk 6 (Final Goal): Go to the gym 5 days a week for 50 minutes each time for a total of 250 minutes a week. Post Week: Continue to go to the gym 5 days a week for 50 minutes each time for a total of 250 minutes a week. 5) Identify Potential Negative Influences (Barriers) and Possible Solutions: 1) Potential Barrier: Spend too much time on homework Possible Solution: Schedule time to workout and stick with it 2) Potential Barrier: Lack motivation to leave the room Possible Solution: Ask a friend to workout with 6) Identify Appropriate Resources (books, videos, facilities, campus services): My Tiny Schedule app, TWU Fit and Rec, Dumbbells in my room 7) Identify a Reward for Reaching Your Goal: 2 new workout shirts, a new pair of workout leggings, and a new pair of workout shoes. 8) Supporter’s Name: My roommate Signature: _____________________________________________

Date: _______________________

9) Student’s Name: Signature: ______________________________________________ Date: _______________________...