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Exercise Plan Worksheet
You must have JavaScript enabled to use this form.
Contact Information
First and Last Name
First name
Last name
Email address
Cardio Plan (3–4x/week)
Fill in the fields with your weekly plan for exercise and list your goals. Add notes about your daily exercise (e.g. felt good today, some knee pain. RPE 6.)
For each day, please include: type of exercise, time of exercise, and intensity of exercise.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Muscle Building Plan (3x/week)
Fill in the fields with your weekly plan for exercise and list your goals. Add notes about your daily exercise (e.g. felt good today, some knee pain. RPE 6.)
For each day, please include: type of strength training (body weight, free weights, pilates, etc.), muscle groups, and number of sets and reps.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Weekly Exercise Goals
Goal 1
Goal 2
Goal 3
Daily Step Tracking
Enter your steps goal
Type of Exercise
Leave this field blank
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University of Utah Hospital
University of Utah Hospital
Staying at the Hospital
Parking & Valet
Looking for Another Location?
General Questions
801-581-2668
Find an Interpreter
About U of U Health
Education & Research
Education
Spencer Fox Eccles School of Medicine
College of Pharmacy
College of Nursing
College of Health
School of Dentistry
Research
Improving Health Through Innovation
Clinical Trials & Research Studies
Community
Billing & Insurance
MyChart
Search