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Module 2: Healthy Living Check-in Submission Form (50 points)
PART 1: Family History - 6 points
After you have completed the Family History Assessment in Module 2, use the information you reported in your Family History Assessment to complete Part 1 of the HLP Check-In.
Identify two lifestyle behaviors that will help reduce your risk for chronic disease. If you identified specific chronic diseases that were prevalent in your family, focus on behaviors that will reduce risks of those diseases most effectively. If no chronic diseases stand out in your family, select two lifestyle behaviors that will reduce your risk of cardiovascular disease, the #1 killer in the U.S. today.
Describe in detail two specific action steps you will take to implement the lifestyle behaviors identified in Part 1A. Action steps must be expressed using action verbs.
PART 2: Cardiorespiratory Fitness Assessment – 8 points After you have completed the Cardiorespiratory Fitness Assessment in Module 2, use the information you reported in your Cardiorespiratory Fitness Assessment to complete Part 2 of the HLP Check-In.
Your V02 max Result: ____________ Your V02 max Category: _____________
Identify two aerobic/cardiorespiratory activities in which you will participate to improve and/or maintain your cardiorespiratory fitness. Apply the following elements of the FITT Principle to your activities: Frequency, Intensity, Time. See example below.
Example (You may not use this example as one of your activities)
Ocean long board surfing
4 x per week
Moderate to vigorous
PART 3: Goal Setting Review and Update – 36 points
Semester-Long SMART Goal Review:
At this point in the semester, you have already determined your target behavior and created a Semester-Long SMART Goal. If your instructor indicated your goal from Module 1 met all SMART criteria for a semester-long goal, good work!
Enter it here: I will
If your instructor indicated your goal from Module 1 required modification, please make the appropriate edits and enter your revised Semester-Long SMART Goal here:
In order to have sufficient time to make your behavior change, you may not change your Semester-Long SMART Goal target behavior after Module 2. If you need assistance with your SMART Goal, contact your instructor. When communicating via email, be sure to include your section number and your Module 1 and proposed Module 2 SMART Goals. Allow at least 2 business days for your instructor to evaluate and respond before the due date. Feedback from Module 1 can be found in the left column of the rubric used to grade your SMART Goal submission. NOTE: Failure to meet SMART criteria may result in point deduction in this module and in future modules.
*As you develop your action plan to reach your goal, keep the last 2 elements of the SMARTER acronym (E-Ethical and R-Reevaluate/Reward) in mind and make sure that your action plan reflects Ethical practices and how you will Reevaluate and Reward yourself for achieving your goal.
Module Chapter Concept Check-In:
Identify 2 specific chapter concepts you learned in this module that relate to your Semester-long SMART goal or that relate to your personal wellness concerns. Module concepts are listed in the Module Learning Objectives found at the beginning of each module. Each module concept is taken directly from the book and matches heading found in each chapter.
Module Concept 1:
Module Concept 2:
Explain each concept identified in #B1 above fully in your own words. Be sure to include detailed information, terminology, examples, and assessment methods as appropriate. Reference your information from the chapters and/or as well as any outside source you used.
Provide details explaining how you will apply these specific concepts to improve your wellness. How will you measure that you have applied them successfully?
Describe one or more specific action step(s) you will take toward achieving your Semester-Long SMART Goal. Action steps must be expressed using action verbs.
Module 2: Healthy Living Check-In Grading Criteria (50 points)
Family History Behaviors
Identified 2 or more lifestyle health behaviors to help reduce the risk of chronic disease
Identified 1 lifestyle health behavior to help reduce the risk of chronic disease
Identified 1 lifestyle health behavior, but it was not relevant to reducing the risk of chronic disease
Did not identify any lifestyle health behaviors to help reduce the risk of chronic disease
Family History Action Steps
Listed and provided a detailed explanation of at least 2 specific action steps to take to implement the lifestyle behaviors identified
Listed and explained 1 or more specific action step to take to implement the lifestyle behaviors identified, but only 1 would be relevant to the lifestyle behaviors identified
Listed, but did not explain action step(s) to take to implement the lifestyle behaviors identified OR none of the action step(s) were relevant to the lifestyle behaviors identified
Did not list any action steps
Included VO2 max result
Did not include VO2 max result
Included VO2 max category
Cardiorespiratory Assessment – Cardiorespiratory Activity
Identified at least 2 appropriate activities that would improve or maintain cardiorespiratory fitness
Identified 1 or more activities, but only one activity would not improve or maintain cardiorespiratory fitness
Did not identify any activities that would improve or maintain cardiorespiratory fitness
Cardiorespiratory Assessment - FITT Principle Activity 1
Correctly applied all elements of the FITT Principle for Activity 1
Did not apply 1 element of the FITT Principle for Activity 1
Did not apply 2 or more elements of the FITT principle for Activity 1
Cardiorespiratory Assessment - FITT Principle Activity 2
Correctly applied all elements of the FITT Principle for Activity 2
Did not apply 1 element of the FITT Principle for Activity 2
Did not apply 2 or more elements of the FITT principle for Activity 2
Semester-Long SMART Goal
Included one-sentence Semester-Long SMART Goal and edited goal if required
One sentence Semester-Long SMART Goal missed 1 component of SMART criteria OR goal is not expressed in 1 sentence OR goal targets one wellness-related behavior and includes all components of SMART criteria, but is not done in one sentence
One sentence Semester-Long SMART Goal missed 2 or more components of SMART criteria
Did not include Semester-Long SMART Goal
Identified 2 specific concepts from the module readings
Identified 1 specific concept from the module readings
Did not identify any concepts from the module readings
Explained and referenced 2 module concepts fully. Included detailed information, terminology, examples, and assessment methods as appropriate.
Explained and referenced 1 module concept fully. Included detailed information, terminology, examples, and assessment methods as appropriate
Explained 1 or more module concept(s), but explanation was incomplete OR did not provide appropriate references
Did not identify any module concepts
Check-in – Applied Concepts
Provided detailed description of application of 2 module concepts
Provided detailed description of application of 1 module concept
Provided description of application of 1 or more module concepts, but details were missing
Did not provide description of any module concepts
Described 1 or more specific action steps toward helping achieve Semester-Long SMART Goal
Identified action steps but were not specific toward helping achieve Semester-Long SMART Goal
Did not identify any specific action steps toward helping achieve Semester-Long SMART Goal
Module 2: Healthy Living Check-In Page 7 of 7
Created on 9/6/16 2:18 PM Page 7 of 7f chronic disease