Complete the following exercise to make a formal record of your overall physical activity goals and obstacles. Its OK to dream a little and make these long-term goals something you'd like to achieve over a year or so - just be sure to keep them realistic for you. Once you have complete part 1, proceed to breaking down the overall goals into a more specific set of short-term goals and actions for the next 1-4 weeks.

Date

YYYY

Name

First Name

Last Name

My long-term physical activity goal is:

Setting S.M.A.R.T goals, what would you like to achieve or have accomplished in the next 4 to 6 months? Specific. Measurable. Atainable. Realistic to you. Time-Specific

To achieve this, I need to focus on:

I am willing to do the following to make it happen:

What are you willing to commit to that you are currently not doing, that will help you achieve your goals?

Others will know the change I am making when:

I might sabotage my plan by:

What are some obstacles or challenges that you might face along the way to achieving your goals? These are important to know so that you can be prepared for whatever comes your way.

Therefore, my promise to myself is:

Goals and Actions

What are some goals you can work on within this month that will help you achieve your long term goals, and some actions you can take to achieve them, now?

Goal #1:/Actions:

Goal #2:/Actions:

Goal #3:/Actions:

Success Indicators

How will you know you have achieved your goals, or are close to achieving your goals? What will indicate this success to you?

Success Indicator #1

Success Indicator #2

Success Indicator #3

Success Indicator #4

Success Indicator #5