Exercise Prescription

Name _____________________________ Age___________________

Weight _____________________________ Height ________________

Date _______________________________

Goal/s: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Medical Condition/s (Any Injuries, or Risk Factors That May Affect Exercise Prescription): __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Nutrition/ Diet
Nutritional/ dietary needs will be determined based on your goals and current level of physical fitness; diets for losing weight/body fat will differ from diets for gaining weight/ muscle mass.

In order to establish a starting point a daily caloric expenditure must be established. This will determine how many calories you burn in a 24-hour period of time, not how many calories you consume. Consumption of calories will be discussed later.

Activity LevelDescription
Calories per Pound of Body Weight Expended During a 24-Hour Period


Very sedentary (restricted movement such as patient confined to a house)



Sedentary (most U.S. Citizens; light work or office job)



Moderate activity (many college students; some daily physical activity and weekend recreation)



Very physically active (vigorous activity at least 3-4 times/week)



Competitive athlete (daily activity in high-energy sport)


Estimated daily caloric expenditure = _______________________ calories/ day.

National Dietary Guidelines

The following is a brief overview of the national dietary guidelines.

Total Fats - The American Heart Association says that total fat intake should be less than 30% of total calories. Most Americans are getting closer to 40% or more of their calories from fat.

Saturated Fats - According to the American Heart Association, most Americans obtain 12% to 18% of their total calories from saturated fat. The AHA recommends getting no more than 10% of daily calories from saturated fat. Much of this comes from eating baked goods containing coconut oil, palm oil, or cocoa butter. Just because a food\'s advertising says 100% vegetable oil does not mean it is low in saturate fat. Palm oil gets approximately 79% of its calories from saturated fat, making it higher in saturated fat than any animal fat source.

Carbohydrates - The American Heart Association recommends obtaining 50% to 55% of daily calories in the form of carbohydrates, with a strong emphasis on increasing sources of complex carbohydrates. Populations with high intakes of carbohydrates--60% to 75% of daily calories--enjoy a very low incidence of coronary heart disease. Most Americans would benefit by reducing their intake of simple carbohydrates (sugar) and increasing their intake of complex carbohydrates (pasta, whole-grain cereals, breads, legumes, vegetables, and fruit).

Protein - Experts recommend obtaining about 12% to 15% of your calories in the form of protein. Most Americans eat much more protein than is required. Most Americans would improve their health by obtaining more of their calories from non-meat proteins since meat tends to carry large amounts of saturated fats.

Sodium - The American Heart Association suggests reducing sodium intake to approximately 1,000 mg per 1,000 calories, not to exceed 3,000 mg total. The human requirement for sodium is only about 200 or 250 mg per day, but most Americans consume 4,000 to 5,000 mg of sodium per day. Populations who consume lower levels of sodium than Americans have a lower incidence of high blood pressure. Approximately 20% of persons with high blood pressure could sizably reduce their blood pressures by limiting their sodium consumption.

Cholesterol - The original American Heart Association guidelines suggested an intake of 100 mg of cholesterol per 1,000 calories. NutriBase uses this formula, since the human body can manufacture all the cholesterol it requires. The AHA has since adjusted its recommendation to "no more than 300 mg day" to bring it in line with the guidelines established by the National Cholesterol Education program. Dietary cholesterol appears to have the biggest impact on blood cholesterol when consumed with saturated fats.

Fiber - Most authorities recommend a fiber intake of 15 to 35 grams per day. NutriBase suggests an intake of 10 grams per 1,000 calories, with a minimum of 15 grams and a maximum of 35 grams. Experts recommend obtaining your intake of fiber from a wide variety of fruits, vegetables, breads, cereals, and pastas. Most experts do not recommend getting your fiber from pills.

Fats < 30% of daily caloric intake with saturated fats < 10

Carbohydrates = 50-55% of daily caloric intake

Protein = 15% of daily caloric intake

Sodium = 1,000 mg/per 1,000 calories

Cholesterol = 100 mg/per 1,000 calories

Fiber = 10 grams/per 1,000 calories

It is a fact that one-pound fat is the equivalent of 3,500 calories; therefore reducing your daily caloric intake by 500 calories a day will result in a loss of 1 pound per