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1. What would you consider your present attitude towards exercise? 1 – I can’t stand the thought of it 2 – I’ll do it because I know I should, but I don’t enjoy it 3 – I don’t mind exercise, and I know it is beneficial. 4 - I am motivated to exercise *Your answer: ____ How would you like to feel about exercise, if you could change your feelings? Your answer: ____ 2. What would you consider your present attitude toward goal achievement? 1 - I feel that whatever happens, happens, and I’ll roll with the punches 2 - I set goals and believe it adds clarity and gives me some control over my outcome 3 - I write down my goals and believe it is a very valuable exercise in determining my future performance and achievement 4 - I have written goals and I review them often. I believe I have the power to achieve anything I desire and know that setting goals is a vital part of achievement. *Your answer: ____ How would you like to feel about goal achievement, if you could change your feelings? Your answer: ____ 3. How important to you are the concepts of health and well-being? 1 - I don’t need to put any effort into bettering my health 2 - I make certain I devote some time and effort into bettering my physical body 3 - I am committed to maintaining and working to improve my health and physical well-being 4 - My health and well being are the foundation of all that I achieve, and they must remain my top priorities *Your answer: ____ How would you like to feel about the concepts of health and well-being, if you could change your feeling? Your answer: ____ 4. How strong and driving is your desire for improvement? 1 - I’m really pretty satisfied with the way things are. Striving for improvement might leave me frustrated and disappointed 2 - I’d like to improve but don’t know that it’s worth all the work involved 3 - I love feeling as if I’ve bettered myself and am open to any suggestions for improvement 4 - I’m driven to excel and am committed for striving for consistent and ongoing improvement *Your answer: ____ How strong and driven would you like to feel about improvement? Your answer: ____ 5. How do you feel about yourself and your abilities (self-esteem)? 1 - I am not comfortable with the way I look, feel, or perform in most situations 2 - I would love to change many things about myself although I am proud of who I am 3 - I’m very good at the things I must do, take pride in many of my achievements, and am quite able to handle myself in most situations 4 - I have great strength, ability, and pride *Your answer: ____ How would you like to feel about yourself and your abilities, if you could change your feelings? Your answer: ____ 6. How do you feel about your present physical condition in terms of the way you look? 1 - I would like to completely change my body 2 - There are many things about my reflection in the mirror that I’m not comfortable with 3 - For the most part I look OK, and I can look really good in the right clothing, but I do feel uncomfortable with a few things about my physical appearance 4 - I am proud of my body and am comfortable in any manner of dress in appropriate situations *Your answer: ____ How would you like to feel about the way you look, if you could change your feelings? Your answer: ____ 7. How do you feel about your present physical condition in terms of overall health? 1 - I wish I felt healthy 2 - I feel healthy for my age compared to most people I meet 3 - I maintain a high level of health 4 - I am extremely healthy *Your answer: ____ How would you like to feel about yourself and your abilities, if you could change your feelings? Your answer: ____ 8. How do you feel about your physical condition in terms of your performance in any chosen physical fields of endeavor (sports, training, etc.)? 1 - I feel as if I’m in very poor condition and am uncomfortable when faced with a physical challenge 2 - I am not comfortable with my performance abilities; however, I am comfortable training to improve 3 - I feel pretty good about my ability to perform physically although I would like to improve 4 - I have exceptional physical abilities and enjoy being called upon to display them *Your answer: ____ How would you like to feel about your performance, if you could change your feelings? Your answer: ____ 9. How strongly do you believe that you can improve your body?1 - I believe most of my physical shortcomings are genetic, and most efforts to change would be a waste of time 2 - I’ve seen many people change their bodies for the better and am sure with enough effort I can see some improvement 3 - I strongly believe the proper combination of exercise and nutrition can bring about some improvement 4 - I know without question that with proper combination of exercise and nutrition I can bring about dramatic changes in my body *Your answer: ____ How would you like to feel about your ability to improve you body, if you could change your feelings?Your answer: ____ 10. When you begin a program or set a goal, how likely are you to follow through to its fruition? 1 - I’ve never been real good at following things through to the end. 2 - Witt the right motivation and some evidence of results I think I might stick to a program 3 - I have the patience and ability to commit to a program and will give it a chance in order to assess its value 4 - Once I set a goal, there’s no stopping me *Your answer: ____ How would you like to feel following thru on your goals, if you could change your feelings?Your answer: ____
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