Appendix - Extra Resources
“I believe in the person I want to become.”
-Anon
Food Monitoring Page
Date
|
Time
|
What food / drink?
|
How much?
|
Comments
|
Exercise Log
Date
|
What you did
|
How long/ how much?
|
Goal Setting Template
What’s my goal? (what exactly will I be doing?)
| |
How much am I going to do? (how many minutes, how many times)
| |
How often am I going to do it? (every day? A few times this week?)
| |
When am I going to do it?
|
Breaking down the goal: Now that you’ve picked your goal, what are the steps you’ll need to do to get there?
1. ___________________________________________________________________________
2. ___________________________________________________________________________
3. ___________________________________________________________________________
Menu Planner
Day
|
Meals
|
Notes
|
Monday
| ||
Tuesday
| ||
Wednesday
| ||
Thursday
| ||
Friday
| ||
Saturday
| ||
Sunday
|
Shopping List
Produce
|
Pantry
|
Meat & Fish
| ||
Bakery
|
Frozen
|
Deli & Dairy
| ||
Drinks
|
Other
| |||
The Gym Program
· This program will run for 6 weeks/12 sessions, Level 3 West block, Nepean hospital
· You will be required to attend a 45 minute assessment before and after the gym program. This assessment consists of a walking test, strength test and questionnaires.
· You will attend two supervised gym sessions a week lasting up to 60 minutes.
· You will be taught an individualised exercise program to perform in the class – Your physiotherapist will adjust your program to accommodate any pre-existing injuries, joint aches and pains.
· The class will involve a combination of aerobic exercises and resistance training.
· On Tuesdays, prior to exercising, you will be given a 20 minute education session that will aid you in reaching your health goals.
· You will be given an exercise and education diary to refer to during and after the program.
Safety
· Please wear closed in shoes, joggers preferably.
· Bring a towel and a bottle of water.
Diabetes
· If you have diabetes, you must check your blood sugar level (BSL) before and after your exercise session.
· Your BSL must be between 5-15 mmol/L before and after the gym session.
· Please bring a small snack in the case of a low BSL.
Before each session
· You must immediately inform your Physiotherapist if there is any change in your medical condition.
· Please give as much notice as possible if you are unable to attend your session by calling 4734 4533.
Please Note: If you fail to attend three sessions without notice, you will be discharged from the program.
I, _________________________________________ (print name) consent to the above conditions and to participate in the Healthy Weight Gym program at Nepean Hospital.
I have acknowledge the rules of this gym program and agree to respect them as outlined.
Signed: ________________________________ Date: ____________________________
Relationship to patient (if not signed by patient)_________________________________________________
Relationship to patient (if not signed by patient)_________________________________________________
Please return completed forms to reception at 62 Derby St, Kingswood 2747 between 08:00am – 04:00pm
Referrals can also be faxed to the following number 02 4734 1920
Referrals can also be faxed to the following number 02 4734 1920
Screening Tool for the Healthy Weight Gym – To be completed by your GP
Name: ___________________________________
DOB: ____________________________________
Contact Number: __________________________
BMI (Wt/ht2 = _____) : Body weight = _____ Height = _____ cms
Diabetes: Yes / No Insulin dependent: Yes / No
If Insulin dependent, please specify no. of units ___________________________________________
Cardiovascular Disease: Yes / No
If Yes, please provide further details ____________________________________________________
__________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________
Respiratory Disease: Yes / No
If Yes, please provide further details ____________________________________________________
__________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________
Smoking: Non-Smoker / Ex-smoker / Current Smoker
Comorbidities:
Depression and/or Anxiety Yes / No If yes, currently stable/unstable?
Prev. Surgery (if applicable): ___________________________________________________
Other: _____________________________________________________________________
Medications:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Musculoskeletal Issues (Chronic pain, OA, OP) Yes / No
Please describe (History and location) __________________________________________________________________________________
__________________________________________________________________________________
Previous treatment (If any) __________________________________________________________
Falls History (Past 12 months) _________________________________________________________
Mobility: Distance walked without rest (approx) = _______
Mobility aid: _____________________________
Screen Completed by:
Name: _________________________________ Designation: ________________________
Contact number _________________________ Date: ____/_____/_____
Signature _______________________________
For Physio use only
Modifications to exercise program:
Psychological supports
Name
|
Area of interest
|
Website/Contact details
|
BeyondBlue
|
Depression, Anxiety
| |
Mindspot
|
Depression, Anxiety
| |
Moodgym
|
Depression, Anxiety
|
https://moodgym.com.au/
|
This Way Up
|
Depression, Anxiety
|
https://thiswayup.org.au/
|
Gambling Help
|
Gambling
|
http://www.gamblinghelp.nsw.gov.au/
|
St Vincent’s Hospital Gambling Treatment Program
|
Gambling
| |
NBM Drug and Alcohol
|
Drug and Alcohol Use
|
https://www.nbmlhd.health.nsw.gov.au/drug-and-alcohol-service
|
Lifeline
|
Crisis Support
|
13 11 14
|
Australian Clinical Psychology Association
|
Find a Psychologist
|
https://acpa.org.au/
|
Australian Psychological Society
|
Find a Psychologist
|
https://www.psychology.org.au/
|
Western Sydney Uni Psychology Clinic
|
Psychology Services
|
https://www.westernsydney.edu.au/
ssap/ssap/psychology_clinic
|
UNSW Psychology Clinic
|
Psychology Services
| |
Sydney University Psychology Clinic
|
Psychology Services
| |
UTS Psychology Clinic
|
Psychology Services
| |
Macquarie Uni Psychology Clinic
|
Psychology Services
|
https://www.mqhealth.org.au/hospital-clinics/psychology-clinic
|
Physical Activity Resources
Name
|
Website
|
Find Your 30
|
https://www.sportaus.gov.au/findyour30
|
Get Active Australia
|
https://www.heartfoundation.org.au/active-living/get-active
|
Better Health Victoria
|
https://www.betterhealth.vic.gov.au/healthyliving/keeping-active
|
Obesity In Motion
|
https://www.facebook.com/nepeanobesityinmotion/
|
Everybody Live Well
|
http://www.everybodylivewell.com/
|
Weekly Weight Journal
Weekly Log
|
Weight
|
Comments
|
Session 1
|
kg
| |
Session 2
|
kg
| |
Session 3
|
kg
| |
Session 4
|
kg
| |
Session 5
|
kg
| |
Session 6
|
kg
| |
Session 7
|
kg
| |
Session 8
|
kg
|
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