Readiness for Change

Name*

First name Last name

Email address*

Mobile number*

Do you look in the mirror and feel frustrated, upset, or humiliated because of how your body looks?

Yes (+3)
I’m not sure (0)
No (–3)

When you feel run down and tired, what do you think is the source of these feelings?

Getting older (–1)
My lifestyle choices (+3)
Something else altogether (–3)

Are you taking any medications for heart disease, high blood pressure, or type II diabetes that you didn’t have to take when you were younger?

Yes, I’m on two or more of these medications (+3)
Yes, I’m on only one of these medications (+1)
No, I’m not on any of these medications (–3)

If your fitness has deteriorated over the years, how do you explain the fact that you’re in worse shape than when you were younger but haven’t changed your habits at all?

a) I think it’s my family history (–1)
I think it’s that I’m less active (+3)
I think it’s a natural consequence of aging (–1)
I don’t know why it’s happening (0)

If you don’t have anyone to exercise with regularly, are you willing to look for a physical activity partner?

Yes (+5)
No (–5)

Readiness for Change

Step 1 of 3

Your score and what it means