Post on 18-Jan-2017
www.move.va.gov Standard Handouts ! S08 Version 5.0 Page 1 of 6
Daily Food and Physical Activity Diary
Instructions for Completing the Daily Food and Physical Activity Diary MOVE! is all about helping you manage your weight. This diary is designed to help you monitor your weight, physical activity, and dietary intake. This will be one of your most valuable tools to reach your goals because it will increase your awareness and help you change. Complete the diary as frequently as possible. It is worth the effort!
1. In the top section of the diary: • Write your name and the date. • Fill in your daily calorie goal. Use
this chart to select your calories. • Set a weekly food goal to improve
your diet. Example: “I will cut down on calories by eliminating snacking while watching TV in the evenings this week,” or “I will drink water or sugar-free beverages in place of regular soda this week.” 2. Weigh yourself daily and record your weight in the header row, next to the day. 3. Write down everything you eat and drink, and the amount. If you know the measured amount, list it. If
you don’t know the exact amount then estimate the size (2" x 1" x 1"), the volume (1⁄2 cup), the weight (2 ounces), and/or the number of items (12) of that type of food. Include as much detail as possible.
4. Complete the line that has “M PC H” listed: • Circle M if you were mindful (aware of what & how much you ate). • Circle PC if the meal was portion-controlled (see Handout S06, Making Healthy Food Choices with a
Healthy Plate). • Circle H if the meal was healthy (see Handout S06) • Mark the numbers on 1–10 Hunger/Fullness rating scale
(1=starving, 5=neither hungry nor full, 10=uncomfortably full) • Place an X over the number that represents the Pre-meal hunger/fullness level. • Draw a circle around the number that represents the Post-meal hunger/fullness level.
5. Fill in a word to describe your mood (happy, content, sad, angry, lonely, excited, exhausted, bored, anxious, fearful, or any other emotion).
6. Use a calorie counter to enter total calories for the day. Purchase a booklet, use a Web site or a Smartphone App to count calories easily.
7. At the end of the day, circle whether you met your goal for the day: • If you met your goal, circle “I did it!” • If you almost met your goal, circle “Almost.” • If you didn’t achieve your goal, circle “Try again.”
FOOD and BEVERAGES
S08
www.move.va.gov Standard Handouts ! S08 Version 5.0 Page 2 of 6
Physical Activity
1. Write your weekly physical activity goal on the top line. Example: “I want to walk 15 to 30 minutes per day for 4 out of 7 days this week and do strength training twice a week. I will also look for additional ways to be active throughout the day, like taking the stairs instead of the elevator, three times a day.”
Refer to Handout S02, Set Your Weight Loss Goals, for an explanation of how to set a SMART goal. NOTE: You do not need to do all four types of activity each day. See below for descriptions and guidance for recommended amounts of physical activity. Refer to the sample plan to see how to spread out the types of activities over the week.
2. Aerobic activity is when the body’s large muscles move together and your heart beats faster than usual. Examples include aerobics, swimming, running, walking, kickboxing, dancing, and cycling. This type of activity burns the most calories and promotes weight loss. In this box, write down what
you did, how long you did it, and/or the number of steps/wheelchair revolutions.
3. Strengthening activity is when is when the body’s muscles work against a force or weight. Examples include elastic bands, weights, or body weight. In this box, write down the type of
strength training and how many repetitions and sets of each exercise you performed.
4. Flexibility (stretching) lengthens a muscle. This makes a muscle feel loose while increasing range of motion. Examples include self-stretch, yoga, Pilates, and chair stretching routines. In this box, write
down the type of stretch you participated in.
5. Lifestyle activity occurs during normal, everyday activity such as vacuuming, walking the dog, mowing the lawn, participating in a walking meeting at work, or dancing.
6. Recommended Amounts of Physical Activity • Aerobic:
• Weight Loss: 300 minutes (5 hours) per week. Start with what you can do and build to 300 minutes over time.
• Health/Weight Maintenance: 150 minutes (21⁄2 hours) per week, in periods of at least 10 minutes.
• Strength: Do strength training 2–3 times/week. Each exercise should be repeated, completing 8–12 repetitions.
• Flexibility/Stretching: Be sure to stretch after each workout, whether it’s aerobic or strength.
• Lifestyle Activity: Get as much as you can.
7. At the end of the day, circle whether you met your goal for the day: • If you met your goal, circle “I did it!” • If you almost met your goal, circle “Almost.” • If you didn’t achieve your goal, circle “Try again.”
8. At the end of each day, total your aerobic activity (in minutes). At the end of each week, add your daily aerobic totals together to determine your weekly aerobic time.
Daily Food and Physical Activity Diary
!!
Day
/Wei
ght
Sund
ay/
26
7!
Mon
day/
26
6.5!
Tues
day/
26
6.5!
Wed
nesd
ay/
26
6!T
hurs
day/
26
6.3!F
riday
/ 2
66
.2!
Satu
rday
/ 2
65
.8!
Brea
kfas
t (6
am
– 1
0am
)
M =
Min
dful
PC
= P
ortio
n Co
ntro
l H
= H
ealth
y
Hung
er/F
ulln
ess S
cale
X
= Pr
e-m
eal
! =
Pos
t-mea
l
8 oz
oran
ge ju
ice
1 cu
p rais
in br
an
1⁄2
cup 2
% mi
lk
1 ts
p sug
ar su
b.
2 sli
ces w
heat
toas
t 1
cup c
offe
e
1 cu
p oat
meal
1⁄
2 cu
p 2%
milk
1
tsp s
ugar
sub.
1
Engli
sh m
uffin
2
tbsp
no su
gar j
am
1 cu
p cof
fee
!
1 ha
rd-b
oiled
egg
3 oz
ham
2
slice
toas
t 1
tsp n
o sug
ar ja
m
8 oz
toma
to ju
ice
!
2 bis
cuits
and
1⁄2
cup g
ravy
2
scra
mbled
eggs
1
cup C
anta
loupe
8
oz or
ange
juice
!
1 cu
p oat
meal
1⁄
2 cu
p 1%
milk
1
cup c
offe
e 1
oran
ge
!
3 pie
ces F
renc
h Toa
st
3 Tb
sp lit
e map
le sy
rup
1 Tb
sp m
arga
rine
1 cu
p 1%
milk
!
1 1⁄
2 cu
ps ra
isin b
ran
1 plu
m
1 cu
p cof
fee
1⁄2
cup 1
% mi
lk !
Lunc
h (1
1 am
– 2
pm)
!
Larg
e sala
d (4
oz
grille
d chic
ken)
2
tbsp
ranc
h 1
cup g
reen
bean
s 1⁄
2 ba
nana
wa
ter w
/lemo
n
Larg
e gar
den s
alad
4 oz
tuna
in w
ater
2
tbsp
low-
fat b
lue
chee
se
1 sm
all di
nner
roll n
o bu
tter
!
2 lar
ge sl
ices
mush
room
& on
ion
thin
crus
t pizz
a sid
e sala
d 2
tbsp
Itali
an dr
essin
g !
1 pr
otein
shak
e 1
pear
8
oz w
ater
!
Grille
d Chic
ken o
n wh
eat b
un
1 sm
all or
der f
ries
1 sm
all di
et co
ke
!
Tuna
Sala
d Sub
1
bag o
f chip
s 1
pickle
1
diet c
oke
1 sm
all co
okie
!
Vege
table
Sala
d 1
cup G
reek
yogu
rt
2 tb
sp O
il and
vin
egar
dres
sing
8 oz
wat
er
!
Din
ner
(5 p
m –
8pm
)
!
Turk
ey an
d pro
volon
e ch
eese
sand
wich
on
whe
at
1 tb
sp m
usta
rd
1 ba
g chip
s 1
diet c
oke
!
8 oz
spag
hett
i 4
small
mea
tball
s sid
e sala
d die
t jell
o 8
oz w
ater
!
6 oz
bake
d chic
ken
with
out s
kin
2 tb
sp bb
q sau
ce
1⁄2
cup s
team
ed ri
ce
+ ma
rgar
ine
1 cu
p bro
ccoli
8
oz w
ater!
6 oz
salm
on
1 cu
p spin
ach
1⁄2
bake
d pot
ato w
ith 1
tb
sp lo
w-fa
t sou
r cre
am
and 1
tbsp
mar
garin
e 8
oz w
ater
!
6 oz
grille
d sirl
oin st
eak
1 cu
p sau
téed
mu
shro
oms
3⁄4
cup s
callo
ped
pota
toes
!
2 ch
icken
soft
taco
s 1⁄
2 cu
p blac
k bea
ns
20 ch
ips w
ith sa
lsa
1⁄2
cup y
ellow
rice
1
skinn
y mar
garit
a !
1 1⁄
2 cu
p che
ese r
aviol
i sid
e sala
d 1
piece
garli
c bre
ad
8 oz
wat
er
!
Snac
ks &
Be
vera
ges
(bet
wee
n m
eals)
Re
mem
ber, a
ll sna
cks
shou
ld b
e hea
lthy,
min
dful
an
d po
rtion
cont
rolle
d;
inclu
de al
coho
lic
beve
rage
s
90-c
alorie
gran
ola ba
r 2
cups
popc
orn
1 me
dium
apple
!
Oran
ge
120-
calor
ie gr
anola
bar
1 me
dium
choc
olate
mu
ffin
!
Celer
y Ca
rrots
2
tbsp
pean
ut bu
tter
15
0- ca
lorie
froze
n yo
gurt
cone
!
!2
strin
g che
ese
15 al
mond
s !
!Ce
lery a
nd ca
rrots
2
tbsp
pean
ut bu
tter
!
Tota
l Cal
orie
s 1
42
2!
19
38!
23
99!
21
75!
17
18!
27
20!
16
25!
Goa
l Met
?!I d
id it
Alm
ost
Try
Aga
in! I
did i
t A
lmos
t T
ry A
gain!!I d
id it
Alm
ost
Try
Aga
in! I d
id it
Alm
ost
Try
Aga
in! I d
id it
Alm
ost
Try
Aga
in!!I d
id it
Alm
ost
Try
Aga
in! I d
id it
Alm
ost
Try
Aga
in!
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: e
xcit
ed
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: c
onte
nt
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: n
eutr
al
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: s
ad
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: o
kay
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: r
elax
ed
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: h
appy
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: h
appy
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: a
nxio
us
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: b
ored
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: h
appy
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: n
eutr
al
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: h
appy
Dai
ly F
ood
and
Phys
ical
Act
ivity
Dia
ry
Nam
e:
D
ate:
D
aily
Cal
orie
Goa
l:
(se
e ins
tructi
ons o
r Stan
dard
Hand
out S
01 fo
r guid
ance
) W
eekl
y Fo
od G
oal:
NOTE
: Inclu
de ev
eryth
ing yo
u eat
and d
rink i
n you
r diar
y.
John
H. H
ero
April
1
20
00
I w
ill d
rink w
ater
or d
iet
cola
s in
stea
d of
regu
lar s
odas
thi
s w
eek.
Stan
dard
Han
dout
s!!!!"
S08
Vers
ion
5.0
Page
3 o
f 6
ww
w.m
ove.
va.g
ov
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: h
appy
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: a
nxio
us
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: a
ngry
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: s
ad
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: h
appy
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: h
appy
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: c
onte
nt
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d: w
orrie
d
X X
X X
X X
X X
X X
X X
X
X X
X X
X X
X
!!
Su
nday!
Mon
day!
Tues
day!
Wed
nesd
ay!
Thur
sday!
Frid
ay!
Satu
rday!
Aero
bic
(Typ
e, T
ime/
St
eps/
Whe
elch
air
Revo
lutio
ns)
20 m
inute
s on
ellipt
ical
45-m
inute
wat
er
aero
bics c
lass !
10-m
inute
bike
ride
30
minu
te tr
eadm
ill !
!45
-minu
te w
ater
ae
robic
s clas
s !
! !
Stre
ngth
!
Type
: Ty
pe:
resis
tanc
e Ban
d (1
2 ex
ercis
es) !
Type
:! Ty
pe:!
Type
: fre
e weig
hts a
nd
body
weig
ht ex
ercis
es!
Type
:! Ty
pe:!
Repe
titio
ns:
Repe
titio
ns:
10-1
5 Re
petit
ions
: Re
petit
ions
: Re
petit
ions
: 10
-15
Repe
titio
ns:
Repe
titio
ns:
Sets
: Se
ts:
2 Se
ts:
Sets
: Se
ts:
3 Se
ts:
Sets
:
Flex
ibili
ty
(Typ
e)
!
10-m
inute
stre
tch
of lo
wer b
ody
!
5-mi
nute
stre
tchin
g af
ter s
tren
gth
train
ing ro
utine
!!
1-ho
ur yo
ga cl
ass !
!15
-minu
te st
retc
h in
pool !
!20
minu
tes
stre
tchin
g !
Life
styl
e Ac
tivity
(T
ype/
Tim
e)
Two 1
0-mi
nute
walk
s !15
-minu
te w
alk
at lu
nch !
Shop
ping a
t the
mall
fo
r 1 ho
ur
park
ed at
back
of
park
ing lo
t
30-m
inute
danc
e les
son!
!!
mowe
d the
gra
ss w
ith
push
mow
er
weed
ed th
e gar
den
wash
ed th
e car!
18 ho
les of
golf
walki
ng co
urse
!!
Goa
l Met
?!I d
id it
Alm
ost
Try
Aga
in!I
did i
t A
lmos
t T
ry A
gain!! I d
id it
Alm
ost
Try
Aga
in!I d
id it
Alm
ost
Try
Aga
in! I d
id it
Alm
ost
Try
Aga
in!!I d
id it
Alm
ost
Try
Aga
in! I d
id it
Alm
ost
Try
Aga
in!
Tota
l Wee
kly
Aero
bic T
ime
(# m
inut
es)
50 m
inute
s!60
minu
tes
40 pl
anne
d minu
tes
35 m
inute
s mall
wa
lking!
0 pla
nned
minu
tes o
f ae
robic
activ
ity
!
45 m
inute
s 70
minu
tes!
30 m
inute
s on
golf c
ours
e
!
Phys
ical
Act
ivity
Wee
kly
Goa
l:
I w
ant t
o be
phy
sica
lly a
ctive
5 d
ays
this
wee
k thr
ough
wal
king
, aer
obic
exer
cise
, and
par
tici
pate
in 2
day
s of
str
engt
h tr
aini
ng.
Pedo
met
er:
9,5
58
ste
ps
Pedo
met
er:
12
,20
0 s
teps
Pe
dom
eter
: 1
6,4
59
ste
ps
Pedo
met
er:
4,3
26
ste
ps
Pedo
met
er:
11
,00
9 s
teps
Pe
dom
eter
: 1
3,9
88
ste
ps
Pedo
met
er:
14
,45
0 s
teps
Stan
dard
Han
dout
s!!!!"
S08
Vers
ion
5.0
Page
4 o
f 6
ww
w.m
ove.
va.g
ov
!!
Day
/Wei
ght
Sund
ay/ !
Mon
day/
!Tu
esda
y/ !
Wed
nesd
ay/
!Th
ursd
ay/
!Fr
iday
/ !
Satu
rday
/ !
Brea
kfas
t (6
am
– 1
0am
)
M =
Min
dful
PC
= P
ortio
n Co
ntro
l H
= H
ealth
y
Hung
er/F
ulln
ess S
cale
X
= Pr
e-m
eal
! =
Pos
t-mea
l
!
!!
!!
!
Lunc
h (1
1 am
– 2
pm)
!
!
! !
!!
!
Din
ner
(5 p
m –
8pm
)
!
!!
!!
!!
!
Snac
ks &
Be
vera
ges
(bet
wee
n m
eals)
Re
mem
ber, a
ll sna
cks
shou
ld b
e hea
lthy,
min
dful
an
d po
rtion
cont
rolle
d;
inclu
de al
coho
lic
beve
rage
s
!!
!!
!!
!
Tota
l Cal
orie
s !
!!
!!
!!
Goa
l Met
?!I d
id it
Alm
ost
Try
Aga
in!I
did i
t A
lmos
t T
ry A
gain!!I d
id it
Alm
ost
Try
Aga
in!I d
id it
Alm
ost
Try
Aga
in!I d
id it
Alm
ost
Try
Aga
in!!I d
id it
Alm
ost
Try
Aga
in!I d
id it
Alm
ost
Try
Aga
in!
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
Dai
ly F
ood
and
Phys
ical
Act
ivity
Dia
ry
Nam
e:
D
ate:
D
aily
Cal
orie
Goa
l:
(se
e ins
tructi
ons o
r Stan
dard
Hand
out S
01 fo
r guid
ance
) W
eekl
y Fo
od G
oal:
NOTE
: Inclu
de ev
eryth
ing yo
u eat
and d
rink i
n you
r diar
y.
Stan
dard
Han
dout
s!!!!"
S08
Vers
ion
5.0
Page
5 o
f 6
ww
w.m
ove.
va.g
ov
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
M
PC
H
1
2 3
4 5
6 7
8 9
10
Moo
d:
!!
Su
nday!
Mon
day!
Tues
day!
Wed
nesd
ay!
Thur
sday!
Frid
ay!
Satu
rday!
Aero
bic
(Typ
e, T
ime/
St
eps/
Whe
elch
air
Revo
lutio
ns)
!
! !
! !
!
Stre
ngth
!
Type
: Ty
pe: !
Type
:! Ty
pe:!
Type
: !
Type
:! Ty
pe:!
Repe
titio
ns:
Repe
titio
ns:
Re
petit
ions
: Re
petit
ions
: Re
petit
ions
:
Repe
titio
ns:
Repe
titio
ns:
Sets
: Se
ts:
Se
ts:
Sets
: Se
ts:
Se
ts:
Sets
:
Flex
ibili
ty
(Typ
e)
!
! !
!!
!!
!
Life
styl
e Ac
tivity
(T
ype/
Tim
e)
! !
!!
!!
!
Goa
l Met
?!I d
id it
Alm
ost
Try
Aga
in!I
did i
t A
lmos
t T
ry A
gain!!I d
id it
Alm
ost
Try
Aga
in!I d
id it
Alm
ost
Try
Aga
in!I d
id it
Alm
ost
Try
Aga
in!!I d
id it
Alm
ost
Try
Aga
in!I d
id it
Alm
ost
Try
Aga
in!
Tota
l Wee
kly
Aero
bic T
ime
(# m
inut
es)
!
!!
!
!
Phys
ical
Act
ivity
Wee
kly
Goa
l:
Pedo
met
er:
Pedo
met
er:
Pedo
met
er:
Pedo
met
er:
Pedo
met
er:
Pedo
met
er:
Pedo
met
er:
Stan
dard
Han
dout
s!!!!"
S08
Vers
ion
5.0
Page
6 o
f 6
ww
w.m
ove.
va.g
ov