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

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Pos

t-mea

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oran

ge ju

ice

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p rais

in br

an

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cup 2

% mi

lk

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p sug

ar su

b.

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heat

toas

t 1

cup c

offe

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1 cu

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meal

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2 cu

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tsp s

ugar

sub.

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tbsp

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gar j

am

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!

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slice

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m

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8

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2 cu

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cup c

offe

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ge

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renc

h Toa

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rup

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!

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2 cu

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isin b

ran

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m

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fee

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cup 1

% mi

lk !

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h (1

1 am

– 2

pm)

!

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e sala

d (4

oz

grille

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tbsp

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cup g

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bean

s 1⁄

2 ba

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ter w

/lemo

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!

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g !

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oz w

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n wh

eat b

un

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all or

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ries

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et co

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!

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diet c

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!

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table

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8pm

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at

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!

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1⁄2

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ith 1

tb

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ns

20 ch

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lsa

1⁄2

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er

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ks &

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vera

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mem

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ll sna

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lthy,

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d po

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rolle

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inclu

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dium

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15 al

mond

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l Cal

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s 1

42

2!

19

38!

23

99!

21

75!

17

18!

27

20!

16

25!

Goa

l Met

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ost

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in! I

did i

t A

lmos

t T

ry A

gain!!I d

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in! I d

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ost

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in! I d

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in! I d

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in!

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PC

H

1

2 3

4 5

6 7

8 9

10

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d: e

xcit

ed

M

PC

H

1

2 3

4 5

6 7

8 9

10

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d: c

onte

nt

M

PC

H

1

2 3

4 5

6 7

8 9

10

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d: n

eutr

al

M

PC

H

1

2 3

4 5

6 7

8 9

10

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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

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d: h

appy

M

PC

H

1

2 3

4 5

6 7

8 9

10

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d: h

appy

M

PC

H

1

2 3

4 5

6 7

8 9

10

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d: a

nxio

us

M

PC

H

1

2 3

4 5

6 7

8 9

10

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d: b

ored

M

PC

H

1

2 3

4 5

6 7

8 9

10

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d: h

appy

M

PC

H

1

2 3

4 5

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8 9

10

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d: n

eutr

al

M

PC

H

1

2 3

4 5

6 7

8 9

10

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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

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d: h

appy

M

PC

H

1

2 3

4 5

6 7

8 9

10

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d: h

appy

M

PC

H

1

2 3

4 5

6 7

8 9

10

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d: c

onte

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M

PC

H

1

2 3

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8 9

10

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d: w

orrie

d

X X

X X

X X

X X

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!!

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!

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:! 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:

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: 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 !

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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.

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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

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4 o

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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

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d:

M

PC

H

1

2 3

4 5

6 7

8 9

10

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d:

M

PC

H

1

2 3

4 5

6 7

8 9

10

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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

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10

Moo

d:

M

PC

H

1

2 3

4 5

6 7

8 9

10

Moo

d:

M

PC

H

1

2 3

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nday!

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day!

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day!

Wed

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ay!

Thur

sday!

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rday!

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Goa

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met

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met

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met

er:

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met

er:

Stan

dard

Han

dout

s!!!!"

S08

Vers

ion

5.0

Page

6 o

f 6

ww

w.m

ove.

va.g

ov