S08 
                                                                         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! 
         FOOD and BEVERAGES 
         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.”  
       www.move.va.gov                 Standard Handouts    ! S08 Version 5.0             Page 1 of 6 
     
        
                                                                                                                                      Daily Food and Physical Activity Diary 
        
                   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. 
                 www.move.va.gov                                                         Standard Handouts    ! S08 Version 5.0                                                                           Page 2 of 6 
        
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