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Physical Fitness

1. I exercise aerobically (continuous, vigorous exercise producing sweat for a minimum of thirty minutes) at least _____ per week.

2. My resting pulse rate is _____ beats per minute.

3. I avoid the extremes of too much or too little exercise.

4. I approach exercise in a relaxed manner.

5. I increase my exercise by walking or biking whenever possible.

6. I stretch before exercising.

7. I stretch after exercising.

8. I get an adequate amount of sleep.

9. My exercise program includes and adequate amount of each of the three major fitness components--endurance, strength and flexibility.

10. If I am not in shape, I avoid sporadic (once a week or less) strenuous exercise.

Physical Nutrition

1. When choosing non-vegetable protein, I select lean cuts of meat, poultry, and fish.

2. I minimize my salt intake.

3. I eat fruits and vegetable fresh and uncooked.

4. I eat breakfast.

5. I include fiber in my diet on a daily basis.

6. I drink enough fluid to keep my urine light yellow.

7. I plan my diet to insure an adequate amount of vitamins and minerals.

8. I minimize foods in my diet that contain large amounts of refined flour (bleached white flour, typical store bread, cakes, etc.)

9. I minimize my intake of fats and oils including margarine and animal fats.

10. I avoid adding sugar to my food and I minimize my intake of pre-sweetened food such as sugar-coated cereals, syrups, chocolate milk, and most processed and fast foods

Physical Self-Care

1. I maintain an up-to-date immunization record.

2. I examine my breasts or testes on a monthly basis.

3. I take action to minimize my exposure to tobacco smoke.

4. When I'm experiencing illness or injury, I take necessary steps to correct the problem.

5. I brush my teeth after eating.

6. I floss my teeth after eating.

7. My resting pulse is 60 or less.

8. I get an adequate amount of sleep.

9. I keep my blood pressure in a range that minimizes my chances of disease (e.g. stroke, heart attack kidney).

10. I keep my cholesterol level, high density lipids and triglycerides in a range that minimizes my chances of disease.

Drugs and Driving

1. I do not operate vehicles under the influence of alcohol or other drugs.

2. I do not ride with vehicle operators who are under the influence of alcohol or other drugs.

3. I stay within the speed limit.

4. I maintain a safe driving distance between cars based on speed.

5. Vehicles which I drive are maintained to assure safety.

6. I avoid use of tobacco.

7. I do not consume more than two alcoholic drinks per day.

8. I avoid using drugs obtained from unlicensed sources.

9. I consider alternatives to drugs.

10. I follow the instructions provided with any drug I take.

Social Environment

1. I take steps to conserve energy in my place of residence.

2. I contribute to the feeling of acceptance within my family.

3. When I see a safety hazard, I take action (warn other or correct the problem).

4. I avoid unnecessary radiation.

5. I contribute time and/or money to community projects.

6. I use creativity in constructive ways.

7. My behavior reflects fairness and justice.

8. When possible, I choose an environment which is free of noise pollution.

9. When possible, I choose an environment which is free of air pollution.

10. I do my part to promote clean air.

Emotional Awareness

1. I am comfortable in my relationships with others.

2. I feel positive about myself.

3. I feel there is an appropriate amount of excitement in my life.

4. My emotional life is stable.

5. When I make mistakes, I learn from them.

6. I feel enthusiastic about my life.

7. I find it easy to laugh.

8. I enjoy my life.

9. I have plenty of energy.

10. My sleep is restful.

Emotional Control

1. I can express my feelings of anger.

2. I say 'NO' without feeling guilty.

3. I make decisions with a minimum of stress and worry.

4. There is an appropriate amount of time urgency in my daily routine.

5. I include relaxation time as part of my daily routine.

6. I am able to develop close, intimate relationships.

7. I set realistic objectives for myself.

8. I can relax my body and mind (without using drugs).

9. I accept responsibility for my actions.

10. I accept the responsibility for creating my own feelings.


1. I keep abreast of social and political issues.

2. I am interested in learning about scientific discoveries.

3. I make an effort to maintain and improve my verbal skills.

4. I make an effort to maintain and improve my writing skills.

5. I am satisfied with the entertainment choices I make.

6. I carefully select my movies and television choices.

7. I maintain a continuing education program relative to my career.

8. I am satisfied with the amount and variety I read.

9. It's easy for me to apply knowledge gained in one situation to a new situation.

10. I am interested in understanding the views of others.


1. I enjoy my work.

2. I take advantage of opportunities to learn new skills in my work.

3. My work is challenging.

4. I feel my job responsibilities are consistent with my values.

5. I look forward to doing my job.

6. I am satisfied with the balance between my work time and leisure.

7. I am satisfied with my ability to plan my workload.

8. I receive adequate feedback to judge my work performance.

9. To extent that I can, I create an environment which minimizes my stress.

10. To the extent I can, I create an environment which minimizes the stress at my organizational level or other levels.


1. I am satisfied with my spiritual life.

2. Prayer, meditation, and/or quiet personal time is/are important part(s) of my life.

3. My values guide my daily life.

4. My spiritual growth is an important lifelong process.

5. I am concerned about humanitarian issues.

6. I participate in discussions about spiritual values.

7. Contemplating my purpose in life is an important issue for me.

8. I am satisfied with the degree to which my job is consistent with my values.

9. I am satisfied with the degree to which my leisure time activities support my life goals.

10. I am tolerant of the values and beliefs of others.

LiveWell is an educational tool developed by Bill Hettler, MD.  (C) 1977 - 2007