Endurance Factor | Professional Endurance Sports Coaching

Startup Kit - Please be as complete as possible and be sure to hit the submit button on the bottom of the page. After submitting form, please print confirmation page for your records. Please use the tab key to move between fields and the ENTER key to submit form.
First Name
Last Name
Address

Gender

Birth date

Weight

Height

How can I contact you?

Home Phone

Work Phone		Best time to reach you?
E-mail address

Which Sport(s) are you seeking coaching for?
Have you been confirmed with a Coach?

yes no

If yes, who:

Your other-than-athletic life (Optional)

Occupation		Hours worked weekly (give work schedule)
Married?		Spouse's name

Children?

_{Your Health History:}
_{1. Have you or anyone in your family had coronary artery disease?}
_{yes no}	If yes, explain:

_{2. Do you ever have chest, shoulder, neck, or arm pains after exercise?}
_{yes no}	If yes, explain:

_{3. Have you ever fainted, felt dizzy, or unusually winded after exercise?}
_{yes no}	If yes, explain:

_{4. Has a doctor said that your blood pressure is too high or uncontrolled?}
_{yes no}	If yes, explain:

_{5. Has a doctor ever said you have heart trouble, a heart murmur, or that you have had a heart attack?}
_{yes no}	If yes, explain:

_{6. Are you diabetic, have a thyroid condition, or any chronic condition?}
_{yes no}	If yes, explain:

_{7. Are you using any medications? List Them}
_{yes no}	If yes, explain:

_{8. Is your cholesterol level high? What's your cholesterol count?}
_{yes no}	If yes, explain:

_{9. Have you ever had a complete physical exam including stress test on a treadmill or ergometer?}
_{yes no}	If yes, explain:

_{10. Do you have any condition that a doctor says may limit your exercise?}
_{yes no}	If yes, explain:

_{11. Have you ever smoked? When did you quit?}
_{yes no}	If yes, explain:

_{12. Have you ever had a joint or back disorder or any current injury?}
_{yes no}	If yes, explain:

_{13. Have you had surgery in last 12 months?}
_{yes no}	If yes, explain:

_{14. Are you now, or have you been pregnant in last three months?}
_{yes no}	If yes, explain:

Your Athletic History:

1. List your favorite sports and years of participation

2. Do you currently have a strength training routine? If yes, please describe (machines or free weights, days per week, sets, reps, resistance, etc)

3. Have you ever had an exercise related injury which caused you to stop exercising for a week or more?

4. For multisport and running, list your best race times, with splits if possible. Cyclists and MTBers list race category and years at that category.

Your Current Athletic Information

1. Have you planned what races you will compete in for next season? If so, please list with dates and priority (A, B, or C, A being most important)

2. What are your three most important goals? Rank them 1-2-3.

a)
b)
c)

3. At the completion of our first season together, how will we know if we were successful? What is the single most important thing we must accomplish?

4a. What is your training week like now?

Day	Type of workout, length of workout, and intensity of workout
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

4b. Is the above high, normal, or low for you.

5. What is your longest workout in the last 3 weeks? Describe.

6)	How many weekly hours do you have available to train? Be realistic
7)	What time of day do you expect to do most of your training during the work week?
8)	Multisport and/or Cycling: Do you have a bike trainer?
9)	Multisport and/or Cycling: Do you have a cycle computer with cadence function?
10)	Multisport/Running. Do you have access to a track?
11)	Multisport/Running: Do you run with a running club?
12)	Do you ever train with a group or participate in group classes? Please list days and times.

13)	Multisport only: Do you have access to a pool? What size? Day you prefer to swim?

14)	Multisport only: Do you have access to a masters swimming program?
15)	Which day is best for you to take off from training?
16)	How many miles or hours did you train in the past three months for each sport?
	Swim
	Bike
	Run
17)	What were the most important races you did in the last 12 months?"

18)	Do you own a heart rate monitor?
19)	How familiar are you with training with a heart rate monitor?
20)	Do you own a Computrainer or other power meter device? Please list devices.
21)	What is the highest heart rate you have observed during exercise and what sport?
22)	Do you know your lactate threshold heart rate for any sport? Please list and describe how it was determined.
	Swim
	Bike
	Run

Limiters:
In order to focus your training most efficiently, we need to determine your limiters: those aspects of fitness that are limiting your current performances. Please take a few moments to assess your abilities on a score of 1-5.

1 = among the worst in my race category
3 = about the same as others in my race category
5 = among the best in my race category

See descriptions of each ability below.

Abilities/Techniques	Swim	Bike	Run
Endurance
Force
Speed Skills
Muscular Endurance
Anaerobic Endurance
Power

Definitions:
Endurance is the ability to delay the onset and reduce the effects of fatigue, implies an aerobic level of conditioning.

Force is the ability to overcome resistance: how well you do in rough water, hills, or in the wind.

Speed Skills is the ability to move effectively while swimming, biking, or running. A measure of economy and technique.

Muscular Endurance is the ability of the muscles to maintain a relatively high force load for a prolonged time. A combination of force and endurance.

Anaerobic Endurance is the ability to resist fatigue at very high efforts when arm or leg turnover is rapid.

Power is the ability to apply maximum force quickly.

Miscellaneous Factors:


Time to train
Injuries
Health
Body Strength
Flexibility
Mental Skills
Body Composition
Nutrition

Comments or Questions: