Baseline outcome measure reporting

Exercise Professional Name *

First

Last

Exercise Business Name

Patient Name *

First

Last

Patient date of birth

Body mass (kg)

Waist circumference (cm)

Hip circumference (cm)

Resting blood pressure (systolic/diastolic)

Total minutes of moderate-vigorous aerobic activity per week

Number of resistance training sessions (greater than 15 minutes or more)

6-minute walk score

30-second sit to stand score

30-second arm curl stand

FACT-P Total Score

FACT-P calculator can be found at: www.expo.org.au

FACT-P physical well-being score

FACT-P social/family well-being score

FACT-P emotional well-being score

FACT-P functional well-being score

FACT-P Additional prostate cancer concerns score

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