April 18, 2021

Brittany Ward, CSEP-CEP

Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, Women and Children’s Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada

Background

• Until recently, Clinical Practice Guidelines recommended all individuals obtain medical clearance before beginning or continuing to exercise during pregnancy using the PARmed-X for Pregnancy.
• While this was meant to identify medical conditions where exercise could be potentially harmful to the mother and/or fetus (termed contraindications), seeking clearance became a key barrier to participation.
• Extensive research has established the safety and health benefits of exercise for the vast majority of pregnant individuals, so the requirement of medical clearance was removed by the Society of
• Obstetricians and Gynaecologists of Canada (SOGC/CSEP 2019 Canadian Guideline for Physical Activity throughout Pregnancy).
• Identifying contraindications to exercise during pregnancy remains important.

How the development of the pre-screening tools was done

• CSEP convened the Get Active Questionnaire for Pregnancy Working Group which consisted of key stakeholders from CSEP, SOGC, College of Family Physicians of Canada, Canadian Physiotherapy Association Women’s Health Division, and content experts in prenatal exercise and knowledge translation from Canada and the USA.
• The goal of the working group was to develop a new exercise pre-participation screening tool for pregnant individuals that would replace the PARmed-X for Pregnancy.
• This new document follows the latest guidance from the American College of Sports Medicine on exercise pre-screening.
• Specifically, it is self-administered to reduce barriers to prenatal physical activity, be more user friendly, and safely “screen-in” the majority of pregnant individuals for regular physical activity.
• These documents were developed following consultations with pregnant and postpartum (<1 year following delivery) individuals, Qualified Exercise Professionals, Health Care Providers, and policy makers.

What is it?

The first page of the Get Active Questionnaire for Pregnancy is designed to identify the minority of individuals who may have a contraindication to exercise during pregnancy (i.e. those who require additional consultation with their health care provider).

• Individuals who answer no to all questions are recommended to proceed with physical activity while those who answer yes to one or more questions are referred to speak to their Health Care Provider.

The Health Care Provider Consultation Form for Prenatal Physical Activity was designed to facilitate a conversation about contraindications to prenatal exercise.

• This document outlines both absolute and relative contraindications while providing an opportunity for the clinician to provide additional feedback to their patient and the Qualified Exercise Professional.
• The presence of absolute contraindications indicate pregnant individuals should not proceed with exercise due to increased risk for harm to mother and/or fetus; however, activities of daily living (i.e. walking or light stretching) are recommended to avoid adverse effects of inactivity.
• Presence of relative contraindications may require modification of intensity, type, and duration of activity but physical activity is still recommended.

The second page of the Get Active Questionnaire for Pregnancy inquires about the level of activity prior to, and during pregnancy, as well as the individual’s desired level of physical activity.

• This serves as a starting point for more detailed discussion and provides general advice.
• At the end of the second page, declaration and client signature are required to satisfy liability insurance requirements for Qualified Exercise Professionals.

If an individual’s health changes during pregnancy, the Get Active Questionnaire for Pregnancy should be filled out again.

Conclusion

• The Get Active Questionnaire for Pregnancy helps individuals decide whether they should speak to their Health Care Provider before they begin or continue to engage in physical activity.
• This evidence informed pre-screening tool removes a key barrier to exercise participation (medical clearance) for the majority of pregnant individuals.

For more detailed information on how to use the GAQ-P, please refer to www.csep.ca/getactivequestionnaire-pregnancy. 

Take home message

• Extensive evidence supports the safety and benefits of exercise for most pregnant individuals.
• A small number of individuals develop medical conditions during pregnancy (e.g., preeclampsia; high blood pressure plus signs of damage to organs such as liver or kidneys) where exercise is not recommended.
• The Get Active Questionnaire for Pregnancy (GAQ-P) and associated Health Care Provider Consultation Form for Physical Activity during Pregnancy have been designed to identify individuals who may not benefit from prenatal exercise, while reducing barriers to physical activity for the majority of pregnant individuals.