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Health Care Provider Consultation Form For Prenatal Physical Activity

The document is a consultation form for a health care provider to provide guidance to a pregnant patient on physical activity. It recommends that most pregnant individuals can be physically active and benefit from at least 150 minutes of moderate exercise per week. However, for patients with certain medical conditions, physical activity may need to be modified or avoided. The provider is asked to discuss any concerns and indicate any recommended modifications to physical activity for the patient.

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Mariela Prieto
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26 views2 pages

Health Care Provider Consultation Form For Prenatal Physical Activity

The document is a consultation form for a health care provider to provide guidance to a pregnant patient on physical activity. It recommends that most pregnant individuals can be physically active and benefit from at least 150 minutes of moderate exercise per week. However, for patients with certain medical conditions, physical activity may need to be modified or avoided. The provider is asked to discuss any concerns and indicate any recommended modifications to physical activity for the patient.

Uploaded by

Mariela Prieto
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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HEALTH CARE PROVIDER

CONSULTATION FORM FOR


PRENATAL PHYSICAL ACTIVITY
PATIENT NAME: DUE DATE (DD/MM/YYYY): TODAY'S DATE (DD/MM/YYYY):

Your patient wishes to begin or continue to be physically active during


pregnancy. Your patient answered "Yes" to one or more questions on the Get
Active Questionnaire for Pregnancy and has been asked to seek your advice
Absolute contraindications
(www.csep.ca/getactivequestionnaire-pregnancy). Pregnant women with these conditions
should continue activities of daily living,
Physical activity is safe for most pregnant individuals and has many health but not take part in moderate or vigorous
benefits. However, a small number of patients may need a thorough physical activity:
evaluation before taking part in physical activity during pregnancy.
ruptured membranes,
The Society of Obstetricians and Gynaecologists of Canada/Canadian premature labour,
Society for Exercise Physiology 2019 Canadian Guideline for Physical Activity unexplained persistent vaginal bleeding,
throughout Pregnancy recommends that pregnant women get at least 150 placenta previa after 28 weeks gestation,
minutes of moderate intensity physical activity each week (see next page or preeclampsia,
csepguidelines.ca/pregnancy). But there are contraindications to this goal for incompetent cervix,
some conditions (see right). intrauterine growth restriction,
h
 igh-order multiple pregnancy
Specific concern from your patient and/or from a Qualified Exercise (e.g. triplets),
Professional: uncontrolled Type I diabetes,
uncontrolled hypertension,
uncontrolled thyroid disease,
o
 ther serious cardiovascular,
respiratory or systemic disorder.
To ensure that your patient proceeds in the safest way possible, they were
advised to consult with you about becoming or continuing to be physically
active during pregnancy. Please discuss potential concerns you may have Relative contraindications
about physical activity with your patient and indicate in the box below any
Pregnant women with these conditions
modifications you might recommend:
should discuss advantages and
disadvantages of physical activity with
Unrestricted physical activity based on the SOGC/CSEP 2019 Canadian you. They should continue physical
Guidelines for Physical Activity throughout Pregnancy. activity, but modify exercises to reduce
intensity and/or duration.
Progressive physical activity
recurrent pregnancy loss,
Recommend avoiding:
gestational hypertension,
a history of spontaneous preterm birth,
Recommend including: m
 ild/moderate cardiovascular or
respiratory disease,
symptomatic anemia,
Recommend supervision by a Qualified Exercise Professional, if possible.
malnutrition,
Refer to a physiotherapist for pain, impairment and/or a pelvic floor assessment. eating disorder,
twin pregnancy after the 28th week,
Other comments:
other significant medical conditions.

© Canadian Society for Exercise Physiology (CSEP) Page 1


SOGC/CSEP 2019
CANADIAN GUIDELINE
FOR PHYSICAL ACTIVITY
THROUGHOUT PREGNANCY
The evidence-based guideline outlines the right amount of physical activity women
should get throughout pregnancy to promote maternal, fetal, and neonatal health.

Research shows the health benefits and safety of being active throughout pregnancy
for both mother and baby. Physical activity is now seen as a critical part of a healthy
pregnancy. Following the guideline can reduce the risk of pregnancy-related illnesses
such as depression, by at least 25%, and of developing gestational diabetes, high blood
pressure and preeclampsia by 40%.

Pregnant women should get at least 150 minutes of moderate-intensity physical


activity each week over at least three days per week. But even if they do not meet
that goal, they are encouraged to be active in a variety of ways every day. Please
visit csepguidelines.ca/pregnancy for more information. The guideline makes six
recommendations:

1 2 3
All women without contraindication Pregnant women should Physical activity should be
should be physically active accumulate at least 150 minutes accumulated over a minimum of
throughout pregnancy. Specific of moderate-intensity physical three days per week; however, being
subgroups were examined: activity each week to achieve active every day is encouraged.
clinically meaningful health benefits
• Women who were previously inactive. and reductions in pregnancy
• Women diagnosed with gestational
complications.
diabetes mellitus.
• Women categorized as overweight or
obese (pre-pregnancy body mass index
≥25kg/m2).

4 5 6
Pregnant women should Pelvic floor muscle training (e.g., Pregnant women who experience
incorporate a variety of aerobic Kegel exercises) may be performed light-headedness, nausea or feel
and resistance training activities to on a daily basis to reduce the risk of unwell when they exercise flat
achieve greater benefits. Adding urinary incontinence. Instruction in on their back should modify their
yoga and/or gentle stretching may proper technique is recommended exercise position to avoid the supine
also be beneficial. to obtain optimal benefits. position.

No. 367-2019 Canadian Guideline for Physical Activity throughout Pregnancy


JOINT SOGC/CSEP CLINICAL PRACTICE GUIDELINE | Volume 40, ISSUE 11, P1528-1537, November 01, 2018

© Canadian Society for Exercise Physiology (CSEP) Page 2

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