Pre & Post-Natal Questionnaire

About This Questionnaire

I understand the purpose of this programme is to provide safe and individualised exercise sessions to improve health and fitness during pregnancy or post natal.

The programme may include:

• Cardiovascular activity: walking, jogging, running, use of equipment, high intensity interval training, circuit training and other such activities
• Resistance/Strength training: body weight exercises, use of equipment including holding your baby and use of pram or carrier for exercise
• Warm up, cool down and flexibility exercises

The sessions are tailored to provide safe and effective pre and post natal exercise. Various options will be given at every stage to suit all levels of fitness, ability and term. Please inform your instructor if you have any concerns, feel unwell or become injured during the sessions. Breaks will be given throughout the sessions but please stop exercising immediately if you feel unwell.
Babies are parents responsibility and must remain with parent throughout and remain securely fastened while using pram, buggy or carrier. Exercise options will be given to include baby but can also be done individually with baby watching on.

During pregnancy, unless you have been told not to exercise by a health professional, keeping physically active has many benefits including reducing the risk of complications during pregnancy and labour, quicker recovery after giving birth, ease back and pelvic pain, reduce fatigue, boost mood, lower blood pressure, improve sleep and reduce constipation. Exercise during pregnancy also provides baby with many health benefits.

Exercise has many benefits for postpartum women too, including strengthening the abdominal muscles, improving posture and balance, boosts energy, improve sleep, relieve stress and improve mood. It is generally advised to wait until you have had your 6-8 week check before commencing a programme of exercise but we would also advise a session with a pelvic health physio to ensure you are ready to exercise.

Involving your bump or baby in exercise is positive! Active Mums = Active Bubs!

As well as these specific benefits, there are many general benefits that exercise can provide including:

•A decreased risk of heart disease
•A decrease in body fat
•Improved blood pressure
•Improved physiological function
•Improved fitness

Potential risks:

This programme is designed to place a gradually increasing workload on the cardiovascular and muscular systems to improve their functions. There is a risk of certain changes that may occur during or following the exercise which could affect blood pressure or heart rate and the possibility of muscle soreness. Specific movements should be avoided during pregnancy to prevent any potential risk to both Mum and baby and these are explained in video and during sessions. Similarly, there are some movements which should be introduced with caution in post partum exercise and are also explained in video and during sessions.

The programme has been explained to me and my questions regarding the programme have been answered to my satisfaction. I understand that I can withdraw at any time. This information is treated as private and confidential.



This is designed to help us to develop a programme that is suited to your health needs. For most people, increasing the amount of physical activity will not pose a problem or hazard, however, this will allow us to minimise risk and if necessary allow you to seek medical advice before proceeding.

Please be honest when answering the following questions. Your answers are treated as private and confidential.

First Name *
Last Name *
Email *
Phone Number *
First Line Of Address *
Last Line Of Address
Postcode *
Town/City *
Emergency Contact Name *
Emergency Contact Phone Number *
Date Of Birth *
Has your doctor ever said that you have a heart condition and that you should only undertake physical activity recommended by a doctor? *
Do you feel pain in your chest when you undertake physical activity? *
In the past month, have you had chest pain when you were not doing physical activity? *
Do you often feel faint, or have spells of severe dizziness or loss of consciousness? *
Have you ever suffered from unusual shortness of breath at rest or with mild exertion? *
Do you have high or low blood pressure? *
Do you have any chronic illness or physical limitations such as asthma or diabetes? *
Are you on any prescribed medication? *
Do you have a bone, joint or muscular condition (for example, arthritis) that could be made worse by a change in physical activity? *
Do you know of any other reason that would affect your ability to take part in physical activity? *
If you answered yes to any of the aforementioned questions, please provide more detail below.
Are you currently pregnant or have you recently had a baby? *
Do you know of any other reason that would affect your ability to take part in physical activity? *
If you are currently pregnant, what gestation are you? If you are post-natal, how many weeks/months? *
Do you have consent from a health professional (midwife/health visitor/GP) to exercise? *
Would you like your workouts for home or gym? * *
If yes, are you willing to complete an honest food diary using MyFitnessPal for 5 days to be analysed?
Would you like support with nutrition? *
Since being pregnant, have you ever been told by a medical professional not to exercise? (If yes, please tell us why) *
Do you have any pregnancy, birth or postpartum-related illnesses, health conditions or concerns which may affect your ability to exercise that you have not listed in the general health questions? (e.g. pelvic girdle pain, incontinence, gestational diabetes etc) Please give as much detail as possible.
What type of birth did you have and have you any lasting complications as a result? (Move to next question if currently pregnant).
Have you exercised in the last 3 months? If so, what type of activity? *
What goals would you like to achieve in the next 4 weeks? *
What goals would you like to achieve in the next 8 weeks? *
What goals would you like to achieve in the next 12 weeks? *
What are your exercise likes/dislikes? (e.g. anything you really enjoy or movements that you really don't?!) *
If home, what if any, fitness equipment do you have at home? If gym, what gym are you a member at?
Please tell us if you have any concerns about exercise while pregnant or post-natal? *