Contraindications to Exercise

    Listed below are the current guidelines on ABSOLUTE AND RELATIVE CONTRAINDICATIONS to exercise. Please select any of the following conditions if you have experienced them or have been told by your HCP that you are experiencing them.

    Absolute Contraindications to Exercise

    Have you ever experienced any of the conditions listed below whilst exercising during your current or previous pregnancies?

    Please select any condition you are/have experienced

    Significant heart diseaseSignificant lung diseaseIncompetent cervixMultiple gestation at risk of premature labourPersistent spotting/bleeding or Placenta PraeviaPremature labourRuptured membranesUncontrolled Type 1 Diabetes or Gestational DiabetesEvidence of Intrauterine Growth RestrictionPregnancy-induced Hypertension or Pre-EclampsiaUncontrolled Epileptic Fits/Seizures

    Please provide further information for any selected conditions

    Relative Contraindications to Exercise During Pregnancy

    Please select any condition you are/have experienced

    Vaginal ’Spotting’Dyspnoea (difficult or laboured breathing) before exertionDizzinessHeadacheChest PainCalf Pain or swellingPrevious preterm labourPrevious decreased foetal movement‘Suspected’ Amniotic fluid leakageDramatic recent weight gain or lossSwelling or general noticeable appearance of puffinessItchinessNoticeable increase in your thirst

    Please provide further information for any selected conditions

    COVID - Please select YES or NO to the following questions:

    Have you tested positive for covid-19? *

    YesNo

    Have you had both covid vaccines? *

    YesNo

    Please DO NOT attend class should you or a member of your household have, even minor symptoms akin with those related to the coronavirus COVID-19.

    I am aware that I must feel well prior to each class and will notify you (the trainer) should I feel unwell at any time during the class.

    Data Protection: The information you provided in this form will be used for fitmums purpose only, by your instructor and will not be shared with any third party without your prior permission. It will be stored for 5 years on your trainers’ private computer. By submitting this form you confirm you agree.