AF30455F_v6

VTCT Level 3 Award in Designing Physical Activity Programmes for Antenatal and Postnatal Clients

Operational start date: 1 October 2012Credit value: 6Total Qualification Time (TQT): 60Guided learning hours (GLH): 36Qualification number: 600/6735/4

Statement of unit achievementBy signing this statement of unit achievement you are confirming that all learning outcomes, assessment criteria and range statements (if/where applicable) have been achieved under specified conditions, and that the evidence gathered is authentic.

This statement of unit achievement table must be completed prior to claiming certification.

Unit code Date achieved Learner signature

Assessor initials

IQA signature (if sampled)

Mandatory units

UV31474

UV31473

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The qualification

Introduction National Occupational Standards (NOS)

The VTCT Level 3 Award in Designing Physical Activity Programmes for Antenatal and Postnatal Clients is a specialist vocational qualification focused on developing the knowledge, understanding and skills needed for working with this specialist population.

Throughout this qualification you will develop an in depth-understanding of the physiological and biomechanical changes associated with pregnancy, the key considerations when programming physical activity for antenatal and postnatal clients and the benefits of physical activity. You will develop your communication and screening skills and those required to design and adapt programmes to meet the specific needs of antenatal and postnatal clients. You will also develop the ability to provide relevant and appropriate support and advice.

This qualification is recognised as Continued Professional Development (CPD) by the Register of Exercise Professionals. It also satisfies the requirements for the REP’s additional category of antenatal and postnatal exercise.

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This qualification has been mapped to the relevant NOS, and is regulated on the Regulated Qualifications Framework (RQF).

This qualification is approved and supported by SkillsActive, the sector skills council for active leisure and learning.

Prerequisites

You must hold a Level 2 fitness instructing qualification (i.e. Gym, Exercise to Music, Aqua) or higher to access the VTCT Level 3 Award in Designing Physical Activity Programmes for Antenatal and Postnatal Clients.

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Progression

On completion of this qualification you may choose to diversify in other specialist areas, qualifications you could progress to include:• VTCT Level 3 Award in Designing Physical

Activity Programmes for Older Adults • VTCT Level 3 Award in Designing Physical

Activity Programmes for People with Disabilities

You will be equppied with the knowledge, understanding and skills to work with antenatal and postnatal clients who have no medical complications (for which a medical referral is needed).

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Qualification structure

Mandatory units - 6 creditsVTCT unit code

Ofqual unit reference Unit title Credit value GLH

UV31474 J/504/3340 Principles of physical activity for antenatal and postnatal clients 3 18

UV31473 R/504/3339 Designing physical activity for antenatal and postnatal clients 3 18

Total credits required - 6

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All mandatory units must be completed.

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Guidance on assessment

External assessment (any requirements will be shown in the unit)

Externally assessed question papers completed electronically will be set and marked by VTCT.

Externally assessed hard-copy question papers will be set by VTCT, marked by centre staff and sampled by VTCT external quality assurers.

This book contains the mandatory units that make up this qualification. Optional units will be provided in additional booklets (if applicable). Where indicated, VTCT will provide assessment materials. Assessments may be internal or external. The method of assessment is indicated in each unit.

Internal assessment (any requirements will be shown in the unit)

Assessment is set, marked and internally quality assured by the centre to clearly demonstrate achievement of the learning outcomes. Assessment is sampled by VTCT external quality assurers.

Assessment explained

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VTCT qualifications are assessed and quality assured by centre staff. Work will be set to improve your practical skills, knowledge and understanding. For practical elements, you will be observed by your assessor. All your work must be collected in a portfolio of evidence and cross-referenced to requirements listed in this record of assessment book.

Your centre will have an internal quality assurer whose role is to check that your assessment and evidence is valid and reliable and meets VTCT and regulatory requirements.

An external quality assurer, appointed by VTCT, will visit your centre to sample and quality-check assessments, the internal quality assurance process and the evidence gathered. You may be asked to attend on a different day from usual if requested by the external quality assurer

This record of assessment book is your property and must be in your possession when you are being assessed or quality assured. It must be kept safe. In some cases your centre will be required to keep it in a secure place. You and your course assessor will together complete this book to show achievement of all learning outcomes, assessment criteria and ranges.

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Creating a portfolio of evidence

As part of this qualification you are required to produce a portfolio of evidence. A portfolio will confirm the knowledge, understanding and skills that you have learnt. It may be in electronic or paper format.

Your assessor will provide guidance on how to prepare the portfolio of evidence and how to show practical achievement and understanding of the knowledge required to successfully complete this qualification. It is this booklet along with the portfolio of evidence that will serve as the prime source of evidence for this qualification.

Evidence in the portfolio may take the following forms:

• Observed work• Witness statements• Audio-visual media • Evidence of prior learning or attainment• Written questions• Oral questions• Assignments• Case studies

All evidence should be documented in the portfolio and cross-referenced to unit outcomes. Constructing the portfolio of evidence should not be left to the end of the course.

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Unit assessment methods

This section provides an overview of the assessment methods that make up each unit in this qualification. Detailed information on assessment is provided in each unit.

Mandatory units External Internal

VTCT unit code Unit title Question

paper(s) Observation(s) Portfolio of Evidence

UV31474 Principles of physical activity for antenatal and postnatal clients 0 û

UV31473 Designing physical activity for antenatal and postnatal clients 0 *

*VTCT encourages that Outcome 1 is observed, however, SkillsActive state that there is no formal requirement for practical assessment. Instead your centre may require you to produce other forms of evidence to demonstrate understanding of all criteria. For more information, please refer to unit UV31473.

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Unit glossary

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Description

VTCT product code

All units are allocated a unique VTCT product code for identification purposes. This code should be quoted in all queries and correspondence to VTCT.

Unit title The title clearly indicates the focus of the unit.

National Occupational Standards (NOS)

NOS describe the skills, knowledge and understanding needed to undertake a particular task or job to a nationally recognised level of competence.

LevelLevel is an indication of the demand of the learning experience; the depth and/or complexity of achievement and independence in achieving the learning outcomes.

Credit valueThis is the number of credits awarded upon successful achievement of all unit outcomes. Credit is a numerical value that represents a means of recognising, measuring, valuing and comparing achievement.

Guided learning hours (GLH)

The activity of a learner in being taught or instructed by - or otherwise participating in education or training under the immediate guidance or supervision of - a lecturer, supervisor, tutor or other appropriate provider of education or training.

Total qualification time (TQT)

The number of hours an awarding organisation has assigned to a qualification for Guided Learning and an estimate of the number of hours a learner will reasonably be likely to spend in preparation, study, or any other form of participation in education or training. This includes assessment, which takes place as directed - but, unilke Guided Learning, not under the immediate guidance or supervision of - a lecturer, supervisor, tutor or other appropriate provider of education or training.

Observations This indicates the minimum number of competent observations, per outcome, required to achieve the unit.

Learning outcomes

The learning outcomes are the most important component of the unit; they set out what is expected in terms of knowing, understanding and practical ability as a result of the learning process. Learning outcomes are the results of learning.

Evidence requirements This section provides guidelines on how evidence must be gathered.

Observation outcome

An observation outcome details the tasks that must be practically demonstrated to achieve the unit.

Knowledge outcome

A knowledge outcome details the theoretical requirements of a unit that must be evidenced through oral questioning, a mandatory written question paper, a portfolio of evidence or other forms of evidence.

Assessment criteria

Assessment criteria set out what is required, in terms of achievement, to meet a learning outcome. The assessment criteria and learning outcomes are the components that inform the learning and assessment that should take place. Assessment criteria define the standard expected to meet learning outcomes.

Range The range indicates what must be covered. Ranges must be practically demonstrated in parallel with the unit’s observation outcomes.

UV31474Principles of physical activity for antenatal and postnatal clients

The aim of this unit is to provide you with the underpinning knowledge and understanding of the benefits of physical activity for antenatal and postnatal clients.

This unit addresses the physiological and biomechanical changes that occur during pregnancy, possible barriers and contra-indications to physical activity, and the importance of a balanced diet, hydration and appropriate clothing.

UV31474_v7

GLH

Credit value

Level

Observation(s)

External paper(s)

18

3

3

0

0

On completion of this unit you will:

Learning outcomes Evidence requirements

Principles of physical activity for antenatal and postnatal clients

1. Understand the physiological and biomechanical changes associated with pregnancy

2. Understand the benefits, barriers and contra-indications to physical activity for antenatal and postnatal clients

3. Understand the importance of hydration, nutrition and appropriate clothing for antenatal and postnatal clients

1. Knowledge outcomes There must be evidence that you possess all the knowledge and understanding listed in the Knowledge section of this unit. In most cases this can be done by professional discussion and/or oral questioning. Other methods, such as projects, assignments and/or reflective accounts may also be used.

2. Tutor/Assessor guidance You will be guided by your tutor/assessor on how to achieve learning outcomes in this unit. All outcomes must be achieved.

3. External paper There is no external paper requirement for this unit.

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Achieving knowledge outcomes

Developing knowledge

You will be guided by your tutor and assessor on the evidence that needs to be produced. Your knowledge and understanding will be assessed using the assessment methods listed below*:

• Projects• Observed work• Witness statements• Audio-visual media • Evidence of prior learning or attainment• Written questions• Oral questions• Assignments• Case studies• Professional discussion

Where applicable your assessor will integrate knowledge outcomes into practical observations through professional discussion and/or oral questioning.

When a criterion has been orally questioned and achieved, your assessor will record this evidence in written form or by other appropriate means. There is no need for you to produce additional evidence as this criterion has already been achieved.

Some knowledge and understanding outcomes may require you to show that you know and understand how to do something. If you have practical evidence from your own work that meets knowledge criteria, then there is no requirement for you to be questioned again on the same topic.

*This is not an exhaustive list.

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Knowledge

Outcome 1

Understand the physiological and biomechanical changes associated with pregnancy

You can: Portfolio reference

a. Describe physiological and biomechanical changes associated with each trimester

b. Explain the implications of these changes for clients taking part in physical activity

c. Explain how long these changes may persist for post-birth

d. Explain the importance of avoiding dramatic or sudden weight gain

e. Explain the relevance, incidence, timing and benefits of the postnatal check

f. Explain the importance of resuming postnatal activity on an individual, gradual and progressive basis

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Outcome 2

Understand the benefits, barriers and contra-indications to physical activity for antenatal and postnatal clients

You can: Portfolio reference

a. Explain benefits of physical activity for: • antenatal clients • postnatal clients

b. Explain the types of barriers, real and perceived, to physical activity for antenatal and postnatal clients

c. Provide solutions to barriers to physical activity for antenatal and postnatal clients

d. Describe contra-indications for antenatal and postnatal clients, to include: • absolute contra-indications • relative contra-indications

e. Identify warning signs whereby women should stop exercising during pregnancy

f. Describe postnatal complications/considerations that may affect the resumption of physical activity

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Outcome 3

Understand the importance of hydration, nutrition and appropriate clothing for antenatal and postnatal clients

You can: Portfolio reference

a. Explain the importance of staying hydrated, and avoiding hot and humid conditions for: • antenatal clients • postnatal clients

b. Explain the implications of fatigue for: • antenatal clients • postnatal clients

c. Identify foods that are important during pregnancy, stating the reasons why

d. Identify foods that should be avoided during pregnancy, stating the reasons why

e. Explain the importance of nutrition for postnatal clients

f. Describe appropriate clothing, footwear and support for antenatal and postnatal clients

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Outcome 1: Understand the physiological and biomechanical changes associated with pregnancy

Unit content

This section provides guidance on the recommended knowledge and skills required to enable you to achieve each of the learning outcomes in this unit. Your tutor/assessor will ensure you have the opportunity to cover all of the unit content.

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Physiological and biomechanical changes: Musculoskeletal system – weight gain, ligamentous laxity, joint instability (hips, sacroiliac, symphysis pubis, pelvis, lumbosacral spine), postural changes, muscular imbalances (abdominal wall, lower back, upper back, neck, chest and shoulders), effects of weight gain (on knees, feet, ankles), biomechanics (feet, change in centre of gravity), balance, abdominal/uterine/pelvic changes, breast development, effects of musculoskeletal changes on exercise.

Cardiovascular system – blood volume, cardiac output, stroke volume, heart rate, oxygen consumption, haemoglobin, iron levels, total peripheral resistance, blood pressure, effects of cardiovascular changes on exercise.

Respiratory system – lung function, hyperventilation in pregnancy, tidal volume, respiratory rate, effects on the diaphragm, oxygen cost of breathing, effects of respiratory changes on exercise.

Metabolic changes – insulin resistance, substrate utilisation, hypoglycaemia, effects of hypoglycaemia, metabolic demands of pregnancy, effects of metabolic changes on exercise/temperature/sweating.

Endocrine system – hormonal changes (oestrogen, relaxin and progesterone), hormonal effects, effects on exercise (e.g. relaxin is still present six months postnatally).

Length of time and implications of changes: Trimesters (1st trimester (0 to 3 weeks - fatigue), 2nd trimester (14 to 27 weeks - common to have increased energy), 3rd trimester (28 to 40 weeks - fatigue)), implications and considerations for exercise during each trimester, changes that occur during each trimester, postnatal implications.

Changes post-birth: Between 3 to 6 months (dependent on variables - exercise, breastfeeding, nutrition, etc.), ‘fourth trimester’ (stretched muscle and skin (stretch marks may remain), swollen uterus (nursing can help this process), weight, hormones (e.g. may be emotional), shedding of hair, discharge from vagina, irregular/missing periods, hormones, excess sweating (especially at night)), some physical changes may be permanent (e.g. hip size, feet usually larger).

Weight gain: Tendency to eat for two, eat wrong foods, sudden weight change (more likely to retain weight after birth, stretch marks).

Weight loss: Implications for your health and the health and development of baby, lack of energy/nutrients.

Postnatal check: Incidence (typically 6 weeks), purpose (checks and tests (weight, urine, blood pressure, breast examination, smear test, internal examination), contraception, discuss mood, opportunity to ask questions), benefits of the postnatal check.

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Importance of resuming postnatal activity on individual, gradual and progressive basis: Always resume as a newcomer to fitness, allow time to assess capabilities, identification of any complications from pregnancy, caution with forward flexion/abdominal work, diastis recti (separation of abdominal wall).

Outcome 1: Understand the physiological and biomechanical changes associated with pregnancy (continued)

Outcome 2: Understand the benefits, barriers and contra-indications to physical activity for antenatal and postnatal clients

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Benefits of physical activity: Reduction of common pregnancy complaints (leg cramps, oedema, carpal tunnel syndrome, high and low blood pressure, constipation, haemorrhoids, varicose veins, gestational diabetes), improved posture and body awareness, better functional movement and pelvic floor muscle function, possible reduction in lower back pain, weight control, maintenance of cardiovascular and strength fitness levels, improved maternal wellbeing (better sleep patterns, less anxiety and depression, improved ability to cope with stress), possible reduction of labour length and birth complications, easier resumption of postnatal activity.

Barriers to physical activity: Real and perceived barriers, concerns and myths regarding the growing baby/pregnancy, motivation, anxiety and tension, pain and discomfort, accessibility, prejudice, underestimation of exercise ability, level of interest, scepticism of exercise effectiveness, exercise perceptions and misconceptions.

Solutions to barriers: Be sensitive, show empathy, dietary/sleep advice, advice that may assist in increasing energy (e.g. exercise), referral for advice, gentler exercises, take into account likes/dislikes, include family/partners in decision making.

Absolute contra-indications: Haemodynamically significant heart disease, restrictive lung disease, incompetent cervix/cervical cerclage, multiple gestation risk for premature labour, persistent second or third trimester bleeding, placenta praevia after 26 weeks gestation, premature labour during the current pregnancy, ruptured membranes, pregnancy induced hypertension,

symphysis pubic dysfunction.

Relative contra-indications: Severe anaemia, unevaluated maternal cardiac arrhythmia, chronic bronchitis, poorly controlled Type I diabetes, extreme morbid obesity, extremely underweight (body mass index <12), history of extremely sedentary lifestyle, intrauterine growth restriction in current pregnancy, poorly controlled hypertension/pre-eclampsia, orthopaedic limitations, poorly controlled seizure disorder, heavy smoker.

Warning signs to stop exercising: Vaginal bleeding, dyspnoea before exertion, dizziness, headache, chest pain, muscle weakness, calf pain or swelling (need to rule out thrombophlebitis), pre-term labour, decreased fetal movement, amniotic fluid leakage, poorly controlled thyroid disease.

Postnatal complications/considerations that may affect resumption of physical activity: Involution of the uterus, placental site healing and lochia (bleeding), secondary post-partum haemorrhage, air embolism, thrombosis, infection (breast, uterine, urinary tract or caesarean wound site), pelvic floor trauma, sensation loss, pelvic dysfunction, caesarean section, abdominal muscle separation, back or coccyx pain, pelvic girdle pain, pelvic torsion or instability, knee pain, carpal tunnel syndrome, anaemia, establishment of breastfeeding, postnatal anxiety and depression, separation anxiety (from baby), extreme fatigue.

Outcome 3: Understand the importance of hydration, nutrition and appropriate clothing for antenatal and postnatal clients

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Importance of staying hydrated and avoiding hot and humid conditions: Risk of birth defects, dangerous to developing fetus, role of water in the body, hydration guidelines and strategies (timing and volume), effects of dehydration, hyperthermia, importance of avoiding hot and/or humid environments, especially during the first trimester.

Implications of fatigue: Body is under additional stress, excess energy is needed, hormonal changes, nausea and vomiting use energy, iron deficiency, tips for avoiding fatigue (diet, exercise and lifestyle).

Foods that are important during pregnancy: Nutrient dense foods, good supply of vitamins and minerals, broad spectrum of fruit and vegetables, starchy carbohydrates (energy levels), good quality protein (build tissues), foods rich in folic acid (important for creation of baby’s nervous system, prevent neural tube defects), foods rich in iron (produce blood needed to supply nutrition to placenta), foods rich in zinc and calcium (development of the embryo), increase calorie intake by up to 500 calories during breastfeeding, any supplementation should be discussed with GP.

Foods that should be avoided during pregnancy: Alcohol, limit caffeine, limit sugar/sweets, salt in moderation, limit ‘refined carbohydrates’, need extra 200/300 extra calories than before pregnancy (do not eat for two), avoid dieting, eat safely (preparation, hygiene, avoid risk of bacterial infections, avoid certain foods, (e.g. mould-ripened cheese, raw shellfish, pâté (even vegetable pâté), large doses of vitamin A (found in liver, meal replacement shakes)).

Importance of nutrition for postnatal clients: Protect health of you and baby, development of baby, balanced diet, variety of foods.

Clothing, footwear and breast support: Comfortable, loose fitting and non-restrictive, breathable materials, supportive shoe, breast support, support belts.

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Notes Use this area for notes and diagrams

UV31473Designing physical activity for antenatal and postnatal clients

The aim of this unit is to provide you with the knowledge and understanding required to design appropriate physical activity programmes which safely address the needs of antenatal and postnatal participants.

UV31473_v10

GLH

Credit value

Level

Observation(s)

External paper(s)

18

3

3

1

0

On completion of this unit you will:

Learning outcomes

Evidence requirements

Designing physical activity for antenatal and postnatal clients

1. Be able to gather and analyse client information for antenatal and postnatal clients

2. Be able to design and record an individualised exercise programme for antenatal and postnatal clients

3. Understand key professional considerations when working with antenatal and postnatal clients

4. Understand key considerations when designing exercise programmes for antenatal and postnatal clients

5. Understand how to gather and analyse client information for antenatal and postnatal clients

products of work are likely to be the most appropriate sources of performance evidence. Professional discussion may be used as supplementary evidence for those criteria that do not naturally occur. *Please refer to the Assessment guidance section on the Achieving observations and range page.

4. Knowledge outcomes There must be evidence that you possess all the knowledge and understanding listed in the Knowledge section of this unit. In most cases this can be done by professional discussion and/or oral questioning. Other methods, such as projects, assignments and/or reflective accounts may also be used.

5. Tutor/Assessor guidance You will be guided by your tutor/assessor on how to achieve learning outcomes in this unit. All outcomes must be achieved.

6. External paper There is no external paper requirement for this unit.

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1. Environment Evidence for this unit may be gathered within the workplace or realistic working environment (RWE).

2. Simulation Simulation is allowed in this unit for the consultation process only. However, assessment practices require you to plan a session for REAL antenatal and postnatal clients. The plan must deal with BOTH antenatal and postnatal clients and their specific needs.

3. Observation outcomes Competent performance of Observation outcomes must be demonstrated on at least one occasion*. Assessor observations, witness testimonies and

Achieving observation outcomes

Achieving observations and range

UV31473

Your assessor will observe your performance of practical tasks. The minimum number of competent observations required is indicated in the Evidence requirements section of this unit.

Criteria may not always naturally occur during a practical observation. In such instances you will be asked questions to demonstrate your competence in this area. Your assessor will document the criteria that have been achieved through professional discussion and/or oral questioning. This evidence will be recorded by your assessor in written form or by other appropriate means.

Your assessor will sign off a learning outcome when all criteria have been competently achieved.

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Achieving range

There is no range section that applies to this unit.

Assessment guidance

Outcome 1VTCT encourages that Outcome 1 is observed, however, SkillsActive state that there is no formal requirement for practical assessment. Instead your centre may require you to produce other forms of evidence to demonstrate understanding of all criteria.

For example in Outcome 1a, rather than demonstrate communication skills, you will be required to explain the communication skills which effectively establish rapport.

For Outcomes 1b/c, your tutor may provide you with information on a theoretical case study (i.e. PAR-Q) which you will be required to interpret.

Outcome 2Your programme must include adaptations for both antenatal and postnatal clients.

Outcome 1

Observations

You can:

Observation 1 Optional OptionalDate achievedCriteria questioned orallyPortfolio referenceAssessor initialsLearner signature

*Please refer to the Assessment guidance section on the Achieving observations and range page.

Be able to gather and analyse client information for antenatal and postnatal clients*

a. Use communication skills to establish rapport with antenatal and postnatal clients

b. Collect information about the antenatal or postnatal client, using appropriate screening methods

c. Interpret the information gathered and identify any reasons for referral

d. Observe legal and ethical responsibilities regarding screening, client records and confidentiality

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Achieving knowledge outcomes

Developing knowledge

You will be guided by your tutor and assessor on the evidence that needs to be produced. Your knowledge and understanding will be assessed using the assessment methods listed below*:

• Projects• Observed work• Witness statements• Audio-visual media • Evidence of prior learning or attainment• Written questions• Oral questions• Assignments• Case studies• Professional discussion

Where applicable your assessor will integrate knowledge outcomes into practical observations through professional discussion and/or oral questioning.

When a criterion has been orally questioned and achieved, your assessor will record this evidence in written form or by other appropriate means. There is no need for you to produce additional evidence as this criterion has already been achieved.

Some knowledge and understanding outcomes may require you to show that you know and understand how to do something. If you have practical evidence from your own work that meets knowledge criteria, then there is no requirement for you to be questioned again on the same topic.

*This is not an exhaustive list.

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Knowledge

Outcome 2

Be able to design and record an individualised exercise programme for antenatal and postnatal clients*

You can: Portfolio reference

a. Design an exercise programme to meet the specific needs of antenatal and postnatal clients

b. Apply current evidence-based guidelines to the design of exercise programmes for Frequency, Intensity, Time and Type (FITT)

c. Select appropriate types of activity for the clients and stage of pregnancy

d. Select appropriate alternatives or modifications

e. Select appropriate equipment for antenatal and postnatal clients

*Please refer to the Assessment guidance section on the Achieving observations and range page.

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Outcome 3

Understand key professional considerations when working with antenatal and postnatal clients

You can: Portfolio reference

a. Explain the considerations/adaptations when working with antenatal and postnatal clients, to include: • teaching skills • structure/content of class • exercise environment

b. Explain the importance of engaging in regular continuous professional development (CPD)

c. Explain the importance of: • undertaking thorough risk assessments • checking insurance arrangements   when working with antenatal and postnatal clients

d. Justify the importance of having an up to date first aid qualification

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Outcome 4

Understand key considerations when designing exercise programmes for antenatal and postnatal clients

You can: Portfolio reference

a. Explain the types of exercise that should be avoided antenatally and postnatally, giving reasons why

b. Explain the importance of pelvic floor exercises

c. Explain how to teach pelvic floor exercises

d. Explain how to check for abdominal muscle separation

e. Describe the most effective way to rehabilitate the abdominal wall, post-birth

f. Explain the general guidelines on appropriate stretching for antenatal and postnatal clients

g. Explain why it is inappropriate to use babies as a resistance or weight during exercise

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Outcome 5

Understand how to gather and analyse client information for antenatal and postnatal clients

You can: Portfolio reference

a. Explain the considerations when establishing and developing an effective working relationship with antenatal and postnatal clients

b. Explain the importance of antenatal exercise screening

c. Summarise information to be collected by the fitness professional

d. Discuss the sources of information and advice available when working with antenatal and postnatal clients

e. Explain under which circumstances it may be appropriate to obtain written consent from healthcare professionals

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Unit content

This section provides guidance on the recommended knowledge and skills required to enable you to achieve each of the learning outcomes in this unit. Your tutor/assessor will ensure you have the opportunity to cover all of the unit content.

Outcome 1: Be able to gather and analyse client information for antenatal and postnatal clients

Effective communications skills: Personalised service, friendly and welcoming, active listening, open questions, empathy, positive body language, show respect, gain mutual confidence, gain mutual trust, determine needs, review needs.

Collect and interpret information: Collect relevant information, screen participants, identify reasons for referral, identify adaptations/modifications, devise appropriate class/programme.

Observe legal and ethical responsibilities: Screening, records, confidentiality.

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Outcome 2: Be able to design and record an individualised exercise programme for antenatal and postnatal clients

Programme design: Implications, goals and objectives of programme, warm-up and cool down, antenatal and postnatal exercise guidelines, safety considerations, types of exercises, consider principles of training and the FITT principle, abdominal and pelvic floor focus, for each exercise include (teaching points, frequency, intensity, time).

Goals/objectives: Maintenance of cardiovascular fitness, maintenance of functional muscular strength and endurance, improved posture, pelvis and spine stability, improved motor skills, balance and co-ordination, pelvic floor muscle education and improved strength and function, resumption of appropriate safe and effective postnatal exercise, quicker return to non-pregnancy state.

Exercise guidelines: Range of exercise guidelines, exercise frequency, exercise intensity, exercise type, duration of exercise, guidelines as they apply to antenatal and postnatal clients, guidelines for previously active and previously inactive clients, never exceed heart rate of 140bpm, temperature should never exceed 100°F (38°C).

Recommended types of physical activity: Recommended exercise duration/frequency/type, muscles to strengthen (scapula retractors, lumbar paravertebrals, gluteus maximus and medius, quadriceps, abdominals, pelvic floor), core stability, practical and functional skills, stretching, relaxation and stress management programmes, group exercise modes (low impact aerobics, step training (step no higher than 10cm), yoga, Pilates, water-based exercises, cycling), modified resistance training exercises, offer

alternative exercises and positions, exercise after second trimester (do not lie supine, rotations, twisting, isometric exercises).

Alternative exercises and modifications: Positional changes to avoid supine hypotensive syndrome, splinting techniques (using a towel or pelvic belt), progression exercises, water-based exercise, cueing for technique, emphasising the lengthening of the spine and encouraging space between the ribcage and pelvis.

Appropriate equipment for antenatal and postnatal clients: Relevant to type of class, adaptations/modifications for individual, resistance (fixed, free), cardiovascular machines, portable equipment.

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Outcome 3: Understand key professional considerations when working with antenatal and postnatal clients

Considerations/adaptations:Teaching skills – clear and concise instructions, communication and interpersonal skills, personalised instruction, listening and responding, body language, positive and supportive attitude, quality of demonstration, positioning, cueing, repeating demonstrations, breaking down demonstrations, ensuring client understanding, analysing and modifying client technique, safe transition, consideration of guidelines and effects of pregnancy, reinforcement of safety guidelines.

Structure/content of class – educate participants for safe participation, graduated (warm-ups, cool downs), meet aims and objectives of class/individual participants, stage of pregnancy (trimester), follow antenatal/postnatal exercise guidelines, FITT guidelines, low impact, positioning for safety and comfort, heart rate below 140bpm, abdominal and pelvic floor focus, regular breaks (toilet, rehydrate).

Exercise environment – safety, space, ventilation, temperature, appropriate equipment, group size, hazards.

Engaging in regular CPD: Keep up to date with current concepts/new ideas/research and thinking, requirement of Register of Exercise Professionals (REPs), insurance.

Importance of:Undertaking risk assessments – Minimise risk of injury, adherence to legislation, instructors (appropriate training/qualifications to work with this specific group).

Assess risk before/during/after class, assess on individual basis (screening), thorough consultation process, consider all variables, assess risk (participants, environment, equipment).

Reduce risk through risk assessments, observation/monitoring/cueing skills to ensure safe exercise intensity, giving toilet and hydration breaks, technique correction (reinforcement of posture, joint alignment), speed of instruction, safe transitions, pelvic floor awareness.

Pros and cons of different positions to take into account supine and postural hypotensive syndromes, pelvic girdle pain, carpal tunnel syndrome, rib pain, gastric reflux and low back pain, the standing position for functionality/balance/optimal pelvic floor muscle function.

Checking insurance arrangements – adequately insured, higher risk group, specialist skills.

Importance of having an up to date first aid qualification: Higher-risk exercise environment, increased risk of injury, greater probability of needing first aid skills, to be able to deal with emergency situations, CPD to keep up to date with current concepts/research/thinking.

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Outcome 4: Understand key considerations when designing exercise programmes for antenatal and postnatal clients

Types of physical activity to be avoided: Excessive twisting and turning activities, breath holding activities, asymmetrical weight bearing activities, one-legged activities, prolonged standing static exercise, high-intensity physical activities, hip abduction, supine exercise after the first trimester, vigorous or exhaustive exercise, contact sports or exercise at risk of abdominal trauma, heavy weights, excessive breaststroke, exercises that cause pain, reasons for avoiding (dizzyness, high blood pressure, hip adduction, symphysis pubis dysfunction (SPD), risk of damage to foetus).

Importance of pelvic floor exercises: Sling of muscles/ligaments/sheet-like tissue (stretches from pubic bone to base of spine), structure and function of the abdominals and pelvic floor muscles, supports (bladder, bowel and uterus), control over bladder and bowel movement, weak vaginal muscles (sex less satisfying, possibility of prolapse), weak pelvic floor (may result in stress incontinence), postnatal stress incontinence common, control and relaxation of labour and alignment of hip and sacroiliac joints, constipation in pregnancy (more stress on pelvic floor).

Teaching pelvic floor exercises: Transversus abdominis and spinal stabilisation, cueing, routines, visualisation, teach independently, teach prior to integration with other abdominal and pelvic stabilisation exercises, Kegel’s exercises, do exercises anywhere and regularly, establish routine.

Abdominal separation (diastasis recti): Defining abdominal separation, testing for abdominal separation (knees bent, feet

flat on floor, place two fingers across the abdomen around the tummy button area and gentle apply pressure, ask client to slowly raise head and shoulders off floor and hold, ensure no holding of breath, lower with control, if gap appears to be wider than two fingers try three fingers and repeat test, any more than two fingers, no forward flexion until gap reduces.

Rehabilitation of abdominal wall, post-birth: Effective postnatal exercise programme, core exercises, target pelvic floor and transversus abdominus, include resistance and cardiovascular training.

Stretching: Types of stretching, general guidelines, muscles to stretch (levator scapula, thoracolumbar area, hip flexors, iliotibial band, piriformis, hamstrings, hip adductors, gastrocnemius, soleus), stretching should be gentle, possibility of excessive flexibility due to the hormone relaxin, relaxin present until six months postnatally.

Inappropriateness of using babies as resistance or weight: Health and safety implications, ethical issues, disruption to class, distress to baby, risk of harm to baby (e.g. shaking of brain, impact).

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Outcome 5: Understand how to gather and analyse client information for antenatal and postnatal clients

Considerations when establishing and developing effective working relationships: Perceived body image, confidence, mood, sleep deprivation, ethical considerations, anxiety, depression.

Pre-activity screening: Importance of, risk assessment, method of gathering information, screening information used for goal setting and programme design, legal requirement, ethical responsibilities of the instructor.

Information to be collected: Lifestyle, medical and pregnancy history, physical activity history, physical activity preferences, attitude and motivation to participate, current fitness level, stage of readiness, methods of gathering information (interview, validated questionnaire, physical assessment, observation).

Information and advice available: Internet sources, journals, books, guidelines (Royal College of Obstetricians and Gynaecologists), SkillsActive, REPs, National Health Service (NHS), ACOG (American Congress of Obstetricians and Gynecologists).

Obtain written consent from healthcare professionals: Special circumstances, risk identified, past history of miscarriage, problems in pregnancy, multiple births, premature labour, warning signs/symptoms, complications, if low risk then OK to exercise.

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Notes Use this area for notes and diagrams