3.5 PASB-Q, Stages of Change, AAL-Q & Screening in Pregnancy
Key Takeaways
The adult PASB-Q asks about aerobic days and minutes per week, muscle-strengthening sessions, perceived aerobic fitness, hours of sitting at work and in leisure, and how often sitting is broken up.
The Stages of Change Questionnaire places the client in a Transtheoretical Model stage, which guides stage-matched counselling and the choice of CSEP-PATH tools.
The Abilities for Active Living Questionnaire (AAL-Q) lets a person living with a disability identify accommodations needed for assessment or supervised exercise.
The Get Active Questionnaire for Pregnancy has four questions; any YES means the client speaks with their obstetric health care provider before beginning or continuing activity.
The 2019 Canadian Guideline for Physical Activity throughout Pregnancy recommends at least 150 minutes of moderate activity per week over at least three days.
3.5 PASB-Q, Stages of Change, AAL-Q & Screening in Pregnancy
CSEP-CPT competency 3.10 requires you to administer and explain the purpose and scoring of the Stages of Change Questionnaire, the Abilities for Active Living Questionnaire (AAL-Q) and the PASB-Q. Competency 2.2 asks you to use the PASB-Q to identify and suggest improvements in lifestyle behaviours. Competency 3.1 adds pre-screening in pregnancy. These tools sit in the CSEP-PATH Toolkit under Step 1 – Ask and Step 2 – Assess.
| Toolkit tool | Step | Purpose |
|---|---|---|
| Get Active Questionnaire for Pregnancy (#7) | Ask | Pre-screen pregnant clients |
| Prenatal Physical Activity HCP Consultation Form (#8) | Ask | Support the conversation with the obstetric provider |
| Abilities for Active Living Questionnaire, AAL-Q (#9) | Ask | Identify accommodations for clients living with a disability |
| Movement Counselling Tool (#13 and #14) | Assess | Brief counselling on activity, sitting and sleep against the 24-Hour Guidelines |
| PASB-Q Adults (#15) and Youth (#16) | Assess | Measure activity and sedentary behaviour |
| Healthy Sleep Assessment (#17) | Assess | Screen sleep habits |
| Stages of Change Questionnaire (#18) | Assess | Identify readiness to change |
The PASB-Q (Adults, 18 and Over)
The Physical Activity and Sedentary Behaviour Questionnaire asks about a typical week. The client may log activity for a week beforehand to improve accuracy.
| Item | What it asks | Unit |
|---|---|---|
| 1 | Days per week of moderate- to vigorous-intensity aerobic activity | days/week |
| 2 | Average minutes per day on those days; multiply by days | minutes/week |
| 3 | Times per week of muscle-strengthening activity (resistance training, very heavy gardening) | times/week |
| 4 | Perceived aerobic fitness | Excellent, Very Good, Good, Fair or Poor |
| 5 | Hours per day in continuous sitting at work, meetings, volunteering and motorized commuting | hours/day |
| 6 | Hours per day sitting in leisure (TV, computer, reading, sitting quietly) | hours/day |
| Total | Items 5 + 6 | hours/day |
| 7 | When sitting for an hour or more, how often the client stands and moves for two minutes | interval category |
Using the results:
- Compare aerobic minutes with the 150 minutes per week guideline and strengthening sessions with twice a week.
- Compare total sitting with the 8 hours or less guideline.
- Look at item 7 for break-up opportunities.
CSEP-PATH assigns Health Benefit Ratings to aerobic activity, strengthening, perceived fitness and sedentary behaviour on the Client Information Sheet. The PASB-Q has been shown to be valid and reliable for adults (Fowles et al., 2017, Applied Physiology, Nutrition, and Metabolism). A Youth PASB-Q (ages 12–17) uses the youth guideline targets.
Worked Example
A client walks briskly 3 days a week for 30 minutes (90 minutes/week), strength trains once a week, rates their aerobic fitness "Fair", sits 7 hours at work plus 3 hours in the evening (10 hours/day), and takes a break only every 1 to 1.5 hours.
- Gaps: 60 more aerobic minutes per week, one more strengthening session, and about 2 hours/day of sitting above the guideline.
- Agree-step ideas: add two 30-minute walks, add a second strengthening session, and break up sitting every 30 minutes at work.
The Stages of Change Questionnaire
This short CSEP-PATH tool asks the client which statement best describes their current physical activity. Each statement maps to a Transtheoretical Model stage:
- Precontemplation: not intending to become active in the next six months.
- Contemplation: intending to start within six months.
- Preparation: intending to start within the next month, with some activity already.
- Action: regularly active for less than six months.
- Maintenance: regularly active for six months or more.
Its purpose (competencies 2.12, 2.17 and 2.19) is to match counselling and tools to readiness:
| Stage | Counselling emphasis | CSEP-PATH tools that fit |
|---|---|---|
| Precontemplation | Build awareness, respect autonomy, avoid pressure | Movement Counselling Tool; brief information |
| Contemplation | Explore ambivalence; weigh pros and cons | Decision Balance Worksheet |
| Preparation | Set a small first goal and plan | First Step Planning Worksheet; Goal Setting Worksheet |
| Action | Build skills, solve barriers, monitor | Barriers to Physical Activity; Alternatives for Action; Weekly Planner and Log |
| Maintenance | Prevent relapse, add variety | Relapse Planning Worksheet |
The Abilities for Active Living Questionnaire (AAL-Q)
The AAL-Q recognizes that people living with a disability are more likely to face environmental barriers to activity. Disability here means physical or mental differences in function that affect the ability to perform specific tasks. Completed in Step 1, it invites the client to tell the trainer, ideally in advance, about limitations and the accommodations that would make the first meeting and assessment a success. Examples include accessible entry and washrooms, transfer assistance, a seated or arm-cycle option, extra time, communication supports, or a support person.
Use it to adapt the setting and choice of protocols, not to exclude the client. If the disability involves a medical condition, the usual screening rules still apply: one stable condition, Health Screening Tool checks, or referral.
Pregnancy: The Get Active Questionnaire for Pregnancy
CSEP released the Get Active Questionnaire for Pregnancy to accompany the 2019 Canadian Guideline for Physical Activity throughout Pregnancy (CSEP and the Society of Obstetricians and Gynaecologists of Canada). It replaces the PARmed-X for Pregnancy, which required every pregnant client to obtain health care provider clearance first; CSEP's competency list still mentions the PARmed-X by name.
Page 1 asks four questions:
- In this pregnancy, do you have: respiratory or cardiovascular disease; unstable epilepsy; type 1 diabetes that is unstable or outside target ranges; unstable thyroid disease; an eating disorder or malnutrition; twins at 28 weeks or later, or triplets or more; anemia with high fatigue or lightheadedness; high blood pressure (preeclampsia, gestational or unstable chronic hypertension); a baby growing slowly; unexplained bleeding, ruptured membranes or labour before 37 weeks; placenta previa; incompetent cervix; or a cerclage?
- In previous pregnancies, have you had recurrent miscarriages (two or more before 20 weeks) or early delivery before 37 weeks?
- Any other medical condition that may affect activity during pregnancy?
- Any other reason you are concerned about activity during pregnancy?
Any YES means the client speaks with their obstetric health care provider (physician or midwife) before beginning or continuing activity. The Health Care Provider Consultation Form for Prenatal Physical Activity supports that conversation. Page 2 records activity before and during pregnancy and the client's goals.
General advice on the form:
- At least 150 minutes of moderate-intensity activity per week, spread over three or more days.
- Consult the health care provider before vigorous activity or activity at elevations above 2500 m.
- Complete the questionnaire again if health changes as the pregnancy progresses.
CSEP also offers a Pre and Postnatal Exercise Specialization for professionals who want advanced competence in this area.
A client's PASB-Q shows 3 days × 40 minutes of brisk walking, strength training once per week, 6 hours of sitting at work and 4 hours of leisure sitting per day. Which interpretation is correct?
The client meets all of the adult guideline targets and needs no change to their routine.
Below the aerobic and strengthening targets, and above the 8-hour sedentary limit.
The client meets the aerobic target but already exceeds the muscle-strengthening target.
The client's sedentary time is within limits, because only sitting at work is counted.
What is the main purpose of the CSEP-PATH Abilities for Active Living Questionnaire (AAL-Q)?
To clear clients with heart disease for vigorous exercise without involving a physician.
To estimate aerobic fitness for clients who cannot complete a step or treadmill test.
To score a client's readiness to change on the stages of the Transtheoretical Model.
To let people living with a disability identify accommodations they need for assessment or exercise.
A pregnant client at 30 weeks answers YES on the Get Active Questionnaire for Pregnancy because she is expecting twins. What should the CSEP-CPT do?
Advise her to see her obstetric provider first, using the HCP Consultation Form for Prenatal Physical Activity.
Proceed with an mCAFT, because a twin pregnancy at 30 weeks is not listed as a reason for concern on the form.
Tell her that she must stop all physical activity until after delivery, because twins make any exercise unsafe.
Ask her to complete the standard GAQ instead, because the pregnancy version is optional for multiple births.
Sections you finish are checked off in the contents.