Aerobics in Pregnancy Main Presentation

8/16/2019 Aerobics in Pregnancy Main Presentation

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EROBICS IN PREGN NCY.EXPECT TIONS OF PHYSIOTHER PIST

BY

OBSTETRICS ND GYN ECOLOGY UNIT

PRESENTERS RE

NDIFE IJEOM C

NUK M G BRIEL C

NEKWU MORIS E


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OUTLINE

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Introduction

Classifcation o exercise

Pregnancy

Facts about exercise in pregnancy

Physiology o exercise and pregnancy

Classifcation o exercise by age o pregnancyContraindication

Precautions

enefts o exercises!eerences


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INTRODUCTION

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Physical acti"ity is any bodily #o"e#entproduced by s$eletal #uscles thatre%uires energy expenditure

&xercise is any physical acti"ity that isplanned' structured and repetiti"e or thepurpose o conditioning any part o thebody(

It is used to i#pro"e health' #aintain

ftness and is i#portant as a #eans o


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CLASSIICATION O !"!RCIS!

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Wishif U, July2009 #

A$%&'i( $)$%(is$ is any physical acti"itythat uses large #uscle groups and causesyour body to use #ore oxygen than it

)ould )hile resting(

Th$ *&+l is to increase cardiorespiratory

endurance( &(g( cycling' s)i##ing' bris$)al$ing' s$ipping rope' ro)ing' hi$ing'playing tennis' etc(


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CLASSIICATION O !"!RCIS! CONTD

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A+$%&'i( $)$%(is$ or strength orresistance training is any physical acti"itydone )ithout needing oxygen(

Th$ *&+l is to fr#' strengthen and tone#uscles as )ell as i#pro"e bonestrength' balance and co*ordination( &(g(

push ups' biceps curl ups usingdu#bbells' )eight training' sprinting etc


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CLASSIICATION O !"!RCIS! CONTD

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Wishif U, July

2009 6

l$)i'ili-y $)$%(is$ is any acti"ity doneto stretch and lengthen #uscles' it alsohelps to i#pro"e +oint ,exibility(

Th$ *&+l is to i#pro"e the !-. o +oints)hich can reduce the chance o in+ury


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.R!NANC

5/28/16 Wil&%$ J,2003

.%$*+(y is the period ro# conception

to birth(

Pregnancy usually lasts 0 )ee$s

beginning ro# the ist day o the )o#anslast #enstrual period' this period isdi"ided into tri#esters' each lasting

#onthsIst tri#ester lasts ro# )ee$ 1 until end

o )ee$ 1

2nd

tri#ester lasts ro# )ee$ 1 until end


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.R!NANC

5/28/16 Wil&%$ J,20038

Is- &-h 4the e#bryo is about a third o

an inch long' its head and trun$ plus thebeginnings o ar#s and legs starts tode"elop(

he e#bryo recei"es nutrients andeli#inates )aste through the u#bilical cordand placenta(

y the end o the ist #onth' the li"er anddigesti"e syste# begin to de"elop and the

heart begins to beat


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.R!NANC

5/28/16 Wil&%$ J,2003 9

2,3 &-h4 the heart starts to pu#p' the

ner"ous syste# begins to de"elop(1 inch or 2(5c# long

as a co#plete cartilage s$eleton )hich isreplaced by bone cells'

y #onth end' the ar#s' legs' and all o the#a+or organs begin to appear(

Facial eatures begin to or#(


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.R!NANC

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3%3 &-h 4 the oetus has gro)n to

inch 710c# and )eighs a little #ore thanan ounce 728g he #a+or blood "essels and the roo o

the #outh are al#ost co#pleted as theace starts to ta$e on a #ore recogni9ablyhu#an appearance(

Fingers and toes appear:ll the #a+or organs begins to or# he $idneys are no) unctional and the

cha#bers o the heart are co#plete(


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.R!NANC

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#-h &-h4 the oetus begins to $ic$ and

s)allo)';eighs ounce7112g

he oetus can hear and urinate and hasestablished sleep )a$e cycles

:ll organs are no) ully or#ed although they)ill continue to gro) or the next f"e #onths(

he oetus has s$in' eyebro)s and hair(


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.R!NANC

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5-h &-h4 )eighs upto 1lb75g and

#easuring 8*12 inches720*0c#

he oetus experiences rapid gro)th as

its internal organs continue to gro)

he #other #ay eel her baby #o"e and

hear the heartbeat )ith a stethoscope


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.R!NANC

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6-h &-h4 )eighs 1*1(5lbs 75*681g

&"en though its lungs are not ully de"eloped' aoetus born during this #onth can sur"i"e )ithintensi"e care(

he oetus is red' )rin$ly and co"ered )ith fnehair all o"er its body

he oetus )ill gro) "ery ast during this #onthas its organs continue to de"elop


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.R!NANC

5/28/16Wil&%$ J,20031

-h &-h4 there is a better chance that

a oetus born during this #onth )illsur"i"e

;eighs lbs71(1g


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.R!NANC

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8-h &-h4 gro)th continues but slo)s

do)n as the baby begins to ta$e up #osto the roo# inside the uterus

;eighs *5lbs 71(8*2($g and #easuring16*18inches 70*5c#

he oetus #ay at this ti#e prepare ordeli"ery next #onth by #o"ing into thehead*do)n position


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.R!NANC

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9-h &-h4 adds 0(5lbs7223g a )ee$ as

the due date approaches(

he oetus drops lo)er into the #others

uterus and prepare or the onset o labour)hich #ay begin anyti#e bet)een 8th and 2nd )ee$ o gestation(

.ost healthy babies )eigh 6*=lbs72(3*$g' 20 inches long(


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ACTS AOUT !"!RCIS! IN .R!NANC

5/28/16 ->Connor ?'20051

!egular exercise can help reduce bac$

pain' i#pro"e or #aintain #uscle tone'reduce leg cra#ps' s)elling andconstipation and i#pro"e sleep(

W&$ h& $)$%(is$ u%i*7%$*+(y

1 :re less li$ely to experience atigue dueto i#pro"ed sleep' reduced anxiety andneuro#uscular tension


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->Connor ?'200518

2( a"e reduced )eight gain and at

deposition during pregnancy(

( a"e e)er pregnancy disco#orts

( !eport a #ore rapid physical ande#otional reco"ery ro# deli"ery

5( end to ha"e easier' shorter and lessco#plicated labors(


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5/28/16 ->Connor ?' 2005 19

6( a"e less need or pain relie during labor(

3( a"e #ore sta#ina during labor(

8( Increase their aerobic capacity(

=( ?ecrease their susceptibility to illness

10( Increase their energy le"el(


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.R!NANC

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->Connor ?'2005 20

abies o exercising #others@

1( a"e signifcantly lo)er heart rates thanbabies o non*exercising #others(

2( :re better able to cope )ith the stress obirth(

( a"e a greater ability to adapt to lieoutside the uterus

( :re #ore healthy at birth(


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5/28/16->Connor ?'2005 21

5( :re leaner at birth and tend to stay lean as

they gro)(

6( Aleep through the night sooner(

3( :re better able to sel*cal#(

8( Acore higher on tests o general intelligence

and oral language s$ills(

=( a"e decreased ris$s o cardio"ascular and

#etabolic diseases later in lie(


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PBAI--DB -F P!&D


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P!&D


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.usculos$eletal adaptations

:nato#ical and physiological changes duringpregnancy ha"e the potential to aJect the#usculos$eletal syste# at rest and duringexercise(

)eight*gain signifcantly increase the orces

across +oints by as #uch as 100K duringexercise(

Gar9el and Fried#an' 1==1(

. l $ l t l d t ti tLd


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.usculos$eletal adaptations contLd

:lso' lu#bar lordosis contributes to the pre"alenceH50K o lo) bac$ pain in pregnant )o#en(

his change in posture #ay alter balance'increasing ris$ o alling(

Calguneri et al' 1=82(


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.usculos$eletal adaptations contLd

increased liga#entous laxity due to the in,uenceo the increased le"els o oestrogen and relaxinincreases the incidence o strains and sprains(

Calguneri et al' 1=82

Cardio"ascular adaptations


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Cardio"ascular adaptations

Pregnancy alters #aternal hae#odyna#ics such asincrease in blood "olu#e' heart rate' and stro$e"olu#e as )ell as cardiac output' and a decrease insyste#ic "ascular resistance

:rtal et al' 1==1

y #idpregnancy' cardiac outputs are 0450K

greater than beore pregnancy(

.orton .M' 1==1


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Cardio"ascular adaptations contLd

.aternal stro$e "olu#e Ns by 10K by the end othe frst tri#ester' ollo)ed by a 20K N in heartrate during the subse%uent tri#esters(

.ean arterial pressure Os 5410 ## g by the#iddle o the second tri#ester and then gradually

increases bac$ to prepregnancy le"els(

Pi"arani$' 1==6

tLd


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contLd

he decreased #ean arterial pressure is the resulto@Nuterine "asculatureNuteroplacental circulation

O"ascular resistance o s$in $idney(

Pi"arini$' 1==6(

C di l d t ti tLd


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Cardio"ascular adaptations cont d

hese changes appear to establish a circulatory reser"e

to pro"ide nutrients and oxygen to both #other andetus at rest and during #oderate but not strenuousphysical acti"ity(Pi"arini$' 1==6

:ter the frst tri#ester' the supine position results inrelati"e obstruction o "enous return and thereore Ocardiac output(

Clar$ et al' 1==1(

tLd


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contLd

#otionless standing is associated )ith a signifcantdecrease in cardiac output(

For this reason' these positions should be a"oidedas #uch as possible during rest and exercise(

Clar$ et al' 1==1


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!espiratory adaptations

• .inute "entilation Ns by 50K' due to increased tidal"olu#e(

Pro)se and Daensler ' 1=65Q :rtal et al' 1=86

• !esulting in an N in arterial oxygen tension to 1064108 ## g in the frst tri#ester' O to a #ean o 1014106 ## g by the third tri#ester(

e#pleton and Gel#an ' 1=36

! i t d t ti tLd


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!espiratory adaptations cont d

• here is associated increase in oxygen upta$e' and a10420K increase in baseline oxygen consu#ption(

• Physiological dead space during pregnancy re#ains

unchanged(Aady et al' 1=8=


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PBAI--DB -F &E&!CIA&

Chronic exercise pro"ides sti#ulus or the

syste#s o the body to change(

Ayste#s )ill adapt according to le"el' intensity'and "olu#e(

.el9er et al' 2010


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Factors that #ay deter#ine responsesto exercise

Apecifcity o training .etabolic diJerences Haerobic "s( anaerobic in

acti"ities .etabolic diJerences )ithin an acti"ity

Denetic endo)#entFibre type patterns

Ao#atotype H&cto'.eso'&ndo .el9er et al' 2010


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&n"iron#ental actors

Fitness training status( i#e course o adaptations.agnitude o expected changes.echanis# o adaptations(

Dender

.echanis# o adaptation(:ge

Children "s( adults "s( older adults

.el9er et al' 2010 s

+(-&%s -h+- +y $-$%i$%$s7&s$s -& $)$%(is$


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.hysi&l&*i( %$s7&s$s +++7-+-i&s -& $)$%(is$


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:us(ul&s;$l$-+l ++7-+-i&s

Ahort ter# responses [email protected] fbre #icro tears.uscle sorenessIncreased blood supply

Increased #uscle pliabilityIncreased M!-.(

.el9er et al' 2010


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ong ter# adaptations


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:us(ul&s;$l$-+l ++7-+-i& (&-


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:us(ul&s;$l$-+l ++7-+-i&s (&-


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:us(ul&s;$l$-+l ++7-+-i&s (&-


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:us(ul&s;$l$-+l ++7-+-i&s (&-


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:us(ul&s;$l$-+l ++7-+-i& (&-


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:us(ul&s;$l$-+l ++7-+-i&s (&-


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CARDIO=ASCULAR ADA.TATIONS

:erobic exercise re%uires #ore energy' and'hence' #ore oxygen(

o) #uch oxygen is needed dependspri#arily on the intensity at )hich the acti"ityis peror#ed and secondarily on the durationo the acti"ity(

!o)ell' 1=86(


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C+%i&>+s(ul+% ++7-+-i&s (&-


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C+%i&>+s(ul+% ++7-+-i&s (&-


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(&-

he N preload stretches the #yocardiu# and

causes it to contract #ore orcibly

hus' an N in the let "entricular end4diastolic

"olu#e and a O in the let "entricular end4systolic "olu#e HW&AW account or the N instro$e "olu#e during light to #oderatedyna#ic exercice(

Poliner' et al(' 1=80(

(&-


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(&-

eart rate N i##ediately at the onset o acti"ity asa result o parasy#pathetic )ithdra)al(

:s exercise continues' urther N in heart rate are

due to the action o the sy#pathetic ner"oussyste#

H!o)ell' 1=86(

-


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(&- Aystolic blood pressure )ill rise in sy#pathy to

Ncardiac output!o)ell' 1=86

?iastolic blood pressure re#ains relati"ely

constant because o peripheral "asodilation' )hichacilitates blood ,o) to the )or$ing #uscles(

;ade and Freund' 1==0

+% &>+s(u +% + +7-+- &s


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+% &>+s(u +% + +7-+- &s(&-


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C+%i&>+s(ul+% ++7-+-i&s (&-


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(&-

:rterial blood pressure at rest' blood pressureduring sub #axi#al exercise' and pea$ bloodpressure all sho) a slight decline as )ell(

o)e"er' decreases are greater in persons )ithhigh blood pressure(

Fagard and ipton 1==

-


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(&-

For instance' resting blood pressure )ill O ona"erage */* ##g(

• :lso'!OAWN

Fagard and ipton 1==(


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R!S.IRATOR ADA.TATIONS

he #a+or changes in the respiratory syste#ro# exercise are@ :n N in the #axi#al rate o pul#onary

"entilation' )hich is the result o N in both tidal"olu#e and respiratory rate

:n N in pul#onary diJusion at #axi#al rates o)or$' due to Nin pul#onary blood ,o)'particularly to the upper regions o the lung(

otgering et al' 1==1Q Aady et al'1==0

O!TAL ADA.TATIONS TO


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O!TAL ADA.TATIONS TO:AT!RNAL !"!RCIS!S

he #ain concerns o exercise in pregnancy )ereocused on the etus' and any potential #aternalbeneft )as thought to be oJset by potential ris$s

to the etus(

o)e"er' in the unco#plicated pregnancy' etalin+uries are highly unli$ely(

)))(b+sport#ed(co#


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CONT


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CONT D

o)e"er' any acute alterations could result in etalheart rate changes' )hereas chronic eJects #ayresult in intrauterine gro)th restriction(

nortunately' there are no reports to lin$ suchad"erse e"ents )ith #aternal exercise alone(

)))(b+sport#ed(co#

CONT


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CONT


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CONT DFetal heart rate decelerations and bradycardia

occurs )ith a re%uency o 8(=K(

he #echanis# leading to etal bradycardia during#aternal exercise can only be speculated on

probably@ a "agal re,ex( cord co#pression' orFetal head #alposition(

:rtal !' 1==0


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!TAL ADA.TATIONS CONT


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!TAL ADA.TATIONS CONT


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:!TAOLIC I:.LICATIONS

Pregnancy and exercise are associated )ith ahigher need or energy(

In the frst t)o tri#esters' an increased inta$e o150 calories per day is reco##endedQ

:rau+o' 1==3

:!TAOLIC I:.LICATIONS CONT


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:!TAOLIC I:.LICATIONS CONT D

:n increase o 00 calories per day is re%uired in

the third tri#ester(

he co#peting energy needs o the exercising#other and the gro)ing etus raise the theoreticalconcern that excessi"e exercise #ight ad"erselyaJect etal de"elop#ent(

:rau+o' 1==3


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:ssess#ent and &xerciseprescription in pregnant

)o#en

i -


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i&4+-+


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ASS!SS:!NT

Palpation@ enderness

e#perature

Apas#

Acar Hhealed or unhealed

A)elling/-ede#a

5/28/1632 Aagar et al' 200=


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ASS!SS:!NT

&xa#ination@ Wital signs

:bdo#inal girth Ay#physis Fundaleight HAF

;eight

!ange o .o"e#ent H!-.

5/28/163 Aagar et al' 200=

ASS!SS:!NT


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ASS!SS:!NT!-.

Ahould be )ithin per#issible range

:"oid end range pressure

:"oid ballistic #o"e#ent


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ASS!SS:!NT

.anual #uscle testing@ e#phasis on :bdo#inal #uscles

Dluteal #uscles

Perineal #uscles-ede#a :ssess#ent@ * girth #easure#ent

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Aagar'


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ASS!SS:!NT

?iastesis !ecti :ssess#ent@ hoo$ lying toshoulder lit' place fngers hori9ontally onthe linea alba

Aacroiliac Moint dysunction :ssess#ent@

Fabers testCo#pression ?istraction tests

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Aagar'


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ASS!SS:!NT

Incontinence :ssess#ent HPel"ic ,oor#uscle test

Perino#etry

Per "aginal exa#ination )ith sterile

glo"esPad test

Atress incontinence test

5/28/1633 Aagar et al' 200=

ASS!SS:!NT


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ASS!SS:!NT

&xercise tolerance test6 * #inutes )al$ test

4 step test

Functional :ssess#ent

Dait :ssess#ent

5/28/1638 Aagar et al' 200=

STATUS O CURR!NT .R!NANC


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?uring this pregnancy' ha"e you experienced@

.ar$ed atigue leeding ro# the "agina HRspottingSY nexplained aintness or di99inessY

nexplained abdo#inal painYAudden s)elling o an$les hands oraceY

A+7-$ @%& C++i+ s&(i$-y @&% $)$%(is$ 7hysi&l&*y*ui$li$ & 7hysi(+l + $i(+l %$+i$ss $)+i+-i&

2013




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?uring this pregnancy' ha"e you experienced@

Persistent headaches or proble#s )ithheadachesYA)elling' pain or redness in the cal o

one legY:bsence o etal #o"e#ent ater 6th#onthYFailure to gain )eight ater 5th #onth

A+7-$ @%& C++i+ s&(i$-y @&% $)$%(is$ 7hysi&l&*y*ui$li$ & 7hysi(+l + $i(+l %$+i$ss $)+i+-i&

2013

ACTI=IT AITS DURIN T! .AST :ONT


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:


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ACTI=IT AITS DURIN T! .AST :ONT

;: ?-&A B-! !&D:! -CCP:I-<HM-/-.& :CIWIB I


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?o you currently s#o$e tobaccoY]?o you consu#e alcoholY]

&E&!CIAI


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&E&!CIAI


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!"!RCIS! .R!SCRI.TION

: controlled analysis o exercise prescription islac$ing' because studies in hu#ans are li#ited(

:ny exercise regi#en should be indi"iduallystructured to the patientQ her goals' physical

conditioning and general health should beconsidered(

he physician should oJer an explanation othe theoretic causes o concern' balanced )itha re#inder that clinical studies to date ha"esho)n no ad"erse eJects ro# #oderateexercise



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&le#ents o exercise prescriptionbasic health'recreational pursuits co#petiti"e acti"ities

CONSID!RATIONS OR


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he type and intensity o exercise he duration and re%uency o exercise

sessions Hhis is to careully balance bet)eenpotential benefts and potential har#ul eJects

:dditional attention should be gi"en toprogression in intensity o"er ti#e(

asic exercise prescription or o"erall health

and )ellbeing

INT!NSIT


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INT!NSIT

For #oderate exercise' ratings o percei"edexertion should be 1241 Hso#e)hat hard onthe 6420 scale(

&"idence o the eTcacy o this approach isthat' )hen exercise is sel paced' #ostpregnant )o#en )ill "oluntarily reduce theirexercise intensity as pregnancy progresses

OR SCAL! O !"!RTION


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OR SCAL! O !"!RTION

TAR!T !ART OR T!


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Adapted from royal society of obstetrics and gynaecologists statement on exercise inpregnancy 2006

TAR!T !ART OR T!.R!NANT WO:!N IN

!"!RCIS!

DURATION O !"!RCIS!


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DURATION O !"!RCIS!

)o considerations beore prescribingprolonged exercise regi#ens or pregnant)o#en Hin excess o 5 #inutes o continuousexercise

her#oregulation&nergy balance

T!R:OR!ULATION


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T!R:OR!ULATION he #etabolic rate increases during both

exercise and pregnancy' resulting in greaterheat production(

he i#portance o #aintaining ade%uatehydration should be e#phasi9ed(

500 # o li%uid beore exercising250 # o li%uid e"ery 0 #inutes during

exercise

It is co##on to lose 1 to 2 litres o ,uid perhour in s)eat

!N!R ALANC!


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!N!R ALANC!

First t)o tri#esters an increased inta$e o150 calories per day is reco##ended

hird tri#ester an increase o 00 caloriesper day is re%uired

Caloric needs )ith exercise are e"en higher

R!U!NC O !"!RCIS!


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R!U!NC O !"!RCIS!

he reco##endation or non*pregnant )o#enis that an accu#ulation o 0 #inutes a day oexercise occur on #ost i not all days o the)ee$( In the absence o either #edical or

obstetric co#plications' pregnant )o#encould adopt the sa#e reco##endation(

:#erican college o sports #edicine and center or diseasecontrol reco##endation or pregnant )o#en HC?C*:CA.

.ROR!SSION


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.ROR!SSIONPregnant )o#en )ho ha"e been sedentary

beore pregnancy should ollo) a gradualprogression o up to 0 #inutes a day(

;o#en )ho ha"e attained a high le"el oftness through regular exercise beore

pregnancy should exercise caution in engagingin higher le"els o ftness acti"ities duringpregnancy(

Further' )o#en )ith high le"el o ftness shouldexpect o"erall acti"ity and ftness le"els todecline so#e)hat as pregnancy progresses

CONTRAINDICATIONS


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CONTRAINDICATIONS

!uptured #e#branesPreter# labour

ypertensi"e disorders o pregnancy

Inco#petent cer"ix

Dro)th restricted etusigh order #ultiple gestation H^triplets

Placenta pre"ia 28th )ee$

Persistent 2nd

or rd

tri#ester bleedingncontrolled type II diabetes' thyroid disease'

or other serious cardio"ascular' respiratory orsyste#ic disorder

R!LATI=! CONTRAINDICATIONS


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R!LATI=! CONTRAINDICATIONS

Pre"ious spontaneous abortion.ild/#oderate cardio"ascular disorder

.ild/#oderate respiratory disorder

:nae#ia H_ 100g/l

.alnutrition or eating disorder

)in pregnancy ater 28th )ee$

-ther signifcant #edical conditions

:!DICAL SU.!R=ISION WIL!

UND!RTAIN !"!RCIS! IN


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UND!RTAIN !"!RCIS! IN.R!NANC

Cardiac disease

!estricti"e lung disease

Persistent bleeding in the second and third

tri#estersPre*ecla#psia or pregnancy*induced

hypertension

Preter# labour Hpre"ious/presentIntrauterine gro)th restriction

cer"ical )ea$ness/cerclage




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Placenta prae"ia ater 26 )ee$s

Preter# prelabour rupture o #e#branes

ea"y s#o$er H#ore than 20 cigarettes a day -rthopaedic li#itations

Poorly controlled hypertension

&xtre#ely sedentary liestyle

ne"aluated #aternal cardiac arrhyth#ia

Chronic bronchitis





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.ultiple gestation Hindi"idualised and#edically super"ised

Poorly controlled thyroid disease

.orbid obesity Hbody #ass index greaterthan 0

.alnutrition or eating disorder

Poorly controlled diabetes #ellitus

Poorly controlled sei9ures

:nae#ia Hhae#oglobin less than 100 g/l(


WARNIN SINS TO T!R:INAT! !"!RCIS!


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&xcessi"e shortness o breath

Chest pain or palpitations

Presyncope or di99iness

Painul uterine contractions or preter# labour

ea$age o a#niotic ,uidWaginal bleeding

&xcessi"e atigue



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:bdo#inal pain' particularly in bac$ or pubicarea

Pel"ic girdle pain

!educed etal #o"e#ent

?yspnoea beore exertioneadache

.uscle )ea$ness

Cal pain or s)elling



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IRST TRI:!ST!R

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Aerobics in Pregnancy Main Presentation

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