Exercise During Pregnancy

Pregnacy and exerciseExercise has become a vital part of many

women's lives

the physiologic changes associated with pregnancy as well as the hemodynamic response to exercise, someprecautions should be observed

Role of physiotherapistAssess physical health and identify any

musculoskeletal , neurological problems that could be aggravated by pregnancy

Advise continues sports or work, how to recognize fatigue as a response of over activity

Advise on back care and liftingTreat any problems with appropriate

physiotherapy techniquesPrescribe exercises according to the

mothers demands and problems

BackacheBackache is caused by the growing uterus

and hormonal changesThe COG moves foreword and lumbar

curvature increases resulting more discomfort in cervical and thoracic area

two common patterns Lumbar pain occurs (area of the lumbar

vertebrae)posterior pelvic pain (back of pelvis)

ManagementAdvices on standing, sitting, sleeping,

working and lifting weights should be given

StandingStretch the head up out of shouldersFeel the baby sitting in the pelvicPull in the abdominal muscles and

tightening the buttocks

Don’tAvoid standing for a prolong time Avoid transferring weight through one limb always

DoIf you are standing lean back against a wall for support to the back

while leaning go up & down from toes

SittingSit back well in the chair (hip 90, knees

90 weight of baby is taken from the seat)Feet are well supported either in the

floor/in a low stoolIf sitting for a long period pelvic tilting

should be practiced While sitting, lumbar curvature should be

maintained (keep a small pillow at the curvature)

Resting on sitting keep your legs in same level or slightly above the sitting position

Remember;While sitting /standing if arms are in use in

front of the body the spinal extensors are in use

How to ease the back, Place both hands at the pelvic girdle along the iliac

crest and extending backwards

Don’ttwist from knees or legs apartstep on high stoolsgoing up two stairs at a time

What is pelvic tilting Supine Pelvic TiltLie on the floor or a bed with your spine in a

neutral position neither arched nor tilted forward. Inhale and allow your lungs to fill up. Exhale as you pull your navel toward your spine and your spine toward the floor, tilting only your pelvis toward the ceiling and holding for approximately 10 seconds. Return to a neutral position. Repeat eight to 10 times.

Seated Pelvic TiltDo a seated pelvic tilt on an exercise ball or any

chair that allows knee joints to create a 90-degree angle when sit down.

Begin the exercise with good seated posture. Inhale as you engage your abdominals and isolate

your pelvis. Tilt your pelvis toward the back of chair or exercise ball. Exhale and pull your navel in toward your stomach and tilt your pelvis toward your knees. Repeat eight to 10 times.

Sleeping Quarter turn from prown (recovery position)

is appropriate positionWith a pillow under the abdomen and one

extra under the top kneeWhen changing positions(turning).

Keep the flexed knees together and turn- it reduce the sacroiliac joint strain

Lifting weights

Never stoopLegs apart to increase BOSAny object to be lifted should kept closer to

bodyLift in stagesFloor chair upright

Relaxation techniques for pregnant mothersCoping strategies for pain tolerance In

labour and reducing stress in day to day activities

Physiological relaxation based on Laura mitchell method

General position of tension is flexion here one group of muscle is contracted isometrically and relaxation and lengthening of the antagonist muscle occurs

Lie in supine positionPush the heels in to the supporting surface, feel

the support now stop pushing and register the comfort

Push the knees Push the lower limbPush the lumbar areaPush the both shoulders downStretch the hands and elbows push them in to

the supporting surfaceClench your hands and let goPush the head downThen concentrate on breathing for 1 – 2 min

If women do not have medical complications and can maintain regular exercise duration of pregnancy

women should avoid exercise that involves the risk of abdominal trauma, falls or excessive joint stress, as in contact sports and vigorous racquet sports

Adequate hydration and proper ventilation are important to prevent possible effects of overheating

Physiological changes during pregnancyMusculoskeletal

One of the most obvious changes in pregnancy is the alteration of the woman's body. Mechanical changes related to the weight of growing breasts, uterus and fetus

Concerns before Exercisesan increase in lumbar lordosis, result in a

shift in the woman's center of gravity, which may cause problems with balance.

Easily get fatigue

Hemodynamic Exercise acts in concert with pregnancy to increase heart rate, stroke volume and cardiac output. However, during exercise, blood is diverted from abdominal viscera, including the uterus, to supply exercising muscle.

Exercise should not be vigorous but slow and smooth

Oxygen Demands

With mild exercise, pregnant women have a greater increase in respiratory frequency and oxygen consumption to meet their greater oxygen demand.

As exercise increases to moderate and maximal levels, however, pregnant women demonstrate decreased respiratory frequency, lower tidal volume and maximal oxygen consumption

Energy Demands

Both exercise and pregnancy are associated with a high demand for energy. In the first two trimesters, an increased intake of 150 calories per day is recommended

an increase of 300 calories per day is required in the third trimester.Caloric demands with exercise are even higher,

The competing energy demands of the exercising mother and the growing fetus raise the theoretic concern that excessive exercise might adversely affect fetal development.

Impact of Pregnancy on Exercise Performance

In the third trimester women go through major changes, and have to be careful with exercises

Of the sixth month of pregnancy intensity exercise are decreases

exercises such as cycling or swimming are very helpful

• Research has shown that moderate exercise in late pregnancy does not influence on premature birth, shooting membranes or damage to fetus

Recommended exercise

WalkingOne of the best cardiovascular exercises for pregnant women, walking keeps fit without jarring knees and ankles. It is safe throughout the nine months of pregnancy and can be built into the day-to-day schedule.

Jogging - Running

Going for a jog is the quickest and most efficient way to work heart and body.

running 15 minutes one day when that's all can fit in and 30 the next when you have the time.

Swimming Healthcare providers and

fitness experts hail swimming as the best and safest exercise for pregnant women.

Swimming is ideal because it exercises both large muscle groups (arms and legs), provides good cardiovascular benefits, and allows pregnant women to feel weightless despite the extra weight of pregnancy.

Aquanatal classes

Many women find aquanatal classes enjoyable during pregnancy. Exercising while standing in water is gentle on joints and can help lessen swelling in legs, which is a common symptom in late pregnancy.

Yoga and stretching

Yoga and stretching can help maintain muscle tone and keep you flexible with little if any impact on your joints. Be careful not to overdo the stretching. You will be more supple as a result of the effects of relaxin, which causes ligaments to be more pliable. Don't hold the stretches for too long or try to develop flexibility too much.

Pilates Pilates is a form of exercise which combines flexibility and strength training with body awareness, breathing and relaxation.

The exercises are based on certain movement patterns performed with tummy and pelvic floor muscules -- known in Pilates as the "stable core" or base.

These muscles are also known as deep stabilizing muscles. Because Pilates targets the tummy and pelvic floor muscles and these muscles can weaken during pregnancy, Pilates exercises can be useful.

Low-impact aerobicsAn aerobics class

specifically designed for pregnant women,

get to enjoy the camaraderie of others just like you, and can feel reassured that each movement has been deemed safe for you and the baby.

Types of aerobics mother can do?

Contraindications to Exercise

women with medical complications should be encouraged to avoid vigorous physical activity

ContraindicationsPregnancy-induced hypertension Preterm rupture of membranes Preterm labor during the prior or current pregnancy Incompetent cervix or cerclage placement Persistent second- or third-trimester bleeding Placenta previa Intrauterine growth retardation Relative contraindications Chronic hypertension Thyroid function abnormality Cardiac disease Vascular disease

Pulmonary disease

Recommendations Studies have not documented a significant rise in core

temperature with exercise, but thermal stressors present a theoretic risk of congenital anomalies in early pregnancy

Women can minimize thermal stress by performing exercise in the early morning or late evening to improve heat dissipation when it is hot outside

May be used during stationary cycling or other indoor exercise, and swimming may be an option to improve conductive heat loss

The intensity, duration and frequency of exercise should start at a level that does not result in pain, shortness of breath or excessive fatigue

Physical conditioning and well-being, including hydration, caloric intake, and quality of rest

Exercises performed in the supine position are inadvisable after the first trimester, as are prolonged periods of motionless standing

Final CommentThe physiologic interactions between pregnancy

and exercise are not fully understood. Although some theoretic concerns remain about exercise in pregnancy, the data thus far have been reassuring

It should be kept in mind, however, that there are major deficits in our knowledge

Some studies have shown positive effects of exercise and some do not because they are not included in all social economic categories of women

Whether exercise is harmful or whether it improves the course and outcome of pregnancy is largely unknown

Therefore, no definitive recommendation can be made to promote exercise during pregnancy

Nevertheless, there appears to be no reason that most women cannot continue with exercise during pregnancy and the possible benefits of improvement in well-being.