Exercise During Pregnancy

1. Exercise During Pregnancy

2. Pregnacy and exercise • Exercise has become a vital part of many women's lives • the physiologic changes associated with pregnancy as well as the hemodynamic response to exercise, some precautions should be observed

3. Role of physiotherapist • Assess 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 lifting • Treat any problems with appropriate physiotherapy techniques • Prescribe exercises according to the mothers demands and problems

4. Backache • Backache is caused by the growing uterus and hormonal changes • The COG moves foreword and lumbar curvature increases resulting more discomfort in cervical and thoracic area

5. two common patterns • Lumbar pain occurs (area of the lumbar vertebrae) • posterior pelvic pain (back of pelvis)

6. Management • Advices on standing, sitting, sleeping, working and lifting weights should be given • Standing • Stretch the head up out of shoulders • Feel the baby sitting in the pelvic • Pull in the abdominal muscles and tightening the buttocks

7. Don’t • Avoid standing for a prolong time • Avoid transferring weight through one limb always Do • If you are standing lean back against a wall for support to the back • while leaning go up & down from toes

8. Sitting • Sit 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 stool • If 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

9. 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

10. Don’t twist from knees or legs apart step on high stools going up two stairs at a time

11. What is pelvic tilting • Supine Pelvic Tilt • Lie 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.

13. Seated Pelvic Tilt • Do 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.

14. Sleeping • Quarter turn from prown (recovery position) is appropriate position • With a pillow under the abdomen and one extra under the top knee • When changing positions(turning). • Keep the flexed knees together and turn- it reduce the sacroiliac joint strain

15. Lifting weights • Never stoop • Legs apart to increase BOS • Any object to be lifted should kept closer to body • Lift in stages • Floor chair upright

16. Relaxation techniques for pregnant mothers • Coping 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

17. Lie in supine position • Push the heels in to the supporting surface, feel the support now stop pushing and register the comfort • Push the knees • Push the lower limb • Push the lumbar area • Push the both shoulders down • Stretch the hands and elbows push them in to the supporting surface • Clench your hands and let go • Push the head down • Then concentrate on breathing for 1 – 2 min

18. 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

19. Physiological changes during pregnancy • Musculoskeletal 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

20. Concerns before Exercises • an increase in lumbar lordosis, result in a shift in the woman's center of gravity, which may cause problems with balance. • Easily get fatigue

21. 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

22. 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

23. 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.

24. 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

25. Recommendedexercise

26. Walking One 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.

27. 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.

28. 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.

29. 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.

30. 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.

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

32. 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.

33. Low-impact aerobics • An 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?

36. Pulmonary disease Contraindications to Exercise • women with medical complications should be encouraged to avoid vigorous physical activity

37. 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

38. FinalComment • The 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

39. 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.