Exercise During Pregnancy R.Behbahani ( MsC PT) Women’s Physiotherapy research group, ACECR

1. Exercise During Pregnancy R.Behbahani (MsC PT) Women’s Physiotherapy research group, ACECR

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

7. STOP exercising and consult obstetrician if any of the following symptoms : • Bleeding • Cramping • Faintness • elevated blood pressure • dizziness • severe joint pain

8. 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, as well as an increase in lumbar lordosis, result in a shift in the woman's center of gravity, which may cause problems with balance.

9. 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

10. 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, although no studies have focused on exact requirements. The competing energy demands of the exercising mother and the growing fetus raise the theoretic concern that excessive exercise might adversely affect fetal development.

11. Pay attention to:

12. Exercise could affect early and late pregnancy outcomes by: Increasing core body temperature during embryogenesis Increasing the risk of congenital anomalies. Shifting oxygenated blood and energy to maternal skeletal muscle away from the developing fetus disturbances in growth.

13. Risk of maternal musculoskeletal injury due to: • Changes in posture and centre of gravity. Fetoplacental injury due to blunt trauma or stress from sudden motions.

14. Both aerobic and strength conditioning exercise in pregnancy, not lead to increase in: • Early pregnancy loss • Late pregnancy complications • Abnormal fetal growth

15. Risks of non practicing exercise during pregnancy: • loss of muscular and cardiovascular fitness. • Excessive maternal weight gain • Gestational diabetes • pregnancy-induced hypertension • Development of varicose veins • Deep vein thrombosis • Higher incidence of physical complaints: Dyspnea ,Low back pain • Poor psychological adjustment to the physical changes of pregnancy

16. For exercising women: • continue an exercise program before pregnancy. 2) For non-exercising women: begin an exercise program

17. 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 • Rresearch has shown that moderate exercise in late pregnancy does not influence on premature birth, shooting membranes or damage to fetuses

18. ABSOLUTE CONTRAINDICATIONS • Preg. Induced HTN BP >140/90 mmhg. • Diagnosed heart disease IHD,RHD,CHF. • Placental abruption. • History of preterm delivery. • Recurrent miscarriage.

19. Persistent vaginal bleeding. • Incomplete cervix • Thrombophlebitis &pulmonary embolism. • Pre-eclampsia • Acute infection

20. RELATIVE CONTRAINDICATIONS • Diabetes • Anemia's or other blood disorders • Thyroid disorder • Extreme obesity / underweight • Breech presentation during third trimester • Multiple gastation • Ex. induced asthma • Peripheral vascular disease • Pain of any kind.

21. Suggested sequence of exercise • General rhythmic activities to warm-up. • Gentle selective stretching • Aerobic activities for CVS conditioning • strengthening ex. • Abdominal ex • Pelvic floor ex. • Relaxation /cool down activities • Educational information [if any] & postpartum ex. Education.

22. Recommendedexercise

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

24. Jogging - Running • Going for a jog is the quickest and most efficient way to work your heart and your body. You can tailor it to your schedule -- running 15 minutes one day when that's all you can fit in and 30 the next when you have the time.

25. 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.

26. 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.

27. Yoga and stretching Yoga and stretching can help maintain muscle tone and keep you flexible with little if any impact on your joints. However, you may have to augment a yoga regime by walking a few times a week to give your heart a workout. Be careful not to overdo the stretching. You will be more supple as a result of the effects of relaxin, which causes your ligaments to be more pliable. Don't hold the stretches for too long or try to develop your flexibility too much.

28. 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 your 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.

29. Low-impact aerobics • One good thing about an aerobics class is that it's a consistent time slot when you know you'll get some exercise. If you sign up for a class specifically designed for pregnant women, you'll 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.

30. 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

31. EXERCISES THAT ARE NOT SAFE DURING PREGNANCY • Bilateral SL • Unilateral wt. bearing activities. • Several activities that have potential for high velocity impact may cause abdominal trauma should be avoided. 1.horse riding & driving. 2. Heavy wt. lifting. 3. Ice skating, etc.

32. Exercises To Be Discouraged • Contact sports • Hockey • Boxing • Football • Horseback riding • Skiing (snow and water) • Weight lifting • Diving

33. Special Exercises in pregnancy

34. Circulatory exe. • Pelvic floor exe. • Abdominal exe. • Stretching exe. • Relaxation exe.

35. Circulatory exercises

36. Pelvic floor muscle exercises EXS1(Long contraction) EXS2(Quick contraction) EXS3(Elevator)

37. Abdominal muscle exercises

41. Upper body and trunk exercises

49. Stretching exercises