By Erin Moore Physiologic Changes with Pregnancy Softtissue edema reported by approximately 80 of women in the last 8 wks Increased fluid retention predispose nerve entrapment carpel tunnel ID: 676308
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Slide1
Exercise During Pregnancy and Postpartum
By: Erin MooreSlide2
Physiologic Changes with Pregnancy
Soft-tissue edema:
reported
by approximately 80% of
women in the last 8 wksIncreased fluid retention: predispose nerve entrapment (carpel tunnel)Ligamentous Laxity Relaxin known to remodel pelvic connective tissue and activate collagenlytic systemInitial increase relaxin levels peak at 12 weeks and decline until the 17th week
20% increase in weight during pregnancy may increase force on a joints by as much as 100%Hyperlordosis accentuates anterior pelvic tiltSymphysis pubis widening begins in 10th and 12th week of pregnancy under the influence of the hormone relaxinSlide3
Anatomic and Physiologic Changes with Exercise during Pregnancy
About 60% of pregnant women experience LBP
Strengthen abdominal and back muscles to reduce these chances
Respiratory Changes
Decrease in pulmonary reserve: ability to exercise anaerobically is impaired, oxygen availability for strenuous exercise decreasesAerobic training increases aerobic capacity in normal weight and overweight womenTemperature regulation Stay well-hydratedWear loose fitted clothingAvoid exercising in high heat and humidity to avoid heat stressDecreased Arch HeightAvoid running on uneven terrain, difficult to adapt Wear supportive shoes, consider orthoticsSlide4
WHY Exercise During Pregnancy
Maintain physical fitness
Helps weight management
Reduces risk of gestational diabetes in obese women
Enhances psychologic well-beingSafe and desirable 150 minutes per week of moderate-intensity aerobic activity (equivalent to brisk walking)Use talk test to prevent over exhaustion Physical inactivity and excessive weight gain risks Maternal obesity Gestational Diabetes Pregnancy complicationsSlide5
Safe and Unsafe Physical Activities
Activities to Initiate
Walking
Swimming
Stationary CyclingLow impact aerobicsYoga, modified Positions that result in decreased venous return and hypotension should be avoided as much as possibleRunning/jogging, Strength trainingSafe for women that participated in these exercises before pregnancy Activities to AvoidContact sports (ie soccer, basketball)Activities with high risk of falling (ie off road cycling)Hot Yoga, Hot Pilates Slide6
Recommended Exercise Frequency/Duration
American and Canadian Guidelines
encourage women with uncomplicated pregnancies to participate in regular aerobic and resistive exercise
Treatment Frequency and Length of Session:
Previously sedentary women Aerobic exercise 15 minutes, 3 x/ week, work up to 30 minutes 4 x/ weekWomen with uncomplicated pregnancies Moderate intensity (rate of perceived exertion: 12-14)Resistance/flexibility training and aerobic exercise, individually or in combination30 min/day, 4 or 5 days/weekSlide7
Absolute Contraindication to Aerobic Exercise During Pregnancy
Hemodynamically significant heart disease
Restrictive lung disease
Incompetent cervix of cerclage
Multiple gestation at risk of premature laborPersistent second or third trimester bleedingPlacenta previa after 26 weeks of gestation Premature labor during prior pregnancy Ruptured membranes Preeclampsia or pregnancy induced hypertensionSevere anemiaSlide8
Relative Contraindications to Aerobic Exercise During Pregnancy
Anemia Unevaluated maternal cardiac arrhythmia
Chronic bronchitis
Poorly controlled type 1 diabetes
Extreme morbid obesity Extreme underweight (BMI less than 12)History of extremely sedentary lifestyleIntrauterine growth restriction in current pregnancy Poorly controlled hypertensionOrthopedic limitations Poorly controlled seizure disorder Poorly controlled hyperthyroidismHeavy smokerSlide9
Warning Signs to Stop Exercising When Pregnant
Vaginal bleeding
Regular painful contractions
Amniotic fluid leakage
Dyspnea before exertionDizziness Headache Chest painMuscle weakness affected balance Calf pain or swelling (rule out thrombophlebitis) Slide10
AVOID: Activities that make the pain worse
Standing on one legBending and twisting to lift or carry a toddler or baby on one hip
Crossing legs
Sitting on the floor
Sitting twistedSitting or standing for long periods of timeLifting heavy weights (grocery bags, vacuum cleaners)Carrying anything in only one handSlide11
During Pregnancy DO:
Be as active as possible, avoid activities that make the pain worseRest when possible, may need to sit down more often
Wear supportive shoes (lose arch, due to weight gain)
K
eep knees together when moving in and out of the car, rolling in and out of bedSleep in comfortable position (with pillow between the knees)Take stairs one at a time: upstairs leading with less painful leg, downstairs leading with more painful legSlide12
Benefits of Exercise Postpartum
Improved Cardiovascular fitnessFacilitated weight loss
Increased positive mood
Decreased anxiety and depression
More energy following exerciseDecreased lactation-induced bone lossDecreased urinary stress incontinence Slide13
Weight Retention Postpartum
Mother’s with normal weight prior to pregnancy and those who gained the recommend weight are less likely to require intervention postpartum
Mother’s with additional
weight
gain in the postpartum periodMore susceptible to long term weight gainMore likely to have related disease:Obesity Heart diseaseDiabetes Decrease postpartum weight retentionIncreased physical activity helps toMaintain lean body massEnhance fat lossImprove aerobic fitnessWeight loss of more than 1.5 kg is not recommend for lactating women Slide14
WHY Strengthen the Pelvic Floor Muscles
Urinary stress incontinence
30-60% of pregnant
women
15 % of postpartum women have it 3 months after deliveryPelvic floor traumaDue to vaginal delivery Intervention Strengthen pelvic floor musclesPelvic training program: perform 8-12 maximum pelvic floor muscle contractions twice a day (3x per week)Hold the max contraction for 6-8 seconds, adding 3-4 fast contractions at the end of each maximal contraction Slide15
Looking after your baby
Change diapers at waist heightDo not lift baby too often
Carry baby in front of you, don’t carry baby on one hip
Kneel at the bath side rather than bending over
Keep your baby close to you when moving them in and out of the car seatIf you have to carry baby in car seat hold it in front of you, not on one hipDon’t lift baby out of high shopping trolleysDo pelvic floor muscle exercises dailySlide16
The Effect of Core and Lower Extremity Strengthening on Pregnancy- Related Low Back and Pelvic Girdle Pain: Systematic Review
Biomechanical
stresses:
Change
in pelvic and spinal alignment, joint laxity, and weight gainMuscle weaknesses:Weakness at the proximal hip, abdominal and lumbosacral regions may contribute to impaired core stability thus, altered alignment, decreased ability to withstand stress, and disruption of normal gait patternPPGP (Pregnancy Pelvic Girdle Pain) : pain of musculoskeletal origin between the levels of the posterior iliac crests and gluteal folds involving the anterior and/or posterior aspects of the pelvis that may radiate into the posterior thighInterventions: Activity modification, exercise, joint and soft tissue mobilization, aquatics, acupuncture, bracing,
positioningMuscle Strengthening: local stabilizers, specifically the TA more effective to reduce the laxity of the lumbopelvic and sacroiliac joints than global stabilizers aloneSlide17
Intervention: Land Versus Aquatic Exercise
Physiological and Psychologic benefitsDecreased
j
oint compressive forces
Improved edema management Increased blood volume and cardiac outputImproved control of weight gainDecreased back painReduced postpartum depressionMuscle relaxationSlide18
Intervention: Exercise
Pelvic Floor Core Exercise
First find comfortable spinal position, tilt the pelvis forward and backward until you find a neutral spinal position that is comfortable for your back
Contract Pelvic floor: Hold in gas
Contract Transverse Abdominus: Pull belly button to spinePurpose: Strengthen the pelvic floor, which helps to stabilize SI joint laxity Slide19
Intervention: Exercise
Quadruped Pelvic Tilts
Obtain the quadruped position with spine in neutral position.
Extend the lumbar spine, performing an anterior pelvic tilt to end range.
Next flex the spine, performing a posterior pelvic tilt to end range. Then return to neutral spine position. Continue in a controlled mannerPurpose: Facilitate and maintain a neutral hip positionSlide20
Intervention: Exercise
Clamshell
Get into the side lying position with the hips stacked on top of each other
Contract the muscles you would use to prevent a bowel movement
Continue to contract the muscles as you rotate the top leg toward the ceiling (make sure feet stay together)Purpose: Improve hip strength and stabilize spineSlide21
Intervention: Exercise
Diaphragmatic Breathing
Sit with back straight
Place one hand on chest and one on bell. Breath in through the nose slowly and deeply. The hand on your belly should be the one that is moving.
Breath out through your mouthPerform this exercise slowlyPurpose: Facilitate deep core muscle activation, relaxation techniqueSlide22
Resources
Borg-Stein J, D. S. (2015). Musculoskeletal Aspects of Pregnancy.
American Journal of Physical Medicine & Rehabilitation
, 180-192.
Lillios, S. (2012). The Effects of Core and Lower Extremity Strengthening on Pregnancy-Related Low Back and Pelvic Girdle Pain: A Systematic Review. Journal of Womenʼs Health Physical Therapy. 116-124.Mottola, M. (2002). Exercise in the Postpartum Period: Practical Applications. Current Sports Medicine Reports. 362-368Opinion, C. (2015). Physical Activity and Exercise During Pregnancy and the Postpartum Period. The American College of Obstetricians and Gynecologists
, 1-8.Slide23
Questions?