Exercise During Pregnancy
R.Behbahani (MsC PT)
Women’s Physiotherapy research group, ACECR
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
 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
STOP exercising and consult
obstetrician if any of the following
symptoms :
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Bleeding
Cramping
Faintness
elevated blood pressure
dizziness
severe joint pain
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.
 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, 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.
Pay attention to:
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.
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.
Both aerobic and strength
conditioning exercise in
pregnancy, not lead to increase
in:
Early pregnancy loss
 Late pregnancy complications
Abnormal fetal growth
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
1) For exercising women:
continue an exercise program before
pregnancy.
2) For non-exercising women:
begin an exercise program
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
ABSOLUTE CONTRAINDICATIONS

Preg. Induced HTN BP >140/90 mmhg.

Diagnosed heart disease IHD,RHD,CHF.

Placental abruption.

History of preterm delivery.

Recurrent miscarriage.
 Persistent vaginal bleeding.
 Incomplete cervix
 Thrombophlebitis &pulmonary embolism.
 Pre-eclampsia
 Acute infection
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.
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.
Recommended
exercise
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 dayto-day schedule.
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.
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. 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.
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.
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.
Recommendations
 Studies have not documented a significant rise in core temperature
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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
EXERCISES THAT ARE NOT SAFE DURING PREGNANCY
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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.
 Exercises To Be Discouraged
 Contact sports
 Hockey
 Boxing
 Football
 Horseback riding
 Skiing (snow and water)
 Weight lifting
 Diving
Special Exercises in
pregnancy
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Circulatory exe.
Pelvic floor exe.
Abdominal exe.
Stretching exe.
Relaxation exe.
Circulatory exercises
Pelvic floor muscle exercises
 EXS1(Long contraction)
 EXS2(Quick contraction)
 EXS3(Elevator)
Abdominal muscle exercises
Upper body and trunk
exercises
Stretching exercises
RELAXATION & BREATHING EX

Relaxation & Breathing exercise.
Are given with the following objectives
1.
To obtain rest during pregnancy.
2.
To help the mother regain normal health
afterwards by preventing unnecessary fatigue.
3.
Most common method of relaxation is
MITCHELLS METHOD.
4. Patient position in kneeling forward on to one’s arm
on a cushion placed on a seat of a chair.
5. In this position wt. of the fetus lies on the anterior
abdominal wall & pelvic floor relaxes
6. In this position pt. take deep diaphragmatic
breathing.
7. Other methods of relaxation are
a. mental imagery.
b. muscle setting – “Jacobson’s
Method”
BREATHING & PUSHING
 ask the mother to place her index finger over
epigastrium, take a breath in & feel the expansion in
this area.
 fix the ribs & increase the intrathoracic pressure,
with inspiration bear down & diaphragm will then act as
a piston directed downwards towards the fundus.
 place the other hand on the waist feel it expand
sideways & become aware of the forward bulging of
the lower abd.muscle & the relaxation of the pelvic
floor.”open the door for the birth of baby”
A prog. of labour training consist of
1.
Body awareness & labour/ positioning during labour.
2.
Relaxation during labour.
3.
Breathing during labour.
4.
Massage during labour.
Positioning During Labour
1st stage of labour –
In this stage uterus
anteverts
Forwards leaning facilitates
ante version
Woman should be
encouraged
To change position during
first stage of labour
2. POSITIONING
DURING 2ND STAGE
OF LABOUR.
Commonly used positions
are
 Lithotomy
 Dorsal (recumbent)
 Lateral & semirecument
RELAXATION DURING LABOUR
 Once the labour begins, the of contraction of the
uterus progress.
 Relaxation during contraction becomes more
demanding.
 Provide the women with suggested tech. to assist
in relaxation.
1.Moral support from family members.
2.Seek comfortable position including lying on pillows,
gentle motions such as pelvic rocking.
3.Slow breathing with each contraction.
4.Visual imagery.
5. During transition there is often an urge to push . Use
quick blowing tech. using the cheeks during push.
6. Local heat/ cold application.
7. Gentle touch provides relaxation.
BREATHING DURING LABOUR
 according to Williams & Booth (1985)
1st stage
Easy
breathing- a
little slower &
deeper then
usual.
Transitional
stage
Breathing to
prevent
pushing
“fairly deep
breathing”
to move the
diaphragm
up &down
together
with a sharp
blow out
through
relaxed lip
2nd stage
1 or 2 deep breaths
in & out, then hold
making the
diaphragm “piston
go down” repeat
when breath runs
out, after a gulp of
air.
 Relaxation of the jaws should explain to the
patient.
 The direction of the push is downward under the
pubic bone.
 Breath hold for only 6-7sec. To minimize any
adverse effect on the fetus due to a prolonged
pushing maneuver.
 several pushes may be necessary during
contraction. b/w contraction sigh out, rest & relax.
LABOUR
 It is helpful in pain relief during labour.
 soothing effect of massage activates “gate closing”
mechanism at spinal level.
 tissue manipulation stimulates the release of
endogeneous opiates.
 massage is applied over1. BACK MASSAGE
2. ABDOMINAL MASSAGE
3. LEG MASSAGE
4. PERINEAL MASSAGE
1.
Ex. Can be started as soon as after delivery as
the women feels able to ex.
2.
All prenatal ex. Can be performed safely in
postpartum period.
3.
Before starting ex. Proper assessment of
position & consistency of the fundus of the
uterus should be done.
4.
Assessment of perineum
5.
Monitoring of lower limb edema, varicosities.
6.
Care & advise on breast feeding & baby care.
 SUGGESTED ACTIVITIES FOR THE PT. WITH A CS.
 All prenatal ex. Should be done.
 The women should be instructed to begin preventive
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ex. As soon as possible during recovery period.
Ankle pumping activities &early ambulation to
prevent venous stasis.
Pelvic floor ex. Kegals ex. &pelvic tilting ex.
Abdominal ex. Should be progressed more slowly.
Deep diaphragmatic breathing
Women should wait at least 6 to 8 wk before
resuming vigrous ex.
COUGHING & HUFFING
 huffing is a forceful outward breath using the
diaphragm rather then abdominal to push air out of
lungs.
 The abdominals are pulled up &in rather then
pushed out causing decreased abdominal pressure
& less strain on the incision.
 Support the incision with pillows or hands during
cuffing or huffing.& say “HA” forcefully while pulling
in abdominal muscle.
EX TO RELIEVE INTESTINAL GES PAINS
 Abd. Massage or kneading while lying on the left
side.
 Pelvic tilting ex.
INITIAL POSTNATAL EX.
Breathing Ex.
Deep breathing for circulatory &
relaxing effect
Leg exercise
Foot ankle leg exercise
Abdominal exercise
In crook line position combined
with expiration
Pelvic tilting exercise Crook lying position
Tilt- Relax-Tilt – Relax Exercise
PATOHLOGY
1. diastesis recti
PT MANAGEMENT
1.Modified abdominal muscle
ex. With crossed hand
over the abdomen.
2. Lower back pain & pelvic
pain.
2.In acute condition bed rest
do’s or don’t
gentle heat & massage
pelvic tilting in croock lying
TENS if indicated
3. SI dysfunctioN
3. Modified ex. For SI pain
4. Nerve compression
syndrome
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Carple tunnle syndrome
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Brachial pluxus pain
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Meralgia paraesthetica
4. Splinting
ice packs
elevation of the limb
TENS
Posterior tibial nerve
compress
-
5.Circulatory problem
varicose vein of leg
vulval varicose vein
leg cramps
-thrombosis &
- thromboembolism
5. –prolonged standing
avoided
ankle ex. ,calf stretching
- raising foot end of standing
should bed.
deep kneading massage
- stocking & breathing ex.
6. Stress incontinence
6. pelvic floor ex
7. Postural backache
7. postural correction
8. coccydynia
8. Ice packs ,heat, US,
TENS,
use of rubber ring to
relieve pressure in
sitting.
THANKS