Perinatal Maternal Exercise

Rationale Increased awareness of the benefits of regular exercise generally. Exercise has become a vital part of daily life for many women.

Rationale Pregnancy is a state of health, not of illness so, a well-conditioned body will perform better during the stress of advanced pregnancy, and delivery. Objective data regarding the impact of exercise on the mother, the fetus and the course of pregnancy are limited.

AIMS OF EXERCISES Relief of minor discomforts Promotion of speedy postnatal recovery Preparing for labour Prevention of gynecological problems Promote body awareness Facilitate mental & physical relaxation

ADVANTAGES Stimulates circulation Keep joints flexible Creates good muscle tone Promote sense of well being Relieves discomforts

Pregnancy induced pathology 1. Diastasis recti

2. Low back & Pelvic pain

3. Varicose veins 4.Joint laxity

Contd… 5. Pelvic floor dysfuction 6. Compression syndromes 7. Symptomatic supine hypotension syndrome

8. Cervical & lumbar lordosis

9.Episiotomy 10.Perineal tears

1)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.

2) Risk of maternal musculoskeletal injury due to: Changes in posture and centre of gravity. 3) Fetoplacental injury due to blunt trauma or stress from sudden motions.

Recent Investigations 2003 1) Both aerobic and strength-conditioning exercise in pregnancy, not lead to increase in: Early pregnancy loss Late pregnancy complications Abnormal fetal growth Adverse neonatal outcomes.

Recent Investigations cont…. 2) 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.

2) Risks of non practicing exercise during pregnancy: cont… Higher incidence of physical complaints:- Dyspnea Low back pain, Poor psychological adjustment to the physical changes of pregnancy.

Recent Investigations cont…. 3) Benefits Of Exercise During Pregnancy: Minimize minor discomfort associated with the pregnancy. Improve posture. Make the body more supple, Enhance circulation.

3) Benefits Of Exercise During Pregnancy cont…. Assist expulsion of fetus during delivery Provide a feeling of general well-being. Strengthen the muscles stressed by pregnancy—(abdominal, low back and Pelvic floor).

A general guideline for For exercising women during pregnancy Consider your pre-pregnancy fitness and activity level. Do not try to exceed pre-pregnancy levels.

3. Exercise with the least risk should be choosen. 4. Adverse maternal or foetal outcome are not increased with exercise.

Pelvic floor exercises should be initiated immediately postpartum to reduce the risk of future urinary incontinence. 6. Moderate exercise during lactation does not adversely affect breast milk.

How To Attain These Guidelines ? Medical consultations before beginning an exercise program ( exclude contraindications).

Absolute Contraindications PIH Preterm rupture of membranes Threatened preterm labor . Incompetent cervix .

Absolute Contraindications Persistent second- trimester bleeding Placenta previa. Intrauterine growth restriction.

Relative contraindications Chronic hypertension Thyroid dysfunction Cardiac disease Vascular disease Pulmonary disease Multiple pregnancy

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

How To Attain These Guidelines ? Listen to your body (individual tolerance). Exercise regularly, rather than occasionally. Exercise should not be painful.

The Best Exercises During Pregnancy Stationary walking Stationary cycling

The Best Exercises During Pregnancy Aerobics Swimming Walking. Yoga Praying.

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

How To Attain These Guidelines ? Exercise regularly at least three times per week. Begin with as little as 5 minutes a day and add 5 minutes a week until you can stay active for 30 minutes a day.

Avoidance Avoidance Exercise in hot, humid weather. Exercise during illness with fever. Exercise increasing lordosis Exercise causing compression of the uterus. Exercise while lying on the back After 20 weeks.

Avoidance breathless space competitive events. Deep flexion and extension of the joints Activities that require jumping or rapid changes in direction. breathless space competitive events.

Avoidance Exercises that use the Valsalva maneuver ; for example, lifting weights while holding breath. increase in BP &PROM. Exercising outdoors during the hottest time of the day.

How To Attain These Guidelines ? Drink plenty of fluids, especially water, before and after exercise to avoid becoming dehydrated. Drink even if you are not thirsty, as thirst lags behind the body's need for fluids

How To Attain These Guidelines ? Rise gradually from the floor to avoid a sudden, rapid decrease in BP momentary blackout. Continue walking after rising to assist return blood flow to the heart.

How To Attain These Guidelines ? Exercise at a comfortable intensity (the talk test): You should be able to maintain a conservation while exercising.

How To Attain These Guidelines ? Measure your heart rate 2-3 times during peak activity to make sure you are exercising at the proper intensity.

How To Attain These Guidelines? Do not become overheated. If you feel you are becoming too hot, decrease your exercise intensity.

How To Attain These Guidelines ? Follow your exercise with a 5-15 minute cool-down consisting of slow biking or walking. Cool down until your heart rate is less than 100 beats per minute (16 beats in 10 seconds).

Recommendations Recommendations Maternal perinatal exercise should not be forgotten, and the obstetricians should be aware of the different guidelines and recommendations regarding this issue.

Recommendations Any exercise regimen should be individually structured to the patient; taking in consideration the general health.

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