1. Perinatal Maternal Exercise

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

3. 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.

4. 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

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

6. Pregnancy induced pathology
1. Diastasis recti

7. 2. Low back & Pelvic pain

8. 3. Varicose veins
4.Joint laxity

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

10. 8. Cervical & lumbar lordosis

11. 9.Episiotomy 10.Perineal tears

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. 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).

21. 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.

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

24. 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.

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

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

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

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

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

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

31. The Best Exercises During Pregnancy
Stationary walking
Stationary cycling

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

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

34. 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.

35. 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.

36. 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.

37. 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.

38. 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

39. 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.

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

41. 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.

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

43. 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).

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

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

46. Thank you