1. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 17 Resistance-Training Strategies During Pregnancy

2. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Exercise and Pregnancy During low-risk pregnancy, moderate exercise for 30 minutes or more recommended American College of Obstetricians and Gynecologists (ACOG) does not distinguish between aerobic and resistance training

3. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Exercise and Pregnancy Physical Activity Readiness Medical Examination (PARmed-X) for Pregnancy conversely has specific guidelines and precautions Effects of resistance training rarely examined

4. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Contraindications of Resistance Training During Pregnancy Heavy lifting or straining Activities with static or isometric exercise component Changes in maternal blood pressure Heavy resistance training (> 80 percent of 1 RM) may reduce uterine blood flow and oxygen supply

5. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Exercise During Pregnancy May prevent: –Excessive weight gain –Postpartum weight retention –Gestational diabetes –Associated future risk of developing T2D

6. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Other Benefits of Exercise Improves heart and lung health Reduces risk of hypertension and heart disease May increase stamina for labor and delivery May assist in faster postpartum recovery

7. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Other Benefits of Exercise Improves self-esteem and mood Improves sleep-patterns Promotes healthy lifestyle Decreases postpartum anxiety and depression

8. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Other Benefits of Exercise Improves muscle strength –May improve or prevent urinary incontinence and back pain Improves upper-body strength –Supports breasts –Assists in carrying infant

9. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Research Supports Resistance Training Little research available due to concerns about possible contraindications Studies show healthy pregnant women lack hypertensive response to resistance exercise Supine position may cause transient changes in fetal heart rate

10. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Research Supports Resistance Training Maintaining muscular fitness should be emphasized in light of general activity decline during pregnancy Beneficial for preventing muscle-related complications of pregnancy –Incontinence Kegel exercises –Lower-back pain

11. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Precautions Medical prescreening to ensure low-risk pregnancy –Physicians can use PARmed-X for Pregnancy as screening tool Follow safety considerations during warm-up and cooldown Follow five resistance training precautions

12. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. First Precaution: Body Position Uterus may impinge abdominal aorta during exercise in supine position Beyond four months of pregnancy, do not perform exercises in supine position Modify supine exercises to sitting position

13. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Avoid Supine Position

14. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Second Precaution: Joint Laxity Hormone relaxin loosens ligaments and may makes joints more injury-prone Avoid rapid change of direction and bouncing ballistic movements Perform stretching and flexibility movements with caution

15. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Third Precaution: Diastasis Recti Bulging or rippling of connective tissue along linea alba when abdominal exercise performed Contraindication for abdominal exercises –Could lead to tear in connective tissue

16. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diastasis Recti

17. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fourth Precaution: Breathing Maintain proper breathing technique –Prevents injury –Ensures no change in blood pressure related to resistance training

18. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fourth Precaution: Breathing Emphasize continuous breathing during activity –Exhalation upon exertion –Inhalation upon relaxation Avoid Valsalva maneuver

19. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fifth Precaution: Posture Emphasize correct posture and neutral pelvic alignment Incorrect posture may lead to back and pelvic pain Avoid extreme positions

20. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Correct Posture for Pregnant Woman

21. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Warm-Up and Cooldown Warm-up may take longer 10- to 15-minute warm-up 10- to 15-minute cooldown Include lower intensity calisthenics, stretching, and relaxation during both

22. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. PARmed-X Absolute Contraindications Ruptured membranes Preterm labor Uncontrolled T1D or T2D Pregnancy-induced hypertension Incompetent cervix

23. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. PARmed-X Absolute Contraindications Intrauterine growth restriction High-order pregnancy –E.g., triplets Vaginal bleeding Relative contraindications –If risk to pregnancy exceeds exercise benefits

24. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Design Considerations Gain medical clearance Follow guidelines Women with no experience may begin in second trimester –Approximately 12 to 13 weeks

25. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Design Considerations Maintain strength and endurance Follow safety precautions and guidelines on when to stop

26. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Safety Considerations Avoid exercise in warm, humid environments Avoid isometric exercise or straining while holding breath Maintain adequate nutrition and hydration Avoid exercise in supine position past fourth month of pregnancy

27. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Safety Considerations Avoid activities that involve physical contact or danger of falling Know limits Know reasons to stop Monitor temperature of heated pools

28. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Reasons to Stop Exercise Persistent uterine contractions –More than six to eight per hour Bloody discharge from vagina Any “gush” of fluid from vagina Unexplained pain in abdomen

29. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Reasons to Stop Exercise Sudden swelling of extremities –E.g., ankles, hands, face Swelling, pain, and redness in calf of one leg Persistent headaches or disturbance of vision

30. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Reasons to Stop Exercise Unexplained dizziness or faintness Marked fatigue, heart palpitations, or chest pain Failure to gain weight Absence of usual fetal movement

31. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Design Considerations Incorporate low-impact warm-up Use weight that allows 12 to 15 repetitions per set without fatigue May need to decrease intensity during third trimester Incorporate with aerobic exercise, if desired

32. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Design Considerations Perform ideal number of sessions –Three to four times per week Do not exceed five times per week Use one to two exercises for each major muscle group –Including pelvic floor muscles

33. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Design Considerations Use target heart rate zones provided in PARmed-X for Pregnancy Begin with 15 minutes of exercise –Adding two minutes each week to maximum of 30 minutes Refer to Table 17.4 for exercises Review sample 24-Week Program