Pre Natal Exercise

1
Pre Natal Exercise

• What you need to know to include mum safely in
  your mainstream classes
• Vicky Hatch

2
Effects of Pregnancy

• Breast discomfort
• Fear of miscarriage
• Joint instability
• Changes in posture and centre of gravity
• Fluid retention/Oedema
• Thermoregulatory changes.

• Frequent urination
• Possible
• Diastasis
• Supine hypotensive syndrome
• Pelvic girdle pain
• Carpal tunnel syndrome
• Digestive reflux.

3
Pre-activity screening

• Who
• Everyone
• Why
• Determine the risk/benefit ratio of exercise
• How
• Extended PAR-Q / PARmed X (www.csep.ca)/consult
  ation
• Referral/deferral
• When and to whom.

4
Essential Pre Exercise Screening Questions

• How many weeks pregnant are you?
• Is this a normal pregnancy for you so far?
• Has your midwife or other health care
  professional identified any issues or potential
  problems?
• Are you currently experiencing, or have you had
  any back, pelvic or other joint discomfort /pain
  in this pregnancy?
• Are there any other symptoms that you are
  currently experiencing or have had in this
  pregnancy?

5
Absolute contraindications
If any of the following are present exercise is
contraindicated

• Haemodynamically significant heart disease
• Restrictive lung disease
• Incompetent cervix/cerclage
• Multiple gestation at risk of premature labour
• Persistent 2nd or 3rd trimester bleeding

• Placenta praevia after 26 weeks
• Premature labour during current pregnancy
• Ruptured membranes
• Pregnancy induced hypertension or pre-eclampsia.

Source ACOG 2002/RCOG 2006
6
Relative contraindications
The following indicate caution/clearance prior to
exercise

• Severe anaemia
• Unevaluated maternal cardiac arrhythmia
• Chronic bronchitis or heavy smoking
• Poorly controlled type 1 Diabetes
• Extreme morbid obesity or underweight

• History of extremely sedentary lifestyle
• Intrauterine growth restriction
• Poorly controlled hypertension, seizure disorder
  or thyroid disease
• Orthopaedic limitations
• Acute illness or infection.

Source ACOG 2002/ RCOG 2006
7
Warning signs
The following indicate cessation of exercise

• Vaginal bleeding
• Dyspnoea before exertion
• Excessive shortness of breath
• Dizziness
• Severe or sudden headache
• Chest or abdominal pain

• Weakness/excessive fatigue
• Calf pain or swelling
• Preterm labour or amniotic fluid leakage
• Decreased foetal movement during or after
  activity
• Pelvic girdle pain.

8
Activity cautions

• Definitely no..
• Scuba diving
• Contact sports
• High altitude activity (over 6000 feet)

• Caution with
• Riding
• Skiing
• Gymnastics
• Road cycling.

Source ACOG 2002 and RCOG 2006
9
Activity guidelines for the 1st Trimester

• In the absence of any contraindications, aim to
  do 30 minutes or more of moderate exercise on
  five or more days of the week
• Avoid activities with a high risk of falling or
  abdominal trauma e.g. ice hockey, football
• Scuba diving only under doctors direction
• Exertions at altitudes up to 6000ft appear safe,
  higher altitudes carry a risk of hypoxemia.
• Source ACOG 2002

10
Activity guidelines for the 2nd Trimester

• As for Trimester 1 plus
• Avoid supine lying from week 16 20 onwards due
  to the risk of supine hypotensive syndrome
• Avoid prolonged motionless standing
• Source ACOG, RCOG, ACPWH, CSEP, SCOG, ACSM,
  RACOG

Activity guidelines for the 3rd Trimester

• As for Trimester 1 and 2 plus
• Include specific abdominal and pelvic floor
  exercises

11
Summary Gym

• Gym equipment is suitable for the early stages of
  pregnancy, but could become uncomfortable or
  inaccessible as mum gets bigger
• As mum gets larger her centre of gravity changes
  so allow more time to get in and out of
  equipment and from one machine to another .

• If balance is affected, there is a chance of her
  falling if she tries to rush
• Remember, the bigger she gets the less chance
  shes got of seeing her own feet!
• Bike
• Saddle may need to be adjusted to a lower
  position than normal to keep the pelvis level and
  make it easier to get on and off.

12
Summary Gym

• Treadmill
• A good choice throughout pregnancy
• Allow more time to get on and off safely
• Rower
• May be difficult to get on and off as mum gets
  larger and heavier
• Knee alignment may be compromised to avoid her
  growing abdomen
• It may feel uncomfortable to pull the handle in
  to the bump.

• Stepper / cross trainer
• May cause a grinding feeling in the pelvis so
  coach mum to keep her hips level and lift the
  baby
• Knees should not come up too high
• Ensure feet are straight to minimise twisting of
  the pelvis.
• These machines are only suitable if mum was
  already experienced pre-pregnancy

13
Summary Gym

• An interval approach to cardiovascular training
  to keep intensity moderate
• Aim for 6-7 (on 0-10 RPE scale) or 13-14 (on
  Borg scale).

• From about 15 weeks onwards, reduce weights to
  around 70 of pre-pregnancy resistance and aim
  for 10-15 repetitions (endurance bias) to keep
  mum comfortable and maintain technique.

14
Summary Studio

• Keep wide stance moves such as plies, V steps
  and side steps to a moderate width to avoid
  pelvic discomfort or dysfunction
• High knee lifts and repeater moves may cause
  discomfort around the hips
• Get mum to keep knees low whilst keeping hips
  level and rib cage lifted
• Slow down the pace of the session as pregnancy
  progresses to accommodate the changes in centre
  of gravity and balance.

• Avoid high impact exercises as she gets larger
  due to stress on the pelvic floor and lax joints
• Give low impact alternatives and encourage mum to
  use them!
• Avoid quick changes of direction as mum gets
  larger and less balanced, add on the spot moves
  before changing direction
• These will all help to keep overall intensity at
  a more moderate level
• Allow frequent toilet breaks.

15
Summary Studio

• Stepping
• Reduce intensity as pregnancy progresses by
  lowering step height and/or by alternating
  routines on and off the step
• Too many repeaters and side leg raises may put
  uneven pressure on the pelvis and lax joints
• Fit ball
• Fit ball is useful for core stability if mum is
  experienced in its use
• It is not appropriate to introduce the ball if
  mum has not used it before.

• LBT/body conditioning
• No supine work after 16 weeks due to risk of
  supine hypotension
• Focus on core stability in a sitting or all
  fours position
• This is a great time to include pelvic floor
  exercises
• Combat Style Aerobics
• Not generally suitable after 16 weeks due to
  joint laxity and intensity of the class
• Yoga
• Pregnancy classes are the best option.

16
Summary Group indoor cycling

• Recheck bike set up at the start of each session
• As she gets bigger it may be necessary to lower
  the saddle to get on and off more easily and help
  to keep the pelvis stable
• Higher handlebars encourage upright posture,
  allow space for the growing baby and help
  alleviate lower back pain
• Remind mum to sit up straight and relax arms and
  shoulders from time to time
• Reduce or eliminate any out of saddle profiles
  or jumping.

• Consider alternative activity if knees are
  uncomfortable or bow outwards due to the growing
  bump
• As indoor cycling can be very intense be careful
  with new pregnant participants
• Encourage regulars to reduce intensity by
  adjusting the resistance and duration of each
  profile or session
• A session of 30 minutes may be better than 45 or
  60 minutes
• Ensure mum listens to her body to keep intensity
  safe for her.

17
Summary General Advice

• Focus on good posture throughout the session
• Offer support for any exercise or stretch
  requiring balance
• Continually screen your client(s), gain feedback
  from them and be alert for any warning signs.

• Follow the recommendations issued by ACOG (2002)
  (1) and RCOG (2006) (2)
• Allow mum to exercise as much as she feels able
  (within the guidelines)
• Ensure adequate hydration and no overheating
  during the session
• Recommend a well fitting, supportive sports bra.

18
Questions?

• Questions?