PREGNANCY

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PREGNANCY EXERCISEMENOPAUSE EXERCISE

• Jane Banting
• Musculo-Skeletal Physiotherapist
• Tuesday, 8 October 2002

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PREGNANCY EXERCISE

• Musculo-Skeletal Factors
• Ligamentous factors
• Increased pelvic range of movement
• Increased lumbar lordosis
• Flattening of lumbar lordosis
• Disengaging of self-locking pelvis

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PREGNANCY EXERCISE

• Physiological Changes
• increase blood volume 40-50
• Increase haemaglobin VO2max
• at rest in submaximal exercise
• Slightly higher oxygen uptake
• Higher heart rate
• Higher cardiac output
• Drop in blood pressure in 2nd trimester

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PREGNANCY EXERCISE

• Specific Exercises
• Pelvic floor strengthening
• Abdominal strength and core stability
• Postural exercises
• Cardio-vascular fitness
• Warm-up
• Program
• Cool-down

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PREGNANCY EXERCISE

• General Fitness Exercise
• Want to continue competitive sport
• Want to maintain fitness
• Want to commence fitness program
• Good exercise in Pregnancy
• walking
• Stationary bike
• Low impact aerobics
• swimming

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PREGNANCY EXERCISE

• Guidelines from American College of Obstetricians
  Gynaecologists
• Mild-moderate exercise routines 3/week
• Avoid supine posture after first trimester
• Modification of exercise intensity
• Extra 300 kcal required in daily diet
• Ensure appropriate heat loss strategies

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PREGNANCY EXERCISE

• Sport In Pregnancy
• Jogging
• walking
• Cycling
• Swimming
• Minimal contact sport
• Contact sports
• Racquet sports

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PREGNANCY EXERCISE

• Sport in Pregnancy
• Softball baseball
• Golf
• Winter sports
• Contra-indicated During Pregnancy
• Scuba diving
• Weight lifting

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PREGNANCY EXERCISE

• Training and Self Help Tips
• monitor heart rate
• note perceived level of exertion
• talk test
• avoid overheating
• monitor fluid levels

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PREGNANCY EXERCISE

• Check for fatigue and soreness
• lumbo-sacral pain
• posterior pelvic pain
• anterior pelvic pain
• pelvic floor strain (incontinence)
• calf cramping

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PREGNANCY EXERCISE

• Contra-Indicatory Symptoms
• bleeding, especially vaginal
• dizziness or shortness of breath
• palpitations, faintness, tachycardia
• abdominal pain
• chest pain
• nausea
• presence of infection

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PREGNANCY EXERCISE

• Contra-Indicatory Signs
• pregnancy-induced hypertension
• toxaemia
• pre-eclampsia
• pre-term rupture of membranes
• history of pre-term labour
• persistent bleeding (all trimesters)
• incompetent cervix
• signs of intra-uterine growth retardation

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POST-NATAL EXERCISE

• Key Factors
• type of birth (caesarian)
• post-delivery pain (musculo-skeletal)
• joint stability may take 6 months to return to
  normal
• Different exercise phases
• post-delivery (0 - 6 weeks)
• 6 weeks-6 months post-delivery
• six months post-delivery

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MENOPAUSE

• Transition period 5-10 years
• Physical Symptoms
• hot flushes
• night sweats
• sleep disturbance and tiredness
• fatigue
• loss of strength
• loss of libido

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MENOPAUSE

• Emotional Symptoms
• depression
• mood changes
• irritability
• forgetfulness

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MENOPAUSE

• Critical Factors
• loss of muscular strength
• loss of bone mass and risk of osteoporosis
• reduction in resting metabolic rate
• reduction in oestrogen levels, which may lead to
  
• heart disease
• arthritis

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MENOPAUSE EXERCISE

• Exercise has positive effect on
• reducing bone loss risk of osteoporosis
• improving balance and co-ordination
• improving fitness and strength reduces risk of
  falls
• improving muscular strength
• improving cardio-vascular fitness, and reducing
  cardio-vascular risk

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MENOPAUSE EXERCISE

• Exercise improves sleep patterns and reduces
  impact of insomnia
• Exercise has Positive Mental Effect by reducing
  impact of
• depression
• anxiety

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MENOPAUSE EXERCISE

• Rehabilitation Practitioner needs to understand
  the effect of hormone depletion
• deterioration in performance
• inability to maintain performance
• inability to maintain skill level
• Rehabilitation Practitioner needs to know whether
  hormone replacement therapy is taken

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MENOPAUSE EXERCISE

• Hormone Replacement Therapy
• positive effects
• increased energy levels
• reduced hot flushes and night sweats
• improves sleeping patterns
• reduced fatigue
• reduced risk of osteoporosis

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MENOPAUSE EXERCISE

• Negative Effects of HRT
• US longtitudinal study, published in 2002, had
  controversial findings
• Study of women over 60 yrs, who were smokers and
  overweight
• Usage of HRT for greater than 5 years
• Increased risk of heart disease
• Slightly increased risk of breast cancer

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MENOPAUSE EXERCISE

• Indirect effect of reduction in
• Osteoporosis
• Breast cancer
• Alzheimers disease
• Cardio-vascular disease

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MENOPAUSE EXERCISE

• drug testing
• part of Masters sport competition
• some HRT products contain Testosterone, which is
  a banned substance

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MENOPAUSE EXERCISE

• Role of rehabilitation Consultant
• encourage client to keep diary of hormonal
  behaviour vs performance level
• liaise with other health professionals
• be flexible with training programs, allowing
  modifications such as
• reduced intensity of training
• reduced weight in training
• longer recovery periods, including more stretches
• cross training