Exercise Dos and Don'ts for Pregnant Women

Do’s:
• • • Check with your physician before beginning any prenatal exercise program. Think safety. Remember that with exercise, the health of the baby and the mother are the top priority. Listen to your body. If it doesn't feel right, modify the movement, or eliminate it. Modify or stop exercise if you experience extreme fatigue or discomfort. Include muscular endurance exercises. Specifically, strengthen the thighs, chest, shoulders, upper and lower back, buttocks, abdominals, and pelvic floor muscles. Include stretching. Specifically, hamstrings, chest, and calves. stretch the inner thighs, lowerback,

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Modify the intensity of the activity. Women who have exercised vigorously before becoming pregnant should be willing to modify their activities, particularly during the third trimester of pregnancy. Modify the exercises if shortness of breath occurs. Take in adequate calories. The demands of pregnancy require 300 extra calories per day, plus the calorie requirement of activity. Eat a high-carbohydrate snack prior to exercise. juice, nuts, or fruit are good examples. Graham crackers, bagels,

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Stay well hydrated. Drink plenty of fluids before, during, and after exercise to help prevent dehydration. Dress appropriately. Wear light, cotton clothing that breathes. Overdressing contributes to overheating during exercise. Use relaxation exercises. Exercise daily.

Don'ts:
• Use jerky, jarring, and twisting movements. This type of activity puts additional stress on joints and body areas already overloaded by the increased weight of the pregnancy and affected by hormonal changes. Make quick directional changes. Your body shape and center of gravity changes continually as the pregnancy progresses, resulting in reduced balance. Lie on the back after the first trimester of pregnancy. The supine position may restrict blood flow by the enlarging uterus. If you are lying on your back and symptoms occur such as dizziness, nausea, or shortness of breath, roll to your left side. Do exercises that decrease the lung space. This includes curl-ups or bending forward with the head down. Do exercises or activities that compromise hip/pelvis joint structure. includes extreme or rapid leg lifts. Do activities that could cause trauma to the abdominal area. Engage in competitive, unfamiliar activities. Hold your breath during exercise. Exercise for weight loss during pregnancy. Fitness before, during, and after pregnancy can be an important part of motherhood. By following these guidelines and doing what feels good, your exercise efforts are sure to contribute to the health and well-being of yourself and your baby. GET FIT! BE FIT! STAY This

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Guidelines and Precautions for Prenatal Exercise Programs
• Always maintain correct posture by tilting your pelvis and straightening your back. Monitor your breathing and maintain the ability to walk and talk comfortably while exercising. Stop exercising when fatigued and do not exercise to exhaustion. Exercise should be regular; three times per week. During pregnancy, aerobic exercises should not exceed five times per week in order to allow your body to recover and rest properly. Avoid any type of exercise involving the potential for even mild abdominal trauma. Avoid rigorous bouncing. Avoid arching your back. Don't bring your feet over your hips, i.e. candlestick or bicycling-in-air position. Don't do sit-ups past 45 degrees. Breathe continually while exercising; do not hold your breath. In general, exhale on exertion. Check for separation of the abdominal muscles each week and take necessary precautions if indicated. Drink fluids liberally before, during and after exercising to prevent dehydration. Avoid activities which require precise balance and coordination. As your pregnancy progresses, your increasing weight, shifting center of gravity, and softening and increased mobility of your joints and ligaments may alter your coordination. Muscles that are used in aerobic activity should be appropriately stretched before and after the exercise. Decrease your exercise level as your pregnancy progresses. Your increased body weight will require a larger energy output, so you will feel more fatigued. If you feel tired, reduce your exercise level and switch to simple stretching/strengthening exercises. Check with your health care provider. In general, continue doing any activity you enjoyed before you became pregnant as long as it feels comfortable. If you want to begin a new aerobic program, consult your health care provider or try a program with a trained professional. Consider using an approved pregnancy exercise video (available at Newborn Connections) that follows the ACOG (American College of Obstetricians and Gynecologists) guidelines to work out at home.

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Benefits of Walking
A good activity to begin during pregnancy is a walking program, three to five days/week. Walking is an inexpensive form of exercise, as the only requirements are a suitable pair of shoes and comfortable clothing. Also, it is an activity that can be readily integrated into daily schedules.

During pregnancy, you can improve your aerobic fitness by walking on level ground at a comfortable pace. However, it may be necessary to use modified forms of walking to gain significant benefits. Walking at increased speeds, walking up and down hills, and walking while carrying weights can raise the heart rate to levels that will improve aerobic fitness.

Basic Prenatal Exercises
These few basic exercises will help increase your strength and flexibility. If you have limited time, these exercises are highly recommended and should take only about ten minutes per day. Check with a qualified prenatal exercise instructor if you are not sure you are doing the exercises correctly.

Arm/Upper Back Stretch (Flying Arm Exercise) - repeat 5 times: 1. Raise your arms over your head, keep your elbows straight and the palms of your hands facing one another. Hold for at least 20 seconds. 2. Lower your arms out to your side. Keep your upper back straight. 3. Bring the backs of your hands together as far as possible behind your back and stretch.

Abdominal Muscles
Before beginning the next exercises-—the pelvic tilt and sit-ups—-review the following information on separation of the abdominal muscles. During pregnancy, it is important to check for advanced separation of the abdominal muscles in order to take precautions to avoid any further separation.

1. The abdominal muscle in the center is divided by a seam, so the muscle is
really two halves. 2. The hormones present during pregnancy cause this seam to soften and stretch as the abdominal muscles accommodate the growing baby. If the seam stretches enough, a separation of the abdominal muscle may occur. A separation can happen gradually or as a result of sudden exertion if the abdominal area is weak. You may be unaware of the separation as it causes no direct pain. However, you might have increased backache, as the abdominal muscles are needed to control a pelvic tilt and maintain proper posture. How to Check for Abdominal Muscle Separation You can check for separation anytime during your pregnancy by following these instructions:

1. Lie on your back and bend your knees, feet flat on the floor. 2. Slowly put your chin to your chest - raise your head and shoulders until your
neck is 6-8 inches from the floor. Hold one arm out in front of you.

3. With the other hand, check for a gap (usually present in the first few months of
pregnancy or postpartum) or a bulge (present in last 3 months of pregnancy) in the middle of your abdomen. There may just be a soft region between the muscles, wider than two fingers' width. 4. If any separation is found, avoid further separation by: • Doing mild abdominal strengthening while crossing your hands over your abdominal area to support and bring the muscles together. • Exhale as you lift your head; this decreases pressure in your abdomen and allows your abdominal muscles to work more efficiently. • Avoid abdominal bulging by consciously contracting your abdominal muscle when lifting and avoid straining of any kind.

Pelvic Tilt
This exercise is very important because it is the building block of good posture; strengthens your abdominal and back muscles; and therefore decreases back strain and fatigue. Practice it often. (see pictures below) 1. Lie on your back with your knees bent.

2. Inhale through your nose and tighten your stomach and buttock muscles
3. Flatten the small of your back against the floor and allow your pelvis to tilt upward. (see example below on left)

4. Hold for a count of five as you exhale slowly.
5. Relax, repeat.

Other positions in which you can perform the pelvic tilt are while on your hands and knees or while standing upright. • CAUTION: DO NOT arch your back, bulge your abdomen or push with your feet to obtain this motion! (as in example on right)

Sit-ups
There are two variations of sit-ups: Forward Sit-up 1. Lie on your back with your knees bent and breathe in slowly through your nose. 2. Breathe out through partially pursed lips as you raise your head, hands pointing to your knees or placed behind your head. 3. Tuck your chin toward your chest and lift your shoulders off the floor (not more than 45 degrees).

Diagonal Sit-up 1. Lie on your back with your knees bent. Slowly breathe in through your nose. 2. Point your right hand toward your left knee while raising your head and right shoulder. Breathe out slowly through your mouth. Keep your left knee bent slightly and your heel on the floor.

Kegels
Kegel exercises tone the pubococcygeal (PC) muscle. This is the muscle you use to stop and start the flow of urine. Exercising this muscle helps prevent hemorrhoids, supports your growing baby, assists during and after labor, keeps the muscles of the vagina toned, and may increase sexual pleasure for you and your partner. Learn to isolate this PC muscle by stopping the flow of urine a few times. Use this technique only to locate the muscle. Don't exercise the muscle this way as it may lead to a urinary tract infection. Another way to locate the muscle is to put your clean finger in the opening of your vagina and tighten. By feeling the muscle tighten around your finger you will know you are doing the exercises correctly. • • • Squeeze the PC muscle for five seconds; relax for five seconds, then squeeze again. At first, do 10 five-second squeezes three times a day. Flutter exercises: Squeeze and release, then squeeze and release as quickly as you can. Work up to doing 100 Kegels each day.

Squatting
1. Move to the squatting position, knees over your toes. 2. Keep your heels on the floor; feel the stretch in the back of your thighs.

3. Hold for 20-30 seconds. Gradually increase the time to 60-90 seconds.
4. Relax your head and arms throughout this exercise.

This is a good exercise to prepare for squatting during the pushing stage of labor

Calf Stretch
1. Lean against a wall or firm surface. 2. Reach one leg out behind you, keeping your heel on the floor. 3. Lean into the wall to increase the stretch of your calf. 4. Hold for 20-30 seconds. 5. Repeat with each leg. This is a good exercise to do before going to bed if you are bothered by leg cramps at night

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Prenatal Exercises
Exercise slowly without bouncing or jerking. Do not stretch to the point of pain. Start with a small number of repetitions and gradually increase to your individual tolerance. It does not take long exercise sessions to ease aches, increase flexibility and circulation, and generally make you feel better. These exercises detailed in this section can be done while watching television or during short stretch breaks anytime during the day. Use all the pelvic tilt exercises to help ease backache during pregnancy and labor. During labor, the pelvic tilt on all fours may be helpful in rotating a posterior baby. Pelvic Tilt Position - Lie on back with knees bent.

Action

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Tighten the stomach muscles and flatten the small of the back down against the floor. Hold for 5 counts. Relax. Repeat.

Lying flat on your back after 20 weeks of pregnancy is not recommended. Pelvic Tilt on All Fours Position Assume all-fours position keeping back straight. Do not let lower back sag.

Action • • • Tighten the stomach muscles so pelvis tucks under and lower back rounds. Hold for 5 counts. Relax. Repeat

Standing Pelvic Tilt Position

Stand with knees slightly bent. Action

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Tighten stomach and press the small of the back flat, as if against an imaginary wall. Hold this position for one minute. Relax. Repeat often if standing for long periods.

Passive Pelvic Tilt Position • • Lay on your side with knees bent. Have your partner position himself behind your hips. Using his hand nearest your head, your partner places his palm on the crest of your hip and then his other hand on your tail bone.

Action

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Partner slowly rotates the crest of your hip back toward himself. Release and repeat.

Wall Stretch Position Stand against the wall with knees slightly bent.

Action • • • • • • Place shoulders, elbows, and wrists against the wall with elbows bent and fingers pointing upwards. Slowly slide arms up the wall, straightening elbows. Once arms are overhead, try to pull abdomen up and in so the back flattens against the wall. Slide arms back down to the starting position. Relax abdominals. Repeat.

Tailor Stretch Position Sit on floor with legs spread apart.

Action • Tilt pelvis and maintain position.

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Extend legs with knees straight. Extend both arms and reach forward slowly until you feel a mild stretch. Return to starting position. Repeat.

Tailor Sitting Position • Sit on firm surface, preferably the floor. • Sit up straight with your legs stretched out in front of you.

Action

Bend your knees then lower them outward toward the floor. Pull your heels toward your body.

Wall Squat Position Hold a standing pelvic tilt with back against a wall.

Action • • Slowly slide your upper body down the wall until knees are bent as if sitting on a stool. Hold this position with contracted thighs and abdominals while relaxing all muscles not being used.

Slowly return to standing position.

Progression • • • Tighten and release pelvic floor. Use the contracted thighs to stimulate uterine contractions while practicing breathing patterns. Slowly return to standing position.

Building Pelvic Floor Muscles with Kegel Exercises Pregnancy often causes noticeable pelvic floor muscle weakness. Pelvic muscle weakness and trauma can lead to: • • • A difficult delivery. Reduced sexual responsiveness after delivery. Onset of incontinence (uncontrolled loss of urine or stool).

Good muscle tone in pelvic floor muscle helps: • • • • • • • Prevent urinary "dribbling" when coughing or laughing. May prevent the need for surgery later in life to pull up a "sagging" uterus or other pelvic organs. Decrease discomfort during pelvic exams. Shortens and makes second stage labor easier when the baby is actually born. Improve perineum healing with episiotomy repair and/or hemorrhoids. Increase pleasure during sexual intercourse. Fifteen minutes of exercise each day for a month can strengthen the pelvic floor muscles. This helps some women reach orgasm more consistently during intercourse. • When done by men, these exercises can help sustain erections and allow the woman more time to achieve orgasm.

Kegel Exercises Prenatal pelvic floor exercises, called Kegel exercises, can result in fewer

complications with vaginal delivery, reduced tearing of the perineum, reduced need for episiotomy and reduced experience of back labor. Kegel exercises are done by contracting and releasing the pelvic floor muscles.

To find the pelvic floor muscles, position yourself seated with your legs reclined. Tense the ring of muscles around your rectum as if suppressing gas or as if stopping a urine stream or bowel movement. • • • • Relax your legs. Do not lift your buttocks off the chair. Stomach should be relaxed. Continue to breathe normally.

Position Sit on a chair.

Action • Tense or squeeze the ring of muscles around the vaginal and rectal area like you are stopping the flow of urine in midstream. Squeeze the muscles tightly for 10 seconds and then release and relax the muscles slowly. Repeat these exercises 10 times, several times a day.


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Another way to explain Kegel exercises is to use an elevator that goes up and down five floors as an example. To go up: Tighten the muscles, slowly making the muscles tighter with each floor. To go down: Relax the muscles, slowly allowing the muscles to relax with each floor. Rest

Be sure to get sufficient rest. Take time to lay down, nap if possible or just put your feet up and rest whenever possible. Try to get at least eight hours of sleep each night.

HELPFUL PRENATAL EXERCISES IMPORTANT FOR RELIEVING COMMON PROBLEMS DURING PREGNANCY

1. As the uterus and abdomen increase in size, lordotic posture often occurs
(back sways). Moms should concentrate on strengthening abdominal muscles, buttocks and quadriceps, and stretching the low back and hip flexor muscles. An ideal way to work the abdominals during pregnancy is in a supine, inclined position on a large exercise ball. (See illustration) Modified crunches and pelvic tilts can be done in a more upright position, keeping weight off the Inferior Vena Cava which typically is compressed when in a flat position. The back muscles also benefit from these exercises by increasing strength and flexibility. Buttock and quadricep muscles can be simultaneously strengthened

in a modified squat exercise done at the wall against the ball. (See illustration) Keep knee flexion minimal during squat as connective tissue surrounding the joints becomes much softer due to hormonal increases. Stretching the low back during pregnancy can be done on all fours, rounding the back as the pelvis tilts under. Hip flexors are stretched in a "split stance" standing position, tilting the pelvis under until stretch begins in the hip flexor of the back leg.

2. The extra weight of larger breasts during pregnancy tends to pull the
shoulders forward, shortening pectoral muscles in the chest and overstretching and weakening the rhomboid and trapezium muscles in the back. Concentrate on stretching the chest muscles by holding a towel with both hands shoulder width apart and pushing the towel back overhead with extended arms. Then strengthen the back muscles by using low weights and rowing the arms back, contracting the shoulder blades together.

3. Edema associated with pregnancy can cause swelling in the wrists resulting in
compression of the median nerve. Symptoms include numbness and tingling when the wrists are in a flexed position, so avoid exercises which place the wrists in this position. Do not use rubber tubing for the upper body strengthening due to the tendency to 'break" the wrist alignment.