Exercise During Pregnancy and Postpartum

BY: ERIN MOORE

 Physiologic Changes with Pregnancy

 Soft-tissue edema: reported by approximately 80%  20% increase in weight during pregnancy may increase
of women in the last 8 wks force on a joints by as much as 100%
 Increased fluid retention: predispose nerve  Hyperlordosis accentuates anterior pelvic tilt
entrapment (carpel tunnel)  Symphysis pubis widening begins in 10th and 12th week
 Ligamentous Laxity of pregnancy under the influence of the hormone relaxin
 Relaxin known to remodel pelvic connective
tissue and activate collagenlytic system
 Initial increase relaxin levels peak at 12 weeks
and decline until the 17th week
Anatomic and Physiologic Changes with Exercise
during Pregnancy

 About 60% of pregnant women experience  Temperature regulation

LBP
 Strengthen abdominal and back muscles
to reduce these chances
 Respiratory Changes
 Decrease in pulmonary reserve: ability to
exercise anaerobically is impaired,
oxygen availability for strenuous exercise
decreases
 Aerobic training increases aerobic
capacity in normal weight and overweight
women
 Stay well-hydrated
 Wear loose fitted clothing
 Avoid exercising in high heat and
humidity to avoid heat stress
 Decreased Arch Height
 Avoid running on uneven terrain, difficult
to adapt
 Wear supportive shoes, consider orthotics
 WHY Exercise During Pregnancy

 Maintain physical fitness

 Helps weight management
 Reduces risk of gestational diabetes in obese women
 Enhances psychologic well-being
 Safe and desirable
 150 minutes per week of moderate-intensity aerobic activity (equivalent to brisk walking)
 Use talk test to prevent over exhaustion
 Physical inactivity and excessive weight gain risks
 Maternal obesity
 Gestational Diabetes
 Pregnancy complications
 Safe and Unsafe Physical Activities

Activities to Initiate Activities to Avoid

 Walking  Contact sports (ie soccer, basketball)
 Swimming  Activities with high risk of falling (ie off road cycling)
 Stationary Cycling  Hot Yoga, Hot Pilates
 Low impact aerobics
 Yoga, modified
 Positions that result in decreased venous return and
hypotension should be avoided as much as possible
 Running/jogging, Strength training
 Safe for women that participated in these exercises
before pregnancy
 Recommended Exercise Frequency/Duration

 American and Canadian Guidelines encourage women with uncomplicated

pregnancies to participate in regular aerobic and resistive exercise
 Treatment Frequency and Length of Session:
 Previously sedentary women
 Aerobic exercise 15 minutes, 3 x/ week, work up to 30 minutes 4
x/ week
 Women with uncomplicated pregnancies
 Moderate intensity (rate of perceived exertion: 12-14)
 Resistance/flexibility training and aerobic exercise, individually
or in combination
 30 min/day, 4 or 5 days/week
Absolute Contraindication to Aerobic Exercise During Pregnancy

 Hemodynamically significant heart disease

 Restrictive lung disease
 Incompetent cervix of cerclage
 Multiple gestation at risk of premature labor
 Persistent second or third trimester bleeding
 Placenta previa after 26 weeks of gestation
 Premature labor during prior pregnancy
 Ruptured membranes
 Preeclampsia or pregnancy induced hypertension
 Severe anemia
Relative Contraindications to Aerobic Exercise During Pregnancy

 Anemia  Intrauterine growth restriction in current

pregnancy
 Unevaluated maternal cardiac arrhythmia
 Poorly controlled hypertension
 Chronic bronchitis
 Orthopedic limitations
 Poorly controlled type 1 diabetes
 Poorly controlled seizure disorder
 Extreme morbid obesity
 Poorly controlled hyperthyroidism
 Extreme underweight (BMI less than 12)
 Heavy smoker
 History of extremely sedentary lifestyle
Warning Signs to Stop Exercising When Pregnant

 Vaginal bleeding
 Regular painful contractions
 Amniotic fluid leakage
 Dyspnea before exertion
 Dizziness
 Headache
 Chest pain
 Muscle weakness affected balance
 Calf pain or swelling (rule out thrombophlebitis)
 AVOID: Activities that make the pain worse

 Standing on one leg

 Bending and twisting to lift or carry a toddler or baby on one hip
 Crossing legs
 Sitting on the floor
 Sitting twisted
 Sitting or standing for long periods of time
 Lifting heavy weights (grocery bags, vacuum cleaners)
 Carrying anything in only one hand
 During Pregnancy DO:

 Be as active as possible, avoid activities that make the pain worse

 Rest when possible, may need to sit down more often
 Wear supportive shoes (lose arch, due to weight gain)
 Keep knees together when moving in and out of the car, rolling in
and out of bed
 Sleep in comfortable position (with pillow between the knees)
 Take stairs one at a time: upstairs leading with less painful leg,
downstairs leading with more painful leg
 Benefits of Exercise Postpartum

 Improved Cardiovascular fitness

 Facilitated weight loss
 Increased positive mood
 Decreased anxiety and depression
 More energy following exercise
 Decreased lactation-induced bone loss
 Decreased urinary stress incontinence
 Weight Retention Postpartum

 Mother’s with normal weight prior to  Decrease postpartum weight retention

pregnancy and those who gained the
recommend weight are less likely to require
intervention postpartum
 Mother’s with additional weight gain in the
postpartum period
 More susceptible to long term weight gain
 More likely to have related disease:
 Obesity
 Heart disease
 Diabetes
 Increased physical activity helps to
 Maintain lean body mass
 Enhance fat loss
 Improve aerobic fitness
 Weight loss of more than 1.5 kg is not
recommend for lactating women
 WHY Strengthen the Pelvic Floor Muscles

 Urinary stress incontinence

 30-60% of pregnant women
 15 % of postpartum women have it 3 months after
delivery
 Pelvic floor trauma
 Due to vaginal delivery
 Intervention
 Strengthen pelvic floor muscles
 Pelvic training program: perform 8-12 maximum pelvic
floor muscle contractions twice a day (3x per week)
 Hold the max contraction for 6-8 seconds, adding 3-4
fast contractions at the end of each maximal contraction
 Looking after your baby

 Change diapers at waist height

 Do not lift baby too often
 Carry baby in front of you, don’t carry baby on one hip
 Kneel at the bath side rather than bending over
 Keep your baby close to you when moving them in and out of the car seat
 If you have to carry baby in car seat hold it in front of you, not on one hip
 Don’t lift baby out of high shopping trolleys
 Do pelvic floor muscle exercises daily
The Effect of Core and Lower Extremity Strengthening on Pregnancy-
Related Low Back and Pelvic Girdle Pain: Systematic Review

Biomechanical stresses:
Change in pelvic and spinal alignment, joint laxity, and weight gain
Muscle weaknesses:
Weakness at the proximal hip, abdominal and lumbosacral regions may contribute to impaired core stability
thus, altered alignment, decreased ability to withstand stress, and disruption of normal gait pattern
PPGP (Pregnancy Pelvic Girdle Pain) : pain of musculoskeletal origin between the levels of the posterior
iliac crests and gluteal folds involving the anterior and/or posterior aspects of the pelvis that may radiate into
the posterior thigh
Interventions:
Activity modification, exercise, joint and soft tissue mobilization, aquatics, acupuncture, bracing, positioning
Muscle Strengthening:
local stabilizers, specifically the TA more effective to reduce the laxity of the lumbopelvic and sacroiliac
joints than global stabilizers alone
 Intervention: Land Versus Aquatic Exercise

 Physiological and Psychologic benefits

 Decreased joint compressive forces
 Improved edema management
 Increased blood volume and cardiac output
 Improved control of weight gain
 Decreased back pain
 Reduced postpartum depression
 Muscle relaxation
 Intervention: Exercise

Pelvic Floor Core Exercise

• First find comfortable spinal position, tilt the

pelvis forward and backward until you find a
neutral spinal position that is comfortable for your
back

• Contract Pelvic floor: Hold in gas

• Contract Transverse Abdominus: Pull belly button

to spine

Purpose: Strengthen the pelvic floor, which helps to

stabilize SI joint laxity
 Intervention: Exercise

Quadruped Pelvic Tilts

• Obtain the quadruped position with spine in neutral

position.

• Extend the lumbar spine, performing an anterior pelvic tilt

to end range.

• Next flex the spine, performing a posterior pelvic tilt to end

range.

• Then return to neutral spine position. Continue in a

controlled manner

Purpose: Facilitate and maintain a neutral hip position

 Intervention: Exercise

Clamshell

• Get into the side lying position with the hips stacked
on top of each other

• Contract the muscles you would use to prevent a

bowel movement

• Continue to contract the muscles as you rotate the top

leg toward the ceiling (make sure feet stay together)

Purpose: Improve hip strength and stabilize spine

 Intervention: Exercise

Diaphragmatic Breathing

• Sit with back straight

• Place one hand on chest and one on bell. Breath in

through the nose slowly and deeply. The hand on
your belly should be the one that is moving.

• Breath out through your mouth

• Perform this exercise slowly

Purpose: Facilitate deep core muscle activation,

relaxation technique
 Resources

Borg-Stein J, D. S. (2015). Musculoskeletal Aspects of Pregnancy. American Journal of Physical

Medicine & Rehabilitation, 180-192.

Lillios, S. (2012). The Effects of Core and Lower Extremity Strengthening on Pregnancy-Related Low
Back and Pelvic Girdle Pain: A Systematic Review. Journal of Womenʼs Health Physical Therapy. 116-
124.

Mottola, M. (2002). Exercise in the Postpartum Period: Practical Applications. Current Sports Medicine
Reports. 362-368

Opinion, C. (2015). Physical Activity and Exercise During Pregnancy and the Postpartum Period. The
American College of Obstetricians and Gynecologists, 1-8.
Questions?