Session Benefits of physical activity for pre and post natal clients Unit: Physical activity and health considerations for the pre and post natal client
Aim of the session • To understand the benefits of physical activity for pre and post natal clients
Learning outcomes By the end of this session, you will be able to: • Explain the value of physical activity for pre and post natal clients
Introduction: current research and trends • Since 1970’s, interest in exercise during pregnancy has risen • 2 schools of thought – liberal vs. conservative • Seminal guidelines by ACOG in 1985 – still many unanswered questions • Clear understanding that most types of exercise are safe for mother and baby
Task What are 4 benefits of exercise during pregnancy? Keep a note of your ideas in your portfolio.
Value of physical activity • RCOG (2006) recommend: – maintenance of cardiovascular fitness, muscle length and flexibility – maintenance of a healthy weight – improved circulation – improved co-ordination and body awareness – preparation for labour, and assistance in post natal recovery.
What does the research say? • Women who exercise during pregnancy and lactation (Clapp, 2002): – Gain less weight – Deposit less fat – Feel better – Have shorter labours – Recover more rapidly – Are more likely to continue exercising post partum
Considerations for the fitness professional • Emphasise that care must be taken when exercising during pregnancy • Clients cannot realistically expect fitness levels to improve during the course of pregnancy • Expectant mothers should work to maintain their baseline fitness to aid pregnancy outcomes
Learning outcomes Can you now? • Explain the value of physical activity for pre and post natal clients
Session Physiological and biomechanical changes during pregnancy Unit: Physical activity and health considerations for the pre and post natal client
Aim of the session • To understand the physiological and biomechanical changes that take place during pregnancy
Learning outcomes By the end of this session, you will be able to: • Summarise the three trimesters • Describe the physiological and biomechanical changes associated with each trimester • Explain the implications of these changes for taking part in physical activity
Stages of pregnancy • Pregnancy can be measured by several points of reference: – Day of last menstruation – Ovulation – Fertilisation – Chemical detection 1st trimester 2nd trimester 3rd trimester 0-12 weeks 13-26 weeks 27-40 weeks
Task Think about the changes that occur to the circulatory and respiratory systems. Note down your ideas in your portfolio
Changes to the circulatory system • Relaxation of blood vessels, leading to vascular under fill: – waves of sudden fatigue – a racing pulse – nausea – pallor – sweating – dizziness • Symptoms usually subside by 4 th month
Heart rate changes • During early pregnancy, exercising heart rate will be elevated at a given intensity as a result of the deficiency in blood volume and the corresponding low blood pressure. • During mid-pregnancy increases in blood volume and blood pressure will mean that exercising heart rate will gradually decrease • During late pregnancy, the combined effects of exercise and pregnancy expand blood volume further
Temperature and sweating • Overheating of both mother and baby is a common concern if the mother’s core temperature is elevated substantially during and immediately following exercise • The set point for sweating also comes down; so when core temperature does increase they are more able to dissipate the heat through sweating.
Changes to the respiratory system • Pregnant women have a tendency to over breathe and sometimes feel breathless – therefore, most aspects of respiratory function are actually improved during pregnancy • Expanding uterus presses on and moves the diaphragm upwards reducing normal downward excursion of the diaphragm - therefore depth of breathing is increased
Task Research the changes that occur to the hormonal/metabolic systems
Changes to the hormonal system • At the onset of pregnancy, relaxin begins to rise, peaking in the second trimester – it isn’t unusual for relaxin levels to remain elevated for up to 6 months post birth • The main effects of relaxin are to soften ligaments, cartilage and the cervix (particularly relates to the pubis symphysis and SIJ) • Insulin resistance increases during pregnancy. This makes the pregnant woman’s pattern of energy utilisation similar to that of a mild diabetic
Weight gain • During early to mid-pregnancy, weight gain is normally 7-11 pounds, most of which is maternal fat. • During late pregnancy, weight gain is normally 7-11 pounds. Growth of the foetus and placenta are responsible for most weight gain at this stage. • The additional fluid retention and blood volume expansion of pregnancy account for an additional 9-15 pounds. • Total pregnancy-related weight gain in western society is approximately 24 - 33 pounds
Task Investigate the changes that occur to the musculoskeletal system
Changes to the musculoskeletal system • During pregnancy, the mother’s centre of gravity becomes greatly altered, affecting her posture and gait • As the mother becomes increasingly lordotic (an exaggerated lumbar curve), the abdominal muscles can become strained as they stretch, and the lower back muscles become tighter, leading to soreness/pain
Abdominal muscles • Strong abdominals are needed to support the weight of the baby and to protect the back, which is very vulnerable through pregnancy – strong abdominals will give the muscles of the uterus some extra help during delivery
Abdominal separation • The increased abdominal distension can often cause a splitting of the fascia (the linea alba) between the rectus abdominis muscles; this is known as diastasis recti abdominis
Pelvic floor • During pregnancy the pelvic floor muscles can become weakened and dysfunctional • This can lead to urinary incontinence (leaking of urine), pelvic organ prolapse, haemorrhoids and other colonic-related issues
Learning outcomes Can you now? • Summarise the three trimesters • Describe the physiological and biomechanical changes associated with each trimester • Explain the implications of these changes for taking part in physical activity
Session Considerations for exercise participation Unit: Physical activity and health considerations for the pre and post natal client
Aim of the session • To understand the key considerations for pre and post natal clients participating in physical activity
Learning outcomes By the end of this session, you will be able to: • List the contraindications to exercise for pre / post natal clients • Explain the guidelines for referral • Identify warning signs for cessation of exercise • Explain how to respond to any warning signs during exercise • Describe the key considerations when developing effective working relationships • List the types of real and perceived barriers • Describe ways in which these barriers can be overcome
Contraindications to exercise • There are four main contraindications that need evaluation prior to beginning or resuming exercise during pregnancy: 1. Significant physical injury 2. An acute bout of illness or chronic underlying disease 3. The onset of persistent or recurrent localised pain 4. Abnormal or heavy vaginal bleeding
ACOG guidelines Absolute contraindications Relative contraindications Haemodynamically significant heart disease Severe anaemia Restrictive lung disease Unevaluated maternal cardiac arrhythmia Incompetent cervix/cerclage Chronic bronchitis Multiple gestation at risk for premature labour Poorly controlled type I diabetes Persistent second or third trimester bleeding Extreme morbid obesity Placenta praevia after 26 weeks gestation Extreme underweight (body mass index < 12) Premature labour during the current pregnancy History of extremely sedentary lifestyle Ruptured membranes Intrauterine growth restriction in current pregnancy Pregnancy induced hypertension Poorly controlled hypertension/pre-eclampsia Orthopaedic limitations Poorly controlled seizure disorder Poorly controlled thyroid disease Heavy smoker
Warning signs • ACOG guidelines (2002) have also identified a number of warning signs to stop exercising: – Vaginal bleeding – Dyspnoea before exertion – Headache – Chest pain – Muscle weakness – Calf pain or swelling (need to rule out thrombophlebitis) – Preterm labour – Decreased foetal movement – Amniotic fluid leakage
Barriers to participation • Fatigue/tired • Medical complications • Discomfort and pain • Embarrassment • Disapproval
Developing working relationships with clients • All clients are entitled to good standards of practice and care from their fitness professional – requires professional competence; good relationships with clients and colleagues; commitment to and observance of professional ethics; and excellent communication skills.
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