INTRODUCTION

Exercise during pregnancy has a benefits not just for expectant mothers but also for

their growing babies. Antenatal exercise can relief back pain, get women ready for labor

by improving muscle strength and flexibility and improve energy levels. And it will be

the best to continue with the familiar activities rather than begin new types of exercise

and the women should listen to her body when exercise and stop if it she feels

uncomfortable , fatigue or unwell. There are usually many questions that come to mind

when planning how to exercise during pregnancy. Physical exercise is bodily activity

that improves or maintains physical fitness and overall health and wellness. This type

of exercise during pregnancy is important and can help with some common discomforts

of pregnancy and even help prepare your body for labor and delivery. Exercising during

pregnancy is of utmost importance. Gone are the pleasant days when women used to

spend nine months of their pregnancy comfortably at home. Today women not only

shoulder household responsibilities but also engage professionally. The dual role leaves

her with little or no time to take care of her own health, and the challenge gets notched

up further during pregnancy. Exercises during pregnancy play a crucial role in

maintaining the health of the mother and the baby both during and after pregnancy.

Extensive study has shown that during normal pregnancy it is significant for the

women, to undertake certain amount of light and moderate physical exercise.

Irrespective of being a homemaker or a professional, the type of the exercise should be

tailored keeping in mind the requirements of each and every development stage of

pregnancy.

1
 DEFINITION

“Exercise involves the physical and mental ability to participate in carry out the better

functions of the body throughout the pregnancy”.

“Activity requiring physical effort, carried out to sustain or improve health and fitness”

(Oxford dictionary)

PURPOSE OF ANTENATAL EXERCISE

 Antenatal exercise aims at preventing low back pain and enhancing physical

and psychological preparation for delivery by means of joints stretching and

muscle strengthen. Muscles of good tone are more elastic and will regain their

farther strength more efficiently and more quickly after being stretched than

muscles of poor tone.

 The more active and fit you are during pregnancy, the easier it will be for you

to adapt to your changing shape and weight gain. It will also help you to cope

with labour and get back into shape after the birth.

 Exercising abdominal muscles antenatally will ensure a speedy return to normal

postnatally

 Helps in the effective pushing in labor

 Lessens backache in pregnancy.

 Exercise will improve your cardiorespiratory fitness, improve your balance,

and tone of muscles

 Urinary incontinence can be prevented.

 It will reduce symptoms of depression during pregnancy.

 Exercising will control weight gain during pregnancy.

2
  The ligaments around the pelvis stretch and no longer give such firm support to

the joints, the muscles become the second line of defence helping to prevent an

exaggerated pelvic tilt and the unnecessary stress on the pelvic ligaments.

ANATOMICAL AND PHYSIOLOGICAL CHANGES OF

MUSCULOSKELETAL SYSTEM IN PREGNANCY

Maternal physiological changes in pregnancy are the adaptations during pregnancy that

a woman’s body undergoes to accommodate the growing embryo or fetus. These

physiologic changes are entirely normal, and include behavioral (brain), cardiovascular

(heart and blood vessel), hematologic (blood), metabolic, renal (kidney), posture, and

respiratory (breathing) changes. Increases in blood sugar, breathing, and cardiac output

are all expected changes that allow a pregnant woman’s body to facilitate the proper

growth and development of the embryo or fetus during the pregnancy. The pregnant

woman and the placenta also produce many other hormones that have a broad range of

effects during the pregnancy.

Anatomical and physiological changes during pregnancy have the potential to affect the

musculoskeletal system at rest and during exercise. The most obvious of these is weight

gain. The increased weight in pregnancy may significantly increase the forces across

joints such as the hips and knees by as much as 100% during weight bearing exercise

such as running. Such large forces may cause discomfort to normal joints and increase

damage to arthritic or previously unstable joints. Because of anatomical changes,

pregnant women typically develop lumbar lordosis, which contributes to the very high

prevalence (50%) of low back pain in pregnant women. Balance may be affected by

changes in posture, predisposing pregnant women to loss of balance and increased risk

of falling. However, increased incidence of falling during pregnancy has not been

3
reported. Another musculoskeletal change during pregnancy is increased ligamentous

laxity thought to be secondary to the influence of the increased levels of oestrogen and

relaxin. Theoretically, this would predispose pregnant women to increased incidence of

strains and sprains. This hypothesis has been substantiated by objective data on the

metacarpophalangeal joints. Despite a lack of clear evidence that musculoskeletal

injuries are increased during pregnancy, these possibilities should nevertheless be

considered when prescribing exercise in pregnancy.

Pelvis and back body posture during pregnancy

Neuromechanical adaptations to pregnancy refers to the change in gait, postural

parameters, as well as sensory feedback, due to the numerous anatomical,

physiological, and hormonal changes women experience during pregnancy. Such

changes increase their risk for musculoskeletal disorders and fall injuries.

4
Musculoskeletal disorders include lower-back pain, leg cramps, and hip pain. Pregnant

women fall at a similar rate (27%) to women over age of 70 years (28%). Most of the

falls (64%) occur during the second trimester. Additionally, two-thirds of falls are

associated with walking on slippery floors, rushing, or carrying an object. The root

causes for these falls are not well known. However, some factors that may contribute

to these injuries include deviations from normal posture, balance, and gait.

Deep core muscles include:

 Pelvic floor muscles (think kegels)

 Transverse abdominals (think lower belly)

 Multifidous (low back)

 Diaphragm (muscle involved in breathing)

Abdominal muscles – ‘Nature’s perfect corset’

You have 4 pairs of muscles arranged in 4 layers – it is only possible to show

2 layers in the diagram: the Rectus and Transversus muscles.

- The Rectus muscles run vertically up and down the centre of your tummy.

- The Transversus muscles are the deepest horizontal muscles encircling

your waist.

- The Oblique muscles crisscross diagonally on your sides.

These muscles work together to hold your spine firm, tilt your pelvis upward and to

pull your tummy in tight. These muscles bend and twist your spine.

5
 Transversus
Abdominus Linea
Rectus Alba
Abdominus

During pregnancy

The body's posture changes as the pregnancy progresses. The pelvis tilts and the back

arches to help keep balance. Poor posture occurs naturally from the stretching of the

woman's abdominal muscles as the fetus grows. These muscles are less able to contract

and keep the lower back in proper alignment. The pregnant woman has a different

pattern of gait. The step lengthens as the pregnancy progresses, due to weight gain and

changes in posture. On average, a woman's foot can grow by a half size or more during

pregnancy. In addition, the increased body weight of pregnancy, fluid retention, and

weight gain lowers the arches of the foot, further adding to the foot's length and width.

The influences of increased hormones such as estrogen and relaxin initiate the

remodeling of soft tissues, cartilage and ligaments. Certain skeletal joints such as the

pubic symphysis and sacroiliac widen or have increased laxity.

The addition of mass, particularly around the torso, naturally changes a pregnant

mother's center of mass (COM). The change in COM requires pregnant mothers to

adjust their bodies to maintain balance.

6
Lumbar lordosis

To positionally compensate the additional load due to the pregnancy, pregnant mothers

often extend their lower backs. As the fetal load increases, women tend to arch their

lower backs, specifically in the lumbar region of their vertebral column to maintain

postural stability and balance. The arching of the lumbar region is known as lumbar

lordosis, which recovers the center of mass into a stable position by reducing hip torque.

According to a study conducted by Whitcome, et al., lumbar lordosis can increase from

an angle of 32 degrees at 0% fetal mass (i.e. non-pregnant women or very early in

pregnancy) to 50 degrees at 100% fetal mass (very late in pregnancy). Postpartum, the

angle of the lordosis declines and can reach the angle prior to pregnancy. Unfortunately,

while lumbar lordosis reduces hip torque, it also exacerbates spinal shearing load,

which may be the cause for the common lower back pain experienced by pregnant

women.

Postural stability

The weight added during the progression of pregnancy also affects the ability to

maintain balance.

Perception

Pregnant women have a decreased perception of balance during quiet standing, which

is confirmed by an increase in anterior-posterior (front to back) sway. This relationship

heightens as pregnancy progresses and significantly decreases postpartum. To

compensate for the decrease in balance stability (both actual and perceived), stance

width increases to maintain postural stability.

7
Under dynamic postural stability, which can be defined as the response to anterior

(front) and posterior (back) translation perturbations, the effects of pregnancy are

different. Initial sway, total sway, and sway velocity (see figure for description of

variables) are significantly less during the third trimester than during the second

trimester and when compared to non-pregnant women. These biomechanical

characteristics are possible reasons why falls are more prevalent during the second

trimester during pregnancy.

Additionally, the time it takes for pregnant women (any stage of pregnancy) to react to

a translational disturbance is not significantly different than that of non-pregnant

women. This alludes to some sort of stability mechanism that allow pregnant women

to compensate for the changes they experience during pregnancy.

Postural changes during pregnancy.

A. Nonpregnant. B. Incorrect posture. C. Correct posture during pregnancy

8
Gait

Gait in pregnant women often appear as a “waddle” – a forward gait that includes a

lateral component. However, research has shown that the forward gait alone remains

unchanged during pregnancy. It has been found that gait parameters such as gait

kinematics, (velocity, stride length, and cadence) remain unchanged during the third

trimester of pregnancy and 1 year after delivery. These parameters suggest that there is

no change in forward movement. There is, though, a significant increases in kinetic gait

parameters, which may be used to explain how gait motion remains relatively

unchanged despite increase in body mass, width and changes in mass distribution about

the waist during pregnancy. These kinetic gait parameters suggest an increased use of

hip abductor, hip extensor, and ankle plantar flexor muscle groups. To compensate for

these gait deviations, pregnant women often make adaptations that can result in

musculoskeletal injuries. While the idea of "waddling" cannot be dispensed, these

results suggest that exercise and conditioning may help relieve these injuries.

The ligamentous and muscular structures of the middle and lower spine may be severely

stressed. These and related changes often cause musculoskeletal discomfort, especially

in older women or those with a back disorder or a faulty sense of balance.Slight

relaxation and increased mobility of the pelvic joints are normal during pregnancy.

They are secondary to the exaggerated elasticity and softening of connective and

collagen tissue caused by increased circulating steroid sex hormones,especially

estrogen. Relaxin, an ovarian hormone, assists in this relaxation and softening. These

adaptations permit enlargement of pelvic dimensions to facilitate labor and birth.The

degree of relaxation varies, but considerable separation of the symphysis pubis and the

instability of the sacroiliac joints may cause pain and difficulty in walking. Obesity and

9
multifetal pregnancy tend to increase the pelvic instability.Peripheral joint laxity also

increases as pregnancy progresses,but the cause is not known.The muscles of the

abdominal wall stretch and ultimately lose some tone. During the third trimester, the

rectus abdominis muscles may separate (Fig. 8-12), allowing abdominal contents to

protrude at the midline. The umbilicus flattens or protrudes. After birth, the muscles

gradually regain tone; however, separation of the muscles (diastasis recti

abdominis)may persist.

Possible change in rectus abdominis muscles during pregnancy.

A. Normal position in nonpregnant woman.

B. Diastasis recti abdominis in pregnant woman.

BENEFITS OF ANTENATAL EXERCISE

In the past, pregnant women were discouraged from exercise. However, this was mainly

due to social and cultural biases and unfounded concerns about safety for the fetus,

rather than based on scientific investigation. Today, the benefits of regular exercise for

10
pregnant women without contraindications are well established. These include physical

benefits for maternal fitness and the prevention of excessive weight gain, as well as

benefits for psychological well-being. In addition to these pregnancy-specific benefits,

regular exercise confers significant life-long benefits for all adults including reduced

risk of cardiovascular disease, type 2 diabetes and some cancers. Despite these

important benefits, many women remain inactive, or significantly reduce their exercise

participation during pregnancy. This statement summarises recommendations for

exercise prescription during pregnancy to assist women to safely and confidently

achieve the benefits that can be gained from regular exercise participation.

 Decreased risk of gestational diabetes & long-term obesity

 Control of gestational diabetes

 Improved energy levels

 Improved posture Improved muscle tone, strength, endurance

 Possible faster delivery

 Enhanced recovery from childbirth

 Reduced backaches

 Reduced bloating and swelling

Benefits during Pregnancy

Listed below are some of the top reasons and benefits for exercising during pregnancy.

 Exercise decreases the length of the labor and helps in reducing the recovery

time as well. Proper exercise routine helps in increasing stamina needed for the

delivery.

11
  Exercise or yoga improves emotional health that in turn makes it easier for the

new mother to get through the experience of pregnancy

 It also helps in weight management after the birth of the child, which is a

common concern among the mothers.

 It helps in reducing the side effects of pregnancy including the common

symptoms like headaches, fatigue, swelling, and constipation.

 It has been estimated that doing exercises during pregnancy help in decreasing

the risk of premature birth by about 50%.

One needs to make sure to drink plenty of water /fluids before exercising, take a

nutritious diet and avoid exertion.

Benefits after Pregnancy

Not only during pregnancy, but regular exercise after pregnancy is also equally

important due to the following reasons:

 Promote weight loss to a large extent.

 Improve the cardiovascular fitness.

 Helps in restoring muscle tone and strength.

 Boosts the level of energy.

 Helps in relieving stress and anxiety.

12
 EXERCISE PRESCRIPTION DURING PREGNANCY

FREQUENCY OF EXERCISE

The pregnant woman should aim to be physically active on most, preferably all days of

the week. For previously sedentary women and those that are overweight or obese,

exercise may be prescribed at a reduced frequency at the commencement of the program

(i.e. 3 to 4 days per week on non consecutive days to provide a day for recovery between

sessions).

DURATION OF EXERCISE

The pregnant woman should aim to accumulate 150 to 300 minutes of moderate

intensity physical activity each week. Ideally, this should be achieved by being active

on most days of the week for at least 30 minutes at a time. While no evidence exists for

an upper limit to exercise duration, it is probably unwise to extend exercise duration

beyond 60 minutes per session, unless the intensity is relatively light. This is primarily

related to concerns about. For previously inactive women and those that are overweight

or obese, a shorter duration of exercise (15-20 minutes) may be necessary at the

commencement of a program, before slowly building up to 30 minutes.

INTENSITY OF EXERCISE

The precise intensity of exercise prescribed to the pregnant woman will depend on her

baseline level of fitness and previous exercise routine. For previously inactive women

commencing an exercise program during pregnancy, maintaining a ‘moderate’ intensity

is adequate to obtain benefits for health and well-being. Likewise, a woman accustomed

to moderate intensity exercise pre-pregnancy should aim to maintain this level of

13
intensity during pregnancy. However, there is limited research regarding exercise at

higher intensities and accordingly, no evidence-based safe upper limit for the intensity

of exercise has been established. For women with a high level of fitness that are

accustomed to regular vigorous exercise, there is no evidence to suggest that continued

participation in vigorous exercise during pregnancy is harmful, provided the woman

adjusts her routine based on changes in comfort and tolerance. However, athletes should

be wary of excessive exertion as fetal well-being may be compromised above a certain

(high) threshold of intensity (with some evidence of transient fetal heart rate

decelerations and alterations in umbilical and uterine artery Dopplers immediately post-

exercise), although it is not known whether such transient changes impact neonatal

outcomes. Special attention should also be paid to ensuring adequate nutrition,

hydration and avoidance of overheating. Regardless of baseline level of fitness and

previous exercise routine, pregnancy is not a time for serious competition or aiming to

reach peak lifetime fitness.

A more practical way to monitor the intensity of exercise is the rating of perceived

exertion,21 which can be used in combination with heart rate, or alone. A rating of 12-

14 on the 6-20 scale”) reflects exercise of a moderate intensity. For those women with

a higher level of fitness that are accustomed to regular vigorous exercise, a rating of 15-

16 (equating to “hard”) may be appropriate. The “talk test” is another simple gauge of

exercise intensity. The intensity of exercise is considered ‘moderate’ if the woman can

comfortably hold a conversation, or ‘vigorous’ if the woman needs to pause for breath

during conversation.

14
MODE OF EXERCISE

Provided there are no contraindications pregnant women should be encouraged to

participate in both aerobic and strengthening exercises. Aerobic exercises involve

continuous activities that use large muscle groups and elevate the heart and breathing

rate. Walking is a practical mode of exercise during pregnancy, but must be performed

at a ‘brisk’ pace for aerobic benefit. Other popular modes of exercise during pregnancy

include stationary cycling and swimming. The weight-supported nature of these

activities may be more comfortable in the latter stages of pregnancy. Stationary cycling

may also allow women to work at a higher intensity compared with walking late in

pregnancy. 22 Meanwhile, swimming and other water-based activities may provide

benefits for oedema as a result of the redistribution of extravascular fluid with

immersion. However, care should be taken to ensure that the water temperature is

appropriate (i.e. not too high)). Prolonged immersion in heated spas and hydrotherapy

pools should be avoided, as these are typically kept at temperatures greater than 32

degrees Celsius. Ultimately, the precise mode of exercise prescribed during pregnancy

is probably best informed by the woman’s personal preference and enjoyment, provided

that the guidelines are adhered to.

For women who are not previously accustomed to running, it is not advisable to

commence during pregnancy – although there is a lack of scientific study around this

notion. For women who are well accustomed to running prior to pregnancy, whether to

continue should be decided on an individual basis, but there is currently no scientific

evidence to support discouraging running for these women, provided they adjust their

routine to accommodate changes in comfort and tolerance and monitor intensity

appropriately.

15
With respect to strengthening exercises, there is limited scientific literature available to

draw upon to provide evidence-based recommendations. However, muscular

conditioning is an important part of the well-rounded exercise program. Women should

aim for two sessions of strengthening exercises per week, on non consecutive days,

covering the main muscle groups of the body. Women without prior experience of

resistance training can aim to perform 1 – 2 sets of 12 – 15 repetitions for each exercise.

Resistance can be provided using light weights, body weight or elasticised resistance-

bands. Overall, these strengthening exercises should be perceived to be of “moderate”

intensity (rating of perceived exertion 12-14). Movements should be slow and steady

and performed with proper breathing technique (i.e. exhalation on exertion). Other

sensible precautions include avoiding heavy weight-lifting and activities that involve

straining, holding the breath, or that are isometric in nature. Exercises should not be

performed lying flat on the back after the first trimester and walking lunges are best

avoided to prevent injury to pelvic connective tissue.

TYPES OF ANTENATAL EXERCISE:

• Pelvic floor Exercise

• Back and Abdominal Exercise

• Ankle Exercise

• Lower limbs relaxation Exercise

• Breathing Exercise

16
 PELVIC FLOOR EXERCISE

Pelvic floor

It is the connective tissue, muscles, ligaments and nerves that support the bladder,

rectum, uterus, and vagina. The muscles of the pelvic floor stretch from the pubic bone

to the backbone. The pelvic floor is especially important during pregnancy. This is

because it supports your growing uterus.

The floor of your pelvis is formed by very elastic muscles which act like a small

trampoline to support your baby during pregnancy. These muscles may become weak

leading to a leakage of urine when you cough or sneeze. Many women have this

problem during pregnancy. Exercise now to strengthen your pelvic floor, do at least 80

exercises each day.

Strong pelvic floor muscles stop leaks from both your bladder and bowel. Strong pelvic

floor muscles ensure you and your partner continue to enjoy intercourse.

17
Specific Functions of The Pelvic Floor

 Urinary Control

A common complaint among pregnant women is accidentally leaking urine when

coughing or sneezing. You may also find it more difficult to hold in your urine. Not

being able to control urination is called urinary incontinence. The reason this

happens is because the strain on the pelvic floor from the growing uterus weakens the

pelvic floor, giving you less control over your bladder.

 Bowel Control

In addition to helping to control urination, the pelvic floor also aids in controlling the

bowel.A weakened pelvic floor can lead to bowel incontinence. Bowel incontinence,

also known as fecal incontinence, is the inability to control the bowel. This can lead to

embarrassing accidents and is also the reason that many pregnant women have trouble

controlling flatulence.

 Support of the Vagina

The pelvic floor also plays a vital role in supporting the vagina. When the pelvic floor

is weakened by pregnancy or otherwise, it can cause pelvic organ prolapse. This is

when the organs in the pelvis - such as the bladder, uterus, and rectum - drop out of

place. When this happens, they tend to push against the walls of the vagina. This can

result in vaginal pain and a bulge in the vagina. It can also cause reduced vaginal

sensitivity and negatively impact your sex life.

18
How Pregnancy Affects the Pelvic Floor

There are different things that can put strain on the pelvic floor with one of the worst

being pregnancy. During pregnancy, your uterus grows a substantial amount and

weighs much more than prior to pregnancy. This extra weight puts strain on your

muscles and can weaken or damage the pelvic floor. During pregnancy, constipation

can also be a common occurrence, and can put even more strain on the pelvic floor.

Protecting Your Pelvic Floor Throughout Pregnancy

 A Healthy Pregnancy Diet Can Help Protect Your Pelvic Floor

Fortunately, there are ways that you can help to prevent weakening and damage to your

pelvic floor during pregnancy. One way to do this is to ensure you have a healthy

pregnancy diet. You should be doing this regardless to ensure a healthy pregnancy and

baby, but it also can benefit your pelvic floor. The reason being is that a healthy and

balanced diet throughout your pregnancy can help reduce the chance of constipation.

Specifically ensure good water and fiber intake to avoid constipation. Chronic

constipation during pregnancy can put unnecessary strain on your pelvic floor causing

weakening and/or damage

 Pelvic Floor Exercises Protect Your Pelvic Floor During Pregnancy

The best way to protect your pelvic floor during pregnancy is to regularly do pelvic

floor exercises. These are exercises where you practice tightening and relaxing the

muscles in your pelvic floor. It might be difficult at first to locate these muscles as

you usually use them without conscious effort to do so. Performing pelvic floor

19
exercises during pregnancy helps to build the muscle strength of the pelvic floor and

can prevent weakening and damage which cause a variety of problems.

Finding the pelvic floor muscles

There are three different areas you want to focus on when performing pelvic floor

exercises during pregnancy.

 Urethra – The urethra is the tubular structure that carries urine from the bladder

out of the body. In women, the urethra is located between the clitoris and the

vagina. To locate the muscles here, imagine that you are urinating and try to

stop your stream of urine. You should not do this while actually urinating.

 Vagina – The muscles in the vagina can be located by placing a finger or two

into the vagina and attempting to squeeze them.

 Anus– The muscles of the anus can easily be located by pretending like you are

trying to hold in flatulence.

When to Perform Pelvic Floor Exercises During Pregnancy

Performing pelvic floor exercises during pregnancy is very simple and can be done at

almost any time.With some pelvic floor exercises, the people around you won’t even

be able to tell that you are doing them, so you can really do them anywhere and

anytime. You could even do them in the grocery store or the doctor’s office.

20
How To Prepare For Kegels

 You should not perform Kegels when your bladder is partially or

completely full as there could be some urine leakage or pain. Make sure your

bladder is empty before you start to exercise.

 The Kegels should focus only on pelvic muscles and you should not flex other

muscles like those of abdomen, thighs, or buttocks.

 Make sure you breathe in and out instead of holding your breath while doing

Kegels. It improves concentration and efficiency of the movements and also

helps you relax.

 You can place one hand on your tummy to relax your pelvic muscles and

tummy.

How to Perform Pelvic Floor Exercises During Pregnancy

Kegels

Kegel or pelvic floor exercises, also known as Kegels, are simple clench and release

exercises which strengthen pelvic floor muscles.

You can do kegal exercises anywhere and anytime because nobody will even know

that you’re doing them! This is because there is no certain position needed; you can

do them standing, sitting, or even laying down. To perform Kegels, simply tighten the

muscles of your pelvic floor. As you do this, you should feel the muscles of your anus

and your vagina lift up inside of you. Hold them as tight as you can for a moment before

releasing and fully relaxing the areas. It’s important that you make sure that you are

21
only tightening the muscles of your pelvic floor while you do these. Don’t tighten your

abdomen, thighs, or buttocks.

Steps

 Sit on chair with your back against seatback

 Sit with your knees apart.

 Don’t hold your breath.

 Don’t clench your buttocks.

 Tightens the vaginal , urethral and anal muscles as if trying to withhold urination

or defecation .you do this exercise in a standing position

Tighten your back passage as if you were trying to stop passing wind. Now tighten the

muscles you would use to stop a flow of urine. Do both together and you should feel

your back passage, vagina and front passage all lift and close at the same time.

22
• Note: pelvic floor exercise enhances the control and support of pelvic floor muscles .

It helps you prepare for child and prevents uterine prolapsed , urinary incontinence and

haemorrhoids.

There are two different ways to work your pelvic floor muscles during pregnancy with

Kegels.

Slow Kegels - You should hold the muscles tightened as long as you can for up to

10 seconds. It’s okay if you can’t hold them for the full 10 seconds at first, just work

your way up to 10 seconds. After fully relaxing, take a few seconds to rest and then

tighten the muscles again, and then relax again. Do this about 10 times to perform one

set of Kegels. It’s a good idea to perform several sets of Kegels each time you exercise

your pelvic floor during pregnancy.

Slow squeeze pelvic floor exercise: steps

This exercise will help support the organs in the pelvis and the growing baby.

You may not be able to hold this squeeze for long at first, but keep building up the time

and make sure you always release it slowly.

 Slowly tighten your pelvic floor, lifting the muscles inwards and upwards.

 Continue lifting up through your pelvis and into your tummy.

 Try to hold it for four seconds, then release slowly.

 If you find you struggle to hold the squeeze for this long and there’s nothing left

to release, try holding it for less time at first and working up to four seconds.

 Gradually increase the length of the hold. Make sure you always have some of

the squeeze left to release and that you’re able to release slowly at the end of

the exercise.

23
Fast Kegels – For fast Kegels, tighten the muscles as much as you can and then

immediately relax followed by immediately tightening back up. Make sure you are

relaxing completely before you start tightening the muscles again. The full

relaxation of the muscles between each tightening is just as important as the tightening

itself. You can do this 10 times per set, and perform several sets at once with small

resting sessions in-between each set.

Quick squeeze pelvic floor exercises : steps

 Tighten and lift your pelvic floor in one quick contraction, squeezing the

muscles inwards and upwards.

 Pause before releasing slowly.

 Relax fully at the end.

 Try to perform each repetition with the same speed and strength as the first.

Remember to breathe normally when you’re doing your pelvic floor exercise.

Types of pelvic floor exercises

1. Floor Lifts:

It is an effective pelvic floor exercise that strengthens the muscles. The lower back and

arms are involved in this exercise, and therefore tones and strengthens the area.

Steps

 Lie on your back with knees bent and feet flat on the surface.

 Inhale by engaging your pelvic floor and lifting your hips

24
  Continue breathing and hold for about ten seconds.

 Lower the hips and release your pelvic floor. Repeat ten more time

Floor lift

2. Vertical thighs using a ball or towel:

It lifts the pelvic floor muscles. When you combine this exercise with floor lifts, you

will be working your muscles from all the angles.

STEPS

 Stand against a support, like a wall or a chair, at an arm’s length by keeping

your hands on the support.

 Keep your feet close, parallel with heels touching each other and place a rolled

up towel or a medium sized ball in between your inner thighs.

 Lift heels off the floor by bending your knees slightly. Hold this position and

try squeezing the towel or the ball at different tempos. First, squeeze quickly for

25
 25 times, followed by a second’s and then squeeze again slowly for another 25

times.

 In the end, lower the hips down to your heels, and move up and down for about

ten times.

3. Exercise -head lift with pelvic tilt

STEPS:

1. The arms are closed over the diastases and pulled towards midline.

2. Slowly lift the head off the floor while performing a posterior pelvic tilt, slowly

lower the head and relax

3. All abdominal contractions should be performed with an exhalation so that intra

abdominal pressure is minimized.

Head lift with pelvic tilt

26
 4. Exercise – leg sliding

STEPS:

1. Hook lying with pelvis in a posterior tilt.

2. Instruct the woman to hold the pelvic tilt as she first slides one foot along the

floor until the leg is straight

3. She stops sliding at a point at which she can no longer hold the pelvic tilt. Slowly

tilt the leg and bring back to the starting position

4. Repeat with other leg breathing should be coordinated with the exercise, so that

abdominal contractions occur with inhalations.

27
This exercise can be performed with both legs at the same time only if abdominal

muscles can maintain the pelvic tilt through the entire exercises.

5. Exercise – pelvic tilt exercise

STEPS :

1. Quadruped (on hands and knees) instruct the mother to perform a posterior

pelvic tilt while keeping her back straight, have her draw in and tighten the

abdomen and hold, then relax and perform an anterior tilt through partial range.

28
 2. Pelvic tilting is useful in strengthening abdominal muscle tone and in reducing

low back pain due to postural changes that commonly occurs as the uterus

enlarges. Pelvic tilt a pelvic rocking are done.

pelvic tilt exercise

Anterior pelvic tilt Posterior pelvis tilt

29
 6. Exercise – pelvic rocking exercise

STEPS :

1. Ask women lie flat on her back with her knees bent and her feet flat on the floor.

2. Slowly the woman decreases the lumbar: curve by tilting the pelvis to press the

small of her back against the floor while simultaneously tighten her abdominal

and buttock muscles.

30
This exercise should be repeated several times, it can also be done in a standing position

using a wall as the flat surface.

7. Tailor sitting

This exercise makes your thigh, pelvic, and hip muscles more flexible.

1. Sit on the floor with the soles of your feet together. Your back should be straight.

2. Gently lean forward until you feel a mild stretch in your hip and thigh muscles.

Your back should remain straight. Don’t push down on your legs with your

hands.

3. Hold and count to 5, then relax.

31
Benefits of Kegel Exercises During Pregnancy:

Kegel exercises make you feel comfortable as you approach your due date.

1. As the uterus expands, it strains the muscles and ligaments that enclose it. If you

have weak muscles, you may experience urine leakage, also referred to as

Urinary Incontinence (UI), especially in the third trimester. Activities like

sneezing, coughing, laughing, or jogging can lead to occasional leakage of

urine. Performing Kegels will, therefore, lessen or prevent this condition

2. Strong pelvic floor muscles ease the delivery process, especially during the

pushing stage. Kegel exercises help you understand how to contract and relax

your muscles in preparation for childbirth. Relaxing your muscles helps the

baby move out of the womb smoothly, reducing any chances of tear or injury in

the intimate area. Research studies state that around one-third of pregnant

women experience some tear or injury in the PFM during childbirth (5). This

happens as the muscles overstretch to make room for labor.

3. Research also states that women who indulge in pelvic floor exercises are

known to experience shorter active phases of labor than those who do not

exercise .

4. Performing Kegel exercises while you are pregnant will improve the blood

circulation in the genitals which will speed up the recovery of hemorrhoids

(swollen or group of veins in the region of the anus) and episiotomies (surgical

cut made at the opening of the vagina during childbirth) after childbirth.

32
 5. These exercises tone up your vaginal muscles, thereby boosting your sex

drive.

BACK AND ABDOMINAL EXERCISES

1. Exercise-abdominal tightening

STEPS:

1. Sit comfortably or kneel on four.

2. Breath in and out then pull in the lower part of the abdomen below the umbilcus

while continuing to breath normally.

3. Hold for up to 10 seconds. Repeat up to 10 times. This tones the deep transverse

abdominal muscles which are the main postural support of the spine and will

help to prevent back ache in future.

33
 2. Elbow plank

 The elbow plank recruits more of your core muscles to do the work than a

traditional plank.

 Clasp your hands together, resting on your forearms and stacking your shoulders

above your elbows. Keep your body in a straight line from neck to heels.

 Hold this position for as long as you can for each set

3. Knee-tuck with sliders

This is a great lower-ab and core workout.

 Place a paper plate or slider under each foot.

34
 Start in a traditional plank position with your shoulders stacked above your

hands, your body held in a straight line from neck to heels and your feet hip-

width apart. Push up through your shoulders so your body doesn’t hang between

them.

 Keeping your belly button pulled in tight towards your spine, draw both knees

in towards your chest. Pause for a moment, then push them back out to the

starting position. Be careful not to arch your back as you push back.

35
 4. Dead bug

This strengthens your abs while minimising pressure on your lower back.

 Lie flat on your back with your hands extended towards the ceiling. Bend your

knees to 90 degrees and raise your calves until they are parallel to the floor. Tilt

your pelvis so you close the gap between your back and the floor.

 Slowly lower your right arm and left leg down to the floor simultaneously until

your lower back almost arches off the ground. Pause for a moment, then slowly

return to the starting position and repeat on the opposite side.

36
 5. Wall Squats

For abdominal muscles, buttock muscles, and thigh muscles

37
Stand with your head, shoulders, and back against a wall with your feet about 1 to 2

feet away from the wall. Press your lower back into the wall and squat as if you were

going to sit down, with the knees approaching a 90-degree angle. Come back up slowly,

keeping your back and buttocks in contact with the wall.

6. Bridging

Purpose is to alleviate discomfort from decreased intestinal mobility , including gas.

Not only will a strong buttocks help with labor and pushing, it will help support your

lower back, taking some of the pressure off as you work to support a growing belly.

Position :

Lying on your back with knees bent and feets on the floor

Movement technique

1. Start lying on your back.

2. Bend your knees and place your feet flat on the ground a few inches away from

your buttocks.

3. Push into your feet and squeeze your glutes to raise your butt off the ground,

creating a flat plane from your knees to your shoulders.

4. Lower to starting position.

Repeat 10 to 15 times, or see how long you can hold it before fatiguing and aim to beat

your time each rep

38
 Bridging

7. Cat/Cow Stretch

The Cat/Cow Stretch, where you alternately arch and curve your back, is a great stretch

for the end of pregnancy and can also provide relief while laboring. Stretching and

working both the core and back muscles is helpful for supporting your belly and easing

discomfort during labor.

STEPS:

1. Position yourself on your hands and knees.

2. Slowly round your spine towards the ceiling, lowering your head and buttocks.

3. Return to starting position.

4. Gently arch your back, reaching the top or your head and your pelvis upwards.

39
 5. Return to starting position.

Repeat approximately 10 times.

40
 8. Side plank

STEPS:

► Lie on your side, say, left.

► Raise yourself on the (left) forearm. Your shoulder should be directly above the

elbow.

► Keep your shoulders, hips, and knees in alignment.

► Rest your other (right) arm along the side of the body.

► Hold the pose for a few seconds, then come back to starting position.

► Next, turn over to your other (right) side.

41
► Repeat the exercise on your right side.

► Do the routine 10 times for each side.

Benefits: Improves balance and strengthens muscles along the sides

9. Seated Hamstring Stretch

STEPS:

► Sit on the floor with your back straight.

► Extend your leg (right) as straight as possible to the floor, and the other (left) leg

bent with sole of foot touching inner right thigh.

► Hold your outstretched leg with your (right) hand near the ankle and place the

other hand on the floor near the bent leg.

42
► Slowly lean forward from the waist. Keep your chin up.

► Hold the pose for 15 to 30 seconds.

► Repeat the stretch with the other leg.

► Repeat the exercise 2 or 3 times.

Benefits: Stretches hamstrings, prevents low back pain, relieves sciatica.

10. Leg lifts

This strengthens the muscles of your back, buttocks, and stomach.

43
STEPS

1. Get down on your hands and knees. Put your arms directly under your shoulders.

Keep your knees shoulder-width apart.

2. Round your back. Then lift your left knee and gently bring it toward your elbow.

Look at your knee as you raise it. (Stop moving your knee if you feel pressure

in your stomach.)

3. Keeping your knee slightly bent, extend your leg. Lift your leg until you feel a

stretch in your low back. Don't lift your leg higher than your hip.

4. Hold for 5 counts, then lower your left leg. Repeat the exercise with your right

leg.

LOWER LIMBS RELAXATION EXERCISE

• This exercise enhance the flexibility and strength of inner thighs and pelvic muscles

it helps to accustoms to the delivery position and prevent thigh spasm during delivery.

• Sit on table low chair against a wall and spread your thighs side ways . hold for 5

seconds and relax.

44
Note : its is suitable for pregnant women with tight thighs and not suitable for those

with the pain over the pubic bones.

1. Front Squat

Squats might be the number one exercise you can do to prepare for labor. Building

strength and stamina in your legs will help get you through the duration of labor without

getting too tired.

STEPS:

1. Stand with feet slightly wider than hip-width apart, toes facing forward and

knees stacked above toes.

2. Bend at the knees, reaching back with your buttocks as if you were going to sit

in a chair, keeping chest and shoulders upright. If using weights*, hold them at

shoulder height.

45
 3. Return to starting position.

Repeat 10 to 25 times.

*If using weights puts too much pressure on your knees, do them without added weight.

2.Farmer Walk

This is another great one to not only build up strength in your legs for laboring, but also

a good way to do standing core work. A strong core will not only help with pushing,

but supporting your back and growing belly.

46
STEPS :

1. Holding a weight in each hand, extend your arms straight by your sides.

2. Engage your core by pulling your belly towards your spine, then walk forward.

The number of reps you do will depend how much room you have to walk, but aim for

10 to 20 laps across the room, increasing as you feel stronger.

*Start with light weights around 5 pounds and increase as necessary. Feel free to get

creative with what you hold if you don’t have any weights.

3. Lunge

Lunges help build leg and glute strength, which can help support the back and core as

well. Make sure you don’t bend your knees past your toes though, or it could put too

much strain on them. Remember, labor is an endurance event and the more stamina you

have, the easier time you’ll have.

47
STEPS :

1. Start by standing with your feet together, hands on hips (or holding light weights

by your sides).

2. Step forward with the left foot, bending at both knees. Aim to keep knees around

90 degrees, pointing directly over your toes. Make sure you don’t bend your

knees past your toes though, or it could put too much strain on them.

3. Return both feet together then repeat with the right foot extending forward. You

can opt to do the lunges standing in places or walking across the room.

Repeat 10 to 15 times on each leg

4. Sumo Squat

Sumo squats use a wider stance with toes turned out, which leaves more room for your

belly as you squat down and puts less pressure on your knees.

48
 4. Knee Extension

STEPS:

► Sit in a comfortable position.

► Extend your leg parallel to the floor.

► Hold it for 15 to 20 seconds and then bring the leg down.

► Repeat with the other leg.

Benefits: Strengthens quadriceps muscle group.

Knee extension

49
ARM AND SHOULDER EXERCISES

1. Military Press

This exercise does work your arms and shoulders, doing it with proper posture and

alignment will also help build and stabilize your core. Traditional core work like sit-

ups and crunches are discouraged during pregnancy, so this is a good alternative.

STEPS:

1. Stand with feet shoulder-width apart.

2. Hold light weights* by your shoulders.

3. Push weights up until arms straighten, then slowly lower back down. Be sure to

keep your core engaging as you raise the weights.

50
Repeat 10 to 15 times.

*Start with 5 or 10 pound weights, and increase as needed.

2. Thoracic extension exercise

Purpose : To strengthen the arms and back

Position : while sitting in a chair, clasp both arms behind the head.

Movement technique

 Gently arch backward and look up toward the ceiling.

 Repeat 10 times.

 Do this several times a day.

51
 3. Chest Muscle Exercise

STEPS :

► Clasp your hands at chest level.

► Press palms together and hold it for 5 to 10 seconds, all the while breathing

normally. Feel the tightness in the chest.

► Relax your hands.

► Repeat the exercise 10 to 20 times.

Chest Muscle Exercise

 Benefits: Strengthens upper back and chest muscles.

4.Wall Push-Ups

STEPS :

► Stand facing a wall. Keep your knees comfortably apart.

► Lean against the wall with your hands. Your hands should be at the level of

52
 your shoulders and slightly greater in width than your shoulders.

► Slowly bending your elbows and without moving your feet, lower yourself

towards the wall till your chin almost touches the wall. Keep your back straight.

► Push back up until your elbows are straight. Starting position.

► Repeat 15 times.

Benefits: Strengthens arm muscles, relieves back pain, improves balance.

Wall pushups

ANKLE EXERCISE

• Sit on chair with your back against your seat back .

• Start with one ankle and turn foot upwards and downwards. Each up and down is

counted as one time .repeat 10 times

53
• Repeat the ankle to draw inward and outward circle each circular movement counted

as one times

• Repeat the same stem at the other ankle.

• Ankle exercise helps reduce leg swelling and varicose vein thus alleviation the

problems of leg cramps.

1. Foot and leg exercise

The circulation during pregnancy particularly the venous return, is sluggish and this can

lead to problems such as cramps, varicose veins and oedema. To prevent following

exercises can be done.

STEPS :

1. Sit or half lie with legs supported.

2. Bend and stretch the ankles at least 12 times circles both feet at the ankle at least

20 times in each direction.

3. Brace both knees, hold for a count of four, then release. Repeat 12 times.

54
 2.Ankle Pumps and Ankle Circle

Ankle Pumps : STEPS

► Sit in a comfortable position.

► Raise your leg and slowly bring your foot up with toes facing up and then down

with toes towards the floor.

► Repeat the exercise with the other foot.

Ankle Circle

► Slowly circle your foot in a clockwise direction and then anticlockwise.

► Repeat with the other foot.

► Do the routine a number of times and whenever possible.

55
  Benefits: Helps improve circulation and reduces pregnancy related leg

swelling.

STRETCHING EXERCISES FOR PREGNANCY

Stretching exercise make the muscles limber and warm, which can be especially helpful

when you're pregnant. Here are some simple stretches you can perform before or after

exercise:

 Neck rotation:

It is a technique were you relax your neck and shoulders. Drop your head forward.

Slowly rotate your head to your right shoulder, back to the middle, and over the left

shoulder. Complete four, slow rotations in each direction.

56
STEPS :

► Sit or stand in a relaxed position with your hands on the lap.

► Relax your shoulders.

► Slowly move your neck downwards, upwards, and to the sides.

► Gently rotate on both sides

Complete four, slow rotations in each direction.

Benefits: Relaxes neck muscles.

 Shoulder rotation:

Bring your shoulders forward and then rotate them up toward your ears and then back

down. Do four rotations in each direction.

Shoulder rotation

57
  Swim:

Place your arms at your sides. Bring your right arm up and extend your body forward

and twist to the side, as if swimming the crawl stroke. Follow with left arm. Do the

sequence ten times.

 Thigh shift:

Stand with one foot about two feet in front of the other, toes pointed in the same

direction. Lean forward, supporting your weight on the forward thigh. Change sides

and repeat. Do four on each side.

 Leg shake:

Sit with your legs and feet extended. Move the legs up and down in a gentle shaking

motion.

58
 BREATHING EXERCISES

Pregnancy is a natural and ought to be a joyful experience for women. For those who
are not exposed to the normal benefits of breathing exercises will be surprised to know
that some simple breathing techniques can do a great deal in making you feel better.
Pregnancy is a stressful state due to the array of changes that it causes in your system.

Breathing exercises are just about the perfect way in which you can effectively reduce
your stress levels and develop an overall feeling of goodness and health. Regular
breathing exercises during pregnancy can have enormous benefits during the pregnancy
term, during labour and delivery. It may include;

Abdominal breathing

Lower coastal

Apical breathing

Abdominal breathing /Abdominal bracing

This exercise is for a deep muscle that wraps right around the abdomen rather like a

corset. The muscle is called the transversus abdominis. It helps the back muscles protect

your spine against injury and pain.

STEPS:

 Lie on your side with your knees bent comfortably and relax completely.

 Breathe in and as you breathe out try to draw your belly button in towards your

spine.

 If you are doing it correctly you should feel this in the lower part of your

abdomen between your belly button and your pubic bone.

It is also important to do this bracing while you are standing.

59
  Begin gently in the first few days, gradually increasing the strength and length

of the hold.

 Aim to draw in your belly button for a count of 5 – 10 while breathing normally.

Release slowly and relax. Repeat this 4 or more times.

This can be done often during the day.

If you can't feel much try this: As you breathe in expand your ribs as much as possible.

Hold that expansion which you breathe out and draw in your belly button towards your

spine. It may help if you imagine you are trying to do up a pair of tight jeans.

Do this exercise in many different positions such as on hands and knees, when walking

and especially when you are bending and lifting. Aim for one long contraction rather

than many little ones.

60
 Diaphragmatic breathing
Stand upright and keep your feet parallel to each other. Keep your mouth closed and

take a deep breath counting till 10. Place your hands on your chest. However, take care

that you don’t press too hard on your chest.

As you inhale, feel your hand move outwards as your lungs expand. Hold your breath

for a few seconds and then exhale slowly. Take as much time to exhale as you did while

inhaling fresh air.

Pranayama

Yoga has a special place for pranayama, especially for improved breathing. It is an

exercise that allows you to develop natural, controlled deep breathing pattern. We

usually take shallow quick breaths which may not allow our body ample time to utilize

all the oxygen and exhale the carbon dioxide. With pranayama, you focus on developing

awareness of your breathing.

61
Alternate Deep and Shallow Breathing

Get into a comfortable sitting position and relax your body. Then take one deep breath

and exhale slowly, taking the same amount of time in each. Now open your mouth wide

and inhale air from your mouth while simultaneously counting up to five. Repeat the

same cycle at least 20 times. You can perform this simple breathing exercise several

times a day.

Benefits of breathing exercise in pregnancy

These breathing exercises can help you to get the following benefits:

 Better circulation of blood, which is good for you and your growing baby
 Improved flow of oxygen
 Improved detoxification
 Reduced stress and improved relaxation

GUIDELINES FOR EXERCISE DURING PREGNANCY

Don't exercise if...

Aerobic exercise during pregnancy is not safe if you have any of these medical

conditions:

 Significant heart or lung disease

 An incompetent cervix or cerclage

 You are carrying more than one baby and are at risk for premature labor

 Persistent second- or third- trimester bleeding

 Placenta previa past 26 weeks of pregnancy

 Premature labor during your current pregnancy

 Ruptured membranes

 Preeclampsia (pregnancy-induced hypertension)

62
Warning Signs to Stop Exercising and seek medical attension

 Vaginal bleeding

 Dyspnea (difficult or labored breathing) prior to exertion

 Dizziness

 Headache

 Chest pain

 Muscle weakness

 Calf pain or swelling

 Preterm labor

 Decreased fetal movement

 Amniotic fluid leakage

Reason to terminate exercise during pregnancy

 Vaginal bleeding

 Dyspnea prior to exertion

 Dizziness or faintness

 Headache or visual disturbance

 Unexplained abdominal pain

 Muscle weakness

 Swelling of ankles, hands, or face

 Swelling, pain, and redness in the calf of one leg

 Preterm labor, persistent contractions (> 6-8/h)

 Decreased fetal movement

 Significant fatigue or muscle weakness

 Vaginal bleeding

63
  Leakage of amniotic fluid

 Fever

 Elevated heart rate or blood pressure that doesn’t return to normal within 30

minutes after completion of an exercise session.

BARRIERS TO EXERCISE IN PREGNANCY

Despite the well-established benefits of exercise during pregnancy, many women do

not meet the current recommendations for physical activity participation. This is in part

related to the numerous barriers to exercise participation for the pregnant woman. These

barriers include a lack of time, physical discomfort, fatigue and uncertainty about

exercise guidelines and how to exercise safely. Accordingly, it may be beneficial for

the prescription of exercise to include discussion around strategies to overcome many

of these common barriers to exercise during pregnancy.

RISKS OF ANTENATAL EXERCISE

Women should clearly understand that they need of exercising in order to cope up the

stress of pregnancy and the impending delivery process. Hence, moderate physical

exercise is needed in pregnancy not really to stay in shape, but instead to adapt the

changes and demands of the gestation period. But too much of anything is bad.

Excessive physical activities can cause:

 Excessive vaginal bleeding

 Amniotic fluid leakage

 Breathlessness with exertion

 Dizziness

64
  Severe Chest Pain

 Regular painful contractions

 Muscle weakness affects balance and calf pain or swelling

 Women who are bearing twins or triplets with the risk of premature labor should

refrain from heavy exercising.

 The moms-to-be who have been diagnosed with placenta Previa, after 26 weeks

of gestation should avoid any kind of strenuous physical activity.

However witnessing the positive effects of all forms of light exercise, women are

medically suggested to do healthy exercise regularly by the doctors. Under the proper

guidance of the obstetricians and gynaecologists, it is estimated that doing exercises

during pregnancy are highly beneficial in the overall and holistic development of the

mother and the child.

Some Activities that Present High Risk for Pregnant Women – Competitive and/or

High Impact Sports

 Scuba Diving

 Diving

 River rafting

 Horseback Riding

 Snow skiing and snow boarding

 Water skiing

 Skydiving and bungee jumping

 Ice-skating and ice hockey

 Gymnastics

 Rock climbing

65
 Road biking and mountain biking

EXERCISES TO BE AVOIDED IN PREGNANCY

66
OTHER SPECIAL CONSIDERATIONS FOR EXERCISE DURING

PREGNANCY

Additional considerations for the prescription of exercise during pregnancy are

included below. Pregnancy is a period of significant physiological adaptation in a

healthy woman's life, with significant cardiovascular, respiratory, metabolic and

musculoskeletal changes. Many of these changes have implications for exercise

prescription.

67
 Increase in body weight : The increase in body weight as pregnancy progresses is

associated with increased loading at the joints. For this reason, weight-supported

activities such as water-based exercise or stationary cycling may be more comfortable

compared with weight-bearing exercises such as walking in the later stages of

pregnancy.

Change in weight distribution : The altered centre of gravity resulting from the

change in weight distribution as pregnancy progresses may influence balance.

Accordingly, modification of the exercise routine to minimise or avoid fast changes in

direction would be a sensible precaution. For this reason, preference may be given to

straight-line activities such as walking, swimming or stationary cycling.

Increase in ligament laxity : The increase in ligament laxity associated with

pregnancy may have implications for the risk of injury. For this reason, the pregnant

woman should take care with weight-bearing exercise and activities involving frequent

changes in direction (i.e. court sports). Despite a lack of scientific evidence in this area,

it is wise to avoid activities involving jumping. Stretching should always be performed

in a slow and controlled manner.

Decrease in blood pressure : To minimise the risk of dizziness or fainting

associated with a reduction in blood pressure, the pregnant woman should take care to

avoid rapid changes in posture (i.e. from lying or sitting to standing). Exercise should

always be completed with a slow and sustained a cool-down and never stopped

suddenly.

Increase in resting and submaximal heart rate : This has implications for

monitoring of exercise intensity using heart rate, since lower workloads are required to

68
reach pre-pregnancy target heart rates. For this reason, pregnancy-specific heart rate

zones are recommended and best used in combination ratings of perceived exertion.

Increase in metabolic rate : Animal studies suggest that a substantial increase in

core body temperature during embryogenesis is associated with congenital defects.

Despite a lack of evidence in humans, the pregnant woman should take precautions to

avoid exercising in high temperatures and humidity, ensure adequate hydration and

wear loose-fitting clothing.

Enlarged uterus : As the uterus grows with advancing pregnancy, the weight of the

enlarged uterus may obstruct venous return. Therefore, pregnant women in the second

and third trimesters should avoid performing exercises in a supine position for

prolonged periods of time. Instead, relevant exercises may be modified to be conducted

in a sitting or standing posture.

Growing fetus : Although there is no strong scientific evidence regarding the risk of

participation in activities with an inherent risk of falling (i.e. horse-riding, learning to

ski) or impact trauma to the abdomen (i.e. team sport games), common-sense suggests

that these activities may be best avoided, or at least undertaken with awareness and

serious consideration of the potential risks.

Weakened pelvic floor : Activities that involve jumping or bouncing may add extra

load to the pelvic floor muscles and are probably best avoided. Targeted exercises to

strengthen the pelvic floor muscles are recommended.

69
EXERCISE TIPS FOR PREGNANCY

Don't exhaust yourself. You may need to slow down as your pregnancy progresses or

if your maternity team advises you to. If in doubt, consult your maternity team.

As a general rule, you should be able to hold a conversation as you exercise when

pregnant. If you become breathless as you talk, then you're probably exercising too

strenuously.

If you weren't active before you got pregnant, don't suddenly take up strenuous exercise.

If you start an aerobic exercise programme (such as running, swimming, cycling,

walking or aerobics classes), tell the instructor that you're pregnant and begin with no

more than 15 minutes of continuous exercise, three times a week. Increase this

gradually to at least four 30-minute sessions a week.

Remember that exercise doesn't have to be strenuous to be beneficial.

Exercise tips when you're pregnant:

 Always warm up before exercising, and cool down afterwards

 Try to keep active on a daily basis: half an hour of walking each day can be enough,

but if you can't manage that, any amount is better than nothing

 Avoid any strenuous exercise in hot weather

 Drink plenty of water and other fluids

 If you go to exercise classes, make sure your teacher is properly qualified, and knows

that you're pregnant as well as how many weeks pregnant you are

 You might like to try swimming because the water will support your increased

weight. Some local swimming pools provide aquanatal classes with qualified

instructors.

70
  Exercises that have a risk of falling, such as horse riding, downhill skiing, ice hockey,

gymnastics and cycling, should only be done with caution. Falls may risk damage to

the baby

CONTRAINDICATIONS

Exercise during pregnancy is important to improve the pregnancy outcome. Here you

find contraindications to exercise during pregnancy.

Absolute Contraindications to Exercise during Pregnancy

 Hemodynamically significant heart disease

 Restrictive lung disease

 Incompetent cervix

 Multiple gestation at risk for premature labor

 Persistent second or third trimester bleeding

 Placenta previa after 26 weeks of gestation

 Premature labor during the current pregnancy

 Ruptured membranes

 Pre-eclampsia/pregnancy-induced hypertension

Relative Contraindications to Exercise During Pregnancy

 Severe anemia

 Unevaluated maternal cardiac arrhythmia

 Chronic bronchitis

 Poorly controlled type 1 diabetes

 Extreme morbid obesity

71
  Extreme underweight (BMI<12)

 History of extremely sedentary lifestyle

 Intrauterine growth restriction in current pregnancy

 Poorly controlled hypertension

 Orthopedic limitations

 Poorly controlled seizure disorder

 Poorly controlled hyperthyroidism

 Heavy smoker

 Third trimester breech presentation

 Multiple pregnancy (>twins)

IMPORTANCE OF REST AND SLEEP IN PREGNANCY

Sleep, like for all living things, is one of the basic needs of human life. When we cannot

get enough sleep or when we don’t have a certain sleeping routine, this affects our daily

lives. If we go to work in the morning after a sleepless night, we feel tired all day and

72
we cannot work efficiently, or even if we're at home, we have difficulties doing our

daily work.

When sleep is so important for all of us, it is undoubtedly more important for pregnant

women carrying another life in their body. Importantly, the sleep pattern of pregnant

women also affects the development of her baby.

However, sleep patterns are also affected by the biological changes of pregnancy. In

fact, sleep disorders are observed in 78% of pregnant women. Therefore, measures to

ensure regular sleep should be established at the beginning of pregnancy.

Pregnant women need to sleep for at least six hours per day. The possibility of a normal

birth in pregnant women whose sleep pattern is disrupted is reduced by up to four or

five times, according to research.

The effects of sleep to the unborn baby in pregnant women cannot be underestimated.

The biggest indicator of this is the progesterone hormone, which is needed for the

continuity of the pregnancy. During pregnancy, the reason for the increasing need of

sleep, especially in the first three months, is because there is an increased secretion of

progesterone during sleep. This causes excessive sleepiness and a constant feeling of

fatigue during the daytime.

One of the most common problems during pregnancy is a disease known as restless

legs syndrome, that shows signs like numbness, burning, prickling, tingling, pain or

intense desire to move etc., and appears when the leg is fixed in a certain position for a

long time as in sleep or in rest.It is recommend to choose an appropriate sleep position

and ensure you have a comfortable bed to reduce the effects of this problem.

73
Establishing good sleep patterns during pregnancy is highly effective, not only

physically but also psychologically. A good sleep pattern plays an important role in the

preparation for birth, and protects the baby from the psychological stresses and strains

of pregnancy.It is important to take adequate rest and sleep during exercise.

WORK IN PREGNANCY

General Exercise

 It is best to avoid high impact activity and contact sport for the first 3-6 months

because your ligaments are softer than normal.

 Low impact activity such as brisker walking and swimming can be started when

you feel comfortable.

Bending and lifting

Brace your lower abdominal muscles by drawing in your belly button whenever

bending and lifting. Bend from your hips and knees keeping your back flat.

Hold the object close to your body and lift by straightening your legs.

Make it a habit to brace your lower abdominal muscles before and during bending and

lifting. Contract your pelvic floor muscles at the same time.

It is recommended that you do not lift anything heavier than your baby in the first 4-6

weeks, but since you will have to do this sometimes remember to be careful and do

these bracing exercises when you do need to lift something heavy.

74
Travel

As long as there are no identified complications or concerns with your pregnancy, it is

generally safe to travel at all times during your pregnancy. The ideal time to travel

during pregnancy is the second trimester. In most cases, you are past the morning

sickness of the first trimester and several weeks from the third stage of pregnancy when

you are more easily fatigued.

Traveling by Air During Pregnancy

Whether you are going by car, bus, or train, it is generally safe to travel while you are

pregnant; however, there are some things to consider that could make your trip safer

and more comfortable.

 It is essential to buckle-up every time you ride in a car. Make sure that you use

both the lap and shoulder belts for the best protection of you and your baby.

 Keep the air bags turned on. The safety benefits of the air bag outweigh any

potential risk to you and your baby.

 Buses tend to have narrow aisles and small restrooms. This mode of

transportation can be more challenging. The safest thing is to remain seated

while the bus is moving. If you must use the restroom, make sure to hold on to

the rail or seats to keep your balance.

 Trains usually have more room to navigate and walk. The restrooms are usually

small. It is essential to hold on to rails or seat backs while the train is moving.

 Try to limit the amount of time you are cooped up in the car, bus, or train. Keep

travel time around five to six hours.

 Use rest stops to take short walks and to do stretches to keep the

blood circulating.

75
RESEARCH STUDIES

1. The effect of exercise on the intensity of low back pain in pregnant women
A. Garshasbi S. Faghih Zadeh First published: 16 January 2005
https://doi.org/10.1016/j.ijgo.2004.12.001

Result

Low back pain intensity was increased in the control group. The exercise group showed
significant reduction in the intensity of low back pain after exercise (p<0.0001).
Flexibility of spine decreased more in the exercise group (p<0.0001). Weight gain
during pregnancy, pregnancy length and neonatal weight were not different between
the two groups.

Conclusion

Exercise during second half of the pregnancy significantly reduced the intensity of low
back pain, had no detectable effect on Lordosis and had significant effect on flexibility
of spine.

2. Aerobic exercise for women during pregnancy. (PMID:16855953) Kramer MS,

McDonald SW The Cochrane Database of Systematic Reviews [19 Jul
2006(3):CD000180] Type: Meta-Analysis, Review, Journal Article DOI:

10.1002/14651858.CD000180.pub2

Abstract

BACKGROUND: Physiological responses of the fetus (especially increase in heart

rate) to single, brief bouts of maternal exercise have been documented frequently. Many
pregnant women wish to engage in aerobic exercise during pregnancy but are concerned
about possible adverse effects on the outcome of pregnancy. OBJECTIVES: The
objective of this review was to assess the effects of advising healthy pregnant women
to engage in regular aerobic exercise (at least two to three times per week), or to
increase or reduce the intensity, duration, or frequency of such exercise, on physical

76
fitness, the course of labour and delivery, and the outcome of pregnancy. SEARCH
STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials
Register (June 2005), MEDLINE (1966 to 2005 January Week 1), EMBASE (1980 to
2005 January Week 1), Conference Papers Index (earliest to 2005 January Week 1),
contacted researchers in the field and searched reference lists of retrieved articles.
SELECTION CRITERIA: Acceptably controlled trials of prescribed exercise programs
in healthy pregnant women. DATA COLLECTION AND ANALYSIS: Both review
authors independently assessed trial quality and extracted data. Study authors were
contacted for additional information. MAIN RESULTS: Eleven trials involving 472
women were included. The trials were small and not of high methodologic quality. Five
trials reported significant improvement in physical fitness in the exercise group,
although inconsistencies in summary statistics and measures used to assess fitness
prevented quantitative pooling of results. Seven trials reported on pregnancy outcomes.
A pooled increased risk of preterm birth (relative risk 1.82, 95% confidence interval
(CI) 0.35 to 9.57) with exercise, albeit statistically nonsignificant, does not cohere with
the absence of effect on mean gestational age (weighted mean difference +0.3, 95% CI
-0.2 to +0.9 weeks), while the results bearing on growth of the fetus are inconsistent.
One small trial reported that physically fit women who increased the duration of
exercise bouts in early pregnancy and then reduced that duration in later pregnancy
gave birth to larger infants with larger placentas. AUTHORS' CONCLUSIONS:
Regular aerobic exercise during pregnancy appears to improve (or maintain) physical
fitness. Available data are insufficient to infer important risks or benefits for the mother
or infant. Larger and better trials are needed before confident recommendations can be
made about the benefits and risk of aerobic exercise in pregnancy

3. Exercise during pregnancy and the postpartum period ACOG technical bulletin
number 189 — February 1994 The American College of Obstetricians and
Gynecologists First published: April 1994 https://doi.org/10.1016/0020-
7292(94)90773-0

Abstract

In the absence of either obstetric or medical complications, pregnant women can

continue to exercise and derive related benefits. Women who have achieved
cardiovascular fitness prior to pregnancy should be able to safely maintain that level of

77
fitness throughout pregnancy and the postpartum period. Depending on the individual's
needs and the physiologic changes associated with pregnancy, women may have to
modify their specific exercise regimens. Despite findings that suggest lower birth
weights among offspring of women who continue to exercise vigorously throughout
pregnancy, there currently are no data to confirm that, with the specific exceptions
mentioned here, exercise during pregnancy has any deleterious effects on the fetus.
While maternal fitness and sense of well‐being may be enhanced by exercise, no level
of exercise during pregnancy has been conclusively demonstrated to be beneficial in
improving perinatal outcome.

Regular exercise has many well-established benefits for women with uncomplicated

pregnancy. These include physical benefits for maternal fitness and the prevention of

excessive weight gain, as well as psychological benefits related to body image,

perceived health status and reduced symptoms of depression.1-5 Regular exercise

during pregnancy has also been associated with shorter and less complicated labour, as

well as fewer neonatal complications, although the evidence is not conclusive. There is

also indication of potential benefits of regular exercise for the prevention and

management of maternal-fetal diseases such as gestational diabetes and pre-eclampsia.

However, this preliminary evidence is primarily based on

observational/epidemiological studies, while randomised controlled trials are limited,

or do not provide strong evidence to support at this stage. Regarding the offspring,

animal studies have demonstrated benefits of maternal exercise for glucose tolerance,

insulin sensitivity and body composition in offspring, but studies in humans are limited

to some preliminary evidence for beneficial effects of maternal exercise on infant

cardiac autonomic control.

Importantly, there is no evidence to suggest that regular exercise during an

uncomplicated pregnancy is detrimental to the woman or fetus. Accordingly, all women

with uncomplicated pregnancy should be encouraged to participate in aerobic and

78
strength conditioning exercise. This is of concern given the potential impact on the

future health of both the woman and her unborn child.

CONCLUSION

Womens who were most active prior to pregnancy reduced their exercise level but

continued to be the most active during pregnancy as to overcoming the problems of

getting risk the antenatal exercises most powerful to the pregnant womens might

benefits from intensified antenatal advice concerning physical activity during

pregnancy through this the womens will entirely resolve the future occurrence risk.

REFERENCE

1. Myles. Text Book For Midwives,.14th Edition. Page no: - 231-240

2. K.Park ,Text book of Preventive and social medicine ,18th edition ,Page no

386

3. http://www. Baby and pregnance .co.uk /pelvic Floor And other Antenatal

exercise .htm/

4. Ann E Heffernan ,”Exercises and pregnance in primary care ,”The Nurse

PRACTIONER,” VOL 25 ,2000 PAGE NO 42.

5. http://www.evybaby.com/en-eg/moms-land/articles/2015/october/the-

importance-of-sleep-during-pregnancy

6. Garshasbi A, Faghih Zadeh S. The effect of exercise on the intensity of low

back pain in pregnant women. International Journal of Gynecology &

Obstetrics. 2005 Mar 1;88(3):271-5.

7. Haakstad LA, Bø K. Exercise in pregnant women and birth weight: a

randomized controlled trial. BMC pregnancy and childbirth. 2011

Dec;11(1):66.

79
8. Kramer MS, McDonald SW. Aerobic exercise for women during pregnancy.

9. American College of Obstetricians and Gynecologists. Exercise during

pregnancy and the postpartum period: ACOG technical bulletin number

189—February 1994. International Journal of Gynecology & Obstetrics. 1994

Apr;45(1):65-70.

80