CHAPTER I EXPLANATION

Many experts recommend exercise during pregnancy, because it can overcome back pain, prevents constipation, keeps the body fit, help the labor process faster and easier, and makes the mother recovered quickly the days of childbirth. In 1985, ACOG decided that the benefits of regular exercise exceed the risks if performed by healthy women with normal pregnancies. Regular exercise during pregnancy is apparently beneficial for mother and fetus. However, this type of exercise performed, duration, intensity and frequency remain to be addressed.

A. PHYSIOLOGICAL RESPONSE OF PREGNANT WOMEN

Physiological responses of pregnant women during exercise Response Mother Maternal physiological responses to exercise may be modified as safe as possible for her pregnancy. In addition, the exercise brings many benefits to the bodys physiological function of adaptation to pregnancy and eliminates complaints that arise. So regularly exercises during pregnancy to be physiologically protective for the mother and fetus. In early pregnancy, vascular reactivity decreased drastically, which in turn causes a decrease in venous blood flow and blood volume functional. Thus, hypotension and tachycardia are common responses that will happen against hemodynamic stress during early pregnancy. Exercise during pregnancy increases cardiac output and splanknikus, kidney, uterus and skin. Blood flow increased, while blood pressure and total peripheral resistance decreased. Regular exercises can also remodeling of the blood vessels in the uterine circulation which increases the size of the placenta and also increase uterine blood flow.

Metabolic Pregnancy is a process of growth that increases the consumption of oxygen and glucose utilization and gluconeogenesis and also decreased insulin sensitivity. It can trouble the balance of maternal substrate utilization toward lipid oxidation, which increases the availability of carbohydrate to fill energy needs of the fetus and placenta. The amount of the increase is matching with increasing gestational age. Exercise also increases oxygen consumption and glucose utilization. Meanwhile, with increased secretion of insulin can

causes an increase in sympathetic nerve function and gluconeogenesis. The combined impact of exercise and pregnancy change glucose response to exercise from the hyperglycemic to hypoglycemia. Thus nutrition is an important consideration for pregnant women who actively exercise, such as the type and amount of nutrient intake during and immediately after the training session. Indeed, regular exercises during pregnancy reduce the level of TNF, it shows that it increases insulin sensitivity.

Muscles, ligaments and bones The combination of increased maternal weight, abdominal muscles are bigger, can cause the load to hold the weight is greater. Bone turnover increased, but bone density has not changed and the influence of pregnancy on the addition of muscle mass is unknown. In pregnant women, these changes make physical activity more difficult, often uncomfortable and associated with high incidence of low back pain. Pregnant women who exercise regularly will be more able to cope with these complaints.

Response fetus and placenta Response decreased uterine blood flow did not last long immediately after exercise. And if exercise is intense enough for more than 10 minutes, the fetal heart rate is always increasing. This is a manifestation of sympathetic responses to a small decrease in fetal PO2 and increased heart rate that is directly related to the intensity and duration of exercise and muscle mass used. Another component is the increase in fetal cardiac output which will maintain adequate tissue oxygenation in the brain, heart, adrenal and placenta. Regular exercise increases the blood volume of the mother and fetus, placenta and surface area are expected to improve the function of placental transfer of 20% or more. Exercise regularly during pregnancy increase maternal blood volume and cardiac output. This will reduce the magnitude of reduction in uterine blood flow, blood flow more into the muscle. The incidence of meconium amniotic fluid is actually decreased in fetuses born by women who exercise regularly, until the birth, fetal cord blood and amniotic fluid erythropoietin levels are not increased. Both findings indicate that untreated fetal tissue oxygenation during exercise in late pregnancy. Finally, the fetus born by healthy women who exercise regularly and motor development relative superiority in various domains during the first 5 years of life.

Research shows that the effect of regular exercise on fetal-placental growth varies depending on the frequency of types of duration, and intensity of exercise, the total volume of exercise done at different times during pregnancy and the intake of carbohydrates.

B. GUIDELINES FOR EXERCISE DURING PREGNANCY

In doing exercise during pregnancy, we must consider some guidelines below: Before Sports: It is approved and recommended by obstetricians. Avoid exercise in extremely hot weather. Avoid rocky soil that is unstable when walking or cycling. Joints become more lax in pregnancy and ankle sprains and other injuries can occur. Use a bra that supports and shoes that fit for you that makes you feel comfortable and certainly safer. Hard sport should be avoided during pregnancy. Eat complete, such as rice and side dishes, must be made 2 hours before exercise. Eat a snack and drink fruit juice is still should be at least 30 minutes before. Regular exercise should be recommended as part of prenatal care and must begin in the first trimester. If a pregnant woman has followed a regular exercise program before pregnancy, pregnant women should be able to maintain that program for some time during pregnancy. Exercise does not increase the risk of miscarriage. If a pregnant woman is just starting an exercise program as a way of improving health during pregnancy, should start very slowly and be careful and should not impose ourselves. Exercise must be ongoing and performed at the level of mild or moderate. Reduce the time you do regular exercise to 3 times a week about 15-20 minutes. Do not exercise until fatigue or shortness of breath. This is a sign that the baby and the mother's body can not get the needed oxygen supply. During the second and third trimesters, avoid exercise that a lot of movement on his back because it reduces blood flow to the uterus. Warm up and stretch. For example, walk 5-7 minutes, then do simple stretching movements (either while standing or sitting). During Exercise Drink taste every 15 minutes, especially if exercising outdoors. It aims to help the body temperature regulation and reduce the risk of dehydration.

 Listen to the signal given body. Because the heart rate of pregnant women during pregnancy increased about 20%. If pregnant women feel tired, so have to rest. Do not force yourself. Concentrate on the muscles that will be used in childbirth, such as legs, abdomen, and pelvis. After exercise Perform cooling and stretching. It may also be continued with the floor exercise or stretching while sitting or lying down. Do not be a complete meal for 2 hours after exercise to avoid indigestion. After exercise, the body needs time to restore the blood of large muscles are active during exercise - to the organs of the body that play a role in digestion. Exercise must be reviewed and modified if clinical cause a pain or injury. WARNING!! Stop exercising and call your doctor, when experiencing the things below: Sick, whatever it is; Vaginal bleeding; Dizziness, lightheadedness; Difficulty breathing; Severe shortness of breath; Palpitations; Uterine contractions; Headaches. The condition of pregnancy that makes you have to be more vigilant exercise: Have several miscarriages; Prior to premature delivery, or currently are at risk of giving birth prematurely; IUGR (intra uterine growth Retardation) infants did not develop as expected; Abnormalities of placental location (placenta previa); Bleeding; Experience around the hip joint disorders; Suffering a heart condition, lung, thyroid, etc.; Suffering high blood pressure; Twins pregnancy.

C. THE SAFE EXERCISE DURING PREGNANCY

There are examples Sport, which can be done by pregnant women is Walking and Static Cycling. Other sports are encouraged, including swimming, light aerobics and now the ANC in several hospitals usually provide Gymnastics Pregnant Women. 1. Walking Walking is one of the best cardio exercises, safest and easiest during pregnancy. Though it appears simple, this sport incredible benefits. Walking while moving both hands in rhythm with the movement of feet, will facilitate the circulation of blood throughout the body. This can be done around the house, on the treadmill or around the office during lunch. With walking, it will increase energy and endurance without doing a lot of pressure on your ankles or knees. There are some tips in doing this simple exercise, including: a. Use of sports shoes that fit comfortably in the leg when walking for b. Choose a grassy area. Stay away from rocky road or slippery roads that make you tense and tired even to walk, even can make you slip. c. Rest when tired. 2. Bicycle Pregnancy does not mean that pregnant women stop to do sports. Indeed low-intensity exercise is recommended so that pregnant women and fetuses in the womb stay healthy and fit. One sport that safely performed during pregnancy is cycling. This sport can be done if the pregnancy is not high risk. Although this type of exercise tends to be relaxed and not too strenuous and better if pregnant women consider the following tips so that activities are carried out remain safe cycling. a. Check the condition of the bike Make sure everything is safe and conditions bike in good condition to minimize the risk of accidents. Make sure the brakes work properly, enough tire pressure and not leaking, as well as bald tires yet to still be gripped properly. b. Stretching and warm up before cycling. Quite five minutes just by moving the head, neck, shoulders, chest, hands, thigh and leg muscles for the body is not rigid. c. Replace saddle is wider Its for the buttocks are not fast pain, and blood flow is not blocked due to heavy pressure of the body.

d. Cycling in the morning Better cycling at around 07:00 to 09:00 when the sun is not too hot to avoid dehydration from the heat. In addition, ultraviolet light B is still good for bone health and vitamin D synthesis is needed so that the fetus does not need sunscreen. e. Much to drink Drink plenty of body heat to expedite expenditure due to increased activity of the muscles of the body. When the body heat was not immediately released, then it can cause congenital abnormalities in the nervous system and spinal system of the fetus, especially during the first trimester. f. Add a portion to eat after cycling When cycling, calories that are used around 150-200 calories. While the weight pregnant women should increase, so need to replace the lost calories from cycling. Also note also some things that should be avoided by pregnant women during cycling: a. Cycling in the afternoon Because usually we were tired of doing various activities and feet tend to swell due to the move all day. b. Too bowed when cycling Because it can increase the risk of lower bone pain and loss of balance because the body's center of gravity too far to the front. Instead, just leaning back about 15-30 degrees. c. Cycling on the road is uneven or potholed Can trigger contractions and increase the risk of accidents. d. Cycling on the road uphill Causing a greater burden leg to make more rapid fatigue, heavy breathing, and pulse and blood pressure rises rapidly. e. Eat when cycling Although it only just snack. Should eat a snack about 30 minutes before cycling and a big meal about an hour after cycling. f. Listen to music through headphones This makes it less wary. Immediately stop cycling if complaints arise, such as dizziness, palpitations, shortness of breath, or there is pain in the back and hips. In addition, also stop in case of stomach contractions. Exercise increases stress hormones that can trigger contractions. If 30 minutes after stopping exercise, still having contractions, see a doctor.

If you pay attention to the things above, undoubtedly pregnant women can bike safely relaxed. 3. Yoga Yoga is one of the arts of body movement and breathing that comes from India. Yoga can be done by anyone, including a pregnant woman. Pregnancy yoga can be done starting from the beginning of pregnancy, as long as the mother did not experience high-risk pregnancy complications. Yoga is done routinely 2 times per week 1 hour dive. Some of the benefits of yoga for pregnant women, namely: Able to build awareness of their bodies during pregnancy Assist physical preparation to face the process of giving birth It can improve strength, flexibility and health of the entire body. It is good to improve body flexibility Supports the normal birth Tighten the muscles in the pelvis and uterus, so as to reduce hip pain and reduce pain and soreness in the area of womanhood. Train other muscles that can reduce pain and fatigue are often experienced by pregnant women. For example, back and leg pain, cramps or muscle aches, and swelling due to fluid buildup. Reduces bruising around the joint Improves blood circulation Therapeutic technique. Techniques in this yoga can help relax the regulation of breath that can reduce pain, life is calmer, so that more stable emotional state. Influence of yoga may not only be felt in the mother. Stretching the mother's body can give the effect of massage for infants. During yoga, waking emotional relationship between mother and the baby she is carrying. Pregnant yoga not only make healthy fetus, but also to feel relaxed and comfortable. Before starting to practice yoga, consult your gynecologist and expert on yoga, whatever movements may be performed. Here are some movements that can be practiced yoga for pregnant women. Baddha Konasana This movement accustomed waist and groin muscles. Take a sitting cross-legged position fingertip grasp your legs. Enforce spine.

 Pigeon (Eka In Rajakapotasana) This movement stretches the thigh muscles, groin, and back. From the cross-legged position straighten your left leg back, let the right foot remains on the front. Bend body forward a bit. Let your body weight rests on the right foot. Warrior II - (Virabhadrasana II) This movement strengthens the arm muscles, legs, and abdomen. From a standing position, bend your right leg forward. Straighten your left leg backward. Align the right hand forward and your left hand back with an open palm position. In doing pregnancy yoga movement, indeed there is little difference with regular yoga movements, such as not to rotary motion, jumping, kicking or kayang especially after age 20 weeks. Also of note is in the pregnancy, an important factor to support the relaxation of pregnant women is also with the emotional involvement of the husband. Ask your husband to be more thoughtful, more caring, and more empathetic when the wife is undergoing pregnancy. Support your husband is a very important thing. 4. Swim The swimming pool can make the body feels light, relaxed and felt cold. Swimming is actually kind of high impact exercise, but it is safe for pregnant women. Movement swim move every muscle in your body, making it more flexible and powerful. Swim regularly two to four times per week. Do about 30 minutes. Chest Style Includes base in swimming, do not need a lot of energy and excessive movement at the waist and abdomen. Do it slowly. Be careful when doing kicking leg movement, do not pulled or too strong kick to the back. Launch breaststroke make you a streamlined body position (straight on the water surface). This ease the tension in the back caused by enlarged abdomen. Take a breath when lifting his head then exhale while gliding in the water, helping to train future breathing during childbirth. Movement rhythmic leg blood circulation and reduce leg swelling caused by substandard blood circulation.

 Movement paddling arms, hands and flexing bicep muscles are stiff. Freestyle Safe, because his movements slow and does not require excessive force at the waist and abdomen. Movement adjustable leg strength, do not be too snapped or too fast. Movement of the hand that plays one by one turn, help strengthens the hand muscles, shoulders, and back, so you are prepared to handle the added weight of his body. Breath settings are also very helping train the breathing, to be ready to deal with normal deliveries. Backstroke Not recommended if you have not mastered the technique. Do in mid-trimester 2 to trimester 3, to cope abdominal weight gain influence on other body parts. Supine position above the water, make your body relax. Movement of the hand turns around to the back, train the muscles in around weak hands, shoulders, and back. Movement foot adjusted for ability, not too fast and did not use excessive force. Backstroke leg movement as freestyle. Avoid Butterfly Style For many workers use a snap waist and hip area. Also a lot of draining the abdominal muscles when lifting the body to take a breath. The whole movement is feared result is less good for the fetus. 5. Pregnancy Exercise Gymnastics pregnant women have a different movement in each trimester. This exercise can be done in a closed room or open. Wherever the place, choose a comfortable place. Perform gymnastic exercises, accompanied by trainers who understand specifically for pregnant women. There are a few tips that need to be considered by pregnant women, namely: a. Note the air circulation during exercise indoors. Do not get too much air into or otherwise feel stuffy. The room should be spacious enough and quiet. b. Note the current climate of outdoor exercise. Avoid cold or hot sun that would make a pregnant woman feel uncomfortable.

c. Use gymnastics clothing and comfortable shoes (not narrow or allowances) for the movement was not inhibited. Important things to do Gymnastics Prior to follow pregnancy exercise classes, there are a number of things to note: Approval Doctor Ask your doctor's approval prior to follow pregnancy exercise class or performing gymnastics own. Because if pregnancies have abnormalities, such as placenta previa, not be recommended for gymnastics. Gymnastics By Instructor Follow pregnancy exercise class provided the hospital with a certified gymnastics instructor pregnant if you have not known the movements. This is very useful when doing gymnastics at home. Just Practicing Do exercises at least once a week. But do not push yourself. Warm up before starting an exercise and do physical exercises to finish cooling. Immediately stop if you feel tired. Rise slowly. Stop the exercise and consult your instructor or your doctor in case of strange signs on your pregnancy. Gymnastics Apparel Wear appropriate clothing, not too tight nor too loose to facilitate movement. So is the place to physical exercises, use a soft pad. Food Food consumption was sufficient calories for extra energy needed during pregnancy and for the purposes of gymnastics. Preparation prior to implementing pregnancy exercise 1. Place The place with adequate ventilation Endeavored surrounded by mirrors Paint the room with soft-colored paint 2. Tool Tape Mattress or mat Pillows Classical music

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Steps in implementing the pregnancy exercise 1. Prepare tools and materials that will be used 2. Breathe

Benefits: for relaxation, and blood circulation.

a. With mouth closed, take a deep breath and blow the breath with a soft, is also quite relaxed and let your stomach wall ride with breathing and fell in blow of breath. b. With mouth closed, breathing slowly - land to shift the ribs laterally, opening the letters in front of the inverted V formed by the ribs. c. With mouth slightly open, breathe faster, which lift the breastbone let him down again. Do as much as 3-5 times. 3. Shakes his head to the right and left 8x.

Benefits: warm-up before carrying out exercises, to make flexible the muscles.

4. Then bend your head to the right and left 8x.

Benefits: warm-up before carrying out exercises, to make flexible the muscles.

5. Then punch the head and lift his head as he took a breath and then exhale. Do as much as 35 times.

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Benefits: for relaxation, and blood circulation.

6. Do move your hands clamped and Capture both breasts with his elbow, do this move by turning the arm. Perform this movement as much as 8 times.

Benefits: tighten the breast muscles.

7. Inhale and exhale through the mouth as much as 3-5 times. Perform movements with the position tilted to the left and right.

Benefits: for relaxation, and blood circulation.

8. Raise legs above hip height, then lower. Lift the back leg up, bend toward the belly with a lower leg alignment, straighten and return to its original position. Repeat the move with the position of vice versa, respectively - each 8 times.

9. Do move your legs like riding a bicycle. Mother is still in a lying position. Repeat the move as much as 8 times.

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Benefits: to improve preparedness and improve muscle tone deal with pregnancy, and parturition.

10. Lift your buttocks a little up, with arms fixed on the floor and legs straight, hold this position for several seconds, then return to starting position while exhalation. Do the move as much as 8 times.

Benefits: naturally tighten the abdominal girdle, to maintain the stability of the pelvis and prevent and relieve back pain.

11. Mother on his side and hand in the abdomen, raise your leg slightly and pull closer to the abdomen and move back away from the stomach. Repeat the move as much as 8 times.

Benefits: to improve the readiness and pussy muscle to face delivery.

12. Mother returned supine. Now lift both legs close to the stomach, keep the hands under the curve of her knees as she took a breath and raised his head, look to the abdomen and then exhale the breath. Repeat the move as much as 8 times.

Benefits: The practice pushing in the face of labor.

13. Mother lying down with the dorsal recumbent position. The hand holds the ankle, and lifted his head, mothers view to the stomach then exhale. Repeat the move as much as 3-4 times at intervals of 2 minutes.

Benefits: The practice pushing in the face of labor.

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14. Mother with the crawl on hands and knees, open legs, lift his back and punch his head as he took a breath. Hold a few seconds, and then return to starting position. Repeat the move 8 times.

15. Mother are instructed to do knee-chest style. Where the chest and knee are touch to the floor. Slide the elbow as far as possible from the body to the side. Hold for 50-10 seconds.

Benefits: This move is anti-breech.

D. BENEFITS OF EXERCISE DURING PREGNANCY

The main benefits of regular exercise during pregnancy is that it can increase the normal physiological adaptation to pregnancy and increase the sense of wellbeing, increased productivity, reduced complaints and discomfort that occurs in pregnancy in general, decreased incidence of situational depression both during and after pregnancy, and fitness increases and a shorter recovery time after childbirth. For the incidence of fetal incidence of fetal distress were diagnosed before or during labor would fall, the growth rate of fat organs that lasted for the first 5 years of life will decline and behavioral profile that is superior to cognitive development. And when combined with diet, the impact on fetal and placental growth can be evaluated. Preliminary research suggests that regular exercise in pregnant women who are healthy is useful in the prevention and treatment of diabetes mellitus in pregnancy and prevention of pregnancy induced hypertension and premature labor.

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