Category: Women health

Most pregnant women can and should keep exercising during the third trimester (with physician approval). With a naturally reduced venous return during the third trimester, it’s very important for a pregnant woman to keep moving to help stave off edema (commonly found in her ankles). This focus on maintaining movement may also lead to a slightly lower birth weight. Stopping exercise in late pregnancy tends to produce a larger baby who has more body fat. A woman in the latter half of her pregnancy will generally require adjustments to her training program based on the unique changes she is experiencing. Here are two specific considerations:

Postural Deviations

From the beginning of a woman’s pregnancy, the hormone relaxin (which causes ligamentous laxity) has been flowing through her body, allowing for essential skeletal shifts that allow for the baby’s growth. However, the presence of relaxin can also lead to exaggerated shifts as a woman moves through her third trimester. The increased weight she is likely carrying can cause an anterior pelvic tilt (lordosis), which may lead to prominent low-back pain. The anterior weight shift also occurs at the breasts throughout pregnancy, profoundly more so in the third trimester. This pull adds to increased kyphosis at the cervical and thoracic spine. Kyphosis pulls her out of a neutral spinal position, which may lead to neck and upper-back pain, as well as diminished power and range of motion when she is operating out of proper posture.

Mindset

As a woman transitions into the later portion of her pregnancy, her mindset often becomes less focused on her own fitness and more on her upcoming labor and delivery. All of a sudden, she’s is much larger than she wants to be, is tired of being kicked by the baby, doesn’t sleep well and wonders if the baby is healthy and what labor and delivery will be like. As a result, her attention turns away from herself to prepare for the labor, the birth and the new baby.

According to the American Congress of Obstetricians and Gynecologists, “…more than 60% of all pregnant women experience low back pain. Strengthening of abdominal and back muscles could minimize this risk”. With the forward shifting of weight as a baby grows, the strength of a pregnant woman’s core musculature is critical to maintaining a neutral spine, and ultimately, helping to decrease muscle fatigue and pain. Without good trunk strength, the weight of the growing baby can pull the pelvis forward, causing a sway back (lordosis). This prolonged position can lead to a very uncomfortable malalignment in the spine. Increasing core strength during pregnancy will aid in getting the pelvis back into a neutral position. In addition to aerobic activity, prenatal core exercises are recommended.

Training program should:

1. Focus on improving core strength. As previously mentioned, most women experience an anterior weight shift during the third trimester, which makes core strength essential for helping to pull the pelvis back into neutral. Focusing on strengthening your pregnant client’s three-dimensional core musculature will also help to keep her lumbo-pelvic complex from making shifts, as well. These shifts can lead to pain at the sacroiliac joint and the pubic symphysis.
2. Reengage the posterior muscular chain. During pregnancy, the muscles of a woman’s upper back (mid/lower trapezius and rhomboids) become weakened and elongated, while the muscles of the low back (erector spinae) shorten and tighten in lordosis. Finally, the glutes tend to “shut off,” which means she must rely more heavily on her quadriceps. This disengagement of the glutes also leads to unwanted shifts at the pelvis. Reengaging the posterior chain requires exercises that focus on strengthening the glutes.
3. Enhance pelvic floor strength (and elasticity). Going into the third trimester, the weight of the baby in utero can drop the pelvic floor up to an inch. Kegel exercises to strengthen the pelvic floor are recommended throughout pregnancy and especially during the third trimester as the pressure is the greatest during this time.

Sources:

“Specific Considerations and Exercises for Late-term Pregnancy”, Farel Hruska, national fitness director of FIT4MOM

1^st Trimester: 0-12 weeks

• Pressure on the bladder may make the woman have to urinate more frequently
• There may be a change in waist girth or some weight gain
• Breast become tender making prone exercises uncomfortable
• Blood pressure may decrease

2^nd Trimester: 13-26 weeks

• Nausea is gone, and the pregnancy is visible
• Very important to avoid supine positions – Supine Hypotensive Syndrome is a risk
• May experience occasional headaches, and aching in the abdominal area due to ligaments stretching
• May feel itchy around the abdomen
• May have swelling in ankles and feet
• Skin changes, darkening of nipples, linea alba, patchy skin, red palms, and facial blotching.
• Heartburn, flatulence, bloating
• Brain lapse, scatterbrain syndrome
• By the end of the 2^nd trimester the baby is about the size of a basketball, has fascial hair and fingernails, may get hiccups and loves to play a good game of tackle football in the belly.
• The greatest changes in pelvic mobility/ lack of stability are from the 20-27 week period. Therefore a focus on stability in neutral is important.
• The centre of gravity is most altered during this stage so a focus on stability is essential. Watch balance exercises, do not do repetitive standing exercises which will be too overwhelming.
• Change positions frequently – avoid spending more than 2 minutes or so in one position. A pregnant woman at this stage will be constantly moving around to find a comfortable position, especially with an active fetus.
• No long levers, or open chain exercises
• No inversions
• Keep ankles mobile to help with circulation of lower extremities
• Weight-bearing exercises may be challenging depending on the size of the belly. Be careful with unilateral standing, it may cause stress in the sacroiliac joints.

3^rd Trimester: 27-40 weeks

• The uterus is now positioned under the rib cage and may contribute to heartburn and shortness of breath.
• Braxton Hicks, otherwise known as “practice contractions”, are a normal occurrence. It’s the bodies way of readying itself for what’s to come. Keep note that when they occur, it is recommended to stop exercising until the contractions subside.
• Body may become achy, especially in the pelvis and buttocks.
• Frequent urination/urinary tract infections are common
• Blood pressure may rise, if so, careful monitoring is essential.
• Constipation, varicose veins, due to increased blood volume plus the arteries and veins are more relaxed due to hormones.
• Edema, or ankle swelling, very common, again due to increased blood volume.
• Breast may become extremely sore and leaky.
• Legs may cramp
• Low energy levels due to low hemoglobin levels and difficulty sleeping
• Do 2 30-min sessions per week rather than one 60-min shorter duration but same frequency
• Very important to avoid supine positions, Supine Hypotensive Syndrome is a risk.
• Side-lying exercises are extremely comfortable and advisable
• Use pillow to support belly
• 4 point kneeling helps to release tension
• Squats are great for circulation and to prepare the pelvis for birth
• Continue with ankle and foot exercises to increase mobility of ankles and increase circulation
• Focus on breath to control movements and aid in stress reduction

 

Sources:

STOTT Pilates Prenatal Matwork Workshop

>>> Part 4. Training in the Third Trimester

The changes a pregnant woman will be experiencing include joint hypermobility, increased mechanical stress on the joints, hyperlordosis, and compression of the pudental nerve caused by the change in pelvic positioning. A few other important considerations: Over the course of pregnancy, blood volume increases by 40%–50%, stroke volume rises by 10% and heart rate goes up by 20%.

Post Partum or Puerperium: commences immediately after birth to approximately 6 weeks (the time in which the woman’s body, including hormone levels and uterus size returns to prepregnancy conditions.) Varies from one woman to the next and is influenced by whether she breast feeds or not.

Lungs and respiration: The respiratory rate naturally increase in pregnancy. The diaphragm is elevated due to the changes in the rib cage placement; which may increase oxygen consumption by 15-20%. This increase makes the body work harder to deliver appropriate levels of oxygen to the developing fetus, which in turn alters the availability of oxygen to the woman for exercise, resulting in a decrease in endurance and a sense of breathlessness.

Joints: Hormonal changes contribute to joint laxity which can result in injury or weakness of soft tissue. The ligaments of the lower back and sacral area are most affected. The primary hormone of pregnancy is Relaxin which will affect collagen metabolism and connective tissue. Hormonal changes begin to occur in the first trimester and become more apparent as the pregnancy progresses. Ligament laxity may be problematic for some, due to the decrease in support of the form closure joints. The two most compromised ligaments during pregnancy are the Sacrotuberous (a lateral stabilizer of the sacrum) and the Sacrospinous (a lateral and torsional stabilizer of the pelvis). However it can affect any or all of the joints.

Body Temperature: avoid exercising in hot weather and pay careful attention to adequate fluid intake while exercising.

Incontinence: 64% of woman develop incontinence symptoms. This is a significant percentage. A woman may reduce her risk of incontinence by strengthening the pelvic floor. It’s the weight of the baby on the bladder that compromises the pelvic floor. Kegel exercises are very effective to help remedy or retard the issue. Pilate-based exercises emphasize the importance of the pelvic floor and encourage engagement fo the pelvic floor musculature is also helpful.

Additional conditions：

• Diastasis Recti: the sheath of connective tissue joining the two sides of the rectus abdominus, called the “linea alba”, can separate due to the increased stretch of the abdominal wall and the hormonal changes during pregnancy. Typically the separation will occur in the later stage of pregnancy but can actually occur from the 12^th week onwards. Contraindicated movements would be flexion, extension, rotation. It is best to work in a neutral position, focusing on transverse abdomins engagement.
• Supine Hypotensive Syndrome: a condition where, when in the supine position, the uterus may compress the vena cava affecting oxygen flow to both the baby and mother. This condition can occur as early as the 12^th week but is more likely to occur from the 20^th week onwards throughout the second and third trimesters. While it is perfectly safe to do exercises lying on both sides, when there is any sign of lightheadedness have the client rest on the left side to minimize pressure on the vena cava.
• Symphysis Pubis Diastasis or Dysfunction: the pubis can separate or slide affecting the integrity of the pelvic girdle and the sacro-iliac joints. This is due to the hormonal changes and joint laxity. Avoid large range of motion stretches and actions of the abductors and adductors. Keep levers short and so small range of motion. In some cases sitting compromises the pubis and it may be best to sit elevated or on a stability ball so there is no excessive pressure or do four point kneeling to relieve pressure.

Balance & postural changes: Due to the normal weight gain and increased size of the womb, a woman’s centre of gravity shifts. There is also an increase in breast size. All of these changes affect posture, especially the natural curves of the spine. Women will experience an increased lumbar lordosis, and increased thoracic kyphosis. These changes will most typically result in increased tension in the muscles and joints.

• Lumbo-pelvic region is affected due to the normal weight gain and the growing fetus. The larger the womb the more balance is challenged.
• Rounded shoulders: due to enlarged breasts

 

Sources:

STOTT Pilates Prenatal Matwork Workshop

>>>Part 3. – Specific considerations and exercise during 1-3 Trimester

Part. 1 Exercise Guidelines & Precaution

Part. 2 Physiological changes

Part. 3 Specific Considerations and Exercise during 1-3 Trimester

Part. 4 Training in The third Trimester

Part. 1 Exercise Guidelines

According to American College of Obstetricians & Gynecologists(ACOG), women who exercised before pregnancy should be able to continue exercising at the same level as before without compromising their baby’s health or development. If you’re in good health and have already been exercising, go ahead and continue your routine. With the proper guidelines you can safely exercise throughout your entire pregnancy. Exercise will promote muscle strength and cardiovascular endurance to help you through the stresses of pregnancy including; carrying extra weight, circulating extra fluids and the physical demands of labor. Being active during your pregnancy can also reduce the physical discomforts of backache, constipation, fatigue, and swelling; can improve your mood and self-image; and can even help you sleep better. It will make it easier to get back into shape after the baby is born. Let your doctor know you plan to continue your workout routine.

Dr. James F. Clapp, one of the leading researchers in the world of prenatal fitness, has confirmed the following benefits from his decades of research:

• Enhanced fetal heart rate variability
• Improved thermoregulatory system
• Increased blood volume from better placental growth

Other benefits:

• Assists in regulating fatigue levels
• Helps to maintain or slightly increase muscle tone, strength and endurance
• Improves posture
• May improve sleep
• Assists in prevention of low back pain, urinary incontinence
• Decreases risk of blood clots, varicose veins, leg cramping and swelling
• May help improve mood, body image and reduce postpartum depression

General Guidelines:

• The Centers for Disease Control and Prevention recommendation: pregnant women get at least 150 minutes of moderate-intensity aerobic activity every week. Moderate intensity means you are moving enough to raise your heart rate and start sweating. You still can talk normally, but you cannot sing.
• Do not exercise to exhaustion.  You have less oxygen available for aerobic exercise while pregnant. Make it a practice to monitor your heart rate while you’re exercising(50%–70% of HRmax), and slow down if you can’t carry on a conversation.
• Activities like walking, jogging, swimming, stationary cycling, stair climbing, elliptical training, and rowing, are all considered good, safe exercise during pregnancy, as long as you don’t overdue it.
• Most sports are safe during the first 2 trimesters as long as there is no risk of impact or trauma. Avoid any contact sports, ones that would throw you off balance or chronic impact.
• The hormone relaxin makes you especially susceptible to strains and injuries, so do take care in choosing your activities.
• During the first trimester, it is especially important that you avoid overheating. After the first trimester, you’ll also need to eliminate exercises that are performed while flat on your back or while you’re standing in one place for long periods, as both can reduce blood flow to the fetus.
• If you’ve never exercises before, you can begin as long as you get the clearance from your health care provider. Begin with engaging in mild to moderate exercise. Stick to low-impact activities such as walking or swimming, and keep workout sessions short.
• As your pregnancy progresses regardless of pre-pregnancy exercise status, you will naturally be inclined to scale down your exercise routine to accommodate your growing baby and uterus.
• The goal during pregnancy should not be to increase fitness level, but to minimize fitness loss and keep both mother and baby safe.

Precautions:

Sometimes exercise during pregnancy is strictly forbidden to protect the health of the mother, the baby or both. Check with your doctor or midwife before starting or continuing any exercise program to determine if you are at high risk for activity. According to ACOG, the warning signs to discontinue exercise while pregnant are:

• Vaginal bleeding
• Regular painful contractions
• Amniotic fluid leakage
• Dyspnea (difficult or labored breathing) before exertion
• Dizziness
• Headache
• Chest pain
• Muscle weakness affecting balance
• Calf pain or swelling
• difficulty walking
• contractions or unusual absence of fetal movements

Always listen to your body. While exercise is recommended throughout pregnancy, if something doesn’t feel right, you must listen to your body and regress or take a break.

Sources:

American College of Obstetricians & Gynecologists( www.acog.org)

STOTT Pilates Prenatal Matwork Workshop

>>>Part 2. – Physiological changes