Exercise for the Pregnant Woman (1)

Heed the need to take naps whenever needed. Balance this with some exercise to keep fit. Pregnancy enhances sensitivity to carbon dioxide, restricts chest space, and increases blood volume. Your pulse (heart rate) will soar more easily and you will find yourself out of breath doing activities you were previously able to tolerate easily. This is normal.

Regular, moderate aerobic exercise during pregnancy improves aerobic capacity without undue stress. You should be able to carry a conversation during an aerobic exercise. Late in the third trimester, physical work capacity declines somewhat during that period due to decreasing resting cardiac output.(2)

Exercise improves all physiological responses, including circulation vital to the growth of the fetus and muscle tone which helps in delivery. Under normal circumstances, none of the exercises in this program should cause any danger to you or your infant; rather they should improve your comfort and general well-being.

Postnatal recovery rate is improved as a result of a sound, prenatal exercise program. Prenatal and postnatal lower back pain is frequently the result of low physical fitness and poor posture. In most instances, it can be corrected with appropriate exercises. Many systems in the body are changing. If when entering pregnancy at a low fitness level, use a mild, gently progressive exercise program that will not create additional or undue physical demands.(3)

The _________________ and its staff and volunteers cannot assume responsibility for unforeseen complications.

As pregnancy progresses, all the body’s joints loosen. You need a good warm-up before exercising. Use slow controlled stretching. Engage in quick walking exercise. Leg-lifts in an all-fours position may become uncomfortable for women with a lot of loosening in the hips and pelvic girdle. Change the exercise to suit your personal needs.

The pressure of an enlarged uterus and growing fetus puts increased strain on the muscles of the pelvic floor and the sphincters that run through it. Avoid high-level hopping exercises. Exercise pelvic floor muscles daily to help support the growing weight and to help prevent such common problems as hemorrhoids and incontinence. Following delivery, these exercises will be essential in rehabilitating the muscles. Incorporate pelvic-floor exercises into your daily routine.

Pregnancy puts a serious load on the spine and muscles of the upper and lower back. In order to maintain proper posture, pregnant women must maintain good abdominal strength and flexibility in the lower back and hamstrings. They must also strengthen the muscles of the upper back to support extra weight in the breasts. Use the pelvic tilt position at all times to avoid strain or injury to the lower back.
For abdominal strength, do curl-ups or lean-backs. Be sure one knee is bent to protect the lower back. Perform abdominal exercises in a well-controlled manner to avoid jerking or straining.

Exercises for Specific Problems (4)

Diastasis Recti:

Hormonal changes soften and weaken the connective tissue of the central abdomen. You may acquire diastasis recti which is a separation of the abdominal rectus muscles–the vertical bands of muscle on the front of the abdomen.

In later pregnancy, lift your head while lying down and observe the abdomen. If there is a distinct mounding in the center of the abdomen, a separation of muscle exists. Hold your abdominal muscles together while doing abdominal exercises. Cross your arms over your abdomen at the widest point and pull your muscles together each time you curl up or lean back. You will be preventing further separation while maintaining strength.

Only the head is to be raised (shoulders stay down). The head is raised forward toward the chest while exhaling and lowered while inhaling. This exercise should be performed several times each day to maintain muscle tone and decrease further separation.(5)

Post-natal, continue to hold your abdominal muscles together during abdominal exercises until the separation has mended (up to six weeks). Until that time, exercise that involve rotating or bending the trunk or twisting the hips should be performed cautiously or be avoided.

To Safely Assume the Lying Position:

Bend the knees and crouch to touch hands to the floor. Lower the knees to the floor and roll onto one hip. Lie down on your side with knees bent. Use your arms to push yourself onto your back while continuing to keep knees bent. To stand up from a lying position, reverse this procedure, one step at a time.

After delivery, continue to hold onto sides to pull the recti muscles toward the mid-line as you raise your head for curl-ups. As these abdominal muscles heal, you may raise both the head and the shoulders in a full curl up. Avoid rotating or bending the trunk or twisting the hips until the gap is closed.

Lower Back Pain

Lower back pain is often due to increasing abdominal girth and weight and a forward shifting of the center of gravity. The pelvis angles forward with the increasing weight and stretching of the abdominal wall during pregnancy. You may be tempted to lead further back on your heels, bringing the head and shoulders forward and increasing the lumbar curve, putting further strain on already weakened ligaments and on specific muscles. Tilting the pelvis with the “pelvic tilt” position and pelvic exercise straightens this angle, improving the spinal alignment.
Key postural muscles need to be strengthened in compensation for the weakening of the ligaments that support the spine and pelvis, shortening the hamstring muscles. These muscles are: abdominals, gluteals (buttocks); hip flexors; extensor muscles of the spine; anterior and posterior muscles of the neck.

The following are six exercises specifically for to relieve lower back pain. Remember, typically exercises are done 10 repetitions in two sets (take a 1 minute break after 10 reps and repeat).

Single Leg Hamstring Stretch

Sit on the floor with one leg straight and the other leg bent so the knee is outward and the foot pulled in close to the body. Hold the thigh, ankle or foot of the straight leg (whichever you can manage). Gently pull the chest toward the thigh, keeping the back flat, and I recommend you hold for 20 seconds, and then try to move into the stretch a little further before you release, and “shake out” leg. Repeat with other leg.

Lower Back Stretch

Lie on your back with both knees bent. Pull one knee up and close to chest. Again, I would have you hold up to 20 seconds. Remember not to hold your breath but to breathe through the exercise. Repeat with other leg. I find this exercise a poser since there is so much baby in the way to be “pulling to the chest”. The diagram I am looking at seems to be raising and stretching the thigh alongside the abdomen, which makes better sense. The head may remain on the floor or be lifted slightly.

Seated Back Curl

Sit with knees bent, hands around knees. (Frankly, my arms are short, and it didn’t take much baby for it to be difficult to reach my knees.) Straighten your back and sit up tall so your head is up and your chest is out. Relax and curve the back down towards the floor still holding onto the knees. Let your head relax forward. Repeat sequence slowly several times.

Pelvic Tilts

Do pelvic tilts with knees bent, whether you are lying, sitting, or standing. In a lying position, tighten your abdominal muscles and press your vertebrae of the lower back to the floor, hold five or six seconds, relax, then repeat several times.

While standing, place feet shoulder width apart with hands on the hips. Tighten the abdominal and buttock muscles, and rotate pelvis forward and under (feel the iliac crest rotate backward at the same time). Hold for 5 to 6 seconds, then release to normal posture and repeat several times. Perform this exercise daily during your pregnancy even if you have no history of back pain.

This exercise strengthens the abdominal and pelvic floor muscles, lengthens and relaxes the lower back muscles, and improves posture.

Curl-Ups

Lie on your back with knees bent, holding a pelvic tilt position. Hands may be at sides or clasped behind head. Lift your head, shoulders and the upper back off the floor smoothly and slowly. Uncurl slowly down so the head touches the ground last. Relax, breathe deeply.

Hip Lifts

Lie on your back with the knees bent. Hold a pelvic tilt with arms to the side. Slowly push hips up so the body forms a straight line (no arching of the back). Hold, while contracting your buttocks and abdominal muscles. Slowly uncurl down, one vertebrae at a time, so your hips touch the floor last.

Hip lifts relieve pressure on the pelvic veins, assist the return of venous blood to the heart from the legs and pelvis, and strengthens thighs, buttocks and abdominals.

Round Ligament Strain

The ligaments which attach the uterus to the pelvis need to be strengthened to counteract the pulling action from the increased weight of the uterus. The pain caused by this round ligament strain can be relieved by the “pelvic rock exercise” to allow the uterus to drop forward and away from the pelvis, thereby relaxing the ligaments.

You may have a stitch or pain in the lower abdomen, groin or even the inner thigh. Do this exercise after every aerobic activity. During late pregnancy, you may experience continuous pain in the ligament whenever you stand or walk. Switch to swimming or a stationary bicycle for your aerobic activity.

Pelvic Rock Exercise

Assume a position on the floor on your hands and knees with your head relaxed. Tilt the pelvis downward while contracting gluteal and abdominal muscles. Tilt the pelvis upward to a relaxed position. Do not allow your back to sag. Continue until your pain is relieved. The abdominals are strengthened, relieving round ligament strain (especially following or during the aerobic portion of work-out).

Stress Incontinence

The weight of the pregnant uterus weakens the pelvic floor and results in poor urethral sphincter tone causing involuntary leakage of urine from the bladder (stress incontinence). This also may cause a predisposition toward bladder infection. Wear protective mini-pads during exercise class and to protect leakage during sudden movements such as coughing, sneezing, laughing, jogging or hopping which will cause the involuntary leakage.

Besides the pelvic tilt exercise, lying on your back with your legs crossed at the ankles, squeeze seat muscles together, press thighs together, pull up inside the pelvic floor as though preventing yourself from going to the bathroom. Hold for the count of five, then relax. Repeat ten times. Practice these several times daily.

Pelvic floor exercises strengthen pelvic floor muscles, thereby improving support for pelvic organs, besides improving bladder control. It may help to prevent the prolapse of the uterus, decrease the incidence of hemorrhoids, tighten muscles of the vagina. These exercises should be continued daily following delivery as well.

Breast Support

Heavier breasts may lead to poor upper body posture by slumping the shoulders forward. You may also feel increased pressure and tingling of the fingers. Do exercises that stretch the pectoral muscles and tighten (tone) the muscles of the upper back and neck. Shoulder flexibility exercises may also help. A firm supportive bra will prevent the breakdown of fibrous tissue that can lead permanently to “droopy” breasts following pregnancy.

Leg Cramps

Often leg cramps indicate a shortage of calcium and magnesium in the body. During pregnancy, leg cramps also occur spontaneously during the night or as a result of specific exercises during a fitness class. Women who are physically active and work at improving circulation and muscle tone in their legs experience fewer leg cramp problems during pregnancy.

To help prevent leg cramps do calf-stretches, leg raises, ankle circles and hamstring stretching with a flexed foot. Make a habit of practicing preventative leg exercises on a daily basis. To improve circulation, walking and other locomotor activities are recommended as well. Avoid toe pointing as you exercise. Reduces tendency to cramping during sleep.

Alleviate a muscle cramp by stretching the leg out straight and strongly flex the foot toward the body. If you can stand, lock the knee so the leg is straight. You may need to avoid aerobic dancing or ballistic movements (putting weight at the front of the foot only).

Contraindications to Exercise During Pregnancy and Immediate consultation/checkup with a doctor:

▸ any signs of bloody discharge from the vagina;
▸ persistent contractions following heavy exercise. (Exercise frequently brings on short periods of Braxton Hicks contractions. If these persist for more than 24 hours following exercise, medical advice is required);
▸ persistent, severe headaches;
▸ any “gush” of water from the vagina (premature rupture of membranes);
▸ sudden swelling of the ankles, feet, hands and face, fingers;
▸ infection, chills and fever;
▸ swelling, pain and redness in the calf of one leg (phlebitis);
▸ severe nausea or vomiting;
▸ anemia;
▸ hypertension (high blood pressure);
▸ toxemia (may be evidenced by headaches and swelling of feet);
▸ kidney infection;
▸ heart disease (check with doctor; some persons may be allowed a modified exercise program), heart murmurs;
▸ dimness or blurring of vision
▸ flashes of light or dots before the eyes
▸ pain in abdomen
▸ long term health problems, e.g., asthma (check with doctor; some persons may be allowed to participate with close supervision);
▸ problems in previous pregnancies (check with doctor; perhaps a modified exercise program would be allowed).

(1) “Chalk Talk”, Leaders Quarterly, Vol. 2, No. 2, PARTICIPaction NETWORK, Toronto, ON, Spring, 1985.

(2) Chapter 3: “Physical Changes During Pregnancy”, Fitness and Pregnancy; A Leader’s Manual, Government of Canada, Fitness and Amateur Sport, Minister of Supply and Services Canada 1983, 28.

(3) Ibid, 29.

(4) Ibid, chapter 5, 39-48.

(5) Ibid, Chapter 5: “Exercises for Specific Problems”, 40.

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