1. Chap. 18a Clients Who are Pregnant Training Pregnant Women

2. Pregnant Women Women who are pregnant may seek out exercise programs for a variety of reasons Women who are pregnant may seek out exercise programs for a variety of reasons Self-conscious about changing body Self-conscious about changing body Concerned about having a healthy baby Concerned about having a healthy baby Want to be able to handle the physical rigors of having a baby Want to be able to handle the physical rigors of having a baby Need social interactions and support Need social interactions and support

3. Pregnant Women Pregnant women who exercised regularly before becoming pregnant are easily able to continue working out if the program is adjusted for Pregnant women who exercised regularly before becoming pregnant are easily able to continue working out if the program is adjusted for This will help to maintain cardiovascular and muscular fitness throughout pregnancy and post-partum This will help to maintain cardiovascular and muscular fitness throughout pregnancy and post-partum Previously sedentary women can benefit as well from exercise during pregnancy Previously sedentary women can benefit as well from exercise during pregnancy However their program should have extra support and adjustments However their program should have extra support and adjustments In all cases pregnant women should consult with their Obstetrics and other health care providers before beginning exercise In all cases pregnant women should consult with their Obstetrics and other health care providers before beginning exercise

4. Pregnant Women Recommendations with respect to exercise during pregnancy…three key concerns or potential outcomes Recommendations with respect to exercise during pregnancy…three key concerns or potential outcomes 1. insufficient oxygen or energy substrates to the fetus 1. insufficient oxygen or energy substrates to the fetus 2. hyperthermia-induced fetal distress or birth abnormalities 2. hyperthermia-induced fetal distress or birth abnormalities 3. Increased uterine contractions 3. Increased uterine contractions Properly designed programs pose an extremely low risk of these things happening Properly designed programs pose an extremely low risk of these things happening

5. Pregnant Women Benefits of Pregnancy During Exercise A. improved cardiovascular and muscular fitness B. facilitated recovery from labor C. faster return to pre-pregnancy weight, strength and flexibility D. reduced postpartum belly E. reduced back pain during pregnancy E. reduced back pain during pregnancy F. more energy reserve G. fewer obstetric interventions H. shorter active phase of labor and less pain I. less weight gain (however, use caution with this as it is important for the mother to be to not focus on losing weight as that is detrimental to the fetus) J. enhanced maternal psychological well being, reduced feelings of stress, anxiety and depression

6. Pregnant Women Participation in an exercise program during pregnancy may also prevent preeclampsia and gestational diabetes Participation in an exercise program during pregnancy may also prevent preeclampsia and gestational diabetes May improve glucose tolerance and thereby decrease a women’s chances of getting gestational diabetes May improve glucose tolerance and thereby decrease a women’s chances of getting gestational diabetes Conditions such as low back pain, pelvic floor muscle dysfunction, urinary incontinence, and chronic musculoskeletal conditions may be prevented or treated through exercise training. Conditions such as low back pain, pelvic floor muscle dysfunction, urinary incontinence, and chronic musculoskeletal conditions may be prevented or treated through exercise training.

7. Pregnant Women Fetal Response to Exercise Fetal Response to Exercise Some research has revealed reduced birth weight in babies whose mothers performed high-intensity exercise throughout their pregnancy. Some research has revealed reduced birth weight in babies whose mothers performed high-intensity exercise throughout their pregnancy. Vigorous exercise associated with 5-15 bpm increase in fetal heart, but no documented adverse affects Vigorous exercise associated with 5-15 bpm increase in fetal heart, but no documented adverse affects American College of Obstetricians and Gynecologists state that healthy pregnant women are not a risk for pre-term labor or increase in baseline uterine contractions due to exercise. American College of Obstetricians and Gynecologists state that healthy pregnant women are not a risk for pre-term labor or increase in baseline uterine contractions due to exercise.

8. Pregnant Women Accommodating Mechanical and Physiological Changes During Pregnancy Accommodating Mechanical and Physiological Changes During Pregnancy Cardiovascular Response Cardiovascular Response Pregnancy alters relationship between heart rate and oxygen consumption Pregnancy alters relationship between heart rate and oxygen consumption Use RPE scale to prescribe aerobic exercise Use RPE scale to prescribe aerobic exercise RPE of 12 - 14 (somewhat hard) seems appropriate for aerobic conditioning during pregnancy RPE of 12 - 14 (somewhat hard) seems appropriate for aerobic conditioning during pregnancy Should be able to keep up a conversation while exercising Should be able to keep up a conversation while exercising However, individually prescribe programs and adjust intensity depending on how woman feels However, individually prescribe programs and adjust intensity depending on how woman feels

9. Pregnant Women Accommodating Mechanical and Physiological Changes During Pregnancy Accommodating Mechanical and Physiological Changes During Pregnancy After first trimester back lying (supine) positions are contraindicated due to restricted venous return of blood to heart because of increasingly larger uterus After first trimester back lying (supine) positions are contraindicated due to restricted venous return of blood to heart because of increasingly larger uterus This also reduces cardiac output This also reduces cardiac output Exercises on the back should be phased out before second trimester Exercises on the back should be phased out before second trimester Alternatives can be abs on the side lying position and upper lower body exercises in the seated position (figure 18.5, pg. 479) Alternatives can be abs on the side lying position and upper lower body exercises in the seated position (figure 18.5, pg. 479) It would be advisable for some pregnant women to use weight machines instead of free weights due to center of gravity issues It would be advisable for some pregnant women to use weight machines instead of free weights due to center of gravity issues Particularly useful for previously sedentary women who want to resistance train Particularly useful for previously sedentary women who want to resistance train Like most people, pregnant women should not perform valsalva maneuver (excessive pressure on abdomen and pelvic floor) Like most people, pregnant women should not perform valsalva maneuver (excessive pressure on abdomen and pelvic floor)

10. Pregnant Women Accommodating Mechanical and Physiological Changes During Pregnancy Accommodating Mechanical and Physiological Changes During Pregnancy Respiratory Response Respiratory Response Pregnant woman can increase per minute ventilations by almost 50%, resulting in 10-20% more oxygen use at rest. Pregnant woman can increase per minute ventilations by almost 50%, resulting in 10-20% more oxygen use at rest. However, avoid high intensity to the point of fatigue or physical exhaustion (lessened diaphragm movement due to increasing uterus size, breathing is more difficult) However, avoid high intensity to the point of fatigue or physical exhaustion (lessened diaphragm movement due to increasing uterus size, breathing is more difficult) Valsalva maneuver should be avoided due to the excessive pressure on the abdominal contents and pelvic floor. Valsalva maneuver should be avoided due to the excessive pressure on the abdominal contents and pelvic floor. Exhale on the exertion or the “lifting” phase of every repetition. Exhale on the exertion or the “lifting” phase of every repetition.

11. Pregnant Women Accommodating Mechanical and Physiological Changes During Pregnancy Accommodating Mechanical and Physiological Changes During Pregnancy Mechanical Response Mechanical Response Woman’s center of mass is going to change with increase in breast and uterus size Woman’s center of mass is going to change with increase in breast and uterus size Exercises with lots of balance should be prescribe with caution, but can be beneficial (special attention to this in 3 rd trimester) Exercises with lots of balance should be prescribe with caution, but can be beneficial (special attention to this in 3 rd trimester) Any activity with the potential for falling should be avoided Any activity with the potential for falling should be avoided Joints are lax during pregnancy, perform exercises slow Joints are lax during pregnancy, perform exercises slow Emphasize abdominal and pelvic floor strength due to supporting and preparing a woman for delivery Emphasize abdominal and pelvic floor strength due to supporting and preparing a woman for delivery Transverse abdominis is a great muscle to work for delivery purposes (blow air out through mouth while contracting abdomen “sucking in the abdomen) Transverse abdominis is a great muscle to work for delivery purposes (blow air out through mouth while contracting abdomen “sucking in the abdomen) Kegel exercise are great for pelvic floor (tightening and relaxing muscles groups in the pelvic region…see books on pregnancy for specific exercises) Kegel exercise are great for pelvic floor (tightening and relaxing muscles groups in the pelvic region…see books on pregnancy for specific exercises)

12. Pregnant Women Accommodating Mechanical and Physiological Changes During Pregnancy Accommodating Mechanical and Physiological Changes During Pregnancy Metabolic Response Metabolic Response Need for more oxygen during pregnancy Need for more oxygen during pregnancy Pregnant women use an extra 300 calories per day to meet increased metabolic requirements for homeostasis Pregnant women use an extra 300 calories per day to meet increased metabolic requirements for homeostasis May use more carbohydrates for exercise during pregnancy so adequate levels of carbohydrates are important as well May use more carbohydrates for exercise during pregnancy so adequate levels of carbohydrates are important as well Sufficient quantities calcium, vitamin D, iron, and folic acid to achieve a healthy pregnancy outcome is advised but must be supervised by a certified nutrition specialist. Sufficient quantities calcium, vitamin D, iron, and folic acid to achieve a healthy pregnancy outcome is advised but must be supervised by a certified nutrition specialist.

13. Pregnant Women Accommodating Mechanical and Physiological Changes During Pregnancy Accommodating Mechanical and Physiological Changes During Pregnancy Thermoregulatory Response Thermoregulatory Response Pregnancy elevates heat production, which may be further increased by exercise (most likely in 1 st trimester) Pregnancy elevates heat production, which may be further increased by exercise (most likely in 1 st trimester) Adequate hydration is necessary Adequate hydration is necessary Appropriate clothing Appropriate clothing Optimal environmental surroundings Optimal environmental surroundings As a trainer just be careful about intensity, etc. As a trainer just be careful about intensity, etc. If a pregnant client feels overheated or fatigued during exercise, the intensity should be decreased, and the cool down should begin. If a pregnant client feels overheated or fatigued during exercise, the intensity should be decreased, and the cool down should begin. If client becomes dizzy, or disoriented stop exercise and refer to client’s health care provider If client becomes dizzy, or disoriented stop exercise and refer to client’s health care provider

14. Pregnant Women Contraindications (absolute) for Exercise Contraindications (absolute) for Exercise Pregnancy induced hypertension (pre-clampsia) Pregnancy induced hypertension (pre-clampsia) Ruptured membranes Ruptured membranes Premature labor during current pregnancy Premature labor during current pregnancy Persistent bleeding after 12 weeks Persistent bleeding after 12 weeks A cervix that dilates ahead of schedule A cervix that dilates ahead of schedule Significant heart disease or restrictive lung disease Significant heart disease or restrictive lung disease Multiple birth pregnancy that creates risk of premature labor Multiple birth pregnancy that creates risk of premature labor A placenta that blocks the cervix after 26 weeks A placenta that blocks the cervix after 26 weeks

15. Pregnant Women Relative Contraindication for Exercise (should be evaluated by client’s physician before participation in an exercise program) Relative Contraindication for Exercise (should be evaluated by client’s physician before participation in an exercise program) Poorly controlled hypertension, type 1 diabetes, seizures or hyperthyroidism Poorly controlled hypertension, type 1 diabetes, seizures or hyperthyroidism Extreme obesity Extreme obesity Extremely low body weight (BMI <12) Extremely low body weight (BMI <12) History of very sedentary lifestyle History of very sedentary lifestyle Unevaluated maternal cardiac arrhythmia Unevaluated maternal cardiac arrhythmia Intrauterine growth restriction in current pregnancy Intrauterine growth restriction in current pregnancy Severe anemia Severe anemia Heavy smoking Heavy smoking Chronic bronchitis Chronic bronchitis Orthopedic limitations Orthopedic limitations

16. Pregnant Women Conditions that pose a reason to discontinue exercise and seek medical advice during pregnancy Conditions that pose a reason to discontinue exercise and seek medical advice during pregnancy Any signs of bloody discharge from the vagina Any signs of bloody discharge from the vagina Dyspnea before exertion Dyspnea before exertion Headaches or unexplained dizziness Headaches or unexplained dizziness Chest pain Chest pain Muscle weakness Muscle weakness Calf pain or swelling Calf pain or swelling Preterm labor Preterm labor Decreased fetal movement Decreased fetal movement Amniotic fluid leakage Amniotic fluid leakage

17. Pregnant Women Exercise Guidelines Exercise Guidelines Perform 15 minutes of moderate intensity physical activity per day and gradually increase to 30 minutes per day of accumulated physical activity on at least three, if not all, days of the week. Perform 15 minutes of moderate intensity physical activity per day and gradually increase to 30 minutes per day of accumulated physical activity on at least three, if not all, days of the week. Resistance training for the major muscle groups can be performed provided that a resistance permitting multiple repetitions (12-15) is used and isometric contractions are avoided. Resistance training for the major muscle groups can be performed provided that a resistance permitting multiple repetitions (12-15) is used and isometric contractions are avoided. Avoid exercise in the supine position after first trimester. Avoid exercise in the supine position after first trimester. Exercise should not continue past the point of fatigue and should never reach exhaustive levels. Exercise should not continue past the point of fatigue and should never reach exhaustive levels. Dynamic, rhythmic physical activities such as stationary cycling or walking are favored for reducing injury risk and continuing the exercise program throughout pregnancy. Dynamic, rhythmic physical activities such as stationary cycling or walking are favored for reducing injury risk and continuing the exercise program throughout pregnancy. Sports activities that present the potential for even mild abdominal trauma or loss of balance should be avoided. Sports activities that present the potential for even mild abdominal trauma or loss of balance should be avoided. Large increases in body temperature should be minimized through adequate hydration, appropriate clothing, and optimal environmental surroundings during exercise. Large increases in body temperature should be minimized through adequate hydration, appropriate clothing, and optimal environmental surroundings during exercise. Many of the physiological and morphological changes of pregnancy persist four to six weeks postpartum, women can gradually resume physical activity programs during the intial postpartum period until prepregnancy fitness levels are achieved. Many of the physiological and morphological changes of pregnancy persist four to six weeks postpartum, women can gradually resume physical activity programs during the intial postpartum period until prepregnancy fitness levels are achieved.

18. Pregnant Women General Exercise Safety Guidelines for Pregnant Women General Exercise Safety Guidelines for Pregnant Women Check with your healthcare provider before you begin exercising Check with your healthcare provider before you begin exercising Exercise at a comfortable level at which you can maintain a conversation Exercise at a comfortable level at which you can maintain a conversation Do not exercise if you have a fever Do not exercise if you have a fever See your health care provider if you are experiencing bleeding, a large amount of discharge, or swelling in your face or hands. See your health care provider if you are experiencing bleeding, a large amount of discharge, or swelling in your face or hands. Avoid lying on your back after the third month Avoid lying on your back after the third month Avoid straining or stretching to the point of discomfort Avoid straining or stretching to the point of discomfort Wear proper footwear, and dress in layers Wear proper footwear, and dress in layers Use equipment in good condition Use equipment in good condition Drink 8 cups (2L) of water a day and avoid exercising in hot, humid conditions. Drink 8 cups (2L) of water a day and avoid exercising in hot, humid conditions. Avoid fatigue and overtraining Avoid fatigue and overtraining