Benefits of physical activity for pre and post natal clients Unit: - - PowerPoint PPT Presentation

Unit: Session Physical activity and health considerations for the pre and post natal client

Benefits of physical activity for pre and post natal clients

Aim of the session

• To understand the benefits of physical activity for pre and post natal

clients

Learning outcomes

By the end of this session, you will be able to:

• Explain the value of physical activity for pre and post natal clients

Introduction: current research and trends

• Since 1970’s, interest in

exercise during pregnancy has risen

• 2 schools of thought – liberal
• vs. conservative
• Seminal guidelines by ACOG in

1985

– still many unanswered questions

• Clear understanding that most

types of exercise are safe for mother and baby

Task

What are 4 benefits of exercise during pregnancy? Keep a note of your ideas in your portfolio.

Value of physical activity

• RCOG (2006) recommend:

– maintenance of cardiovascular fitness, muscle length and flexibility – maintenance of a healthy weight – improved circulation – improved co-ordination and body awareness – preparation for labour, and assistance in post natal recovery.

What does the research say?

• Women who exercise during

pregnancy and lactation (Clapp, 2002):

– Gain less weight – Deposit less fat – Feel better – Have shorter labours – Recover more rapidly – Are more likely to continue exercising post partum

Considerations for the fitness professional

• Emphasise that care must

be taken when exercising during pregnancy

• Clients cannot realistically

expect fitness levels to improve during the course

• f pregnancy
• Expectant mothers should

work to maintain their baseline fitness to aid pregnancy outcomes

Learning outcomes

Can you now?

• Explain the value of physical activity for pre and post natal clients

Unit: Session Physical activity and health considerations for the pre and post natal client

Physiological and biomechanical changes during pregnancy

Aim of the session

• To understand the physiological and biomechanical changes that

take place during pregnancy

Learning outcomes

By the end of this session, you will be able to:

• Summarise the three trimesters
• Describe the physiological and biomechanical changes associated

with each trimester

• Explain the implications of these changes for taking part in physical

activity

Stages of pregnancy

• Pregnancy can be measured by several points of

reference:

– Day of last menstruation – Ovulation – Fertilisation – Chemical detection 1st trimester 0-12 weeks 2nd trimester 13-26 weeks 3rd trimester 27-40 weeks

Task

Think about the changes that occur to the circulatory and respiratory systems. Note down your ideas in your portfolio

Changes to the circulatory system

• Relaxation of blood

vessels, leading to vascular under fill:

– waves of sudden fatigue – a racing pulse – nausea – pallor – sweating – dizziness

• Symptoms usually

subside by 4th month

Heart rate changes

• During early pregnancy, exercising

heart rate will be elevated at a given intensity as a result of the deficiency in blood volume and the corresponding low blood pressure.

• During mid-pregnancy increases in

blood volume and blood pressure will mean that exercising heart rate will gradually decrease

• During late pregnancy, the combined

effects of exercise and pregnancy expand blood volume further

Temperature and sweating

• Overheating of both mother and baby is a

common concern if the mother’s core temperature is elevated substantially during and immediately following exercise

• The set point for sweating also comes

down; so when core temperature does increase they are more able to dissipate the heat through sweating.

Changes to the respiratory system

• Pregnant women have a

tendency to over breathe and sometimes feel breathless

– therefore, most aspects of respiratory function are actually improved during pregnancy

• Expanding uterus presses on

and moves the diaphragm upwards reducing normal downward excursion of the diaphragm - therefore depth of breathing is increased

Task

Research the changes that occur to the hormonal/metabolic systems

Changes to the hormonal system

• At the onset of pregnancy, relaxin

begins to rise, peaking in the second trimester

– it isn’t unusual for relaxin levels to remain elevated for up to 6 months post birth

• The main effects of relaxin are to

soften ligaments, cartilage and the cervix (particularly relates to the pubis symphysis and SIJ)

• Insulin resistance increases during
• pregnancy. This makes the pregnant

woman’s pattern of energy utilisation similar to that of a mild diabetic

Weight gain

• During early to mid-pregnancy, weight

gain is normally 7-11 pounds, most of which is maternal fat.

• During late pregnancy, weight gain is

normally 7-11 pounds. Growth of the foetus and placenta are responsible for most weight gain at this stage.

• The additional fluid retention and blood

volume expansion of pregnancy account for an additional 9-15 pounds.

• Total pregnancy-related weight gain in

western society is approximately 24 - 33 pounds

Task

Investigate the changes that occur to the musculoskeletal system

Changes to the musculoskeletal system

• During pregnancy, the mother’s

centre of gravity becomes greatly altered, affecting her posture and gait

• As the mother becomes

increasingly lordotic (an exaggerated lumbar curve), the abdominal muscles can become strained as they stretch, and the lower back muscles become tighter, leading to soreness/pain

Abdominal muscles

• Strong abdominals are needed to support

the weight of the baby and to protect the back, which is very vulnerable through pregnancy

– strong abdominals will give the muscles of the uterus some extra help during delivery

Abdominal separation

• The increased abdominal distension can often cause a

splitting of the fascia (the linea alba) between the rectus abdominis muscles; this is known as diastasis recti abdominis

Pelvic floor

• During pregnancy the pelvic floor muscles

can become weakened and dysfunctional

• This can lead to urinary incontinence

(leaking of urine), pelvic organ prolapse, haemorrhoids and other colonic-related issues

Learning outcomes

Can you now?

• Summarise the three trimesters
• Describe the physiological and biomechanical changes associated

with each trimester

• Explain the implications of these changes for taking part in physical

activity

Unit: Session Physical activity and health considerations for the pre and post natal client

Considerations for exercise participation

Aim of the session

• To understand the key considerations for pre and post natal clients

participating in physical activity

Learning outcomes

By the end of this session, you will be able to:

• List the contraindications to exercise for pre / post natal clients
• Explain the guidelines for referral
• Identify warning signs for cessation of exercise
• Explain how to respond to any warning signs during exercise
• Describe the key considerations when developing effective working

relationships

• List the types of real and perceived barriers
• Describe ways in which these barriers can be overcome

Contraindications to exercise

• There are four main

contraindications that need evaluation prior to beginning

• r resuming exercise during

pregnancy:

• 1. Significant physical injury
• 2. An acute bout of illness or

chronic underlying disease

• 3. The onset of persistent or

recurrent localised pain

• 4. Abnormal or heavy vaginal

bleeding

ACOG guidelines

Absolute contraindications Relative contraindications

Haemodynamically significant heart disease Restrictive lung disease Incompetent cervix/cerclage Multiple gestation at risk for premature labour Persistent second or third trimester bleeding Placenta praevia after 26 weeks gestation Premature labour during the current pregnancy Ruptured membranes Pregnancy induced hypertension Severe anaemia Unevaluated maternal cardiac arrhythmia Chronic bronchitis Poorly controlled type I diabetes Extreme morbid obesity Extreme underweight (body mass index < 12) History of extremely sedentary lifestyle Intrauterine growth restriction in current pregnancy Poorly controlled hypertension/pre-eclampsia Orthopaedic limitations Poorly controlled seizure disorder Poorly controlled thyroid disease Heavy smoker

Warning signs

• ACOG guidelines (2002) have also identified a

number of warning signs to stop exercising:

– Vaginal bleeding – Dyspnoea before exertion – Headache – Chest pain – Muscle weakness – Calf pain or swelling (need to rule out thrombophlebitis) – Preterm labour – Decreased foetal movement – Amniotic fluid leakage

Barriers to participation

• Fatigue/tired
• Medical complications
• Discomfort and pain
• Embarrassment
• Disapproval

Developing working relationships with clients

• All clients are entitled to

good standards of practice and care from their fitness professional

– requires professional competence; good relationships with clients and colleagues; commitment to and

• bservance of

professional ethics; and excellent communication skills.

Guidelines for referral

• When a client presents with any of the

previously identified contraindications, the fitness professional must refer them to a medical professional for advice regarding further exercise

• All referrals should be discussed with the

client and the client's consent obtained both to making the referral and also to disclosing information.

• Care should also be taken to ensure that:

– the referral practitioner is suitably qualified – any confidential information disclosed during the referral process will be adequately protected

Learning outcomes

Can you now?

• List the contraindications to exercise for pre / post natal clients
• Explain the guidelines for referral
• Identify warning signs for cessation of exercise
• Explain how to respond to any warning signs during exercise
• Describe the key considerations when developing effective working

relationships

• List the types of real and perceived barriers
• Describe ways in which these barriers can be overcome

Unit: Session Physical activity and health considerations for the pre and post natal client

Nutritional requirements for pre and post natal clients

Aim of the session

• To know the nutritional requirements for pre and post natal clients

Learning outcomes

By the end of this session, you will be able to:

• Explain the importance of a balanced diet for pre and post natal

clients

• List sources of food which are important during the pre / post natal

period

• List the foods which should be avoided during pregnancy together

with their reasons

• Explain the importance of adequate hydration for a pre / post natal

client

Importance of a balanced diet

• A healthy pregnancy may

depend as much on pre- pregnancy diet and related body composition as it does to nutrients consumed during the pregnancy

• Two important concerns are

that there is an avoidance of dramatic weight loss during pregnancy; and that there is sufficient calorie intake to support breastfeeding.

Task

Use your research skills to identify some important sources of food during pregnancy. Note down your findings in your portfolio

Important sources of foods

• General advice:

– Ensure a good supply of vitamins and minerals

• broad spectrum of fruits and

vegetables of different colours and structures will help ensure that all nutrients are supplied

– Starchy carbohydrates to provide energy – ‘Refined’ carbohydrates such as white bread, white rice and confectionary should be limited

• small frequent servings of the

unrefined carbohydrates

Task

Research and identify the key vitamins and minerals required during pregnancy?

Foods to avoid

• Food sources which might

contain teratogens

• Foods high in pre-formed

vitamin A

• Sources of food-borne

illness

• Caffeine
• Alcohol
• Oily fish

Importance of hydration

• Good hydration is extremely

important for a healthy pregnancy and postpartum recovery

• During pregnancy, water is

also needed for the expansion in blood volume, and insufficient intake may contribute to constipation, preterm labour, and possibly miscarriage

General advice for staying hydrated

• Drink between 8-12 glasses of water per day

(more if the weather is warm or during exercise)

• Stay proactive - while thirst does signal a

need for hydration, not everyone feels thirsty when they need to drink

• Avoid caffeinated and high-sugar beverages,

which are actually dehydrating

• Drink smaller amounts of healthy liquids

frequently, as opposed to large amounts only a couple times per day

Learning outcomes

Can you now?

• Explain the importance of a balanced diet for pre and post natal

clients

• List sources of food which are important during the pre / post natal

period

• List the foods which should be avoided during pregnancy together

with their reasons

• Explain the importance of adequate hydration for a pre / post natal

client

Unit: Session Design and implement exercise programmes for the pre and post natal client

Collecting information and selecting appropriate activities

Aim of the session

• To be able to collect information and select appropriate activities

with the pre or post natal client

Learning outcomes

By the end of this session, you will be able to:

• Explain the importance of pre-activity screening
• Identify information to be collected
• Collect information about the client
• Interpret information from the screening process
• Record information in an effective manner
• Observe the legal and ethical responsibilities regarding screening,

client records and confidentiality

Importance of pre-activity screening

• Begins with initial

consultation

• Lifestyle assessment

– Questionnaires – Interview

• Functional assessment

Identifying information to be collected

• Lifestyle
• Medical history
• Activity history
• Attitudes
• Motivating factors
• Exercise preferences
• Barriers
• Fitness assessment

Collecting information

• Reports
• Interview
• Questionnaire
• Observation
• Risk assessment
• Functional assessment

TASK: Interpreting information

Describe how the following sources of information can be interpreted to help inform exercise prescription:

• Personal goals
• Lifestyle factors
• Medical history
• Motivation
• Barriers to exercise
• Exercise preferences and current fitness

Recording information

• Fitness professionals are

expected to keep records of all relevant consultations

– Questionnaires (medical, exercise, occupational, lifestyle) – Assessment forms (physical/functional, medical,

• ccupational health)

– Informed consent – Recorded sessions/interviews (audio, video) – Training log – Referral forms and letters

Legal and ethical responsibilities

• Generally, fitness professionals

should only record information based on disclosure by the client themselves, or from direct

• bservation
• If it is necessary to record an
• pinion, the entry should be clear

that it is an opinion and whose

• pinion it is
• It is essential that all fitness

professionals are bound by confidentiality

Learning outcomes

Can you now?

• Explain the importance of pre-activity screening
• Identify information to be collected
• Collect information about the client
• Interpret information from the screening process
• Record information in an effective manner
• Observe the legal and ethical responsibilities regarding screening,

client records and confidentiality

Unit: Session Design and implement exercise programmes for the pre and post natal client

Designing an individualised exercise programme

Aim of the session

• To be able to design an individualized, safe and effective exercise

programme for pre or post natal clients

Learning outcomes

By the end of this session, you will be able to:

• Apply the principles of FITT
• Select appropriate types of activity
• Identify alternative activities and modifications
• Describe the guidelines for stretching
• Explain the importance of pelvic floor exercises
• Explain the importance of not exercising to exhaustion
• Record the programme in an appropriate format

Considerations for exercise

• In which stage of the

pregnancy, is the client?

• How experienced is the

client and what are her exercise capabilities?

Task

Outline some general ‘do’s’ and ‘don’ts’ when it comes to exercise prescription for pregnant clients.

Task

Outline some general guidelines for warming up and cooling down.

Applying the principles of FITT

• It is unrealistic to formulate

generic exercise recommendations that can be applied across the board for all pregnant women

– Individual differences in health status, physical fitness, and previous exercise experience

• National guidelines may

provide a good starting point for prescription

Guidelines for aerobic activity

Guidelines for muscular conditioning

TASK: additional considerations

How does pregnancy affect the following, and what exercise modifications can you make:

• Body position
• Joint laxity
• Abdominal muscles
• Posture
• Resistance training

Importance of pelvic floor exercises

• The pelvic floor performs an

important function in urinary and faecal control, as well as support

• f the pelvic organs (avoiding

prolapse).

– Awareness and control of these muscles may be helpful in order for a woman to relax them during labour – Usually at around the fifth month of pregnancy, there is an increase in pressure around the pelvic area as the uterus grows. Urinary incontinence may become a common problem

Guidelines for flexibility training

Task

Produce a hand-out for your pregnant client that summarises exercise guidelines for each trimester, across aerobic training, muscular conditioning, and flexibility.

Importance of not exercising to exhaustion

• May result in symptoms similar

to overtraining syndrome

• These include fatigue (acute and

chronic), pain, loss of motivation, susceptibility to injury and common infections, and decreased exercise performance

• If symptoms of overtraining

appear, the most sensible solution would be to modify either the exercise programme

• r other lifestyle variables that

produce the fatigue

Recording programmes

• Exercise professionals are

expected to keep records of all client training programmes, in addition to relevant consultations and assessments

– key to an effective service, and can help in monitoring and improvement of a service delivery

• All information written on

programme cards should be clear and precise, and recorded in an appropriate format

Task: programme design

Using the sample programme card provided, design an exercise programme for trimesters 1, 2 and 3.

Learning outcomes

Can you now?

• Apply the principles of FITT
• Select appropriate types of activity
• Identify alternative activities and modifications
• Describe the guidelines for stretching
• Explain the importance of pelvic floor exercises
• Explain the importance of not exercising to exhaustion
• Record the programme in an appropriate format

Unit: Session Design and implement exercise programmes for the pre and post natal client Identifying and managing specific risks for the pre and post natal client

Aim of the session

• To be able to identify and manage specific risks to the pre or post

natal client when participating in physical activity

Learning outcomes

By the end of this session, you will be able to:

• Identify any specific risks for the pre or post natal client
• Describe ways to manage the identified risks

Introduction

• Many experts warn that the risks of exercise may

cause premature labour, abortion, or congenital deformities.

• However, there are no reports documenting that

regular exercise per se, increases the occurrence

• f maternal or foetal injury in a healthy woman

with a normal pregnancy.

• Nevertheless, each woman must be informed of

the potential risks of exercise, and warned of any associated problems so that an educated decision can be made regarding exercise

Occupational risks

• Risks associated with physically

demanding jobs should always be considered by the fitness professional.

• For example, experts warn against

engaging in persistent heavy workloads that include strenuous lifting, long hours of standing, or exposure to loud noise or vigorous vibrations

Foetal hypoxemia

• Exercise may cause decreased utero-placental

blood flow, which may lead to foetal hypoxemia and/or hypoglycaemia.

• During sustained exercise, there is decreased

splanchnic blood flow; however, the trained pregnant woman's placenta will have an expanded blood volume and oxygen extracting capability, thereby providing adequate foetal nutrition

• Problems of foetal distress due to hypoxia are

usually rare and have been shown to occur only in women who were unfit and engaged in episodic, intensive exercise during pregnancy

Hyperthermia

• The greatest threat of foetal defects

caused by high temperature occurs during the first trimester. Intensive exercise, particularly in hot, humid conditions

• However, adaptive mechanisms during

pregnancy will result in improved heat- dissipation, which is enhanced further with exercise training.

Hormonal stress

• Exercise is known to cause surges in certain

hormones such as the catecholamines and prolactin, which may cause premature increases in uterine contractility.

– For women accustomed to exercise, this results in a reduction of these responses

• Furthermore, studies have not shown a correlation

between vigorous exercise and early spontaneous abortion or premature onset of labour

– However, women with a history of multiple miscarriage should be cautious and have all exercise programmes approved by their GP

Foetal growth

• Exercise may also result in decreased

birth size and body weight, especially in those who maintain vigorous activity throughout their pregnancy.

– These infants tend to be leaner, but no less healthy than those born to sedentary mothers

Trauma

• Blunt or penetrating trauma to the

abdomen could result in foetal damage, and is more likely to occur later in pregnancy, when the foetus is anterior to the pelvis and less protected.

• Women involved in contact sports may be

at higher risk, and should be warned that they may become more prone to falls, due to balance alterations

High risk contact sports

High risk contact sports for pregnant women

Ice and field hockey Gymnastics Boxing Horseback riding Wrestling Ice and in-line skating Football Alpine and water skiing Hang gliding Rugby Board and body surfing Competitive basketball Vigorous racquet sports Power lifting Scuba diving Rock climbing High-altitude activities

Strains and sprains

• Pregnant women need to be particularly

careful with ballistic exercise, since it may increase the risk of orthopaedic problems, such as soft tissue injuries.

– This is due to hormonal changes including the increase in relaxin and progesterone, which may cause increased laxity

• If a pregnant woman experiences

considerable posterior pelvic pain or pubic symphysis pain aggravated by exercise, they should immediately be referred back to their GP

Hypoglycaemia

• During pregnancy, hypoglycaemia can occur

as a result of low-intensity, long-distance exercise, becoming more of a problem as pregnancy progresses.

• In addition, pregnant women utilize

carbohydrates more readily during exercise, compared to non-pregnant women.

• If a pregnant client feels dizzy, faint, or tired

during the late stages of an exercise session,

• r during the recovery phase, blood glucose

should be checked

Learning outcomes

Can you now?

• Identify any specific risks for the pre or post natal client
• Describe ways to manage the identified risks

Unit: Session Design and implement exercise programmes for the pre and post natal client

Post-natal exercise considerations

Aim of the session

• To understand the considerations for post-natal exercise prescription

Learning outcomes

By the end of this session, you will be able to:

• Describe the considerations and benefits of post natal exercise
• Describe post natal concerns for exercise

Considerations for exercise

• The first question usually asked at this

point is “when can I resume exercising?”

– dependent upon the events of labour and the 6 week ‘all clear’ by the client’s GP

• However it is normal that transversus

abdominis (TA) and pelvic floor (PF) exercises can be performed immediately post labour

• Current guidelines (ACOG, 2003;

RCOG, 2006) recommend that women should avoid all physical stress for two weeks (i.e. ‘don’t carry anything heavier than the baby’) and not resume full daily activities for a minimum of six weeks after delivery

Benefits of post natal exercise

• Improved posture
• Increased local muscular endurance
• Increased stamina
• Increased energy
• Increased metabolic rate
• Increased weight loss, improved

body image

• Increased self-confidence
• Reduced anxiety

Reduced joint stability

• Rising levels of relaxin produced

during pregnancy increase the elasticity of ligaments and cartilage leading to instability of joints, particularly the sacroiliac joint and the pubis symphysis.

• Exactly how long relaxin stays in

the body is still subject to debate

• The mother is the best judge and

will know when she no longer ‘feels loose’

Exercise implications

• Maintenance stretching is

strongly recommended, and stretching to increase flexibility should be avoided for 16-20 weeks

• When resistance training,

include muscular endurance work and avoiding working to failure

• Avoid high impact activities

for the first few months

Weak abdominals

• It may take six weeks for

muscles to fully recover or even longer if they were weak before pregnancy.

• Gentle abdominal exercises

in the early post-natal period will be vital in encouraging this process (e.g. tummy tightening, pelvic tilting)

– however, guidance and advice should be sought if there is abdominal separation

Breast-feeding

• Both breast-feeding and

exercise are big fluid drains potentially leading to dehydration.

• To avoid dehydration, water

intake around breast-feeding and exercise must be a priority

– Use of a good supporting (sport) bra is essential during exercise – Avoid prone lying during the early post-natal period – Consider vigorous arm/upper body work to promote milk flow

Learning outcomes

Can you now?

• Describe the considerations and benefits of post natal exercise
• Describe post natal concerns for exercise