How Should Exercise Be During Pregnancy?

In human life, every newborn baby is a new hope and future. In order for this hope to be born healthy, the mother must; She must be healthy, have consciously planned her pregnancy, and have sufficient information about her and her baby's health (T.R. Ministry of Health 2002). Pregnancy begins with the placement of the embryo, which is formed as a result of the union of the ovum and sperm ready for fertilization, in the mother's womb and lasts an average of 280 days or approximately 40 weeks. It is a physiological event. Pregnancy is not a disease, it is an enjoyable and natural process that needs to be managed. Although it is a natural event, it causes important anatomical, physiological and psychological changes in the maternal organism. When the mother's body cannot adequately adapt to these changes, health problems that threaten the health of the expectant mother and the fetus arise. In recent years, women's increasing interest in various exercise programs has led to the continuation of these activities during pregnancy, and even to an increased desire to exercise due to aesthetic concerns, especially during this period. Evidence that physically active women give birth more easily dates back to ancient times.

Musculoskeletal System Changes in the Expectant Mother During Pregnancy:

Some secretions secreted during pregnancy Hormones and the weight of the growing baby create some changes in the mother's musculoskeletal system. Postural changes occur as a result of the displacement and expansion of the uterus with the growth of the fetus and the increase in weight gain of the body.

• The lordosis of the lumbar and region occurs. increase,

• Weakening of the shoulder girdle

• Hyperextension formation in the knees

• Weakening of the abdominal muscles

• Shortening of the paravertebral muscles and decreased support to the uterus

• Scapular protraction around the shoulders and upper back as a result of the enlargement of the breasts preparing for lactation

• To compensate for the rounding of the shoulders, the head is displaced forward and there is an increase in cervical lordosis

• Due to the progesterone hormone, all muscles and veins are affected. dilatation occurs. Again, with the Relaxing hormone secreted, there is relaxation and stretching in the joints. Characteristics of pregnancy Joints such as knees and hips become more vulnerable to injury.

 

Changes in the Nervous System;

• Commonly common problems such as rapidly changing mood, anxiety, insomnia, nightmares, aversion or excessive interest in food, slight decrease in cognitive abilities and amnesia accompany pregnancy.

 

Respiratory System Changes;

• Fetus growth and As a result of the expansion of the uterus, the diaphragm can be displaced by 4 cm or more. Especially towards the end of the 3rd trimester, pregnant women may experience fatigue even with small efforts.

Cardiovascular System Changes;

• Hemoglobin level drops by approximately 80%. This effect is differently called dilution anemia or physiological anemia of pregnancy and causes symptoms such as fatigue and weakness from the early period of pregnancy

• Blood pressure may decrease in small amounts in the second trimester of pregnancy, thus He may feel faint easily when standing for a long time.

Circulatory System Changes;

• All varicose veins It causes edema due to gravity in the veins and especially in the legs.

• Varicose veins may occur in the vulva and anus (hemorrhoids, cracks).

• As a result of increased peripheral circulation and hormonal stimulation, the mucous membrane (such as nasal, vaginal) becomes more active and watery. As a result of these symptoms, nasal congestion and vaginal discharge may increase. Cramp formation is also related to diet. Excessive phosphorus intake and insufficient calcium and magnesium consumption trigger cramp formation.

    Urinary System Changes;

• The susceptibility to urinary system infections increases.

• Urge and stress incontinence after pregnancy, especially in later periods may occur.

 

 WHY SHOULD EXERCISE?

• Pregnancy period It is also possible to see it as a period in women's lives that requires adaptation to different and new roles. During this period, the woman needs to embrace her pregnancy and her future role as a mother. This adoption is affected by women's beliefs and attitudes, understanding of duty and responsibility, relationships and behaviors.

 

• In a study conducted in 2016 Sangsawang et al. It has been observed that stress incontinence attacks are reduced in women who exercise twice a week compared to women who do not exercise (Sangsawang et al., 2016).

• When physical activity is done in a controlled manner, it improves health in most chronic diseases, cardiovascular diseases. It has been shown to reduce the risk of diabetes, obesity, certain cancers and hypertension, and improve mental health. Physical activity during pregnancy is necessary for the expectant mother to better adapt to anatomical, physiological, emotional, social and psychological changes. When you exercise regularly, your muscles work meaningfully and your heart rate increases. Thus, as the amount of oxygen in circulation increases during pregnancy, the amount of oxygen in your baby also increases.

 

Pelvic Floor Training;

• Pelvic floor muscles are a muscle group located at the base of the pelvic bone, known as the pelvis, that has important functions in urination, defecation and sexual functions. In addition, it acts as a lever by supporting the bladder, uterus and rectum, our organs in the pelvic area, from below. Mechanical or hormonal effects that occur during pregnancy can negatively affect pelvic support. In pregnant ultrasound examinations, it has been observed that the contractions of the pelvic floor muscles have decreased significantly and the mobility of the bladder and urethra has increased significantly. Therefore, the importance of pelvic floor muscle training during pregnancy is of great importance. Easy birth, easy recovery during and after pregnancy, and incontinence (urinary incontinence) situation. To prevent this from happening, pelvic floor muscle training should be added to exercise programs and the patient should be taught correct contraction. Pelvic floor muscle training should continue before, during and after pregnancy.

 

• Some of the problems that we physiotherapists deal with are;

 

1-Waist and pelvic girdle pain

2- Sacroiliac joint dysfunctions

3-Sciatica

4-Nerve compression syndromes

5-Circulatory problems and edema

6-Incontinence

 What Happens in Expectant Mothers Who Exercise Regularly?

• It enables them to push comfortably during labor and makes the birth easier.

• Tears that occur during birth are reduced

• Urinary incontinence problems that occur during and after pregnancy are minimized.

• Postnatal uterus recovery becomes easier.

• Helps increase endurance and strength,

• Regulates circulatory and digestive functions,

• It makes the birth process more positive and energetic.

• With correct breathing, the ventilation of the lungs increases.

• Reduces biomechanical pain and prevents posture disorders

• Helps the expectant mother in weight control

• Reduces sleep problems .

 

 IN WHICH SITUATIONS IS IT INCORRECT?

In this case, the specialist doctor should recommend that the pregnant woman do regular exercise. There should be no problem. For this reason, the pregnant woman should undergo a detailed evaluation by her specialist before starting an exercise program. If there is no harm in exercising, she should get support from physiotherapists who are trained and working in this field.

 

 

Adverse conditions in which exercise should not be done; (The pregnant woman must be evaluated by the physician.)

• Cardiovascular, respiratory, kidney and thyroid diseases

• Risk of miscarriage, premature birth (early birth)

• Fetal growth restriction (growth retardation in the unborn baby)

• cervical history of insufficiency (cervical insufficiency) üü

• vaginal bleeding,

• decreased fetal (baby) movements,

• placenta previa (the baby's partner being low)

• Hypertension (it is important to get a doctor's opinion.)

 

Exercise Planning;

If the specialist does not see any harm in the pregnant woman exercising, the 10-12th week of pregnancy. Exercise programming can be done 2-3 times a week. It is better to do lighter-paced exercises during pregnancy, especially at the beginning. Short walks will also relieve the expectant mother both physically and spiritually. However, since excessive fatigue will harm the baby and the expectant mother, planning should be made with frequent rest breaks and personalized exercises. Sports such as skiing, water skiing, horseback riding and combat sports that have a high risk of injury should be avoided, and diving sports should not be done as an overdose of oxygen may harm the baby. Especially during this pandemic period when we do not know when it will end, our pregnant women can participate in online exercise programs prepared by experts in this field in order not to remain inactive at home. They can prevent complications that may be caused by inactivity.

Content of Exercise Programs;

• Posture Training and teaching correct body mechanics

• Strengthening the arms for postpartum child care,

• Strengthening the legs to carry the increasing body weight,

• Strengthening abdominal muscles

• Aerobic exercise program to maintain cardiovascular endurance

• Proprioceptive training

• Exercise program to prevent edema, varicose veins and cramps

• Stretching, relaxation and breathing training

• Pelvic Floor strengthening and relaxation exercises

 

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