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Slide 2 Prepared by : Hanaa Behar Shoroq edaliy Khetam elkhafarna Hadeel abo quse Sabren salama Wesam khatab Somya abo omra Slide 3 Slide 4 The exercise in the childbearing year The exercise needs of the disabled woman during the childbearing year that specific. should be assessed individually,so advice and information can be given. Exercising during the childbearing year is not harmful to either. Slide 5 mother or baby if the pregnancy is normal and the mother healthy. and can be positively beneficial if at a mild to moderate level. The aims of exercising in pregnancy should be to maintain, or slightly improve, the woman's level of fitness. Slide 6 Provided there are no specific obstetric or medical contraindications, fit women can safely maintain the same level of fitness during pregnancy. Slide 7 Pregnant women should not undertake new, vigorous exercise, which could make them too warm, tired or breathless and regular exercisers should reduce the intensity and duration of their training as the pregnancy progresses. Slide 8 Slide 9 Slide 10 Slide 11 All women should be encouraged to exercise at a moderate level to derive the associated health benefits. A moderate level is that intensity which can be maintained while able to carry on a conversation. Slide 12 The Borg Scale of Perceived Exertion or the Talk Test can be used, preferably at level 35. This should be used in preference to a heart rate monitor, which is less reliable due to the pregnancy-induced increase in heart rate. Slide 13 There are benefits to exercising in the childbearing year. The benefits according to the ACPWH may include: maintenance of cardiovascular fitness, respiratory and musculoskeletal.status Slide 14 maintenance of healthy weight range for mother Slide 15 improvement of body awareness, balance, coordination and posture Slide 16 improve ment in circulatio n and lowered diastolic pressure. Slide 17 Slide 18 an increase in both endurance and stamina Slide 19 increased feelings of social and emotional well-being, when exercise is combined with social interaction. Slide 20 a possible reduction in problems during labour and delivery. Labour may also be shorter and there may be fewer interventions (forceps, caesarean section) Slide 21 evidence of neurological benefits to the baby and developing child Slide 22 Slide 23 a reduction in common disorders of pregnancy Slide 24 suggestion of a more rapid postnatal recovery as the woman is likely to be fitter Slide 25 Slide 26 better glucose utilization by increasing insulin sensitivity, Slide 27 suggested improved placental growth, increased fetal growth Slide 28 However, further research on the benefits of exercise in pregnancy is needed and health professionals should remain up to date with current literature. Most women will fall into one of the following four types of exerciser. Using the Borg Scale of Perceived Exertion is appropriate for all women, whatever their level of fitnessor ability. Slide 29 Slide 30 . The occasional exerciser These women may recognize the benefit of exercising when pregnant and may wish to increase the level of intensity, duration and regularity. Slide 31 . Slide 32 . The regular exerciser Guidelines for exercise in pregnancy (ACOG 2002) suggest that the woman who exercises regularly should: discuss her exercise programme with the obstetrician, GP, physiotherapist or midwife before continuing Slide 33 exercise at least three times per week for 2030 min to improve aerobic capacity but discontinue contact or dangerous sports Slide 34 self-regulate both the level of intensity and duration of exercise as the pregnancy progresses. This will help to keep core temperature below 38 C. Slide 35 always aim for low impact activity to reduce musculoskeletal stresses and wear supportive footwear Slide 36 prevent dehydration by maintaining an adequate fluid intake and should avoid exercising during hot and humid weather or with pyrexia Slide 37 ensure that they warm up and cool down for at least 5 minutes Slide 38 not overstretch because of the hormonal effects on the ligaments Slide 39 consult the relevant professional for advice on specific exercises, e.g. for the pelvic floor and abdominal muscles Slide 40 avoid certain movements like low squats, cross-over steps, rapid changes of direction and ballistic exercise Slide 41 avoid aortocaval compression by not exercising in the supine position (supine hypotension syndrome, Slide 42 not restrict their calorific intake but aim to eat to appetite Slide 43 aim to pursue a variety of exercise activities in order to avoid overtraining Slide 44 not exercise to the point of fatigue nor become breathless. Slide 45 The athlete These women are often the most difficult to advise as they are often highly motivated and competitive. They should follow the advice of regular exercisers. A safe level of aerobic exercise for the athlete will depend on the chosen sport and degree of fitness attained. Slide 46 The athlete will inevitably need to lower the intensity and length of her training sessions and they should be aware that the same warnings and contraindications apply as for the regular exerciser. Slide 47 Advisors of pregnant women athletes regarding safe exercise should remember that research into strenuous activity during pregnancy is limited, so should Endeavour to keep updated of new information. Slide 48 Slide 49 It is best to continue with familiar activities rather than begin new types of exercise and the woman should listen to her body when exercising and stop if she feels uncomfortable, fatigued or unwe ll Slide 50 Brisk walking during which the Borg Scale/Talk Test is correctly observed is an easy and accessible method of exercising for all. Slide 51 Slide 52 NOT I. Swimming is excellent exercise if aerobic changes are induced. II. Exercising in water also raises the plasma beta endorphin levels significantly and has a beneficial effect on the respiratory cardiovascular and musculoskeletal systems. Slide 53 Slide 54 1. serious cardiovascular, respiratory, renal or thyroid disease 2. 3. poorly controlled type 1 diabetes 4.risk of, or current, premature labor 5.cervical incompetence 6.history or risk of IUGR and premature labor reduce activity after 12 weeks 7.hypertension should be discussed with the woman's doctor 8.placenta praevia after 26 weeks' gestation should be discussed with the woman's doctor 9.sudden swelling of ankles, hands or face 10.acute infectious disease 11.severe rhesus isoimmunization. Slide 55 Slide 56 1.asthma 2.diabetes type 1. If insulin regimes are well controlled and exercise is moderate (Arena and Manfully 2002), discuss with diabetic consultant, GP or specialist nurse 3.history of miscarriage 4.pre-pregnancy hypertension 5.placenta praevia 6.vaginal bleeding 7.reduced fetal movement 8.anemia 9.breech presentation 10.extreme obesity 11.extreme underweight BMI