Introduction to Exercise Considerations During Pregnancy

  1. Be sure to check the patient's history and with the supervising PT about risk factors, particularly prior pregnancy-related complications, diabetes, and prior fitness level
  2. Low to no-impact exercise activities are preferred due to the increased laxity within the musculoskeletal system
  3. Relative perceived exertion (RPE) should be mindful of increased blood volume and cardiac work during pregnancy. Guideline is not to exceed 6-7/10 RPE.
  4. Avoid exercised-induced overheating to protect fetal health and development
  5. Supine positioning can result in increased compression to the inferior vena cava from the uterus; avoid prone positioning
  6. One in 10 (1:10) women have been shown to have chronic post-partum pelvic pain
    1. limit supine positioning to <=5 minutes due to risk of postural hypotension
    2. instruct in positioning techniques to minimize risk when supine
  7. Gentle and progressive spinal stabilization and postural control exercises should be included as tolerated during pregancy and post-partum
  8. Stress incontinence may begin during pregnancy and persist post partum; treatment can include biofeedback and internal mobilization in addition to targeted pelvic and core muscles
  9. Sample Programs
    1. https://www.therapeuticassociates.com/pregnancy-exercises-to-help-strengthen-your-pelvic-floor-core-and-posture-muscles/
    2. www.jospt.org/doi/pdf/10.2519/jospt.2014.0505
    3. alternative accessible content

Supine pregnant.jpg

 

Criteria for Discontinuing Exercise

If any of these are observed during supervised exercise, communicate with your supervising PT and their physician. PTAs educate patients in signs and symptoms of overexertion for self-monitoring during unsupervised exercise

  1. Persistent pain in chest, pelvic girdle, or low back
  2. Leakage of amniotic fluid
  3. Uterine contractions after exercise (mild uterine cramping during exercise is a normal exercise response)
  4. Vaginal bleeding
  5. Decreased fetal movement
  6. Persistent shortness of breath
  7. Irregular HR/tachycardia
  8. Syncope
  9. Swollen, hot calf (think "DVT")
  10. Difficulty in walking

Recall your knowledge of general medical conditions: when there are signs and symptoms of infection, inflammation, or metabolic disorders, exercises may require modification or physician clearance may be needed to insure exercise can be applied safely.

Absolute Contraindications for Exercise

Patients in high risk pregnancy categories may not be able to safely participate in any form or mild to moderate exercise. Absolute contraindications include:

  1. Incompetent cervix (early dilation)
  2. Vaginal bleeding
  3. Placenta previa (potential instability of placenta)
  4. Twins, triplets, etc (multiple gestation)
  5. Pre-eclampsia ( pregnancy-induced hypertension)
  6. Rupture of membranes (loss of amniotic fluid)
  7. Premature labor - labor begins <= 37th week of gestation
  8. Comorbidities (hx of heart, thyroid, and /or respiratory disorder
  9. Maternal Type 1 diabetes
  10. Slowed uterine growth

 

 

 Show quiz question

Value: 1

Your patient is 20 weeks pregnant and you observe shortness of breath prior to beginning therapy. You check vital signs and her resting HR is 104bpm.

Is it safe to begin aerobic exercise?

 
 

 

 Show quiz question

Value: 1

There are no precautions to exercise in supine during mid-to late pregnancy as long as there is no shortness of breath

 
 


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