Antenatal Exercises

Original Editor - Rubi Top Contributors - Rubi, Ruchi Desai, Kim Jackson, Candace Goh, Khloud Shreif and Rishika Babburu

Introduction

Antenatal exercises aim at improving the physical and psychological well-being of an expected mother for labor and preventing pregnancy-induced pathologies by various physical means. It generally includes low impact aerobic exercises and stretching exercises.

During the first trimester, pregnancy brings certain changes in the body for example: morning sickness, fatigue or low energy levels, nausea and increased secretion of the relaxin hormone. Exercise helps to overcome these changes and improves the mood and energy level of the mother. Healthy pregnant women should exercise for at least 150 min per week or 20-30 min everyday in moderate to vigorous aerobic intensity.

Guidelines for Physical Activity during Pregnancy

For more information-

• Physiological Changes in Pregnancy
• Postural Changes during Pregnancy
• Physical Activity and Pregnancy

Advantages of Antenatal Exercise

• Reduces morning sickness.
• Reduces insomnia, anxiety and stress.
• Reduces other pregnancy-related complaints, eg: fatigue, leg cramps, oedema of extremities, etc.
• Prevents excessive weight gain during pregnancy.
• Improves muscle strength.
• Improves core stability.
• Maintains muscle length and flexibility.
• Improves glycemic control.
• Improves posture.
• Enhances relaxation.
• Prepares for physical demands of labour.

Contraindications

There are absolute contraindications and relative contraindications.

Absolute contraindications

• Ruptured membranes
• Premature labour
• Unexplained PV bleeding
• Placenta previa after 28 weeks
• Pre-eclampsia
• Incompetent cervix
• Intrauterine growth restriction
• Higher-order multiple pregnancy (e.g., twins, triplets etc.)
• Uncontrolled high blood pressure, type 1 or type 2 diabetes or thyroid disease
• Other serious cardiovascular, respiratory or systemic disorders

Relative contraindications

• Recurrent pregnancy loss
• Gestational hypertension
• A history of spontaneous preterm birth
• Mild/moderate cardiovascular or respiratory disease
• Symptomatic Anaemia
• Malnutrition
• Eating disorder
• Twin pregnancy after the 28th week
• Other significant medical conditions

Precautions

• Exercises should be performed under supervision.
• Avoid supine lying more than 5 minutes after 3 months of gestation.
• Do not hold your breath(Valsalva's maneuver).
• Do not change positions quickly.
• Stay hydrated at all times (before, during and after workouts).
• Follow proper warm-up and cool-down process.
• Ensure bladder emptying before workouts.
• Avoid exercises which demands higher balancing and different groups of muscles.

When to seek medical care?

• Excessively shortness of breath
• Chest pain or palpitations
• Dizziness
• Vaginal bleeding
• Abdominal pain
• Reduced fetal movement

Let's take a glance at the various form of exercises which can be performed during pregnancy!

Cardiovascular Exercise

• The intensity of the workout will be decided by an assessment on pre-pregnancy fitness level.
• It is important to choose any aerobic activity based on one's interests, such as walking, swimming, hiking etc.
• So if walking is the only cardio workout done by an individual, it can be practiced 20-30 minutes 3-4 times a week safely.

Stretching exercises

Pectoral stretch

• This exercise helps in the opening of the chest and prevents the development of round shoulders.
• Nudge the ball in the corner or near the wall.
• Sit in a comfortable position keeping the back on the ball.
• Keep your hands by the side or clasp them behind your head.
• Rest the head on ball and let the elbows expand and open your chest.
• Repeat 3 to 5 times.

Piriformis stretch

• Piriformis muscle plays an important role in pelvic stabilization and ADL's.
• Sit on the chair with neutral pelvis.
• Now keep your foot over the opposite knee and bend forward from the hips keeping your pelvis neutral until you feel the stretch.
• Hold it for 20-30 seconds.
• Repeat for the other side as well.
• Do 3 to 5 sets.

Hamstring stretch

• Shortening of hamstring can cause back pain and pelvic misalignment.
• This stretch can be performed in various positions and bilaterally or unilaterally.
• Sit in long sitting position, bend one knee and try to reach your extended leg as much as you can.
• Hold it for 20-30 seconds and repeat it for 3-5 times on each side.
• During first trimester, supine lying hamstring stretch can also be done.

Calf stretch

• The more the available length of Tendo achilies, the more force production during push off phase of walking and greater stability.
• Place rolled towel, mat or foam roller on the floor.
• Place ball of the foot on the towel, mat or roller and heel on the floor. keep the leg straight. hold this position for 20-30 seconds.
• Repeat on the other side and perform 3-5 sets on each side.

Butterfly / Tailor Pose

• sitting on the ground, bring the soles of shoes together, allowing knees to point out to each side.
• Grasping feet or ankles, draw both heels in as close to body as is comfortable.
• Lean forward slightly and hold that position. Focus on taking big deep belly breaths.
• For an even deeper stretch, press your thighs down with your hands or elbows to bring your knees closer to the ground. Hold that pose and focus on the stretch and your breath.

This is a fantastic hip-opening stretch for the inner thighs, hips, and groin. This pose not only helps widens your hips, but it also helps ease aches in lower back.

Squats / Garland Pose

• Stand with feet facing forward or slightly outward, shoulder-width or slightly wider than hip-distance, apart.
• Slowly and fluidly bend your knees and lower your body, extending the arms out in front for balance if helpful.
• Balance your weight on the balls of your heels and pause.
• Breathe and slowly rise back up and then repeat the action.

Hip Flexor Stretch

• Kneel on your right knee and put your left foot in front of you, so your leg forms a right angle.
• Put your left hand on your left thigh for balance and put your right hand on your right hip or also on your left thigh.
• Keeping your back straight, lean forward, and shift your body weight to the forward leg. You will feel the stretch in the right thigh.
• Hold for 30 seconds, then switch legs and repeat.

Seated Straddle

• Extend both legs out wide with your feet flexed.
• Press your pelvis and hamstrings into the floor to help straighten your spine.
• Stay in this position if this is enough of a stretch for the backs of your legs or walk your hands out in front of you.

Strengthening Exercises

Wall push ups

• Place hands shoulder-width apart on a wall,
• Step your feet back so your body is in an inclined plank position.
• Slowly lower your chest, making sure your body stays in alignment.
• Exhale as you press back to the plank start position.
• Repeat 5-10 times.

Single Arm Rows & Seated Row With Resistance Band

Single arm rows are one of the best ways to work on back muscles during pregnancy. back Strengthening will ultimately help to improve posture, which is being compromised by your growing breasts and belly. Using a bench to support body means less stress on core, and by focusing on one side at a time can really help to concentrate on back muscles stretching and contracting

To start this exercise, find a bench or platform that’s long enough to support knee and hand on one side of body. Come into an all fours position on the bench, then stick one leg out with foot securely on the floor. Use that same side hand to grab dumbbell. Row the weight up towards armpit with elbow coming up above back. Flex back muscles on that side while keeping the standing elbow in a strong and active stance. Do not rotate body at all, and keep chest facing down throughout the movement. Slowly return the dumbbell to the stretched starting position and repeat.

Bridging

• This exercise put more emphasis on the gluteus maximus and other larger postural muscles.
• Lie on your back, hands by your side, knee hip-width apart and heel under the knee.
• Keep your pelvis neutral, now squeeze your buttocks and lift the pelvis up.
• Hold it for 10-20 seconds, breath regularly.
• Come back to the starting position slowly.

Squats

• Great exercise for all the lower extremities muscle majorly focuses on gluteus maximus.
• Stand feet slightly more than hip width apart.
• Clasp the hands and bring them forward.
• Squat while exhaling and make sure knees won't go beyond the great toes.
• Press down and straighten the legs while going up.
• Ensure the stability.

Lunges

• This exercise put more emphasis on the gluteus,Hamstring and Quadriceps
• Stand straight, take one step forward.
• Now, lower yourself and try to maintain front leg vertical so that gluteus and hamstring will be loaded rather than quads.
• Pressing the leg down straighten yourself.

Third Trimester Specific Exercises

• To begin with the duck walk, one should first stand with feet placed wide apart and both arms at sides. While performing the exercise it is important that the abdominal muscles should be in tighten position so that the back and abdominal muscles are not accidentally injured.
• Thereafter one should required to lower body from the hips as if individual were about to sit on a chair, ensuring that the heels should be bearing the weight

• This way there will be no damage done to the knees. clasping hands together in front of chest is helps to maintain balance during the duck walk.
• Once in the required position, progress walk forward a few steps at a time without changing squat position, then turn around and walk back to the place from where started and slowly stand up. It is advisable that while performing the duck walk exercise, individual should lean forward to retain balance ensuring that the weight remains on the heels
• A modification to the duck walk exercise to increase the difficult level involves placing a resistance band around the ankles right from the start of the exercise. Of late there is a new form of exercise also referred to as the duck walk exercise which requires the individual to squat further down till they are almost seated on their heels.

Women can also practice the duck walk exercise during pregnancy specifically towards the last few months of the pregnancy . it will help to strengthen their thighs and will allow the baby’s head to move lower easily .Duck Walk is highly effective in facilitating easy & normal labor/delivery.,

Activities of Daily Living

• Staying active is advisable in pregnancy until there is any risk associated.
• Walking, squatting, lifting and lunging activities should be included as far as possible, as it will prepare you for the Bib day!
• Make sure you are hydrated.
• Don't compete.
• Don't hold breath.
• While performing exercises, ensure that you won't exhaust yourself.
• Take enough rest intervals.

Occupational therapy intervention

In women's health field occupational therapist creates an individualized care plans that consider physical, emotional, and social aspects through different stages from pre-conception journey to one year post-birth, using a comprehensive wellness model. During pre-conception stage occupational therapist help women to recognize the importance of health and nutrition management before pregnancy to enhance women's pre-conception health. They also assist women in understanding how their medical or mental health conditions could impact pregnancy, while also guiding them in making healthy lifestyle adjustments for maximum positive outcome for the mother and her baby, including medication and nutrition management.

During pregnancy, women face physical and mental challenges. Occupational therapists (OTs) play a crucial role in supporting women during this time. They help manage pain, anxiety, and fatigue, offering strategies and equipment recommendations. OTs also assist with self-care activities, like mobility and cooking, prepare women for childbirth, and provide the pregnant woman with adaptation to decrease the risk of hospital admissions of antenatal period. They ensure functional performance through practical preparations for the baby, like adapting homes and routines. Additionally, OTs empower women with disabilities to manage their new baby independently by using modified equipment. They provide emotional support to cope with potential negative attitudes from others about their abilities as mothers. In all these ways, OTs contribute to healthier pregnancies and positive outcomes.

Resources

American Occupational Therapy Association: Occupational therapy's unique role in maternal health and well-being