Exercise During Pregnancy 

in pregnancy; The posture of the body changes depending on the growth of the uterus and the increase in body weight. Changes in body posture cause low back pain: 

 Are there any benefits of exercise during pregnancy? 

 in pregnancy; The posture of the body changes depending on the growth of the uterus and the increase in body weight. Changes in body posture cause low back pain: 

-To eliminate postural disorders that occur during pregnancy 

reduce back pain 

-Teaching necessary breathing and relaxation during childbirth 

-Increasing the elasticity and strength of the abdominal and perineal muscles 

-Preparing the mother for birth spiritually 

-Conscious birth of the expectant mother 

-Exercise should be done during pregnancy in order to provide assistance and facilitate delivery. 

 When should exercises be started during pregnancy? 

After the first three months, an exercise program should be started and continued regularly once a week until delivery. 

 Who should organize the exercise program? 

 Every woman is different psychologically and physically. Therefore, every pregnant woman should be evaluated by a physiotherapist and an exercise program should be planned. 

 What are prenatal exercises? 

 1- Breathing Exercises; 

       -deep abdominal breathing 

       -deep chest breathing 

       -laryngeal breathing 

2- Relaxation exercises 

3- Exercises to reduce back and waist pain. 

What is the purpose of prenatal exercises? 

Breathing exercises enable the expectant mother to push effectively by using her breath in a controlled manner during pain in the second period of labor. relaxation exercises; During the painless period of labor, it teaches the expectant mother how to relax and provides the necessary energy accumulation for the birth of the baby and helps her to use her power beneficially. 

 What are the most suitable relaxation positions for the expectant mother? 

– Back: There should be a thin pillow under the head, the knees should be bent, and the foot should be in a natural position. 

-Side: There should be a pillow under the head, the body should be forward, the back arm should be on the straight side, the legs should be slightly bent and there should be a pillow between the legs. The front arm can be supported on a pillow. The person who can relax will help the uterus to open in the first stage of labor. 

Which Exercises Relieve Back and Low Back Pain? 

1-Pelvic Tilt: The pregnant woman lies on her back with her knees bent. There is a thin pillow under the head, he presses his hand against the bed, counts to 10 and relaxes. Do this exercise while sitting and standing. 

2-With the pelvic tilt, the expectant mother pulls her knees towards her tummy and straightens them. He breathes in as he straightens his knees, and exhales as he pulls into his stomach. 

3-Lying on his back, with the knees bent, he raises his head and looks towards his knees and leaves. He inhales when lowering his head, exhales when lifting. This exercise should also be done with the pelvic floor. 

4-While the expectant mother lies on her back with her knees bent, she presses her whole back to the bed, counts to 10 and relaxes. 

5-Again, in the same position, he tries to bring his hips together by squeezing, counting to 10 and relaxing. 

6-Lying on his back, he crosses his legs and repeats the previous exercise. 

7-Knees bent on back, bend knees to the side, touch the ground and relax. 

8-Knees bent on back, legs touching left and right. This move can also be done with one leg (one right leg and one left leg). 

9-The expectant mother starts to move with the back straight on the hands and knees. He exhales as he hunches his back and bends his head down, and inhales as he straightens and hollows his back and raises his head. 

10-With the growth of the baby and the increase in weight, pain and circulatory disorders may occur in the legs. To prevent this, the expectant mother lies on her back with her feet raised with a pillow, pulls the foot up and down from the wrist and makes circular movements from the ankle. 

11-He sits cross-legged. Flexes hands and knees to the ground and releases. The same movement is repeated with the soles of the feet together. 

12-Feet 20 cm. with legs apart, squats out and stands up. 

13-He goes in front of the mirror and corrects his body posture. 

What should the expectant mother pay attention to in daily activities? 

 1-He should stay on his knees while doing housework, dusting, cleaning the floor. 

2-In order to get up and sit while lying on his back, he should first turn sideways and then get up by taking strength from the arms. 

3-He should get up from the chair by putting his weight on his legs and getting support. 

What are the actions that the expectant mother should not do? 

 1- Sudden movements 

 2- Heavy to lift 

 3- Squatting or doing work in late pregnancy. 

How many times a day should the exercises be done? 

Each of the exercises should be regularly repeated 5-6 times a day. Pregnant women who have been exercising before can continue with the same exercise program, provided that they are not heavy. Excessive weight gain during pregnancy and not being able to lose excess weight in the postpartum 6 months cause long-term obesity. Exercise and a balanced diet provide the desired weight gain during pregnancy. Exercises done during pregnancy reduce the risk of gestational diabetes and long-term obesity, increase posture, muscle tone, strength and endurance, paving the way for faster labor and a faster recovery process. Exercise is also good for low back pain, gas and swelling in the feet, which are common complaints of pregnancy. However, when a pregnant woman exercises, she should take an extra 300 kcal/day of calories. Behaviors towards exercise during pregnancy have varied over the years. In 1985, ACOG recommended that aerobic exercises should not exceed 15 minutes and heart rate should not exceed 140 beats/min. Ten years later, the same committee stated, based on physiological evidence, that women with uncomplicated pregnancies could exercise at the same level as non-pregnant women. Physiological Effects and Adaptations Cardiovascular System Cardiac output 50%, resting heart rate 

15 beats faster than the speed and blood volume increases by 45%. 

Thanks to the increased capacity in the veins, blood pressure decreases, vasodilation occurs in the skin, and the tendency to hyperthermia decreases with the resulting heat loss. It has been suspected that the increased blood flow to the muscles during exercise may result in less blood pumping to the uteroplacental unit. However, compensatory changes such as increase in maternal hematocrit and oxygen extraction caused by exercise ensure that fetal oxygenation is not impaired. Fetal heart rate increases by 5-15 beats for a short time and does not put the fetus at any risk. 

Episodes of fetal bradycardia do not occur unless there is an obstetric or medical complication. However, this position should be avoided after the first trimester as the supine position will decrease maternal cardiac output. It has also been shown that uterine blood flow is reduced in women living in high altitudes. It is recommended that women living at altitudes exceeding 2500 meters should avoid excessive physical exertion at least until the completion of the 4-5 day period. 

It is known that maternal core temperature exceeding 39.2 degrees metabolically has possible teratogenic effects in the first trimester. Increased ventilation and skin blood flow are adaptive changes that provide protection from hyperthermia during pregnancy. However, it is still not recommended to provide adequate hydration and not to exercise in extremely hot/humid environments in order to prevent hyperthermia. Due to limited expansion of the diaphragm and increased fetal oxygen demand during pregnancy, VO2 max decreases significantly during exercise compared to nonpregnant subjects. As a result, carbohydrates are used more (as indicated by indirect calorimetry). Thus, during prolonged (>45 min) or strenuous exercise, plasma glucose concentrations are significantly reduced. Therefore, in order to reduce the risk of hypoglycemia, it is recommended to keep adequate calorie intake and exercise duration below 45 minutes during exercise. 

Musculoskeletal System Changes in the musculoskeletal system of the pregnant woman increase the risk of injury during exercise. The growth of the breasts, uterus and fetus increases the lumbar lordosis, pulls the center of gravity forward and causes weight loading towards the waist; hormonal changes lead to increased laxity and mobility in the joints. For these reasons, all exercises during pregnancy should be tried to be done without too much strain and without overloading the joints. 

Effects on the Fetus: The birth weight information of the fetuses of women who exercise birth weight is inconsistent. 

A study by Clapp JF in 1990 showed that when pregnant women increased their exercise levels by more than 50% compared to pre-conception, birth weight decreased significantly. In another study conducted by Sternfeld, no difference was found between birth weights when the pregnant women who did heavy exercise were compared with those with a sedentary lifestyle. In a prospective study conducted by Hatch et al. in 800 pregnant women, it was observed that women who exercise at a level to spend a total of 2000 kcal per week gave birth to babies with a higher birth weight than women who did not exercise. In a study by Pivarnik in 1998, it was concluded: “The available evidence shows that moderate to vigorous physical activities during pregnancy can have positive effects on birth weight”, but it should be noted that vigorous exercise programs can lead to low birth weight. 

Duration of Pregnancy It was thought that increased norepinephrine and prostaglandin release during exercise may stimulate uterine activity and premature delivery. However, there is very little research done on this subject. In the study conducted by Hatch in 1998, 876 pregnant women who spent more than 1000 kcal of aerobic activity per week were studied and a decrease in the risk of preterm birth was found when compared to the group that did not exercise at all. Therefore, it has been concluded that exercises during pregnancy are safe. 

Effects on the Mother: It has been observed that symptoms such as nausea, fatigue and low back pain decrease in pregnant women who exercise during pregnancy. 

In an observational study of 398 pregnant women, an inverse association was found between exercise and symptoms. Birth and Labor The effect of exercise on childbirth is unclear. Many women stated that they felt more fit due to exercise, and accordingly, delivery became easier. In a well-controlled and non-randomized study, it was found that the duration of labor was shortened in women who exercised compared to those who did not. In a study conducted by Pomerance in 1974, it was found that the duration of labor was shortened in multiparas who exercised; however, it was observed that this effect was not observed in primiparas. However, many other studies have not found a correlation between exercise level and delivery time. 

Exercise and Gestational Diabetes Mellitus (GDM) The American Diabetes Association (ADA) has recommended exercise as a useful side treatment in cases where diet and euglycemia cannot be achieved in GDM. In a randomized study conducted by Jovanovic in 1989, patients who diet alone and those who do aerobic arm exercises were compared. At the end of the sixth week, hemoglobin A1C, fasting blood glucose, postprandial blood glucose levels decreased in the exercise group, and no improvement was observed in the controls. In another study conducted by Bung et al in 1991, a higher efficiency exercise program was applied and normoglycemia was reached in 1 week. General Advice on Exercise Pregnant women with a sedentary lifestyle should be encouraged to start exercising. It may be recommended to start with sports with low risk of injury, such as walking and swimming, not exceeding 20-30 minutes per day. 

Pregnant women who have been exercising before are recommended to continue with the same exercise program. The points to be considered during the exercises are as follows: 

1-The exercise program should be regular. 

2-Exercise should be stopped when signs of oxygen deprivation such as extreme fatigue, dizziness, and shortness of breath develop. 

3-In order to avoid overheating, exercise should be done in a cool environment and dehydration should be avoided. 

4-In the second and third trimesters, prolonged exercises in the supine position should be avoided. 

5-Contact sports and diving sports should be avoided. 

6-The calorie requirement required by the exercise must be taken (average 300 kcal/day). The contraindications stated by ACOG in 1994 are as follows: 

-Intrauterine growth restriction 

-Persistent vaginal bleeding 

-Cases with suspected cervical insufficiency or cerclage placed 

-Having risk factors for preterm birth 

-Cases with membrane rupture 

-Pregnancy-induced hypertension 

-Severe chronic medical diseases.