Pre postnatal Sample Training Manual by HealthFitnessEducation

AN T E AND P O S T N A T A L FI T N E SS IN S T R U C T O R Level 3 - Student Manual

Section 02

Anatomical and Physiological Changes Associated with Pregnancy

Both fast and slow twitch muscle fibres are found in the layers of muscle that form the pelvic floor, indicating that these muscles are required to operate at speed and under force, and for sustained periods of time. The slow twitch fibres, which contain more enduring properties than fast twitch fibres, provide support to the base of the pelvis for prolonged periods, like resisting a urinary/bowel movement, or maintaining intraabdominal pressure. The fast twitch fibres are largely recruited reflexively when they are needed to brace the pelvic floor against rapid rises in intra-abdominal pressure, such as when coughing or sneezing.

Ante and Postnatal Fitness Instructor Level 3 Student Manual

These fibres have the ability to produce immediate-strong contractions, but become fatigued much quicker. When the effects of the hormone relaxin are coupled with the increased mass of the uterus and foetus, the pelvic floor is prone to stretching and weakness. This can reduce its ability to perform some or all of its functions, and often presents with stress incontinence. In extreme cases, a full pelvic organ prolapse may occur, in which case immediate medical treatment should be sought. The treatments for a prolapse are varied, and range from corrective exercises to surgery.

Summary of Physiological Changes 1st Trimester

2nd Trimester

3rd Trimester

• Vascular underfill (fatigue, sickness, pallor)

• Vascular underfill corrects with greater production of blood

• Blood volume increases further

• Reduced blood pressure

• Heart rate normalises

• Greater weight gain as foetus grows

• Increased heart rate

• Increased energy levels

• Greater fatigue

• Greater insulin resistance

• Better regulation of body temperature (sweat sooner, greater vasodilation to the skin)

• Shortness of breath

• Increased fat storage • Production of relaxin, making joints more lax and unstable

• Increased relaxin production • Increased maternal weight gain (7-11 lb) • Increased lumbar curvature- as baby grows pelvis tilts anteriorly

• Slight reduction in heart rate

• Greater risk of postural changes/ disorders • Relaxin and insulin levels continue to rise • Increase pelvic floor pressure

• Increased pressure on pelvic floor muscles

Digestive and Urinary Changes Associated with Pregnancy

Changes to the Skin Associated with Pregnancy

Most pregnant women tend to experience a general decrease in the motility of food and matter through the gastrointestinal tract. This can often lead to constipation, delayed gastric emptying, heartburn, nausea and vomiting (Tortora and Derrickson, 2011).

During pregnancy there are a variety of common changes that affect the tone and appearance of the skin. The two most common of these changes include those affecting the breast and abdominal area, particularly the linea alba, and those affecting the eyes.

The pressure placed on the bladder by the enlarging uterus can also increase the frequency and urgency of urination, increasing the pregnant woman’s risk of stress incontinence.

Throughout their term, many pregnant women experience an increased pigmentation of the skin around the eyes and cheekbones. This is referred to as ‘chloasma’. The tone and pigmentation of the skin surrounding the areola of the breast also usually darkens. The same also occurs in the linea alba of the rectus abdominis, which usually presents as a dark vertical line in the lower abdominal region. This is referred to as the ‘linea nigra’.

As the pregnancy progresses and the foetus grows, there is a greater need to eliminate both the mother and her foetus’s waste. Consequently, the flow rate of filtered fluid through the kidneys (glomerular filtration rate) can increase by as much as 40%, while the blood plasma flow through the kidneys may increase by as much as 35%. This increased flow of blood and fluids allows the mother’s body to eliminate excess waste more quickly (Tortora and Derrickson, 2011). 18

Ante and Postnatal Fitness Instructor Level 3 Student Manual

Health and Safety Considerations

Section 04

Placenta previa after 26 weeks gestation - a complication in which the placenta is situated wholly or partially in the lower and non-contractile part of the uterus. It occurs in the second and third trimesters of pregnancy and may present a serious risk to both the foetus and the mother. It is one of the leading causes of vaginal bleeding in the second and third trimesters. Premature labour during the current pregnancy when a woman goes into labour before the 37-week term is complete. Common signs of premature labour include the onset of contractions, which occur at a frequency of 10 minutes or less, blood or fluid leaking from the vagina and increased pelvic pressure. Ruptured membranes - rupture of membranes (ROM) or amniorrhexis are both terms used to describe a rupture of the membranous sac that supports and protects the foetus. When this occurs early, the term premature rupture of membranes (PROM) is used. The membranes usually stay intact until several hours before labour commences; when the amniotic sac ruptures early, however, the foetus and mother are at an increased risk of infection and inflammation because the foetus is no longer protected in a sterile environment. Pregnancy induced hypertension - the onset of hypertension (140/90 mmHg) as a result of being pregnant. Pre-eclampsia - a medical condition of pregnancy that is characterised by the onset of sudden hypertension, large amounts of protein in the urine (proteinuria), fluid retention (oedema) and other physical symptoms like headaches and blurred vision. Pre-eclampsia is a precursor to eclampsia, which often results in convulsions and coma. It is, therefore, an extremely serious condition that requires immediate medical treatment.

Relative Contraindications to Exercise When pregnant women present with one or more of the following relative contraindications, medical consent should be sought before exercise commences or a change in physical activity patterns is made: •S evere anaemia - symptoms include breathlessness on mild-moderate exertion and excessive tiredness

•P oorly controlled type 1 diabetes - hyperglycaemia brought about by a deficiency of insulin. When the condition is poorly controlled, the diabetic patient demonstrates an inability to maintain their blood glucose levels within an appropriate range •M orbidly obesity - a BMI >40 •E xtremely underweight - a BMI <12 •H istory of extremely sedentary lifestyle - not achieving the recommended NICE guidelines for physical activity (30 minutes on most days of the week) prior to pregnancy •H istory of miscarriage - irrespective of trimester and cause • I ntrauterine growth restriction - poor growth of the foetus during the current pregnancy •P oorly controlled hypertension - systolic BP ≥160 and/or diastolic BP >90 mmHg •O rthopaedic limitations - disorders of the musculoskeletal system and associated that may affect a person’s physical ability •P oorly controlled seizure disorder - frequent and abnormal electrical discharges from brain cells resulting in seizures, e.g. epilepsy •P oorly controlled hyperthyroidism – sustained and elevated levels of the thyroid hormone •H eavy smoker - > 20 or more cigarettes per day.

•U nevaluated maternal cardiac arrhythmia - an irregular or abnormal heart rate of the expectant mother •C hronic bronchitis - an inflammatory and obstructive condition in the lungs that causes the respiratory passages to become swollen and irritated

Section 04

Health and Safety Considerations

Ante and Postnatal Fitness Instructor Level 3 Student Manual

Such vigorous types of exercise also increase the following risks to the mother and foetus:

• Not exercising in a very hot and humid climate, especially when not acclimatised to such environments

• Dehydration

• Ensuring appropriate fluid and food intake

• Hypoglycaemia

• Wearing appropriate clothing for exercise, preferably layered.

• Hyperthermia.

The following table summarises a range of health and safety concerns and considerations for pregnant women • Limiting the duration and intensity of the exercise sessions when exercising. These risks can be mitigated by:

Mother

Foetus

Risk

Solution

Risk

Solution/Effect

Poor balance while running or jogging because of an altered weight distribution and centre of gravity.

Slow down, run cautiously and never run alone.

Direct foetal trauma. Tissue and fluid surrounding the foetus provides protection.

No scientific data – variable effects depending on the severity of the trauma and the precise location of impact.

Overheating and dehydration. Pregnancy elevates core body temperature by around 0.5°C, elevating metabolic rate by 15-20%. Excessive sweating might therefore reduce blood volume.

Drink plenty of fluids before, during and after exercise. Use appropriate exercise clothing or avoid exercise during extremely hot and humid weather.

Hyperthermia and reduced foetal blood flow.

Might cause neural tube defects, growth retardation, reduced birth weight or foetal abnormalities.

Leg, hip and abdominal pain. Reduced circulation to the lower extremities during late pregnancy, extra weight to carry.

Never forget to stretch and warm-up before any exercise session. Wear cushioned and comfortable shoes.

Reduced foetal blood flow.

No scientific data.

Nutrition availability. Pregnancy increases the energy requirements by around 300 kcal/d.

Pregnant women are expected to increase in bodyweight by around 11-18 kg.

Substrate availability and hypoxia. Reduced foetal glucose and oxygen availability.

Could possibly cause growth retardation, reduced birth weight or foetal abnormalities.

Reduced oxygen availability for aerobic exercise. Cardiovascular drift: additional blood circulation to the placenta.

Modify exercise intensity. Never exercise to the point of fatigue or exhaustion. Avoid intense and prolonged exercise. Monitor heart rates and rates of perceived exertion.

Reduced foetal blood flow. Intense exercise redistributes blood flow – more to muscles and less to other areas, including the placenta.

Light to moderate physical activities are considered wise for mothers and foetuses.

Musculoskeletal injury. Ballistic movements and sudden postural changes can increase the risk of injury. The risk of injury for fit pregnant women is generally lower.

Continuous aerobic exercises are more acceptable than intermittent anaerobic exercises.

Umbilical cord entanglement. Can cause reduced blood flow to important foetal organs.

No scientific data to support activities which increase the risk of this, or that can be performed to prevent it.

Section 05

Nutrition and Pregnancy

Ante and Postnatal Fitness Instructor Level 3 Student Manual

Section 05

Nutrition and Pregnancy Introduction Eating a nutritionally sound diet is important for maintaining optimum health at any stage of life. However, this is even more important during pregnancy because it is imperative for the health of the mother and her foetus that sufficient nutrients and energy are consumed and in the right proportions.

are not qualified or insured to dispense specific nutrition advice, prescriptions or otherwise to their clients.Only general advice and information can be shared with clients. This job must be left to the nutrition professionals trained to work with those requiring specialist nutritionbased interventions.

Healthy Food Choices during Pregnancy Fruit and Vegetables

A woman’s nutritional intake during her pregnancy will not only affect her during her gestation period, but it can also affect her later in life. For example, if a pregnant woman consumes a diet that is deficient in calcium, additional bone density is lost, over and above that which is already lost to the growing foetus. The net result of this shortfall is an overall increase of the woman’s risk of developing osteoporosis and problems with her teeth and gums. Poor nutrition during pregnancy can also affect the baby into childhood, as he or she may be more prone to allergies and general sickness (Baker, 2006). Contrary to popular belief, pregnancy does not require a highly specialised or restrictive diet. Rather, pregnant women should focus on consuming a well-rounded and balanced diet that includes foods from a variety of wholesome and natural sources. Although many of the guidelines for healthy eating still apply to pregnant women, there are also some exceptions and considerations which must be applied to ensure the right balance of energy and nutrients are consumed, and the potential for adverse or allergic reactions are negated. This section is not intended to provide an ‘all-inclusive’ guide to nutrition during pregnancy, but merely seeks to clarify many of the myths and misconceptions about which foods are and are not appropriate. For more information on wider nutrition-related matters, please refer to the Level 3 Nutrition for Physical Activity student manual. It is important to stress at this point that, while exercise professionals may benefit from an increased knowledge of nutrition-related matters for pre and postnatal clients, exercise professionals are not dieticians and so they

Fruit and vegetables provide a valuable source of nutrients and are rich in vitamins, minerals, carbohydrates and fibre. Pregnant women should aim to eat at least five portions of fruit and vegetables each day. The source of these foods can include fresh, frozen, tinned, dried or juiced produce; however, in order to maximise the nutritional benefits of vegetables, they should only be cooked lightly in water or eaten raw. All fruit and vegetables should be washed thoroughly to ensure that they are free of insects and/or chemicals used in farming. Organic produce would always be favourable, although not all clients will be able to afford or be prepared to pay the higher prices for these foods.

Ante and Postnatal Fitness Instructor Level 3 Student Manual

Section 08

Prenatal Exercise Guidelines

Section 08

Prenatal Exercise Guidelines Introduction

Session Structure

The effects of exercise during pregnancy have

A typical prenatal exercise session should include a clearly defined warm-up and cool-down period and include a range of varied and appropriate activities in the main component. The inclusion or exclusion of specific exercises will need to be negotiated with clients on the basis of their exercise preferences, stage of pregnancy, goals, aspirations and exercise experience.

been the subject of extensive and detailed research. In most cases, the conclusion is that exercise is safe and beneficial for both the mother and her foetus during and beyond pregnancy. Such research has given rise to the development of a series of detailed guidelines designed to assist prenatal exercisers determine what is safe and what is not. These guidelines should be applied judiciously, taking into account each client’s circumstances and the changes that occur at each stage of pregnancy.

Introduction/Review

Feedback and reflection

Generally speaking, however, all prenatal exercise sessions should be structured in accordance with the following flow chart. Each element can be adapted to take into account the environment and type of exercise delivered (gym, studio, outdoors, Pilates, Yoga etc.).

Conditioning (muscular and/or cardiovascular)

Warm-up

Relaxation

Cool-down

Pelvic floor exercises

Introduction/Review

Warming-up

When teaching exercise to a prenatal client for the first time, a thorough consultation should be completed to ensure that it is safe for the client to commence exercise. Consultations should typically be completed well in advance of any exercise sessions to allow time for the programme to be designed specifically for the client’s needs. Before any exercise session commences, however, the session should begin with an introduction and review to:

The warm-up guidelines for pregnant clients are generally similar to those of non-pregnant clients. The warm-up should consist of a series of lowintensity exercises that primes the joints, muscles, cardiorespiratory system and energy systems for exercise. Within the warm-up there should be a distinct:

• Verbally screen the client to check for any new contraindications

• Joint mobilising component • Pulse-raising component • Preparatory stretch component.

Generally speaking, the warm-up will be slower and longer, including a more gradual and progressive increase in workload. A typical warm-up may last • Modify the client’s exercise programme in accordance with 10-12 minutes for a non-pregnant client; however, in any changes, and their previous response to exercise pregnancy this duration may need to be increased to 15-20 minutes. • Establish how the client feels generally, including their readiness to partake in exercise at that particular time. • Gather additional information about any changes in the client’s health status

Section 9

Prenatal Exercise Guidelines

Ante and Postnatal Fitness Instructor Level 3 Student Manual

Pregnancy Anatomy

1 3

Trachea

11 Umbilical cord

Heart

12 Foetus

Lung

13 Uterus

Liver

14 Cervix

Diaphragm

15 Bladder

Kidney

16 Pubis

Stomach

17 Urethra

Small Intestine

18 Vagina

Colon

19 Rectum

4 7

9 8 6

11 10 12 13

10 Placenta

14 15 16 19

18 17

Childbirth Descent: As the foetal head engages and descends, it assumes an occiput transverse position (facing the motherâ&#x20AC;&#x2122;s hip) because that is the widest pelvic diameter available for the widest part of the foetal head.

Flexion: While descending through the pelvis. The foetal head flexes so that the foetal chin is touching the foetal chest. This functionally creates a smaller structure to pass through the maternal pelvis.

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