Which of the following exercises should be taught to a pregnant woman who complains of backaches?

Overview

How can I stay fit?

Regular exercise during pregnancy can improve your posture and decrease some common discomforts such as backaches, constipation, bloating, swelling, and fatigue. Exercise can also increase mood and assist with sleep. Being fit during pregnancy means safe, mild to moderate exercise at least 3 times a week, unless you have been otherwise advised by your physician.

If you were physically active before your pregnancy, you should be able to continue your activity in moderation. Don’t try to exercise at your former level. Instead, do what’s most comfortable for you now. Stay within 70 percent of your target heart rate (target heart rate can be measured at 220 minus your current age).

If you have never exercised regularly before, you can safely begin an exercise program during pregnancy after consulting with your healthcare provider. If you did not exercise 3 times a week before getting pregnant, do not try a new, strenuous activity. Start with a low-intensity activity and gradually move to a higher activity level.

Is exercise safe for everyone?

Every pregnant woman should consult with her healthcare provider before beginning an exercise program. Your healthcare provider can give you personal exercise guidelines, based on your medical history.

If you have a medical problem, such as asthma, heart or lung disease, or high blood pressure, exercise might not be advisable for you. Exercise might also be harmful if you have an obstetric condition such as:

• Vaginal bleeding or spotting
• Low placenta
• Weak cervix
• Threatened or recurrent miscarriage
• Premature ruptured membranes
• Previous premature births or history of early labor

What exercises are safe?

Most exercises are safe to perform during pregnancy, as long as you exercise with caution and you do not overdo it.

The safest and most productive activities are swimming, brisk walking, indoor stationary cycling, prenatal yoga and low-impact aerobics (taught by a certified aerobics instructor). These activities carry little risk of injury, benefit your entire body, and can be continued until birth.

Other activities such as jogging can be done in moderation. You might want to choose exercises or activities that do not require great balance or coordination, especially later in pregnancy.

Exercises to avoid

There are certain exercises and activities that can be harmful if performed during pregnancy.

Avoid:

• Holding your breath during any activity
• Activities during which falling is likely (such as skiing and horseback riding)
• Contact sports such as softball, football, basketball, and volleyball (to reduce your risk of injury)
• Any exercise that might cause even mild abdominal trauma such as activities that include jarring motions or rapid changes in direction
• Activities that require extensive jumping, hopping, skipping, bouncing, or running
• Deep knee bends, full sit-ups, double leg raises, and straight-leg toe touches
• Bouncing while stretching (bounce stretching is unsafe for everyone)
• Exercises that require lying on your back or right side for more than three minutes (especially after your third month of pregnancy)
• Waist-twisting movements while standing
• Heavy exercise spurts followed by long periods of inactivity
• Exercise in hot, humid weather (if at all possible)
• Hot tubs, saunas, and steam rooms

What should an exercise program include?

For total fitness, an exercise program should strengthen and condition your muscles.

Always begin by warming up for 5 minutes and stretching for 5 minutes. Include at least 15 minutes of cardiovascular activity. Measure your heart rate at times of peak activity. Your heart rate might range from 140 to 160 beats per minute during activity. Follow aerobic activity with 5 to 10 minutes of gradually slower exercise that ends with gentle stretching.

Basic exercise guidelines:

• Wear loose-fitting, comfortable clothes, as well as a good support bra.
• Choose shoes that are designed for your type of exercise. Proper shoes are your best protection against injury.
• Exercise on a flat, level surface to prevent injury.
• Consume enough calories to meet the needs of your pregnancy (300 more calories per day than before you were pregnant), as well as your exercise program.
• Finish eating at least one hour before exercising.
• Drink water before, during, and after your workout.
• After doing floor exercises, get up slowly and gradually to prevent dizziness.
• Never exercise to the point of exhaustion. If you cannot talk normally while exercising, you are probably over exerting yourself, and you should slow down your activity.

Stop exercising and consult your healthcare provider if you:

• Feel pain
• Have abdominal, chest, or pelvic pain
• Notice an absence of fetal movement
• Feel faint, dizzy, nauseous, or light-headed
• Feel cold or clammy
• Have vaginal bleeding
• Have a sudden gush of fluid from the vagina or a trickle of fluid that leaks steadily (when your bag of “water” breaks, also called rupture of the amniotic membrane)
• Notice an irregular or rapid heartbeat
• Have sudden swelling in your ankles, hands, face, or experience calf pain
• Have increased shortness of breath
• Have persistent contractions that continue after rest
• Have difficulty walking

What physical changes might affect my ability to exercise?

Physical changes during pregnancy create extra demands on your body. Keeping in mind the changes listed here, remember that you need to listen to your body and adjust your activities or exercise routine as necessary.

• Your developing baby and other internal changes require more oxygen and energy.
• Hormones produced during pregnancy cause the ligaments that support your joints to stretch, increasing the risk of injury.
• The extra weight and the uneven distribution of your weight changes your center of gravity. The extra weight also puts stress on joints and muscles in the lower back and pelvic area, and makes it easier for you to lose your balance.

How soon can I exercise after delivery?

It is best to ask your healthcare provider how soon you can begin your exercise routine after delivering your baby.

Although you might be eager to get in shape quickly, return to your pre-pregnancy fitness routines gradually. Follow your healthcare provider’s exercise recommendations.

Most women can safely perform a low-impact activity 1 to 2 weeks after a vaginal birth (3 to 4 weeks after a cesarean birth). Do about half of your normal floor exercises and don’t try to overdo it. Wait until about 6 weeks after birth before running or participating in other high-impact activities.

Exercises to try

Listed here are some basic stretching and toning exercises for pregnant women. Remember: Before you start any exercise program, consult with your healthcare provider. Your healthcare provider can give you personal exercise guidelines, based on your medical history.

Stretching exercises

Stretching makes the muscles limber and warm. Here are some simple stretches you can perform before or after exercise:

Neck rotation: Relax your neck and shoulders. Drop your head forward. Slowly rotate your head to your right shoulder, then back to the middle and over the left shoulder. Complete 4, slow rotations in each direction.

Shoulder rotation: Bring your shoulders forward, then rotate them up toward your ears, then back down. Do 4 rotations in each direction.

Swim: Place your arms at your sides. Bring your right arm up and extend your body forward and twist to the side, as if swimming the crawl stroke. Follow with your left arm. Do the sequence 10 times.

Thigh shift: Stand with 1 foot about 2 feet in front of the other, toes pointed in the same direction. Lean forward, supporting your weight on the forward thigh. Change sides and repeat. Do 4 on each side.

Leg shake: Sit with your legs and feet extended. Move the legs up and down in a gentle shaking motion.

Ankle rotation: Sit with your legs extended and keep your toes relaxed. Rotate your feet, making large circles. Use your whole foot and ankle. Rotate 4 times on the right and 4 times on the left.

Muscle toning exercises

The following exercises can be done to strengthen the muscles of your vagina, abdomen, pelvic floor, back, and thighs.

Pelvic tilt: Pelvic tilts strengthen the muscles of the abdomen and lower back, increase hip mobility, and help relieve low back pain during pregnancy and labor.

All fours: On the floor, get on your hands and knees, keeping your hands in line with your shoulders and your knees in line with your hips. Keep your back flat and shoulders relaxed. Inhale. While tightening your abdomen, tuck your buttocks under and tilt your pelvis forward in one motion. Exhale. Relax, being careful not to let your back sag. Continue to breathe. Repeat 10 times.

Standing: Stand with your feet about 10 inches apart, legs relaxed and knees slightly bent. Place your hands on your hips. Inhale. While tightening your abdomen, tuck your buttocks under and tilt your pelvis forward in one motion. Exhale and relax. Repeat 10 times.

Tailor exercises

Tailor exercises strengthen the pelvic, hip, and thigh muscles, and can help relieve low back pain.

Tailor sit: Sit with your knees bent and ankles crossed. Lean slightly forward. Keep your back straight but relaxed. Use this position whenever possible throughout the day.

3a on the left, 3b on the right.

Tailor press: Sit with your knees bent and the soles of your feet together. Grasp your ankles and pull your feet gently toward your body. Place your hands under your knees. Inhale. While pressing your knees down against your hands, press your hands up against your knees (counter-pressure). Hold for a count of 5.

Kegel exercises

Kegel exercises, also called pelvic floor exercises, help strengthen the muscles that support the bladder, uterus, and bowels.

By strengthening these muscles during pregnancy, you can develop the ability to relax and control the muscles in preparation for labor and birth.

Kegel exercises are highly recommended during the postpartum period to promote the healing of perineal tissues, increase the strength of the pelvic floor muscles, and help these muscles return to a healthy state, including increased urinary control.

How to do Kegel exercises

Imagine you are trying to stop the flow of urine or trying not to pass gas. When you do this, you are contracting the muscles of the pelvic floor and are practicing Kegel exercises. While doing Kegel exercises, try not to move your leg, buttock, or abdominal muscles. In fact, no one should be able to tell you are doing Kegel exercises.

How often should I do Kegel exercises?

Kegel exercises should be done every day. We recommend doing 3 sets of Kegel exercises a day. Each time you contract the muscles of the pelvic floor, hold for a slow count of 10 seconds and then relax. Repeat this 15 times for 1 set of Kegels.

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