Adherence - Pregnancy & Postpartum Flashcards
Characteristics of Adherers
- Enjoy physical activity
- High self-motivation
- High exercise knowledge
- Positive attitude toward exercise
- Perceive benefits outweigh the costs
- Past participation in exercise
- At high risk for heart disease
- Perceived good health
- Sufficient behavioural skills
- Receive social reinforcement for exercise
- Perceived available time
Characteristics of dropouts
- Blue collar occupation
- Smoker
- Overweight
- Psychological mood disturbance
- Perceived poor health
- Low self-motivation
- Low exercise knowledge
- Negative attitude towards
exercise - Perceived disruptions in exercise routine
- Activity too intense, too much exertion
Reasons to Exercise
- Fun
- Feeling good
- Weight control
- Challenge
- Stress Reduction
- Doctor’s advice
- Social reasons
- Appearance
- Achievement
- Competition
- Health
- Skill Learning
- Self-actualisation
- Fitness
Perceived Barriers to exercise
- Lack of time
- Injuries
- Expense
- Lack of support
- Limiting health
- Lack of interest
- Previous exercise experience
- Lack of choice
- Lack of facilities
- Boredom
- Too much effort
Pre-contemplation
- Individuals who are not even considering changing behaviour
- No intention of exercising in the next 6 months
Contemplation
- Individual considers making a change in their behaviour
- Has an intention of starting exercise in the next 6 months.
- Thinks “Maybe I should change”
Preparation
- Individual makes a serious commitment to change their behaviour
- Physically active but below the required level for good health.
- Make enquiries about fitness classes in their area.
- Makes preparation for someone to mind the kids etc……
Action
- Behavioural chance is
initiated. - Physically active but for less than 6 months
- Exercises 3 times a week.
Maintenance
*Sustaining behavioural change.
*Physically active but for more than 6 months
*Exercises 3 times a week every week.
Relapse
- Changed behaviour discontinued.
- Lost interest in their exercise programme
- Another excuse as to why they haven’t exercise in a few weeks
- Busy at work
- New commitments
Ways of encouraging Adherence
- Make exercise sessions easy, interesting and fun
- Acknowledge exercise discomforts
- Use exercise reminders, cues and prompts
- Emphasise positive aspects of exercise
Screening Q’s
- Doctor’s clearance?
- First baby?
- Any complications in previous pregnancies?
- Pre-term rupture of membrane?
- Any persistent bleeding, dizziness,
pain? - Sudden swelling of ankles?
- Pregnancy induced hypertension?
- Stage of pregnancy?
- Regular exerciser or previously sedentary?
Warning Signs to stop exercising
- Vaginal bleeding
- Abdominal/chest pain
- Leaking/gushing from vagina
- Swelling of hands, feet or face
- Severe headache
- Dizziness
- Reduction in fetal activity
- Painful, reddened area in the leg
- Severe pain in hip/pelvic area
- High temperature (>38 degrees C)
- Persistent nausea/vomiting
- Uterine contractions
- Heart palpitations
- Shortness of breath
Pregnancy Pre class advice
- Intensity – low to moderate
- 4-6 RPE scale, <75% HRR, 140 bpm
- Low impact
- “easy” stretches
- Floor exercise adjustments/Adaptations
- No sudden changes in direction
- Placement near exit
- Hydration
Physical changes during pregnancy
- Diaphragm
- Internal organs (stomach & intestines)
- Lumbar spine
- Bladder
- Uterus
- Sciatic nerve
Breathing Changes/implications during pregnancy
Physical Change
* Diaphragm pushes upwards
* Breathing rate increases by
45%
* O2 consumption increases
Ex. Implication
* Lift arms up and out to ease breathing
* Keep intensity low to moderate
* Avoid exercising in humid weather
Heart/Circulatory Changes/implications during pregnancy
Changes
* Heart wall thickens, heart enlarges
* Blood volume increases
* Resting heart rate increases
* Cardiac output increases
* Cardiac reserve diminishes
* Blood vessels soften and stretch
* Varicose veins
* Blood vessels constrict in some cases
Implications
* Tire sooner
* Moderate intensity – RPE 4-6
* < 75% HRR
* Change direction slowly
* Rise slowly from the floor
* No exercises in supine position after 12 weeks
* Avoid holding breath
Stomach and Intestinal
changes/implications
Changes
* Heartburn and indigestion
* Constipation
* “Morning sickness”
Implications
* Exercise at the same time everyday
* Drink plenty of fluids
* Eat an hour before exercise
Kidney and bladder
changes/implications
Changes
* Need to urinate more frequently
* Leaking urine
* Swelling
Implications
* Pelvic floor exercises
* Placement in class
Muscular, posture & joint
changes/implications
Changes
* Centre of gravity shifts
* Lordosis
* Kyphosis
* Relaxin- joint looseness
* Diastasis recti
Implications
* Change direction slowly
* Keep choreography simple
* Strengthen back, buttocks and abdominals
* Don’t stretch to maximum
Pelvic floor
Changes/implications
Changes
* Pelvic Floor sag’s due to weight of uterus
Implications
* Include Pelvic floor exercises
- 50 reps per day
* Also known as Kegel Exercises
Risks/implications for Fetus while Exercising
Risks
* Decrease in blood flow to the uterus
* Reduced glucose supply to the foetus * Overheating
Implications
* Do not exercise to exhaustion
* Reduce exercise time
* Avoid exercise in hot humid conditions * Avoid jacuzzi and steam room
Energy Intake during pregnancy
- Extra energy is required during pregnancy (300 calories extra per day – ACOG)
- Extra demands on blood glucose during pregnancy
- Balanced diet (food pyramid)
- Have a snack an hour before
exercise
First trimester
Changes/Implications
Physical Changes
* Fatigue
* Nausea
* Emotional changes
* Frequent urination
* Blood volume increases
* RHR increases
* Oxygen reserve decreases
Exercise Implication
* Shift to maintenance mode
* Watch for overheating
* Stay hydrated
* Avoid holding of breath
* Avoid overstretching
* Monitor intensity – RPE, HR, observation
Second Trimester
Changes/Implications
Physical Change
* Changes in posture
* Weight gain
* Joint laxity increases
* COG changes
* Lordosis increases
* Risk of diastasis recti
Exercise implication
* All low impact work eg. Stationary bike/treadmill walking/swimming
* 4” or no step
* No sudden changes in direction
* Care when getting up from the
floor
* No supine work
* ‘Easy’ stretches
Third Trimester
Changes/Implications
Physical Change
* Posture and Gait changes
* Uterus is 1000 times its
normal size
* Increased fatigue (insomnia)
* Decreased ROM
* Increased shortness of breath
* Heartburn
Exercise Implications
* Avoid quick jerky movements
* Do not exercise to fatigue
* Opt for swimming and stationary cycling/treadmill walking
* Use stability ball/wall squats to relieve LBP
