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Practice Topics Exam 5 > Pregnancy and Exercise > Flashcards

Pregnancy and Exercise Flashcards

1
Q

Goals of PT

A 
Inc/maintain aerobic ex
Improve cardiac reserve
Improve/maintain mm tone
Promote good posture
Improve sleep
Relieve pain
Prevent excess weight gain
Improve psych aspects
Easier delivery 
Faster recovery
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2
Q

Maternal response to exercise

A

Blood shunted from uterus but inc blood volume and dec vascular resistance
Max exercise capacity reached faster

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3
Q

Maternal response to exercise - exercises and hematocrit

A

10-15% increase

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4
Q

Maternal response to exercise - stroke volume

A

30-50% inc in fit pregnancy

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5
Q

Maternal response to exercise - energy needs

A

Additional 500 calories per day for exercise and pregnant

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6
Q

Maternal response to exercise - core temp

A

dec in fit preg during exercise

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7
Q

Maternal response to exercise - uterine contractions

A

inc strength and freq of uterine contractions

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8
Q

Maternal response to exercise - ballistic WB exercise

A

Can be cont throughout preg without the risk of pre term labor or pre term rupture of membranes
Be careful with FALL RISK INC

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9
Q

Fetal response to exercise

A

Animal studies show less than 50% dec uterine blood flow - not detrimental
Fetal HR inc in response to dec blood flow
Dec body fat at birth and at 5 years

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10
Q

Impact on labor and delivery

A

COnflicting info

More active someone is, the faster they recovery

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11
Q

ACOG recommendations

A

Min risk and benefits
Mod may be necessary
No med reason to avoid exercise needs to be ensured
Aerobic and strength before, during, and after preg
Bed rest rarely indicated (though is freq rx)

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12
Q

ACOG recommendations - regular PA

A

improves or maintains physical fitness, helps weight management, reduces risk of gestational diabetes and enhances well being

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13
Q

ACOG - ex in pregnancy - duration

A

Reg moderate intensity 30 min or more daily

Stay 12-14 on Borg

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14
Q

ACOG - ex in pregnancy - avoid what

A

Avoid more than 5 min in supine
Avoid activities with high fall risk
Avoid scuba diving
Be cautious with ex over 6000ft
Adjust ex level to prenatal fitness level
Stop when fatigued and never go to exhaustion

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15
Q

ACOG - contraindications

A 
Hemodynamically sig. heart disease
Restrictive lung disease
Incompentent cervix
Multiple gestation at risk
2nd or 3rd tri bleeding
Placenta previa
Premature labor 
Ruptured membranes
Preeclampsia
Severe anemia
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16
Q

ACOG - precautions

A 
Anemia
Cardiac arr
Obese
Poorly controlled DM
BMI less than 12
Sedentary life
Intrauterine growth restriction (below 10th perc)
Poor control HPTN
Ortho limitations
Seizures
Hyperthyroid
Heavy smoker
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17
Q

Warning signs to stop exercise

A 
Vaginal bleed
Dyspnea prior to exertion
Dizzy
HA
Chest pain
MM weakness
Calf pain/swelling
Preterm labor
Dec fetal mvmnt
Amniotic fluid leakage
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18
Q

ACOG - ex in postpartum for uncomplicated pregnancy

A

Physiological and morphological changes persist 4-6 weeks post partum
Gradual and as tolerated return to activity
No current lit showing adverse rxns
Mod weight reduction during nursing is safe
Returning to PA during post partum may assist in dev depression!

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19
Q

Meta analysis - ex for preg related lumbar and pelvic girdle pain

A

Better if supervised by exercise professional

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20
Q

Meta analysis - ex for prevention of LBP and PGP in preg

A

Ex reduced risk of LBP in preg by 9%

Prevented new episodes of sick leave of lumbopelvic pain

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21
Q

Flexibility

A

Remember joint are more mobile
Avoid forceful stretching
Emphasize - suboccipitals, pecs, hip flexors, adductors, hams, gastroc

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22
Q

Strengthening - emphasis on

A 
DNF
Thoracic paraspinals
Rhomboids, mid/low trap
Infraspinatus/teres
TA, internal oblique
Gluteals
Quads
Tib Ant
23
Q

Preg induced path (MSK)

A 
joint lax
DR
Postural back pain
Round ligament pain
PGP (SIJ, Pubic symphysis)
Nerve compression
Fall risk
24
Q

Joint laxity

A

Use caution when stretching (esp add)
Elevated levels of hormones have been found up to 5 months post partum
Encourage lower impact ex

25
DRA
Separation of RA at linea alba 3rd trimesters has 66% incidence 7 wks post partum to years = 39% Not only in pregnancy!
26
DRA clinical significance
``` Dec mechanical advantage Dec protection of fetus Potential for herniation Continence contribution Feelings of weakness Aesthetics ```
27
DRA causes
``` Posture Overactive EO Large body Excessive weight gain Multiple gestation ```
28
DRA - exam
Best evaluated with US or calipers | Finger width method is not reliable or valid!
29
DRA - finger method
Hooklying. Patient lifts head slowly off the surface. Place fingers horizontally between the mm bellies of the rectus abdominus. Document number of fingers or centimeters
30
DRA - treatment
Isometric TrA/PFM/diaphragm strengthening until lax CT is controlled KT
31
Postural back pain
50-70% of preg women | Worsens throughout day
32
Postural back pain - causes
postural changes lig laxity Dec abd mm function
33
Postural back pain - intervention
``` Low back ex with TA contraction Superficial thermal mod STM/Manual therapy Gait Body mechanics Support belt (very low) ```
34
Posture - tips
Want shoulders on top of hips and ankles Ribs down Ears on top of shldrs Adjust low back ccurve Feet straight ahead legs not too far apart Avoid the waddle Avoid shoulders WAY behind hips
35
Pelvic girdle pain
Symphysis pubis, SIJ, gluteal region
36
Pelvic girdle pain - location
From PSIS to gluteal folds
37
Pelvic girdle pain - incidence
variable 33-50% before 20 wks 60-70% late preg
38
Pelvic girdle pain - impairemnts
``` Stairs turning in bed Not usually relieved with rest SLS Transfers (STS) ```
39
pelvic girdle pain - risk factors
``` Multiparous Joint hypermob Amenorrhea High BMI Hip and LE dysfunction including glut med and PFM ```
40
Pubic symphysis dysfunction
``` Changes to pubic symph begin at 8-10 wks Widens to avg of 7mm prior to delivery Tenderness Radiation to groin Pain with WB Pain with LE abd Pain with asymm mvmtns ```
41
Pelvic girdle dysfunction tx
``` Manual - MET, joint mobs, STM External support belt Stabilization! AD for gait Water exercise Avoid exacerbating posture Identify causative factor! ```
42
Round ligament pain
Sharp, quick Area of lateral low abdomen OCcurs with movement Often confused with psoas/hip flexor/add pain
43
Nerve comp can be where
Thoracic outlet Carpal tunnel Sciatic
44
Fall risk
``` Comparable to geriatric pop Incidence of 26.8% during preg 35.5% fallen more than twice during preg Changes in gait noted with inc stance width Changes in speed Inc AP postural sway ```
45
Physical agents in preg - contra/prec
``` US over trunk TENS Mechanical traction Diathermy Ionto and phono ```
46
Best activities
``` ealking Swimming Biking gentle yoga strengthening pf postural mm ```
47
Post partum considerations
``` posture skin care nursing positions body mechanics continence fatigue, exhaustion, baby blues, depression sexual health nutriton ```
48
Posture post partum
``` Forweard head thoracic kyphosis and flared ribs Scapular protraction pelvis position lumbar spine is flattened (or can be extra lordotic too) ```
49
Skin care PP
Perineal or C section - US - Scar mob - Stretches - Education on expectations (pain, numbness, PA)
50
Nursing positions
No righ tanswer Use PT common sense May be reclining on many pillows (esp during first 4-6 wks) Pillows, pillows, pillows!
51
Body mechanics
``` Keep baby close to body Limit use of car seat carriers Use ring slings and front carriers with good support Avoid carrying baby on hips asymm Traditional lifting mechancis ```
52
Fatigue/exhaustion/baby blues/depression
Many causes nad very common Post part dep can begin anytime up to a year post partum - 3x more likely if have LBP and pelvic pain Acknowledgement is HUGE
53
Sexual health
Consider perineal lacerations and healing Consider body image Consider fatigue and new demands on time Nursing mothers hormones dec lubrication and libido

Practice Topics Exam 5 (13 decks)

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