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Physical Activity & Pregnancy

Physical Activity & Pregnancy

Physical Activity & Pregnancy

The Facts, the Figures & the False Conceptions

If you are pregnant or planning a pregnancy and you are unsure about the current guidelines for physical activity and what is safe, this is a must read! An excellent team of experts have appraised over 27,000 manuscripts and abstracts (Davies G & Artal R., 2019) in order to bring us the most up to date information and guidelines on physical activity during pregnancy.

THE FACTS:

Physical activity during pregnancy:

  • DOES NOT increase the risks of structural or functional birth defects which stem from in the womb (Davenport MH, et al., 2019)
  • Has a significant effect on reducing the severity of low back pain, pelvic girdle pain and lumbopelvic pain. (Davenport MH, et al., 2019)
  • Decreases the chances of using instruments during delivery (Davenport MH, et al., 2019)
  • Reduces the chances of depression during pregnancy as well as the severity of symptoms. Unfortunately, this does not apply to the post-natal period. (Davenport MH, et al., 2018)
  • Reduces the risk of excessive weight gain during pregnancy as well as weight retention postpartum. (Ruchat S, et al., 2018)
  • Results in a small increase in the mother’s body temperature which is safe for the baby. (Davenport MH, et al, 2019)
  • Effectively reduces the risk of developing gestational diabetes mellitus, gestational hypertension and pre-eclampsia. (Davenport MH, et al., 2018)
  • Reduces the odds of having abnormally large babies (Davenport MH, et al., 2018)

Additionally…

  • There is no association between physical activity during pregnancy and increased risk of miscarriage or perinatal mortality (stillbirth or deaths in the first week of life) (Davenport MH, et al., 2019)
  • There is not enough evidence to inform us if lying on our back to exercise is safe or if it should be avoided altogether during pregnancy (Mottola MF, et al., 2019)
  • There was no association found between exercise during pregnancy and complications with the newborn baby or harmful childhood outcomes (Davenport MH, et al., 2018)

THE FIGURES & RECOMMENDATIONS

(Mottola MF, et al., 2018)

  • An accumulation of 150 minutes of moderate intensity exercise each week is recommended in order to achieve the health benefits and reduce risks of pregnancy complications
  • Exercise over a minimum of 3 days per week, however daily exercise is encouraged
  • Variety is key in order to achieve greater benefits
  • Pelvic floor muscle training can be performed daily in order to reduce risk of urinary incontinence
  • Exercising flat on the back should be modified if the pregnant women is experiencing light headedness, nausea or feeling unwell
  • TAKE HOME MESSAGE: All women WITHOUT contraindications should be participating in physical activity during pregnancy

THE FALSE CONCEPTIONS

  • Exercise will harm the baby. The evidence has shown that there are no increased risks of miscarriage or a small baby when undertaking physical activity during pregnancy
  • Heart rate should be below 140 beats per minute. This is an outdated guideline from the 80s and there was no evidence to even support this guideline, it was based on expert opinion.
  • Exercise needs to be at a gym or with group fitness. Lots of studies that were looked at were walking programmes. Additionally, moderate intensity physical activity can include gardening, mowing the lawns and some household chores.

Other considerations for physical activity & pregnancy

There are other considerations specific to the mother during pregnancy and physical activity. These include, but are not limited to, the pelvic floor and risk of overload/prolapse as well as pelvic pain. If you are planning a pregnancy/already pregnant and have a history of pelvic pain or pelvic floor concerns, it is important to see your physiotherapist before commencing physical activity. Here at Physiotec, your women’s health physiotherapist can assess your pelvic floor muscles to ensure you are using them correctly, assess and address other areas of concern such as low back pain or pelvic pain and advise you on the safest exercises during pregnancy as well as into the post-natal period. You might also like to join one of our Pilates classes to stay strong or build strength and control before, during or after your pregnancy.

Download more information on Physical Activity during Pregnancy here

Try Torpedo Perturbation Training at PhysioTec

Try Torpedo Perturbation Training at PhysioTec

Perturbation Training

See one of our Physiotec staff, Colm Coakley, demonstrating some perturbation training using the CorMax Torpedo. Half filled with water, the Torpedo becomes an unstable load which your muscles need to figure out how to control. Consequently, it provides a great dynamic stability challenge! Also, due to the ever-changing stimulus, it keeps the nervous system guessing.  This requires the system to continually change the way muscles are stimulated to respond.

In response to pain, or sometimes due to excessive training in very rigid unvarying patterns eg like regularly holding a rigid plank for 2+minutes, the nervous system can begin to recruit muscles in very confined, ‘primitive’ patterns. This can lead to a loss of normal efficiency and load sharing-load sparing in muscle recruitment patterns. As a result, this can also potentially contribute to pain, injury and a loss of athletic performance. At Physiotec, we are always exploring and embracing strategies that can help our patients get the best out of their bodies and their lives. Come & join one of our highly qualified physio’s in an innovative and challenging workout.

Why should I exercise during and after Pregnancy

Why should I exercise during and after Pregnancy

For Mums and Mums to be…

Have you ever experienced some pain in the pelvis  or in the hips during or after pregnacy?

Poor pelvic control or instability is a condition more common in women and is most likely to occur during or post –pregnancy.  During pregnancy, a hormone called relaxin is released in the body to allow the ligaments to stretch to accommodate the fast growing baby. With another human being growing rapidly, the pelvis does undergo an increase in loading, which some women cope with a little better than others – this can be due to genetic factors such as natural pelvic and ligamentous structure, or the background muscle conditioning you had prior to the pregnancy.

DON’T WORRY THOUGH…. remember that “instability” does not mean your pelvis is physically out of place but rather your muscles around the pelvis are not providing adequate’ force closure’ or mechanical compression or support around the pelvis while the ligaments are lax.

Who is more at risk of developing Pelvic pain due to pelvic instability?

Research has shown that  women who are involved in strenous work, or have a previous history of low back pain and a history of lumbo-pelvic (lower back and pelvis) pain during previous pregnancies are at risk. Although, direct trauma to the pelvis such as a fall can also result in pelvic instability.

How can Physiotherapy Help?

Use of Physical Aids

Physiotherapy can help by identifying the cause of the pain around the pelvis, whether it is originating from the lumbar spine or from pelvic instability. Off loading the pelvis may be important in reducing the symptoms such as using crutches or walking sticks. Tape or pelvic/abdominal belts  can also provide some compression around the pelvis, assisting with stability in the shorter term.

Postural and Movement Education

Being aware of movements or postures that may overload the pelvis, and optimising muscles support around the lumbar spine and pelvis are the most  important factors in managing this condition. Some specific advice on what movements or positions you may need to avoid or adjust can make a big difference in avoiding pain aggravation.

Specific and Appropriate Strengthening Exercises

Improving activation of the deep supporting muscles around the pelvis is also extremely important for providing dynamic control, so

despite laxity in the ligaments, your muscles can assist in compensating for the reduced support that ligaments can give during your pregnancy. Using real time ultrasound to train deep abdominals and pelvic floor muscles, and some of the deep hip/pelvic muscles are beneficial to someone who has pelvic instability. This is followed by a progressive strengthening program matched to the needs of the individual. Your physiotherapist can recommend appropriate Pilates and Pilates-based exercises as well as monitor your progress throughout your pregnancy and even after your pregnancy.

Transversus Abdominis Ultrasound At Rest
Ultrasound retraining of the abdominal wall – Transversus abdominis

If you are suffering from pelvic pain due to instability, see a Women’s Health Physiotherapist and get some good advice on pain management, training in deep muscle activation and an appropriate exercise program.

Image Courtesy of keerati of freedigitalphotos.net

References:

Vleeming et al. (1992). An integrated therapy for peripartum pelvic instability. A study of the Biomechanical effects of Pelvic Belts. American Journal  of Obstetrics. 166 (4): 1243-1247

Wu et al. (2004). Pregnancy-Related Pelvic Girdle Pain (PPP)I: Terminology, Clinical Presentation and Prevalence. European Spine Journal. 13:575-589

Back into the Spring of Things

Back into the Spring of Things

Back into the Spring of Things: How to get back on track after the lull in the Winter

In winter, it is normal to feel less motivated with exercise and physical activity. Now that the days are getting longer and nights are shorter we can help you get into the spring of things! Research has shown that being active has many health benefits and helps decrease your risk of chronic disease. But if you don’t know where to begin, here’s a list of activities that are inexpensive and fun, especially if you do them with friends, to help you get started:

Outdoor Activites

Gladwell and his colleagues in 2013 reported that exercise performed outdoors helped increase levels of physical activity and decreased the rate of perceived exertion – that is, for the same amount of energy burnt, it felt easier to exercise outdoors than indoors. Psychological benefits of exercising outdoors include improvement in mood and reduced stress levels. Outdoor activities are not only confined to thrill seeking activities but also include simple activities such as walking or cycling around the neighbourhood, around the park or hiking or trail-riding in the bush. Green exercise is good exercise! Trade the treadmill walking for outdoor walking near the river or amongst the trees.

Walking & Running

An outdoor activity such as walking, especially one that accomplishes 10,000 steps a day, can help reduce the risk of developing chronic diseases such as cardiovascular disease, obesity and diabetes (Brown et al 2006) and in a study done in Rockhampton where they walked 10,000 steps for 15 weeks, it was found that the participants reported improved well-being and fitness levels. Using a pedometer to track the number of steps has been found to be effective in increasing physical activity (Chan et al 2004) and significantly decreases Body Mass Index (a measure of determined by height and weight) and blood pressure (Bravata et al 2007). Walk to work if you can and incorporate it to your daily activities.

If walking on the streets is not exciting enough then hiking or nordic walking (walking while using poles) also benefits resting heart rate, exercise capacity and improves quality of life of people with various diseases (Tschentscher et al 2013).

You then may be able to progress to increasing your pace and start adding some jogging or light running intervals to increase the intensity of the exercise. If you have never been much of a runner though, it might be a good idea to have a running assessment and get some instruction on good form and training techniques from your physiotherapist. Always progress a new activity slowly, and if you do develop niggles anywhere, don’t ignore it, pop in for a check-up and advice so we can keep you on the road.

Back into the Spring of Things - beach_running

Cycling

Is your work near your home? Then ditch the car and ride the bike. In Brisbane city, we have access to public bicycles and they are situated in different, easy access locations around the city. Just like walking, researchers have found strong evidence for fitness and health benefits and moderate evidence for risk factors for cardiovascular disease (Oja et al 2013).

Did you know that countries such as Netherlands and Germany have included promotion of safe walking and cycling in their campaign for improving public health (Pucher, Dijkstra 2003). Just recently in July, the Australian Walking and Cycling Inc (AWCC) was formed and it is the only national forum in Australia that has focused on research and promotion of mobility in Australia. They have recently joined forces with the Heart Foundation, which aims to prevent premature death caused by cardiovascular disease in Australia. Be part of the movement! Live long!

mountain_biking

Clinical Pilates

Now, if you are limited by time or musculoskeletal injury, Pilates is a good way to get active if grunting in the gym and crossfit are not your thing. Pilates-based exercise and functional strengthening have been very popular in recent years, especially for people who enjoy performing slow, controlled movement. In fact, for rehabilitation, this form of controlled movement retraining and strengthening under the guidance of a physiotherapist, can provide an ideal foundation for return to normal daily activities and for dynamic higher level sports or work tasks. There is evidence that Pilates helps improve functional ability and decrease pain in people with chronic low back pain (Wajswelner et al 2012). It can also help improve dynamic balance (Johnson et al 2007) which would be beneficial both if you are feeling a little unsteady on your feet, or for higher level sporting activities where balance and control is critical for performance and injury prevention.

As we mentioned above, green exercise is good exercise. You get the best of both worlds with the outdoors all around with our Pilates classses. Try it out.

barrel exercise annie

Now we have given you something to think about, have you decided what activity you would like to spring back into? Once you have decided, set a goal and train for it.

Here are some useful links to activities around Australia for events you may be interested in:

https://www.runningcalendar.com.au/

http://www.cycling.org.au/Events/Events-Calendar

If you are still not sure where or how to start, come and see one of our highly trained physiotherapists to help you spring back into action.

References:

Bravata et al (2007). Using Pedometers to increase Physical Activity  and Improve Health: A Systematic Review. The Journal of the Americal Medical Assoc. 298 (19)

Brown et al (2006) 10,000 Steps Rockhampton: Evaluation of a Whole Community Approach to Population Levels of Physical Activity. Journal of Physical Activity and Health 1:1-14

Johnson et al (2007). Effects of Pilates-based exercises on Dynamic Balance. Journal of Bodywork and Movement Therapies . 11 (3)

Oja et al (2103) Health Benefits of Cycling: A systematic Review. Scandinavian Journal of Medicine and Science in Sports. 21(4)

Pucher,Dijkstra (2003). Promoting Safe walking and Cycling to Improve Public Health: Lessons from the Netherlands and Germany. American Journal of Public Health . 93(9)

Tschentscher et al (2103).Health Benefits of Nordic Walking. American Journal of Preventive Medicine . 44(1)

Wajswelner et al (2012). Clinical Pilates vs. General Exercise for Chronic Low back pain: Randomized Control Trial. Med Sci Sports Exerc . 44 (7)