POSTPARTUM EXERCISE BY JOCELYN IP & RACHEL REW

Transcription

1 POSTPARTUM EXERCISE BY JOCELYN IP & RACHEL REW

2 What is postpartum? Postpartum is the after-birth or the recovery period after childbirth, the recovery can take upwards to one year Postpartum period is also referred to as postnatal or puerperal period, where the body goes through major changes to adjust back to a nonpregnant state (usually first 6 weeks after birth) Critical period The baby starts to adapt to the new environment and the mother goes through physiological and psychological adjustments

3 What is postpartum? Major Areas of Recovery After Successful Vaginal Birth Blood pressure and pulse Blood loss Vaginal discharge Vaginal and perineal soreness Exhaustion Mobility Breast changes Uterine contractions Narrowing of the cervix Urinary system changes Flabbiness and stretch marks Sweating Return to Menstruation 6 week check up (blood pressure, weight, size and shape of uterus, condition of cervix and vagina, incision sites, breasts)

4 Physiological Changes Physical Changes Blood volume Gastrointestinal tract Breasts Abdominal Uterus Lochia flow Cervix Vagina Perineum Involution Bladder

5 Physiological Changes Pelvic floor after birth Pelvic floor are muscles, ligaments, and connective tissues which stretch from your pubic bone at the front of your body to the base of your spine at the back Functions include: It supports your bladder, bowel and uterus (womb). It gives you control over when you empty your bladder and your bowels. It allows for optimal sexual functioning by keeping your vaginal and rectal muscles toned. It stabilizes your hip, pelvis and lower back joints. It acts like a "sump pump" helping blood flow from your top to your bottom half. Due to the larger-than-normal weight bearing during pregnancy, the muscles and tissues may become overstretched and weak Exercise can lead the pelvic floor back to a healthy recovery

6 Physiological Changes Hormonal Changes Estrogen dominance Postpartum thyroiditis Adrenal fatigue Symptoms of hormone imbalance being very emotional and upset tearfulness for no apparent reason low libido being tense and anxious Elevated prolactin difficulty sleeping constant worry about minor problems tiredness and lethargy weight gain hair loss

7 Postpartum Hormone Changes

8 Psychological Changes 85% of women experience some sort of mood disturbances: 1. Postpartum blues/ baby-blues - go away after a few weeks 2. Postpartum depression 3. Postpartum psychosis -seek immediate attention- manic episodes, erratic behaviour, paranoia, delusional beliefs, selfharm/harm to others, suicide, etc. May start up to a year after pregnancy Causes: physical changes, emotional factors, lifestyle influences

9 Postpartum Depression (PPD) Depression suffered by the mother following childbirth, typically arising from a combination of hormonal changes, psychological adjustments to motherhood and fatigues Serious mental illness Signs and symptoms: feeling sad, hopeless, guilty, anxious, worthless, irritated, angry, withdraw from others, affecting eating, sleeping and other physical health Treatments: Counselling and support: cognitive-behavioural therapy, intrapersonal psychotherapy, support groups Medication: antidepressant, hormone therapy

10 Importance of Exercise Postpartum 1. Postnatal exercise helps with postpartum depression 2. Exercise promotes breast milk 3. Look better, recover faster (healthy weight loss) Others boosted energy fewer problems with constipation improved endurance improved mood states reduced postpartum recovery time

11 When is your body ready to exercise postpartum? Can start with light exercise as soon as the individual feels comfortable (ex. walking, modified push-ups, stretching) After 6 weeks, most of the changes from pregnancy has adapted to the nonpregnant state If a c-section was performed, it may take a little longer to recover, and is important that proper rest is incorporated, even if it means starting to exercise later If you have not been exercising during pregnancy, you should start with light exercise before increasing intensity Some women have a condition called diastasis recti which means there is a gap in the abdominal muscle as a result of the belly s expansion during pregnancy. In this case, 4-8 weeks are required for this gap to close. If strenuous abdominal exercises are practiced during this time, you may risk injuring those muscles

12 After C-section May need to check with the doctor before you start to exercise Incision from c-section takes several weeks to heal, but mild exercises like walking at an easy pace may promote healing and help with the prevention of blood clots and other complications During c-section, layers of your abdominal muscles are cut and the scarring affects the muscle s ability to glide over during muscle contraction, this may result in weakness and lack of stabilization Stronger abdominal muscles will help with recovery, then by strengthening deep muscles of the core and pelvic floor Want to close the gap in abdominal muscles(diastasis recti)

13 Safety Tips A good sports bra will go a long way as your breasts are going to be larger than usual (due to milk production) and extra support should be helpful Watch our for high-impact sports- the lax pelvic ligaments and joints from pregnancy may still be recovering to their regular state (joints and ligaments will be loose for 3-5 months) Focus on core workouts (especially abdominal) as they will be the key to preventing lower back and joint injuries Make sure you hydrate yourself- especially when breast feeding Do not push yourself beyond your limits, if you re tired, make sure to get proper rest (listen to your body) Be cautious of warning signs like light-headedness, nauseousness, or changes in your vaginal discharge, this may be a sign of strenuous exercise

14 Safety Tips Doing too much too soon may be harmful (especially in the first few weeks)- may delay healing episiotomy and caesarean incisions Women with low adrenal hormone cortisol (drop in cortisol levels after birth are common)- usually, your adrenal glands pump out cortisol to increase your heart rate, breathing rate, and increase blood flow to your muscles Women who have hemorrhaged after giving birth- may have low iron levels which must be built before exercising Increase in laxity of joints and ligaments may increase risk injury

15 O.F.I.T.T. Objective: Return to pre-pregnancy body Increase energy to cope with demands of motherhood Frequency: Pelvic floor and abdominal exercises DAILY Cardio and bodyweight training 2-3x/week Intensity: low volume, low weight Time: minutes, seconds rest between exercises Type: low weight, bodyweight, aerobic

16 Program Design Before beginning program, get client's exercise plan approved by her physician Maintain open dialogue with physician throughout postpartum period First 6 weeks postpartum: simple and low impact (Zone 1-2) Gentle, casual walking Gentle, isometric stretching Light upper-back exercises Heel slides Ankle pumps/circles

17 Program Design If no medical contraindications (ex. incision precautions) and has been cleared by her physician: 6 weeks postpartum: Zone 3 Abdominal exercises Gradual return to pre-pregnancy exercise routine 9-12 months: muscles, tendons, and joints return to their pre-pregnancy state

18 Activities *Ligaments and joints will be loose AVOID High-impact exercises Sports that require rapid direction changes Vigorous stretching Supine flexion (crunching) movements place more pressure on weakened connective tissue Exercises that involve excessive rotation/stability RECOMMENDED Walking Swimming Aqua-aerobics Yoga Pilates Low-impact aerobic workouts Light weight training Cycling

19 Exercises to Try: Abdominal Muscles Diaphragmatic Breathing Pelvic Tilt Hip lifts Key areas to strengthen = transversus abdominus and pelvic floor (both work hand in hand)

20 Exercises to Try: Pelvic Floor Kegel Exercises Pelvic floor Supports uterus, bladder, small intestine, rectum Gets weakened during pregnancy 1. Contract and lift pelvic floor muscles without holding breath, moving abdomen or glutes 2. Hold 5 seconds 3. Release 10 seconds 4. Repeat Key areas to strengthen = transversus abdominus and pelvic floor (both work hand in hand)

21 Red Flags Stop exercising and follow-up with a doctor if you experience: Pain Fatigue Dizziness Shortness of breath Muscle aches and pains Heart palpitations Faintness

22 Breastfeeding and Exercise MYTH: 1992 study stated that mother's breast milk is higher in lactic acid post-exercise and babies find it less appealing FACT: No difference in milk production/composition between exercising and non-exercising mothers Explanation for the study: If baby refuses mom's milk after strenuous exercise, may be objecting to the salty taste of sweat on mother's breast, NOT the milk content Solution: Shower before nursing Nurse before exercising Postpone feeding time for 30 mins to let lactic acid levels subside (if it is a concern)

23 Maintaining Motivation Challenges Lack of time, energy, etc. Hormonal changes sedentary behaviour Solutions There is power in numbers. Support network Postpartum exercise classes Group stroller walks

24 YOU as the Trainer Demanding, but rewarding Helping someone through one of the most exciting transitions of her life!

25 Thank you for listening! Quiz 1. What happens during the postpartum period? How long does it last? 2. What are 3 symptoms associated with postpartum depression (PPD)? 3. What are the 2 key muscles to strengthen postpartum? 4. How long after childbirth should a mother wait until beginning an exercise program? Questions?