Before you start, here are a few guidelines you will want to review to be sure you are exercising safely and effectively:

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1 Prenatal exercises A good prenatal exercise program can help you stay fit throughout your pregnancy. It helps you to develop and maintain good muscle tone, improve circulation and adapt to the changing shape of your body. The exercises shown here comprise a basic program that you can use daily. Many of these exercises are performed lying on your back. These exercises may be performed for short periods of time as long as you are comfortable. In addition, most women can continue to participate in the recreational activities they did before becoming pregnant, though they may need to be modified. It is important to discuss the specifics with your provider. Guidelines Before you start, here are a few guidelines you will want to review to be sure you are exercising safely and effectively: Do not start a vigorous program during pregnancy. Begin and end your sessions by warming up and cooling down gradually. Perform each exercise slowly and completely. Avoid swayback posture. Avoid exercises that require twisting and balancing on one foot. When stretching, avoid doing so maximally to avoid injury. Avoid bouncing. The first few times you work out do each exercise twice. After some practice, you will be able to build up to five repetitions. If you are able to achieve this without fatigue, you may want to work through the program in reverse order or work out again later in the day. Exercise at a rate and intensity level that is comfortable for you. If, at any time, you begin to feel breathless, dizzy, or very tired, stop and rest. Avoid prolonged positions on your back. Place a pillow under one hip for back-laying exercises. Drink plenty of water before and after exercise. Make sure you breathe normally during exercises. Avoid exercise in hot, humid weather. Avoid exercise after any acute illness for 3 to 4 days. 82

2 Aerobic exercises If you are currently exercising, you may continue throughout pregnancy. If you develop fatigue or dizziness during workout, stop. You should be able to talk comfortably through any exercise program. You may need to decrease your program intensity. Do not let your pulse rate go above 140 beats per minute when exercising. If you are not on a scheduled program, you can increase aerobic capacity by walking regularly. Start 5 to 10 minutes a day at a moderate pace. You can work up to 15 minutes a day. You can do this 3 times a week. Exercise on stationery bikes or treadmills should be at limited intensity. Because there is no breeze, you may have difficulty keeping cool. If you jog now, and your pregnancy is not complicated, you can continue throughout pregnancy. Sports If you regularly participate in non-contact sports, you can continue. However, as your pregnancy progresses, you will likely become less balanced and coordinated. You will need to adjust your activity level or possibly stop these sports. Warm-up exercises Warm-up exercises are important to do to increase circulation and gradually increase joint flexibility. Repeat each of these exercises 5 to 10 times. Head Circle your head slowly Move your head forward and back slowly Move your head side to side slowly, pulling one ear towards your shoulder Shoulders Roll your shoulders forward and backwards Places hands on your shoulders, circle elbows forward and backward Arms Bring arms to shoulder height at your side and make large and small circles forward and backward Wrists Rotate your wrists in a clockwise pattern, repeat in the opposite direction 83

3 Trunk With your arms outstretched at shoulder level, twist trunk from side to side Pelvis With your hands on hips, gently rock your pelvis forward and back. Rotate your hips in a circular pattern, repeat in the opposite direction Hike one hip up, and then the other Pelvic floor Tighten vaginal muscles, hold to a count of 3 and release Hips Stand on one leg and gently swing your opposite leg forward and backward Feet With one leg off the floor, make circles in both directions with your ankle Stretches Stretching is an excellent way to prevent or relieve some of the minor aches and discomforts that are associated with pregnancy. When performing stretches, move slowly until you feel a pulling sensation in the area being stretched. Stretches should never be painful. Hold stretches for 20 to 30 seconds and repeat 2 or 3 times on each side. Stretching can be performed several times a day. Body stretch 1. Straighten out arms and legs 2. Point toes and extend fingers 3. Flex toes toward knees; hold 5 seconds and relax O Connor W., Gourley K. Warm up by stretching entire body 84

4 Neck stretch 1. Sit or stand with good posture 2. Keeping face forward, tip your ear toward your shoulder 3. Use hand for extra stretch as shown Stretches the side of the neck muscles May help relieve headaches associated with tension Pectorals/chest stretch 1. Stand in a corner about 1 or 2 feet from wall with hands on wall as shown 2. Lean into corner so that you feel a stretch 3. Vary the stretch by moving arms higher or lower, or by standing further away from wall Stretches the pectoral/chest muscles Improves forward shoulder posture Spine rotation stretch 1. Sit cross legged on the floor 2. Reach one arm to your opposite knee 3. Rotate your trunk so that you feel a stretch in your sides and back Improves spinal flexibility May help relieve mid-back discomfort O Connor W., Gourley K. 85

5 Adductor/inner thigh stretch 1. Sit with knees bent, feet together as shown 2. Press knees downward toward the floor, by leaning forward and pressing with your elbows as shown Stretches the adductor (inner thigh) muscles Prepares you for the birthing position Hamstring stretch 1. Sit with leg propped as shown 2. Relax, letting the leg straighten 3. Lean forward, keeping the back straight or 1. Lie on back holding your leg with hands as shown 2. Straighten the knee as far as you can, keeping your other leg straight on the floor Stretches the hamstring (back of thigh) muscles May help relieve back pain and sciatica O Connor W., Gourley K. Allows back to maintain good postural alignment 86

6 Hip flexor stretch 1. Assume position shown, with your knee on the floor 2. Lean your whole body forward, keeping your chest upright 3. Place hands on floor if you need additional balance Stretches the front of the thighs May help relieve groin and thigh pain Buttock/piriformis stretch 1. Lie on back with knee bent, holding knee and ankle as shown 2. Pull your knee and hip towards your opposite shoulder so that you feel a stretch in the hip and buttock Stretches the piriformis (buttock) muscles May help relieve sciatica or low back pain Calf stretch 1. Position your body against a wall as shown with one foot behind you 2. Point toes directly toward wall and hold heel down 3. Lean into wall as shown so that you feel a stretch in your calf Stretches the calf muscles Helps relieve/prevent leg cramps associated with pregnancy 87

7 Squatting 1. Stand with you feet flat and shoulder-width apart 2. For support hold onto your partner s hands, a table, or counter 3. Gradually squat down, with back straight, heels on floor 4. Rise slowly and repeat Towels may be used under your heels or at the knees if you are unable to fully squat without discomfort. Stretches hip muscles and perineum Increases endurance for position, as it may be used as a birthing position Postural exercises Maintaining good posture throughout pregnancy is important, but can be difficult as your body grows and changes. As your baby grows, your center of gravity moves and these exercises can help maintain your normal postural alignment. Perform each exercise, holding for 5 seconds; repeat 5 to 10 times. Chin tucks 1. Sit or stand with good posture 2. Tuck your chin in and pull your head straight back 3. Use hand on chin for a guide if needed Increases neck flexibility Avoid forward head posture May help reduce tension headaches Shoulder blade squeezes 1. Stand with arms at sides 2. Squeeze shoulder blades together as shown 88

8 If you have an exercise band, shoulder blade squeezes can be performed against resistance. 1. Anchor rubber tubing to a solid object 2. Hold rubber tubing in both hands, elbows bent 3. Squeeze shoulder blades together 4. Pull arms backward as shown Strengthens the upper back muscles Improves rounded shoulder posture May help relieve upper back and neck pain Pelvic tilts 1. Lie on back with knees bent 2. Tighten abdominal muscles, squeeze buttock muscles and flatten back as shown Strengthens the low back and abdominal muscles Avoid hyperlordosis or swayback posture May help to relieve low back pain Assists with digestive process Once you have a feel for the pelvic tilt exercise, you may do it in a variety of positions. If done frequently, it will help you control the tilt of your pelvis as your pregnancy progresses. Side lying In the side lying position, you may want to use a pillow under your head and between your knees for comfort. Tighten your muscles and roll the pelvis in the same manner as when you were on your back. Sitting Sit on a firm surface and use your arms for balance. Do the pelvic tilt exercise, again being careful not to forcibly arch your back when you relax. 89

9 Standing Stand straight with your arms against your sides and do the pelvic tilt exercise. Do not bend the knees. It is helpful to stand against a wall, place your hand behind you, and try to push it against the wall with your lower back. All fours Get on your hands and knees with your hands directly under your shoulders and your knees under your hips. Keep your head aligned with your back and do not let your lower back sag. When you do the pelvic tilt in this position you will look like a cat arching its back. This will relieve pressure on the spine. Abdominal exercises Before attempting any abdominal exercises like sit-ups or curl-ups, it is important to check for any separation of the abdominal muscles. You should do this quick check periodically throughout your pregnancy: Lie on your back with your knees bent. Press three fingers of one hand firmly on the area above the navel and breathe in deeply through your nose. Slowly curl your head toward your chest, and exhale as if you are blowing out a candle. As you hold this position, feel the soft midline between the tight muscles. If this region is larger than 2 finger widths or if you observe a bulge in this area, it means the muscles may have parted and it will be necessary for you to do the following special exercise to strengthen them before progressing to advanced exercises. To correct abdominal separation: Lie on your back with your knees bent and arms crossed over the abdomen. Take a deep breath through your nose and as you exhale slowly through pursed lips, curl your head forward. Support your stomach muscles with your wrists and hands to confine any bulging in the midline. Slowly return to the starting position. Practice this until the separation is reduced to 2 finger widths or less, then move on to the more advanced exercises. The following abdominal exercises may become more difficult as your pregnancy progresses, but you can practice them as long as you feel comfortable. Perform 10 repetitions, once a day, and gradually advance to 20 repetitions as tolerated. 90

10 Heel slides 1. Lie on back with legs straight 2. Perform the pelvic tilt to flatten back 3. Holding your back flat, slide heel up toward your body as shown 4. Slowly reverse Alternating knee lifts 1. Lie on back with knees bent 2. Perform pelvic tilt to flatten back 3. Holding your back flat, bend and raise your knee on one side 4. Lower your leg 5. Repeat on opposite side 6. Advance to lifting both legs together when able Straight leg raises 1. Lie on back with knee straight, opposite knee bent 2. Perform pelvic tilt to flatten back 3. Raise straight leg to level of opposite knee as shown Crunches 1. Lie on back with knees bent 2. Reach toward knees and curl trunk upward as shown Diagonal crunches 1. Lie on back with knees bent 2. Reach toward knees, raise head and shoulders, curl trunk upward and to the side as shown 91

11 Pelvic Floor Strengthening The sling of muscles that make up the pelvic floor are put under additional stress during pregnancy as they support the growing weight of your uterus/fetus. Strengthening the pelvic floor can help prevent urinary incontinence and improve muscle tone postpartum. Kegel exercises Find a comfortable sitting or standing position. Tighten the muscles surrounding your vagina as if to control urination. Quickly tighten and relax the pelvic floor muscles, squeezing for 2 seconds, then resting for 2 seconds. Repeat 10 times. Then repeat this exercise, but hold the pelvic floor squeeze for 5 to 10 seconds and rest for 5 to 10 seconds. Repeat 10 times. This set of exercises can be performed 3 times a day. These exercises can begin after delivery. Increases strength, elasticity, and awareness of pelvic floor muscles Facilitates awareness of relaxing these muscles for delivery Promotes postpartum recovery Prevents urinary stress incontinence Upper and lower body strengthening Strengthening the arms and legs during pregnancy can help to prepare you for the increased physical demands of caring for an infant. The following exercises can be started without resistance, and then gradually advanced to use 1 to 5 pound ankle or wrist weights, dumbbells, or resistance bands. Perform 10 repetitions, once a day. Shoulder strengthening 1. Anchor rubber tubing to a solid object 2. Stand holding rubber tubing in both hands or use dumbbell weights 3. Raise arms up to shoulder height 92

12 1. Stand holding rubber tubing as shown or dumbbell weights 2. Raise arm up to the side to shoulder height 1. Hold weights in each hand 2. Stand with arms at sides, elbows bent 3. Reach up overhead to straighten arms 4. Slowly lower 1. Hold weight in hand 2. Raise arm backward as shown 3. Slowly lower Biceps and triceps strengthening 1. Stand with arm straight, palm facing forward as shown 2. Hold dumbbell weight 3. Bend elbow as shown 4. Slowly lower 93

13 1. Stand with hands against wall as shown 2. Bend elbows and lower yourself towards the wall 3. Slowly straighten elbows and return to starting position Leg strengthening Leg raises 1. Sit in a chair with knees bent as shown 2. Place weight around ankle 3. Bend hip to lift foot off floor Strengthens the hip flexors Squat 1. Stand holding on to back of chair for support with feet shoulder width apart 2. Squat slowly, bending your knees 3. Straighten knees and return to starting position Strengthens the hip and buttock muscles Teaches you to use squatting position for lifting 94

14 Bridging 1. Lie on back with leg bent as shown 2. Tighten buttocks and raise them off floor as high as you can 3. Keep pelvis level 4. Hold; slowly relax Strengthens gluteals Side leg raises 1. Lie on side 2. Bend lower leg slightly 3. Raise top leg straight up, without letting it come forward 4. Hold; slowly relax Strengthens outer hip and buttock muscles Inner thigh leg raises 1. Lie on side as shown 2. Raise bottom straight leg toward ceiling 3. Hold; slowly relax Strengthens inner thigh muscles 95