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Exercise Prescription: For Pre and Post Natal RN Service Women
Exercise Prescription: For Pre and Post Natal RN Service Women
Exercise Prescription: For Pre and Post Natal RN Service Women
Exercise Prescription
For Pre and Post‐Natal RN Service Women
CPO(PT) MJ Breed BSc (Hons) MSc
December 2011
The effect of exercise in pregnant women has been the subject of comprehensive research. Studies show that, in most cases, exercise is safe for both mother and
foetus during pregnancy and they support recommendations to initiate or continue exercise in most pregnancies in order to derive the health benefits associated
with such activities. This guide is designed to assist the RN Service women in maintaining a safe level of fitness during the pre and post‐natal periods prior to
returning to the Service on completion of maternity leave.
Index
Chapter Section Title Page
1 Introduction 4
2 Factors to Consider when Exercising 5
2.1 Warning Signs to Terminate Exercise 5
2.2 Relative Contraindications to Pre‐Natal Exercise 6
2.3 Absolute Contraindications to Pre‐Natal Exercise 6
3 Exercise Guidelines 7
3.1 Recommendations for Exercise Frequency and Intensity 7
3.2 Modified Heart Rate Training Zones for Aerobic Exercise During Pregnancy 7
3.3 Borg’s Rating of Perceived Exertion (RPE) 8
3.4 The Talk Test 9
4 Nutrition 10
4.1 Maternal Weight Gain 10
4.2 The Importance of Pre & Post Natal Hydration 10
4.3 Calorific Intake of a Pregnant Woman 10
5 Physiological Factors 11
5.1 Physiological Changes 11
5.2 Muscle, Ligament, Joint and Postural Adaptations 11
6 Exercising During Each Trimester 12
6.1 Exercise Prescription During the First Trimester 12
6.2 Exercise Prescription During the Second Trimester 12
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6.3 Exercise Prescription During the Third Trimester 12
6.4 Exercise Prescription During the Post‐Natal Period 12
7 The Warm‐Up and Cool Down
7.1 Suggested Warm Up Prior to Cardiovascular or Resistance Type Exercises:
7.2 Suggested Cool Down Post Cardiovascular or Resistance Type Exercises
8 Body Mobilization Exercises (Pre‐Exercise)
9 Body Mobilization Exercises (Post‐Exercise)
10 Pre‐Natal Exercise Prescription
10.1 Suggested Through Pregnancy Cardiovascular Exercises Relative to Pre‐Pregnancy
Activity Level
10.2 Suggested Through Pregnancy Resistance Exercises Relative to Pre‐Pregnancy
Activity Level
11 Post‐Natal Exercise Prescription 18
11.1 Walk to Walk Faster Programme 19
11.2 Walk to Run Programme 20
11.3 Run to Run Faster Programme 21
12 FAQ 22
13 Further Information 23
14 Index of Figures 24
15 Notes 25
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1– INTRODUCTION
As is the case with many health conditions, exercise can have a powerful and positive contribution to pregnancy when applied correctly. For
example; research suggests that women who exercise during pregnancy are happier with their body shape during the later stages of pregnancy; this
can reduce the chance of pre‐natal depression and subsequently post‐natal depression as well. As an active lady prior to your pregnancy, and as long
as you continue light‐to‐moderate exercise during pregnancy you should, according to available research, reduce the risk of developing gestational
diabetes mellitus. Other significant benefits that research suggests are; a reduction in overall weight gain during the pregnancy (approximately 3.6
kg), a reduction in perceived pain during labour, women who regularly exercise throughout pregnancy tend to have easier, shorter and less
complicated labour. Let’s not forget the other person in the equation, the baby itself: regular exercise during the pregnancy appears to improve the
baby’s ability to deal effectively with any unanticipated maternal stress (complications during labour). Research also suggests that the foetus of a
lady that exercises may tolerate labour better than those of sedentary ladies.
As a Service woman you will be returning to a Service environment at some stage after the pregnancy. Three months after you return to work you
will be required to carry out your Royal Navy Fitness Test (RNFT). The ability to pass the test first time will be greatly enhanced if you maintain a safe
and sensible training programme; this will also reduce the detraining effect that a prolonged reduction in exercise intensity will have. Pregnancy is
not a time to improve your fitness, however it should not be a time to put your feet up and forget about it either!
The graph below gives an estimated snapshot of an individual who continues to exercise during pregnancy compared to an individual who doesn’t.
Imagine how hard the sedentary individual will have to work in order to regain the necessary level of fitness to pass the RNFT in a relatively short
period of time (three months):
Level of Fitness required to pass
Figure 1: Estimated physical fitness level of an individual who continues to exercise during the pre and post‐partum period verses an individual who remains sedentary with respect to regaining an RNFT pass level of fitness
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2 – FACTORS TO CONSIDER BEFORE EXERCISING
Although this booklet has been produced to advocate exercise during the pre and post‐natal period, it is essential to note that there are times that
exercise should not be taken. The following is guidence on when not to exercise, when proffessional opinion should be sought prior to exercise and
what signs indicate you should stop exercising. As with all exercise programmes if you are in doubt regarding your ability to carry out the detailed
physical activity you should consult your physician prior to starting.
2.1 – Warning Signs to Terminate Exercise:
Excessive shortness of breath
Chest pain or palpitations
Presyncope(feeling faint) or dizziness
Painful uterine contractions or preterm labour
Leakage of amniotic fluid, Vaginal bleeding
Excessive fatigue
Abdominal pain, particularly in back or pubic area, Pelvic girdle pain
Reduced fetal movement
Dyspnoea(shotness of breath) before exercise
Headache
Muscle weakness
Calf pain or swelling
2.2 – Relative Contraindications to Pre‐Natal Exercise:
Severe anaemia (haemoglobin less than 100g/l)
Unevaluated maternal cardiac arrhythmia
Chronic bronchitis
Poorly controlled Type 1 diabetes
Extreme morbid obesity (body mass index greater than 40)
Extreme underweight (body mass index less than 12)
Malnutrition or eating disorder
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2.2 – Relative Contraindications to Pre‐Natal Exercise (contd):
Extremely sedentary lifestyle
Intrauterine growth restriction in current pregnancy
Orthopaedic limitations
Poorly controlled seizures
Poorly controlled thyroid disorder
Heavy smoker (more than 20 a day)
2.3 – Absolute Contraindications to Pre‐Natal Exercise:
Cardiac disease
Restrictive lung disease
Incompetent cervix/cerclage
Multiple gestation
Persistent bleeding in the second and third trimesters
Pre‐eclampsia or pregnancy‐induced hypertension
History of premature labour
Ruptured membranes
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3 – EXERCISE GUIDELINES
3.1 – Recommendations For Exercise Frequency and Intensity:
Pregancy is not the time to try and improve your fitness. Your exercise frequency should taper down gradually as you progress through the
respective trimesters. Basically you should look at your level of activity prior to pregnancy and use that as a gauge. For example if you trained three
times a week prior to pregnancy, initially you should aim to continue with three sessions a week until you feel unable to maintain that level of
frequency. The big change comes with intensity, your exercise routine throughout the pregnancy should no longer incorperate high intensity exercise
nor should the exercise type be ‘high impact’ (cross country running etc) or involve ‘contact’ type sports (netball, football etc).
3.2 – Modified Heart Rate Target Zones For Aerobic Exercise During Pregnancy:
The Royal College of Obstetricians and Gynaecologists (RCOG) recommend the following heart rate target zones as a guideline:
Maternal age (years) Heart rate target zone (beats/minute)
<20 140‐155
20‐29 135‐150
30‐39 130‐145
≥40 125‐140
Figure 2: Modified heart rate zones during pregnancy
During pregnancy the individuals heart rate can fluctuate due to changes in the circulatory system, meaning generic guidelines can be fairly
inaccurate, therefore, this is only to be used as a guide.
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3.3 – Borg’s Rating of Perceived Exertion (RPE)
As previously suggested in section 3.2, the changes to the circulatory system will have implications for heart rate and for monitoring exercising heart
rate. Those women who regularly exercised prior to pregnancy may indeed notice an altered heart rate response during pregnancy and not
understand why. One way of making sure exercise is carried out at a safe intensity would be to use a Rate of Perceived Exertion (RPE) Scale, such as
the Borg scale.
If you were asked to indicate your level of exertion as you sit reading this booklet you’d probably point to the number six! If you were asked to
indicate a number at the end of your RNFT you’d probably point to the number ninteen, as the RNFT requires maximal effort. During pregnancy the
level of your exercise intensity should not exceed the hypothetical limit indicated by number forteen, exercise that is somewhat hard but not hard.
6
7 – Very, very light
8
9 – Somewhat light
10
11 – Fairly light
12
13 – Somewhat Hard
14
15 – Hard
16
17 – Very Hard
18
19 – Very, Very Hard
Figure 3: Borg RPE Scale
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3.4 – The Talk Test
Another less scientific (but also less complicated) way of judging the correct exercise intensity is the Talk Test. Imagine reading this paragraph
outloud as you’re sat down resting. You would probably be able to read at least a sentence before requiring to take a breath, this is your sedentary
level. Now imagine reading this paragraph outloud as you are walking very briskly or jogging, you’d probably not be able to complete a full sentence
without having to take a sharp breath. This state is the ideal state to remain in when exercising whilst pregnant. If you are unable to speak at all
whilst exercising then you’re working far too hard and need to reduce the effort level.
Level Description
Too Easy Talking normally
Correct Need to breath more than normal whilst talking
Too Hard Not able to speak
Figure 4: Talk Test Guide
REMEMBER
YOU ARE NOT GOING TO MAKE YOURSELF FITTER DURING YOUR PREGNANCY
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4 – NUTRITION
4.1 – Weight Gain
Weight gain is a natural process during pregnancy. On average 24‐33lbs (11‐15kg) will be gained. Women who exercise gain an average 3.6kg less
during pregnancy than sedentary individuals.
4.2 – The Importance of Pre and Post‐Natal Hydration
Good hydration is extremely important for a healthy pregnancy and postpartum period. Water flushes waste products from the cells and aids in liver
and kidney function for both mother and baby. During pregnancy, water is also needed for the body's expansion as mother’s blood volume increases
significantly. Insufficient water intake can be a factor in constipation, preterm labour, and miscarriage, and even slight dehydration can cause or
contribute to fatigue. Proper hydration is also important for adequate breast milk production and flow.
4.3 – Calorific Intake of a Pregnant Woman
A woman who is not pregnant requires approximately 2100 calories per day.
A pregnant woman needs approximately 2500 calories per day, an increase of approximately 19% additional calories to the pre‐pregnancy
requirement.
A breast feeding woman needs approximately 3000 calories per day, an increase of approximately 43% additional calories to the pre‐pregnancy
requirement.
The calorie figures above are to illustrate, on average, how much more calories an individual should consume prior to, during and post pregnancy.
The actual figure may vary dependant upon an individual’s body size, weight and activity level.
A well‐balanced diet should contain something from all the food groups: dairy products, fruit, vegetables, fish, meat, eggs, fat and carbohydrates. A
pregnant woman needs to eat something from all these food groups every day in order to maintain a sensible diet for the foetus as well as her. It is
important for a pregnant woman to avoid excessive amounts of vitamin A during pregnancy as it may cause damage to the embryo. Foods that
contain large amounts of vitamin A include liver. Unpasteurised cheeses, blue‐veined cheeses and pâté are also not recommended due to the
possible risk of transmission of infectious diseases such as Listeria.
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5 – PHYSIOLOGICAL FACTORS
5.1 – Physiological Changes
In the early stages of pregnancy, the fertilised egg implants itself in the wall of the uterus. At this point, cells that will later develop into the placenta release
hormones that induce a relaxation of blood vessels. The vessels become more elastic, which results in vasodilatation and a corresponding increase in vascular
volume. This will result in a fall in blood pressure with a corresponding decrease in venous return and the amount of blood moving into and being ejected from the
heart. The shortfall in blood volume described is referred to as vascular under fill. These symptoms will subside (usually by the end of the fourth month) as the
body recognises the vascular under fill. This triggers the release of more hormones from the heart and adrenal glands that cause the body to decrease the
excretion of salt and water by the kidneys. This retention of salt and water results in an increase in plasma volume that corrects the deficiency in blood volume.
Therefore, in effect, the body has actually produced more blood to meet the hefty demands of both the mother and the baby. At this point, blood pressure will
increase to a more acceptable level and an adequate blood supply will be assured for both the foetus and the body’s vital organs. By the end of pregnancy, blood
volume will have increased by 30‐50% and cardiac output by 20‐30%. In simple terms, this will mean that the body is working harder than ever before and
therefore demanding more oxygen. This will mean that the pregnant mother will get tired sooner, especially during vigorous exercise. Exercise prescription should
reflect these changes and the individual must understand the shortfall of energy, especially at the latter stages of the pregnancy will reduce the duration of the
exercise.
5.2 ‐ Muscle, Ligament, Joint and Postural Adaptations
The pregnant woman’s centre of gravity becomes greatly altered and this affects her posture and gait. The position of the growing uterus coupled with weight gain
causes the expectant mother’s centre of gravity to shift increasing the mechanical stress on particular areas. For example, as the mother becomes increasingly
lordotic, the stomach muscles can become strained as they stretch and the lower back may become sore as the muscles in that area tighten. These changes are
further facilitated by the stretching and loosening of ligaments that stabilise the pelvis, hips and back which further decrease mobility and increase
musculoskeletal stress. This relates to the sacroiliac joint and the pubis symphysis. As the belly grows through pregnancy, the abdominals are increasingly
stretched and hence, will inevitably weaken. The increased abdominal distension produced by the growing the child, hormonal and biomechanical factors all
contribute to decreased muscle tone and stretching of the abdominals which can often cause a splitting of the fascia between the rectus abdominus muscles
known as diastasis recti abdominus. This condition sounds more serious than it actually is, but can become troublesome. The condition is quite common and
occurs in 66% of women in the third trimester. The pelvic floor muscles act as a hammock to cradle and support the uterus, bladder, bowels and other pelvic
organs. They form a figure of eight around the urethra, vagina and anus. During pregnancy, labour and delivery the biomechanical position of the body changes;
the pelvic floor muscles can become weakened and dysfunctional. The production of the hormone relaxin has implications on joint laxity which in turn means the
individual must be aware of possible temporary hyper mobility. The subjects exercise prescription must reflect this change with a reduction of dynamic stretching
to be replaced by pre‐pregnancy range maintenance stretches.
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6 – EXERCISING DURING EACH TRIMESTER
6.1 – Exercise Prescription During the First Trimester
The first trimester of pregnancy is a time of enormous change. Knowing what to expect and what to do to be comfortable can help you cope with the transitions
that accompany pregnancy. In the first month some women feel tired and emotional; others feel energetic and excited. Still others feel nauseous, thirsty, hungry
weak or dizzy. By the second month of pregnancy, most women feel pregnant. By the third month, some of the complaints of the first two months disappear. For
instance, you may not feel as tired and nauseous as you did in earlier weeks. You may begin to show this month. During this period of the pregnancy you will still
be at work and therefore will have access to your Establishment’s fitness suite and swimming pool.
6.2 – Exercise Prescription During the Second Trimester
Welcome to the second trimester, the most enjoyable trimester for many women. Whereas in the first trimester you adjusted to the new hormonal balance and
physical changes, and in the third trimester you will experience the physical discomforts of carrying a growing baby as you approach delivery. The second trimester
is a time to relish being pregnant. You probably won’t feel as sick as you might have during the first trimester; you may actually enjoy restful nights of sleep and
increased energy during the daytime. You may actually feel better than you have in your entire life. Once again you will still be at work throughout this trimester
so facilities to continue to train safely will not be a problem.
6.3 – Exercise Prescription During the Third Trimester
The third trimester lasts from week 28 to the birth of the baby. This may be an exciting and stressful time for you and your partner. You can and should still
exercise as long as you are happy to, but obviously the size of your baby and shortness of breath means the intensity of your workouts regresses considerably
during this trimester. You may well be at work for most of this trimester, however towards the end of your pregnancy you will leave your Establishment and start
maternity leave in preparation for the birth of your baby.
6.4 – Exercise Prescription During the Post‐Natal Period
The benefits of post‐partum exercise include improved cardiovascular fitness, facilitated weight loss, improved mood, reduced anxiety and depression and more
energy. Post‐partum women are able to participate in moderate physical activity without compromise to infant breast milk acceptance or infant growth. Current
recommendations suggest that, if pregnancy and delivery are uncomplicated, a mild exercise programme consisting of walking, pelvic floor exercises and
stretching may begin immediately, however if delivery was complicated or was by lower segment caesarean section then their healthcare professional must be
consulted before resuming exercise. It is imperative that exercise intensity is increased gradually and that high impact exercise is not incorporated into any
exercise plan too soon.
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7 – THE WARM UP & COOL DOWN
7.1 – Suggested Warm Up Prior to Cardiovascular or Resistance Type Exercises:
In the gymnasium environment a suitable warm up to precede any cardiovascular exercise would be using a static cycle. Start off with a low
resistance (at approximately 60 rpm), make sure seat is set to correct height and upright posture is maintained (pelvis in neutral position). Duration
should be at least five minutes of progressive intensity, (building to 70‐80 rpm) no more than 11 on the Borg RPE scale. Dynamic flexion movements
incorporating movements around the hip, knee, shoulders and elbows should follow to make sure the body is ready for the more vigorous activity
that ensues (dynamic movements are movements that work the joint through its natural range of movement, remember that your body may be
more flexible than normal due the bodies production of the hormone relaxin). Each of these dynamic movements should be carried out for
approximately ten seconds. If you are exercising away from the gymnasium i.e. going for a walk etc then you should make sure that the exercise
starts off slow and gradually builds in intensity. At the very least it’s a good idea to carry out the body mobilising exercises as shown in figure 6.
7.2 – Suggested Cool Down Post Cardiovascular or Resistance Type Exercises:
When you have finished your cardiovascular workout (i.e. cycling, swimming, jogging etc), it’s advisable to continue the particular activity you
finished on for a further five minutes minimum at a reduced intensity to allow the heart rate to safely regress to its pre‐exercise state. You should
aim to reduce the intensity progressively rather than just stick to a single pace. If you have been working out using resistance equipment then the
body remobilising movements as shown in figure 7 should conclude your workout.
REMEMBER
MAINTENANCE OR DEVELOPMENTAL TYPE STATIC STRETCHING IS NOT ADVISED DURING PREGNANCY OR
WHILST BREAST FEEDING
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8 – BODY MOBILIZSATION EXERCISES (PRE‐EXERCISE)
Suggested Warm Up/Mobilization Movements
Full Body Reach‐Up
This opens and strengthens your shoulders, lengthens your spine and neck, and improves
your posture. Keep your arms straight throughout the exercise. Stand with your feet
close together, knees soft, spine in neutral and abdominal muscles set. Slowly raise your
arms up from each side, bringing your palms together above your head. Take your arms
back down to the start position. (10 reps)
Side Bends
Keep your pelvis in neutral throughout and be careful to avoid leaning forwards or
backwards Stand with your feet hip‐width apart, knees slightly bent and arms by your
side. Bend sideways at the waist and extend your left hand down your left leg, then stand
up straight again. Repeat to your right side. Bend a little further as you repeat the
exercise, making sure you do not twist or bend your spine as you do so. (10 reps each
side)
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Torso Rotations
Keep your pelvis in neutral and stand with your feet hip width apart, knees slightly bent.
Rotate your torso to one side and then the other, increasing the range of movement as
you do so. You should feel a slight stretch across your back and shoulders. The twisting
action should force you to come up onto the toes of your opposite foot. (15 reps each
side)
Dynamic Leg Swings
Stand upright, side on to a wall; support the body by reaching out and holding the wall.
Place the weight onto the leg nearest the wall and gently swing the other leg forwards
and backwards from the hip until full range of movement is reached and a slight tightness
can be felt in the Hamstrings on the forward motion and hip flexors on the backwards
action. Carry out 10 full movements before repeating on the other side.
Figure 5: Suggested Body Mobilization Movements
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9 –BODY REMOBILIZATION EXERCISES (POST EXERCISE)
Suggested Cool Down Movements
Shoulder Circles
Whilst seated or standing, rotate your shoulders slowly backwards and down in the largest circle you
can make. This opens the chest, counteracting the rounded shoulders so many pregnant women get.
Carry out this movement for 20 seconds
Chest Stretch
Standing in a doorway, place both hands at shoulder height on either side of the doorway, elbows bent.
Step your right foot forward until you feel a slight stretch in the chest muscles (being careful not to
stretch too much) hold for 10 seconds
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Mermaid
Sitting tall on the floor with knees bent to the right and heels close to your bottom. Your left hand
holds your left ankle for support, your right hand extends overhead. Inhale, then exhale and reach up
and over to the left side. Inhale and hold the stretch. Exhale and return to an upright position. Repeat
one more time on your right hand side before moving to the left. You will feel a stretch in the sides of
your waist, hip and lower back. Repeat twice then swap sides
Dynamic Leg Swings
Stand upright, side on to a wall/sturdy object. Support the body by reaching out and holding the
wall/sturdy object, place the weight onto the leg nearest the wall and gently swing the other leg
forwards and backwards from the hip until full range of movement is reached and a slight tightness can
be felt in the Hamstrings on the forward motion and hip flexors on the backwards action. Carry out 10
full movements before repeating on the other side.
Figure 6: Suggested Body Re‐Mobilisation Movements
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10 – PRE‐NATAL EXERCISE PRESCRIPTION
10.1 – Suggested Through Pregnancy Cardiovascular Exercises Relative to Pre‐Pregnancy Activity Level:
Previously Sedentary Moderately Active Very Active
10‐20 min of exercise 2‐3 days per week 20‐30 min of exercise 3‐4 days per week 30‐40 min of exercise 4‐5 days per week
Brisk Walking Brisk Walking/Jogging Brisk Walking/Jogging/Running
Swimming Swimming Swimming
Static Cycling Static Cycling/Cross Trainer Static Cycling/Cross Trainer/Spinning (Not
maximal)
Pilates/Aquarobics Pilates/Aquarobics Pilates/Aquarobics
12‐14 Borg RPE scale (somewhat hard) 12‐14 Borg RPE scale (somewhat hard) 12‐14 Borg RPE scale (somewhat hard)
Figure 7: Suggested Cardiovascular Exercises during the Pregnancy
10.2 – Suggested Through Pregnancy Resistance Exercises Relative to Pre‐Pregnancy Activity Level:
Suggested Resistance Training (Moderately Active & Very Active Individuals Only)
Exercise: Equipment: Sets/Reps: Training System:
Standing Resistance 1/15 This is an exercise designed to isolate the muscle group in the back of the upper leg. Attach the resistance band to a sturdy
Hamstring Band/Theraband anchor ensuring that it is positioned at floor level. You only need to use one end of the band for this exercise so ensure the
Curl other end is secure. Attach the loose end to an ankle strap and then place around the ankle of the leg you are starting with.
Position yourself so that the band is coming from in front of you and in the correct standing exercise posture with knees in line.
You can place a stable object next to you to hold onto for support. Whilst supporting all your weight with one leg, flex the other
at the knee until the lower leg is at 90 degrees to the upper. Pause and then extend the leg at the knee until your leg is straight.
Repeat using your other leg Ensure that your hips remain still and keep both knees together throughout the exercise. Muscle
groups worked: Back of upper leg (hamstrings)
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Chest Resistance 1/15 This is an exercise designed to isolate the muscle group in the front of the upper body in a forward pushing movement. Attach
Press Band/Theraband the resistance band to a sturdy anchor ensuring that it’s positioned at shoulder height. Position yourself with the band coming
from behind you, your feet in a split stance, and leaning forward slightly with abdominal muscles tight. Hold the handles of the
band in each hand with an overhand grip and elbows bend at 90 degrees. Ensure that elbows and wrists are elevated to
shoulder height and are parallel to the floor. Extend both arms until they are straight and then slowly bend arms back to the
start position, stopping when you feel a slight stretch across the your chest and shoulders. Muscle groups worked: Chest
(pectorals), front of shoulders (anterior deltoid) and back of upper arms (triceps).
Standing Resistance 1/15 This is a multiple joint exercise designed to work the major muscles in the upper back in a pulling/rowing movement. Attach the
Mid Row Band/Theraband resistance band to a sturdy anchor, ensuring that it is positioned at around shoulder height. Position yourself with the band in
front of you, your feet in a split stance and body upright, with abdominal muscles tight. Hold the handles of the band with palms
facing down and arms extended forward until they are straight. Elbows and wrists should be elevated to shoulder height and
parallel to the floor. Slowly bend elbows pulling them back past the line of your shoulders, ensuring that elbows and wrists
remain elevated to shoulder height and parallel to the floor. Then slowly straighten your arms back to the start position,
stopping when they are fully extended. Muscle groups worked: Upper back (lower trapezius), back of shoulders (posterior
deltoid), between shoulders (rhomboids) and front of upper arms (biceps).
Shoulder Resistance 1/15 This is an exercise designed to isolate the muscle group in the top of the shoulder and the back of the upper arm, in an upward
Press Band/Theraband pushing movement. Place the resistance band on top of a Swiss ball and position yourself so that you are seated on top of the
band. Sit straight with the shoulders back and abdominal muscles tight. Using an overhand grip, hold the handles of the band
Swiss Ball with your hands to the side of each shoulder at around shoulder height. Extend both arms above your head until they are
straight and then slowly bend them back to the start position, with your hands returning level with your shoulders. Make sure
that your forearms remain vertical throughout the movement. Muscle groups worked: Front of the shoulders (anterior deltoid),
top of the shoulders (upper trapezius) and back of upper arms (triceps).
Squat Resistance 1/15 This is an exercise designed to isolate the muscle group of the legs in the front of the thighs and buttocks. These groups are used
Band/Theraband to achieve standing from a seated position. Place the resistance band under the arches of your feet. Position yourself in the
correct standing exercise posture, with feet shoulder width apart. Take hold of the handles with an overhand grip and bring
them up to shoulder level with the palm of your hands facing forward. The band should be behind your arms. Slowly bend your
knees keeping your heels down, and push your weight back slightly as if you were about to sit down, stopping just before your
legs reach a 90 degree angle. Pause, and then extend your legs pushing through your heels until you are back to the starting
position. Try to keep your back and lower legs as vertical as possible throughout the exercise. Avoid pushing your knees forward
past the toe line as you bend your knees. Muscle groups worked: Front of thigh (quadriceps), buttocks (gluteus maximus).
Bent Over Resistance 1/15 This is a multiple joint exercise designed to work the major muscles in the upper back in a pulling/rowing movement. Place the
Row Band/Theraband resistance bands under the arches of both feet. Position yourself with feet shoulder width apart, a slight bend in the knees and
bent forward at the waist. The lumber region of your back should be straight and not arched over. Keep abdominal muscles
tight. Hold the handles of the band and extend your arms down towards the floor until they are straight and vertical. With an
overhand grip, bend elbows, pulling them back past the line of your shoulders, retracting shoulder blades and keeping your
forearms vertical. Then slowly straighten your arms back to the start position, stopping when they are fully extended. Ensure
that your back remains still throughout the exercise and prevent any swaying back and forth. Muscle groups worked: Upper
back (lower trapezius), back of shoulders (posterior deltoid), between shoulders (rhomboids) and front of upper arms (biceps).
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Core Stability:
Exercise: Equipment Sets/Reps Teaching Points
Pelvic floor Mat 1/15 Lie on your back with your knees bent and your feel slightly apart, flat on the floor. Relax your buttock muscles. Slowly tighten
contraction your pelvic floor muscles as if you were trying to stop passing water mid‐stream, and try not to tense your buttock muscles. Hold
for a count of 5 seconds, then release.
Figure 8: Suggested Resistance Exercises During the Pregnancy
The resistance exercise element as shown in figure 9 is for experienced individuals who have carried out resistance exercises prior to their pregnancy.
If you’ve never done it before, now is not the time to start. The exercises detailed are also suitable for the post‐partum period, but only when it’s
safe to recommence this type of exercise (when told to by your Health Care Professional).
The key message to remember whilst exercising during pregnancy is that you are not trying to get fitter! You are, however, trying to maintain a
sensible and relative level of fitness in order that your return to full fitness post pregnancy is less stressful (see figure 1). There will be an unavoidable
detraining effect as you progressively reduce the frequency and duration of exercise throughout the duration of your pregnancy. Your body is your
guide, it will tell you when you’re doing too much, just be honest with yourself when it’s saying you could actually do a bit more!
REMEMBER
AS WITH ANY EXERCISE PROGRAMME CONTACT YOUR HEALTH CARE PROFESSIONAL IF YOU HAVE ANY
CONCERNS
11 – POST‐NATAL EXERCISE PRESCRIPTION
Exercise after the birth should only commence when you have been given permission to start by your Health Care Professional. This can range from a
few days (very low level) to months (complex births). No single delivery is the same, so do not expect to start on a specific day after delivery. The
following three programmes should form the framework of getting you back to a fitness level respective of passing the RNFT. You should complete
each programme before moving on to the next. As a rough guide each programme should take approximately three months to complete, taking you
from delivery to your RNFT when back in Service (based on six months maternity leave commencing just prior to delivery and three months in Service
prior to RNFT test).
Exercise prescription for pre and post‐natal RN Service women Page 20
11.1 – Walk to Walk Faster Programme
You should start this programme as soon as your Health Care Professional has given you permission to start low level exercise after giving birth. This
programme should form the basis of your initial cardiovascular training, it works by using two contrasting paces (as shown in the pace table below).
The programme is suitable to carryout whilst pushing a buggy or pram (check your pram/buggies suitability prior to attempting), and can be
encompassed into everyday tasks such as walking to the shops etc. You should not skip levels and should only progress when you feel ready to.
Pace/ Normal Brisk Normal Brisk Normal Brisk Normal Brisk Normal Brisk Normal Brisk Normal
Level Walk Walk Walk Walk Walk Walk Walk Walk Walk Walk Walk Walk Walk
1 5:00 0:30 3:00
2 5:00 0:30 4:30 0:30 3:00
3 5:00 0:30 4:30 0:30 4:30 0:30 3:00
4 5:00 0:30 4:30 0:30 4:30 0:30 4:30 0:30 3:00
5 5:00 1:00 4:00 1:00 4:00 1:00 4:00 1:00 3:00
6 5:00 1:30 3:30 1:30 3:30 1:30 3:30 1:30 3:00
7 5:00 2:00 3:00 2:00 3:00 2:00 3:00 2:00 3:00 2:00 3:00
8 5:00 2:30 2:30 2:30 2:30 2:30 2:30 2:30 2:30 2:30 3:00
9 5:00 3:00 2:00 3:00 2:00 3:00 2:00 3:00 2:00 3:00 3:00
10 5:00 3:30 1:30 3:30 1:30 3:30 1:30 3:30 1:30 3:30 1:30 3:30 3:00
11 5:00 4:00 1:00 4:00 1:00 4:00 1:00 4:00 1:00 4:00 1:00 4:00 3:00
12 5:00 4:30 0:30 4:30 0:30 4:30 0:30 4:30 0:30 4:30 0:30 4:30 3:00
13 5:00 30.00 3:00
Normal Walk (normal everyday walking pace) Brisk Walk (walking with purpose i.e. late for a lesson)
Figure 9: Walk to Walk Faster Programme
WARNING
DO NOT START THIS PROGRAMME UNTIL YOUR HEALTH CARE PROFESSIONAL HAS GIVEN YOU PERMISSION TO
START LOW LEVEL EXERCISE
Exercise prescription for pre and post‐natal RN Service women Page 21
11.2 – Walk to Run Programme
This programme is designed to progressively get you back running. The first six levels gently reintroduce impact to the body’s muscles and help condition them,
reducing the chance of lower limb injury. Levels seven to ten are designed to increase the duration you are able to run for whilst improving cardiovascular fitness.
The final levels (eleven to nineteen) focus on thirty minutes of total running with increasing duration of each run repetition and decreasing recovery times. The
pace should not be excessive (pace description is detailed below). This programme is designed specifically for running either outdoor or in the gymnasium. If you
have a safe and suitable buggy or pram this could be carried out with your child. Each level should be completed prior to moving to the next (do not jump levels)
and you should stay on the same level until you feel ready to progress.
Level Warm Up Rep 1 Rep 2 Rep 3 Rep 4 Rep 5 Rep 6 Rep 7 Rep 8 Rep 9 Rep 10
1 5:00 E 0:30 R 4:30 W 0:30 R 4:30 W 0:30 R 4:30 W 0:30 R 4:30 W 0:30 R 5:00 E
2 5:00 E 1:00 R 4:00 W 1:00 R 4:00 W 1:00 R 4:00 W 1:00 R 4:00 W 1:00 R 5:00 E
3 5:00 E 1:30 R 3:30 W 1:30 R 3:30 W 1:30 R 3:30 W 1:30 R 3:30 W 1:30 R 5:00 E
4 5:00 E 2:00 R 3:00 W 2:00 R 3:00 W 2:00 R 3:00 W 2:00 R 3:00 W 2:00 R 5:00 E
5 5:00 E 2:30 R 2:30 W 2:30 R 2:30 W 2:30 R 2:30 W 2:30 R 2:30 W 2:30 R 5:00 E
6 5:00 E 3:00 R 2:00 W 3:00 R 2:00 W 3:00 R 2:00 W 3:00 R 2:00 W 3:00 R 5:00 E
7 5:00 E 4:00 R 2:00 W 4:00 R 2:00 W 4:00 R 2:00 W 4:00 R 5:00 E
8 5:00 E 5:00 R 2:00 W 5:00 R 2:00 W 5:00 R 2:00 W 5:00 R 5:00 E
9 5:00 E 6:00 R 2:00 W 6:00 R 2:00 W 6:00 R 2:00 W 6:00 R 5:00 E
10 5:00 E 7:00 R 2:00 W 7:00 R 2:00 W 7:00 R 2:00 W 7:00 R 5:00 E
11 5:00 E 8:00 R 1:00 W 8:00 R 1:00 W 7:00 R 2:00 W 7:00 R 5:00 E
12 5:00 E 9:00 R 1:00 W 9:00 R 1:00 W 8:00 R 2:00 W 4:00 R 5:00 E
13 5:00 E 10:00 R 1:00 W 10:00 R 1:00 W 5:00 R 2:00 W 5:00 R 5:00 E
14 5:00 E 12:00 R 1:00 W 10:00 R 2:00 W 8:00 R 5.00 E
15 5:00 E 14:00 R 1:00 W 10:00 R 2:00 W 6:00 R 5:00 E
16 5:00 E 16:00 R 1:00 W 10:00 R 2:00 W 4:00 R 5:00 E
17 5:00 E 18:00 R 2:00 W 12:00 R 5.00 E
18 5:00 E 20:00 R 1:00 W 10:00 R 5:00 E
19 5:00 E 30:00 R 5:00 E
E Steady Walk (normal everyday walking W Brisk Walk (walking with purpose i.e. late R Jog (just fast enough to initiate a running
pace) for a lesson) action, should be comfortable)
Figure 10: Walk to Run Programme
Exercise prescription for pre and post‐natal RN Service women Page 22
11.3 – Run to Run Faster Programme
This programme is designed as a continuation to the Walk‐to‐Run programme, and can be used to prepare for the 2.4km element of the RNFT. Each level can be
completed as many times as you like before progressing to the next one. You should not skip levels as it is designed to be progressive, (working primarily on
endurance before the emphasis is directed at speed endurance during the latter stages). You need to select the RNFT time suitable for your needs and use the
relevant pace or speed detailed. Make sure you warm‐up sufficiently prior to commencing the exercise, not forgetting to cool‐down and hydrate correctly post
exercise. This is a late stage programme that you should concentrate on upon your return to the Service from maternity leave. Although it’s primarily designed for
running, it can also be carried out on a cross trainer.
Remember, this programme should not be attempted until the Walk to Run programme has been completed.
Level Warm Up Int 1 Int 2 Int 3 Int 4 Int 5 Int 6 Int 7 Int 8 Int 9 Int 10 Int 11
1 5:00 E 2:00 S 0:30 F 4:30 S 0:30 F 4:30 S 0:30 F 4:30 S 0:30 F 4:30 S 0:30 F 5:00 E
2 5:00 E 2:00 S 1:00 F 4:00 S 1:00 F 4:00 S 1:00 F 4:00 S 1:00 F 4:00 S 1:00 F 5:00 E
3 5:00 E 2:00 S 1:30 F 3:30 S 1:30 F 3:30 S 1:30 F 3:30 S 1:30 F 3:30 S 1:30 F 5:00 E
4 5:00 E 2:00 S 2:00 F 3:00 S 2:00 F 3:00 S 2:00 F 3:00 S 2:00 F 3:00 S 2:00 F 5:00 E
5 5:00 E 2:00 S 2:30 F 2:30 S 2:30 F 2:30 S 2:30 F 2:30 S 2:30 F 2:30 S 2:30 F 5:00 E
6 5:00 E 2:00 S 3:00 F 2:00 S 3:00 F 2:00 S 3:00 F 2:00 S 3:00 F 2:00 S 3:00 F 5:00 E
7 5:00 E 2:00 S 5:00 F 2:00 S 5:00 F 2:00 S 5:00 F 5:00 E
8 5:00 E 2:00 S 6:00 F 2:00 S 5:00 F 1:00 S 4:00 F 5:00 E
9 5:00 E 2:00 S 7:00 F 2:00 S 5:00 F 1:00 S 3:00 F 5:00 E
10 5:00 E 2:00 S 8:00 F 2:00 S 6:00 F 1:00 S 1:00 F 5:00 E
11 5:00 E 2:00 S 9:00 F 2:00 S 6:00 F 5:00 E
12 5:00 E 2:00 S 9:00 F 1:00 S 6:00 F 5:00 E
13 5:00 E 2:00 S 10:00 F 1:00 S 5:00 F 5:00 E
14 5:00 E 2:00 S RNFT 5:00 E
E = Easy 6.4kph/4mph S = Steady 9.6kph/6mph F = RNFT Pace See Below
RNFT (2.4km Run) Pace Selection
Time mph min/m Kph min/km Time mph min/m kph min/km Time mph min/m kph min/km
11.00 8.2 7.20 13.2 4.30 12.00 7.5 8.00 12.1 4.56 13.01 6.9 8.41 11.1 5.24
Figure 11: Run to Run Faster Programme
Exercise prescription for pre and post‐natal RN Service women Page 23
12 – FREQUENTLY ASKED QUESTIONS
Q: Is exercise during pregnancy bad for me?
A: Staying fit during pregnancy will help you cope better with the physical demands of pregnancy, labour and
motherhood.
Q: Is exercise during pregnancy bad for my baby?
A: Regular maternal exercise appears to improve the baby’s ability to deal effectively with intermittent
decreases in uterine blood flow and oxygen delivery that are part of everyday life. This then provides additional
protection in times of unanticipated maternal stress.
Q: Does a pregnant woman need to eat twice as much?
A: This is not true, what is true however is that the pregnant woman needs to provide good nutrition for two
individuals. The growing baby gets all its nourishment from its mother through the umbilical cord, so diet is very
important. If the mother is lacking any vitamins and nutrients her baby might lack them too.
Q: My friend stated that she exercised all the way through her pregnancy and she still had a long and arduous
labour, is this the case for everyone?
A: No two pregnancies are alike; the research indicates that continued exercise during pregnancy can lead to
easier, shorter and less complicated labour.
Exercise prescription for pre and post‐natal RN Service women Page 24
13 – FURTHER INFORMATION
An excellent source of information for all aspects of pregnancy can be found in the following website: www.healthline.com . This site includes a large
catalogue of information regarding all aspects of your pregnancy, including exercise. Some other excellent sources of information can be found in the
following web sites:
http://www.nhs.uk/planners/pregnancycareplanner/Pages/PregnancyHome.aspx
http://www.babycentre.co.uk/pregnancy/
Alternatively, if you own a smart phone (IPhone, Blackberry etc), there are a number of excellent apps available to download.
Exercise prescription for pre and post‐natal RN Service women Page 25
14 – INDEX OF FIGURES
Exercise prescription for pre and post‐natal RN Service women Page 26
15 ‐ NOTES
Exercise prescription for pre and post‐natal RN Service women Page 27