Pregnancy is a beautiful journey where all the women cherish and enjoy each and every second but due to the change in lifestyle, existing health conditions, predisposing genetic disorders and psychological factors, the pregnancies now a days are becoming complicated. Health experts reveal they encounter a variety of factors which make the pregnancy a high risk one.

These are -

• Autoimmune diseases
• Diabetes
• High blood pressure
• Fibroids
• HIV infections
• Kidney disease
• Obesity
• Mental health disorders (depression)
• Polycystic ovarian syndrome
• Thyroid disease
• Blood clotting disorders.
• Pregnancy related health risks are
• Gestational diabetes
• Low birth weight
• Multiple gestation
• Gestational hypertension, preeclampsia and eclampsia.
• Placental conditions like placenta Previa or placental abruption
• Previous preterm birth
• AFI index level (too high or too low).
• Cardiac condition
• Liver disorders
• Recurrent pregnancy loss.

In an interview with an Lifestyle Magazine, Dr Mohanapriya (PT), Senior Executive Physiotherapist at Cloudnine Group of Hospitals in Chennai - OMR Branch, shared, “The review of the recent research articles and personally as a physiotherapist, the role of physiotherapy exercises are very crucial in managing high risk pregnancies. It is known that physical activity before and after, during the pregnancy which benefits both the mother and fetus. WHO recommends a minimum of 150 minutes of moderate aerobic exercises in a week.”

According to her, physiotherapy helps in reducing -

• High blood pressure
• It reduces the risk of weight gain in mother as well baby
• It helps in postnatal recovery and weight reduction.
• It elevates mood and increases stamina
• Prepares for labor and recovery

She recommended that before indulging in a physical activity, you can assess yourself with a talk test. How to perform this test -

• During the physical activity make the patient to talk some phrases if you are into low frequency exercises you can talk sentences without any difficulty.
• If it is moderate frequency exercises you can talk but you could make phrase with difficulty without continuity.
• If it is high frequency exercises you could not talk properly you can produce only words without continuity. Based on these criteria we can assess the fitness intensity of the individual. Other than the aerobic exercises we do have advanced exercise protocol which can be included in the high risk pregnant woman.

Modification of daily living activities

Dr Mohanapriya said, “In certain high risk pregnancies the obstetricians recommends exercise after 28 weeks of gestational age, and the mother will be advised for complete bed rest. In this time slow and moderate phase walking can be initiated. Especially after each meal to maintain the hemostasis of blood sugar levels and to manage weight, to increase blood circulation and to prevent muscle cramps.” She advised -

• Try to walk faster than you normally would so that your heart is beating faster.
• If you exercised before pregnancy, aim for at least 150 minutes of physical activity, such as walking, every week.
• If you are new to exercise, start off gently and gradually build up your speed and distance.

If you are planning to walk fast or go on longer walks:

• wear comfortable shoes
• stay on level ground
• walk tall and pull your tummy muscles in
• make sure you can pass the ‘talk test’
• avoid walking in hot weather – try going out early or late in the day when it is cooler
• take water and healthy snacks with you
• Think about using a pedometer or step-counting app to keep track of your movements and see your progress.
• Listening to music or trying out new places to walk will help keep walking interesting.

The mothers can involve themselves in less invasive house hold activities like cleaning, kitchen activities, taking care of the pets, cooking. So that it can be a distraction rather than a bed rest or without activities.

Postural correction and exercises

Dr Mohanapriya said, “Mostly mothers with prolonged rest or in sitting posture of slouching, thoracic hump will have more strain on the back which in turn leads to pelvic girdle issues. Awareness about postures like sitting posture, lying down posture and standing posture should be known to the mothers with some mid-back and back strengthening exercises.” These can included -

1. Back to the wall/ wall slides

• Use the wall to support you as you position your body against the wall, pull your chin in head back roll out the shoulders. Tuck your pelvis. Take your time to really feel what its like to be in good posture.

2. Wall angels

• Stand against the wall position your head, shoulders hands sticked to the wall gently lift the hands along the wall up towards the head and bring it down till the hips. keep all the body parts in good posture.

3. Pull your head back

• Keep the head straight and gaze forward keep the eyeball straight and tuck the chin towards the chest.
• Door way lunge
• Stand in an open doorway
• Put the arms out to the sides of the door
• Place a big step back with your right leg, leaning your weight forward in your arms.you should feel a stretch in your upper chest.
• Hold for a few seconds
• Repeat with the left leg.

4. Standing row

• Attach the pulley middle part to a knob and pull with both the palms and bend elbows and graze the rib cage backwards repeat for several repetitions.
• Shoulder blade pull
• Squeeze the shoulder blade as much as possible. And hold for 15 to 30 secs.

5. Pelvic floor exercises

• Pelvic floor exercises in lying down position can be included to prevent the weakness of pelvic floor muscles due to inactivity and to strengthen the muscles for the future gestations.

6. Kegels

• This exercise Serve to fortify the muscles that are stretching during pregnancy and child birth. They also relieve persistent pain in the pain in the back, pelvis or tailbone.
• Imagine that you are trying to stop yourself from urinating or passing wind midway and holding this position for ten seconds.

7. Pelvic tilt

• Lie down with your head flat against a pillow and knees bent pointing towards the ceiling. Draw in your tummy, keep your feet flat against the surface of the bed. Hold yourself in this position for about 4 seconds, breathing as you do so. Practice this as often as you can pelvic floor exercises are best performed 3 times a day.

8. Bridging

• This is posturally similar to the pelvic tilt. To begin with, position yourself with your head against a pillow, your feet flat against the bed and your legs slightly apart. Lift your back off the bed slowly, raising your bottom upwards. Then, bring your body back to its original position.

9. Isometric exercises

Isometric strengthening exercises for neck muscles to acquire correct posture and for knee muscles can be included to overcome the weakness of the lower limb muscles.

• Press your palm against your forehead. Resist with your neck muscles. Hold for 10 seconds. Relax. Repeat 5 times.
• Do the exercise again, pressing on the side of your head. Repeat 5 times. Switch sides.

10. Knee isometric exercises

• Place a towel under the knee try to press downward and try to hold it for 15 to 30 secs. Repeat for 10 times.
• Place a pillow or a wedge which can produce 15 degree of knee extension. Do the movement and hold it for 15 to 30 secs and repeat for 10 times.
• Straight leg raise tighten the knee as much as possible and lift the legs for 30 degree and hold for 30 sec and repeat the exercises.

11. Stretching exercises

Full body stretching exercises should be included to relieve muscle cramps and tightness of muscles. Including gentle warm up exercises and stretching exercises like yoga asanas can help to relieve muscle fatigue and tightness.

12. Resistance exercises

Mild resistance training exercises using dumbbell, thera band exercises, tension tube for all muscle groups can be included for example

13. Dumbbell shoulder press

14. Cat and cow

Dr Mohanapriya concluded, “When you start exercising, reach out to a physiotherapist for a tailor made individualised exercise protocol right away to prevent complication during pregnancy.” Consult your OBG if any of the following symptoms persist -

• Breathlessness
• Chest pain
• Spotting or bleeding
• Pelvic pain
• Water leak
• Reduced baby movements
• Dizziness
• Headache
• Swelling
• Muscle weakness

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