Pilates for low risk pregnant women

Participants in the Intervention group will be able to commence the Pilates intervention after the successful completion of the initial screening appointment, and during 21 to 25 weeks gestation). Participants in the intervention group will be provided with education on safety recommendations for movement during pregnancy (i.e. back care, changing position from lying in supine) and using the Pilates reformer equipment at their initial Pilates class. Intervention group: Pilates Exercise The Pilates intervention will include: one-hour Pilates group classes once per week and daily home exercises over a period of 6 weeks. The Pilates classes will be held at a Physiotherapy and Pilates clinic in Richmond, Melbourne. The Pilates class will be instructed by the student researcher who is a registered nurse/midwife and a certified Polestar(Registered Trademark) Pilates rehabilitation practitioner. The Pilates exercise program will include matwork and reformer equipment exercises incorporating strength-resistant exercises and muscle stretching. The reformer is a bed-like frame with a padded carriage, which moves back and forth on wheels. The carriage is attached to the end of the frame by a set of springs. The choice of springs used varies levels of resistance. An adjustable foot-bar at the end of the reformer can used by feet and hands to push the carriage. On the other end of the reformer, long straps with handles attach the frame to the carriage whereby hands and legs may pull the straps to move the carriage. The reformer allows closed and open chain exercises to be performed, particularly exercises for joint stabilisation and core stabilisation and can be modified to accommodate for an individual’s height and weight. Participants will have a choice of two Pilates classes to attend. Participants will attend the Pilates class along with privately paying clients, who may be pregnant or in the postnatal period. Each class will instruct a maximum of eight women per class. Eight women per Pilates class is large enough to encourage socialisation and cohesion and small enough to permit adequate supervision during exercise. Each 1-hour Pilates exercise class will follow the American College of Obstetricians and Gynaecologists’ (2002) recommendations for physical activity during pregnancy. Each class will consist of: 1. A 10-15 minute warm up beginning with thoracic/lateral breathing exercises, followed by gentle exercise to warm up joints and extremities (i.e. arm arcs, slow squat). 2. 30-35 minute of exercises beginning with postural correction and neutral pelvic alignment awareness exercises. This will be followed by exercises targeting lower extremity strength and endurance; upper extremity mobility, strength and endurance; upper and lower extremity weight-bearing; spine mobility; pelvic mobility; abdominal strength and lumbopelvic stability exercises. Pelvic floor contractions and awareness exercises will also be incorporated. 3. The class will conclude with 5-10 minute of breathing, relaxation and awareness exercises with light muscle stretching. Exercise design and repetitions will be documented on a separate form for each client. The exercise design has been evaluated by an expert panel of two physiotherapists and Principal Polestar Pilates educators Attrition Attrition will be defined as the proportion of subjects who withdraw from the study prior to the follow-up assessment. Reasons for withdrawal will be collected. Adherence Adherence will be measured by recording weekly attendance at the Pilates class and conduct of home exercise. Adverse events: Risk and management Outcome measures for adverse events will include musculoskeletal injury and problematic symptoms). Immediately after each Pilates class, the participants will indicate on a questionnaire any injury sustained in the previous week. The participants will also complete a questionnaire about the presence of potentially problematic symptoms including: headache, light-headedness, tightness in the chest, extreme perspiration, vaginal bleeding, calf pain or swelling, abdominal cramping or pain, heart palpitations extreme shortness of breath, dizziness, nausea, vomiting, uterine tightenings /contractions, amniotic fluid leakage and deep severe back or pubic pain. Home Exercise Participants will be provided with a Pilates exercise program to be performed daily at home. The participants will be provided with an electronic video recording of the exercise program, saved on a USB stick. Participants will be asked to record their completion of exercises including repetition and comments in their logbooks. A maximum of five Pilates exercises will be instructed. Participants will be advised to stop exercising if any of the following occurs, and to contact the student researcher: 1. Frontal headache 2. Light-headedness / dizziness 3. Tightness in the chest 4. Extreme perspiration 5. Vaginal bleeding 6. Calf pain or swelling 7. Abdominal cramping or pain 8. Heart palpitations 9. Extreme shortness of breath 10. Nausea 11. Vomiting 12. Uterine tightenings /contractions 13. Amniotic fluid leakage 14. Deep severe back or pubic pain