Chapter one
Introduction
1.1 Background of the study

During pregnancy the body experience dramatic physiological and psychological changes which is natural and to remain healthy, the pregnant woman must indulge in regular physical activities call exercise.1 The professional health workers need to carefully design physical exercise programme to enable the pregnant woman remain healthy. In country like Brazil, her Ministry of Health stipulates that in addition to consultation and prenatal care, breathing and relaxation techniques should be taught for better control of labour and general well-being (2). Different exercise programmes are available for pregnant mothers; these exercises include aerobic exercises such as dancing, walking and swimming. Another type is Kegel exercise; this involves tightening of pelvic muscles to control urine flow (3).

Exercise has been known scientifically and physically to promote blood circulation to the mother and the foetal vital organs such as the brain, liver and heart etc; exercise also improve pelvic bone and muscle tone thus enhancing normal safe delivery of baby during labour (5). Exercise is an activity requiring physical effort done to improve health, it is a physical or mental activity that is done to stay healthy or become stronger. Exercise session in antenatal clinic should be designed to stimulate interest in the physical changes occurring to promote body awareness and to facilitate physical and mental relaxation.

Heggard states that women who practiced more than one type of sports or leisure time physical activity had 24% of reduced risk of preterm delivery, which compared with women with no sports activity (12).  It must be noted that before asking a group to perform antenatal exercise on the floor, the correct way of getting down and up again must be demonstrated side-lying in the coma position with pillows under arm and knee is usually comfortable position in pregnancy. The pregnant mothers should get up from lying by bending the knees, rolling on to one side then using the arms to push up into a sitting or kneeling position to prevent strains on both the back and the abdominal muscles. Muscles of good tone are more elastic and will regain their former length more efficiently and more quickly after being stretched than muscles of poor tone. Exercising the abdominal muscles antenatally will ensure a speed to normal postnatally, effective pushing in labour, and the lessening of back ache in pregnancy (13).  Exercise during pregnancy are of utmost concern for most medical care giver, educators, the general public as well as pregnant mothers and their family (14). Regular and moderate exercise in early pregnancies is healthy for the mothers and their babies (7,15,16).  Mother’s health physiotherapist is the ideal choice to teach the physical skills required or parenthood.17 However in areas where there is no physiotherapist available, midwives may find themselves responsible for physical preparation as well as parent education in antenatal classes or as one-to-one basis (5).

1.2 Statement of the problem

Prenatal exercise is of benefit to every pregnant mother. Exercise can reduce the length of labour, shorten the recovery time and even help with post-partum weight management (5). The physiotherapists in the hospital always come to the clinic as early as possible but they usually meet only few pregnant mothers because they come late to the clinic for the exercise as they see little or no need for prenatal exercise. The purpose of this study is to study how pregnant mothers perceive usefulness of antenatal exercise as it is being performed in the antenatal clinics. There is need to find a way to change the perception of pregnant women about antenatal clinic through training, seminars and health talks on important of exercises in pregnancy and antenatal clinics.

1.3 Objective of the study

The objective of the study is to research the perception of exercise and recreation among pregnant women attending antenatal clinic.

1.4 Research Questions

What is the meaning of exercise and recreation?

What is the importance of exercise in pregnant women?

How can perception of pregnant women about  exercise during pregnancy be positively improved?

1.5  Significance of the study

Exercise during pregnancy has the following importance:

- Fast labour.

- Weight loss in obese pregnant women.

- Relief of fatigue, swelling and back pain.

Therefore, this study will help in educating pregnant women on the importance of exercise during pregnancy, which has great advantage on the their health.

1.6 Scope of the study

The study focus on the Perception of  exercise and recreation among pregnant women attending antenatal clinic.

References

1. Principles and Labs for fitness and wellness. 10th edition. Warner W K Hoeger, Sharon A Hoger 2010.

2. Ministry of Health (Brazil)- Bureau of Health Polices: Prenatal childbirth and Puerperium. Humane care for women. Brasilia 2001.

3. Sarfraz M, Islami D, Hameed U, Hasan Danish S, Ahmad F. Role of Physical Therapy in antenatal care as perceived by the clients-a cross sectional survey on pregnant females attending antenatal OPD. Pakistan Journal of Medicine and Dentistry 2013;1(01): 34-46.

4. Green M. Expectations and experiences of pain in labor: findings from a large prospective study. Birth 1993;20(2):65-72.

5. Dianne MF, Margaret AC. Myles Textbook for midwives 14th ed. Churchill Livingstone London Elsevier Ltd 2004:873-89.

6. Hornby AS. Advanced learner dictionary 6th ed. New York: Oxford university press, 2004.

7. Clapp JF. Exercise during pregnancy: A crucial update; Clinical sport medicine 2004;19(1):273-86.

8. Yeo S, Steele NM, Chang MC, Leclaire SM, Ronis DL, Hayashi R. Effect of exercise on blood pressure in pregnant women with a high risk of gestational hypertensive disorders. Liberia Republic Medicine 2000;45(4):293-8.

9. Varney R. Text book of Midwifery. 4th ed. New Delhi: All India Publishers, 2005;571-610.

10. Amudha P. Study on the effect of antenatal exercises among pregnant woman. Nightingale Nursing Times 2007;2(12):55-6.

11. Keefer EJ. From Pain to Performance, 2005. Available from: http://www.nyu.edu/classes/keefer/pain/pain1.htm [Accesed November 7, 2013)

12. Haggard P. Leisure time physical activity. American Journal of obstetrics and gynaecology 2008;198(2):180(5).

13. Mac-Phail A, Danis CA, Victory R , Wolis JF. Maximal exercise testing in late gestation fetal responses. Obstetric and gynaecology 2000;96(40):565-70.

14. Adegbesan OA ,Roberts OA. Perception of medical caregivers on the role of exercise in the promotion of Health and Well being of pregnant women. European Journal of Scientific Research 2005;2(1):97-105.

15. Clapp JF & Rizk K. Effects of recreational exercise on midtrimester placenta growth. American Journal of Obstetrics and Gynaecology 1992;167(6):1518-20.

16. Jackson MR, Gott P, Lye SJ, Ritchie JW, Clapp JF 3rd. The effect of maternal aerobic exercise on human placental development. Placental volumetric composition and surface area. Placenta,1995;16(2):179-91.

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