Getting into shape after delivery

Getting Into Shape AfterGetting Into Shape After
DeliveryDelivery
Dr.Maninder Ahuja
Director Ahuja Health Care services
Faridabad Haryana India
24/10/18 Dr.Maninder Ahuja C2D Mumbai 1

Dr.Maninder AhujaPRESENT
DESIGNATION
:
• DIRECTOR AHUJA HOSPITAL AND INFERTILITY
CENTRE
• FARIDABAD
• ON PANEL WITH AIMS, METRO AND
SARVODAYA HOSPITALS
PRESENT
AFFILIATION:
PRESIDENT INDIAN MENOPAUSE SOCIETY
DEPUTY SECRETARY GENERAL OF SOUTH ASIAN
FEDERATION OF MENOPAUSE SOCIETIES
MAJOR
ACHIEVEMEN
TS:
(HONOURS)
(AWARDS)
(PUBLICATION
S)
EDITOR OF BOOK” PREMALIGNANT LESIONSOF CERVIX-EARLY
DIAGNOSIS AND MANAGEMENT”
AUTHOR OF BOOK “STEP BY STEP MANAGEMENTOF
MENOPAUSE
SEVERAL CHAPTERS IN TEXT BOOKS LIKE JEFFCOATE, OPERATIVE
OBSTETRICS AND GYNECOLOGY FOR POST
GRADUATES,PRINCIPLES AND PRACTICE OF OBST, AND
GYNECOLOGY, MANY DVDS ON “ PRESCRIPTION OF
EXERCISE”
BEST FOGSIAN AWARD 2008, BEST PRESENTATION AWARD,
PHOTO
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MANINDER AHUJA 2017 ISAR
HOST CHAIRPERSON
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10/24/18
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DVDs
ON
EXERCIS
E

Pregnancy is a time of change!
It’s a time of “new life” and “expansion” –
physically, emotionally and spiritually.
All women, no matter what age, shape or fitness,
experience incredible physical changes
during pregnancy

Distressing
Depressing
Denigrating

FITNESS FROM ADOLESCENTFITNESS FROM ADOLESCENT
TO MENOPAUSE AND BEYONDTO MENOPAUSE AND BEYOND
10/24/18
Dr.Maninder Ahuja AICOG
AGRA2016
8

BANKING OF GOOD HEALTH HAS TO START FROM ADOLELSCENCEBANKING OF GOOD HEALTH HAS TO START FROM ADOLELSCENCE
10/24/18 9Dr.Maninder Ahuja AICOG AGRA2016

Post partum period ofPost partum period of
bringing back to shapebringing back to shape
involvesinvolves
If she had PCOD
If she had PIH
If she already has diabetes
If she had H/T
Renal problem
Heart problem
Lactation problem
ANEMIA
And last would
come her shape
But here I am
supposed to talk
about her shape.
Don’t lose track of her call her back.

What happens if we don’t control weight and become obese??What happens if we don’t control weight and become obese??
A longer duration of being overweight during adulthood
significantly increased the incidence of all cancers that
are associated with obesity, a new study in
postmenopausal women has concluded. The large
population-based study was published August 16 in PLoS
Medicine
Can Prolonged Obesity Increase the Risk for Cancer? CME /
ABIM MOC / CENews Author: Roxanne Nelson, RN, BSN
CME Author: Laurie Barclay, MD
The authors found that the risk of being diagnosed with an
obesity-related cancer rose for every 10 years of being
overweight (hazard ratio [HR], 1.07).

Ideal weight and WHRIdeal weight and WHR
 BMI of 18-23normal.
(20-25 )
 BMI of 23-28 is
overweight(25-30)
 BMI of over 28 is
obesity(>30)
 BMI of over 35 is
morbid obesity
 BMI is Wt.in Kg /ht in
sqM
 Ideal WHR 0.8
 Ht in cms-100 is wt in
Kgs
10/24/18Dr.Maninder ahuja 14

WEIGHT LOSS BY CALORIEWEIGHT LOSS BY CALORIE
RESTRICTION IS BIG NO!RESTRICTION IS BIG NO!
 AS YOU LOSE
MUSCLE ALONG
WITH FAT
 MUSCLES ARE
RESPONSIBLE FOR
20% OF YOU
RESTING ENERGY
EXPENDITURE
NO!!!!!!!!
!!!

GETTING IN SHAPE AFTERGETTING IN SHAPE AFTER
PREGNANCYPREGNANCY
Getting in Shape
would involve
 Diet modifications
Exercise

Requirement duringRequirement during
lactationlactation
 During lactation women require extra
energy for milk production and it is
generally between 475-500 kcal
 Lactating women are more likely to
suffer from micronutrient deficiencies
than from a shortage of dietary energy
or protein.

Calculate caloriesCalculate calories
banking of calories!banking of calories!
For maintanance
 Multiply your current weight
by an activity factor
between 10-20. Use a
higher number (15 - 20) if
you are younger, moderately
overweight or of ideal
weight and moderate to very
active. The less active and
more overweight you are,
the lower the number should
be, (10-14).
For losing weight
 To lose one pound a
week, subtract 500
from your maintenance
caloric level /day* I
week
 To lose two pounds a
week, subtract 1000
calories from the
maintenance level
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Regular exerciseRegular exercise
Help return to pre-pregnancy weight Easily
 Reduce back pain,
Improve or maintain muscle tone,
Reduce leg cramps, swelling and constipation
Improve sleep patterns.

Exercising to Lose Weight
As a rule, it may take women a year to get back to
normal weight safely. Any celebrities we read about
losing their weight in six weeks are not doing
themselves or their babies any favours.
A good goal is to lose no more than half a kilo or a
pound a week.
This is not only safe but will also help to ensure that
the weight stays off.

There are different ways of
Exercising with baby
STROLLER STRIDES
IMPROVES MOTHER
AND CHILD
RELATIONSHIP

EXERCISE IN POSTPARTUMEXERCISE IN POSTPARTUM
Walking
Swimming (once bleeding has stopped),
post natal exercise classes, water aerobics
 low impact aerobics.
 Light weights program that allows to
maintain posture
Should not involve holding breath.

Fat loss is all about long-term goalsFat loss is all about long-term goals
HOW LONG EXERCISE?HOW LONG EXERCISE?
It takes 20 minutes for an unconditioned
person to actually start burning fat.
An average conditioned person will take
about 10 minutes Aim is 45 min/day
It takes a fit person about 11 sessions of a
45-minute fat-burning exercise period to
burn 1lb of fat, which is 3,500kcal.
10/24/18 Dr.Maninder ahuja 25

 Exercising to Lose Weight
 There is no wonder exercise! Any form of physical
activity that lasts for at least 30 minutes - include
exercises targeted at toning the muscles most
affected by pregnancy - at least five days a week will
help women lose weight.
 Many women will lose weight simply through
breastfeeding, but this is not true for everyone.
Remind the women that it took nine months to put on
the weight, so they shouldn’t expect to lose it too
quickly.

Start with PelvicStart with Pelvic
muscle andmuscle and
abdominalabdominal
muscle trainingmuscle training
 Pelvic floor and abdominal
muscles should regain sufficient
strength before sport, aerobics,
running or heavy lifting is
started
 Most women will require a
minimum of twelve to sixteen
weeks of exercises to
strengthen their pelvic floor and
abdominal muscles before they
return to their normal exercise
routine

INTENSITY OFINTENSITY OF
EXERCISEEXERCISE
Moderate to severe in intensity
How to know about intensity
MHR : 60-80 % of MHR and MHR is
220 _ age in yrs. At 50 yrs 220-50 =
170 and 60 % is 102-136
Borg test of SPE
Talk test
10/24/18dr.maninder ahuja 28

You need stamina forYou need stamina for walking!walking!

Intensity ofIntensity of
exerciseexercise
Gradually
intensity of
exercise program
is increased as
woman feel able
to, provided she
does not
experience any
pain or discomfort.

Very importantVery important
pointspoints
No pain or incontinence
during exercise ,if one feels
then reduce intensity of
exercise
Child birth increases
perineal muscle problems
High impact aerobics
would increase prolapse
and perineal muscle
problems so should be
avoided initially
 Supporting bra
while exercisiing
 Supporting bra
while water
aerobics also
 Take plenty of
water
 Take rest
 Don’t over do

CORE MUSCLECORE MUSCLE
TRAININGTRAINING
Continous Kiegle’s
exercises
 If pt. still problem of urinary of
anal incontinence
 Then should contact their
doctor
 Deepest abdominal muscle
layer is like a living corset. It
helps to stabilise spine before
any movement or action. This
as the Transversus Abdominus
(TA) muscle.

Back muscles need
strengthening and
also abdominal
muscles so that
bending , lifting
weight and baby is
not problem

Kegel Master ?Kegel Master ?
 Helps a woman perform proper and effective Keigel
exercises by applying adjustable targeted resistance
against the muscles of the female pelvic floor.
 The Kegelmaster™ has 15 levels of resistance with a
maximum of 4.5lbs of pressure required to close the
unit.
 The Advanced Kegelmaster has 64 levels of
resistance with a maximum of 9.5lbs of pressure
required to close the unit.
3310/24/18 Dr.Maninder Ahuja
AICOG AGRA2016

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kegelmasterkegelmaster

Stretching exercisesStretching exercises
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AGRA2016

Exercise and exerciseExercise and exercise
 Relaxin hormone works
even after delivery and
during pregnancy, so
maintain good posture,
pick up your perineas
muscle and draw in your
abdominal muscles even
when standing
 Sit ups and crunches
are not advisable
 Planks are best
exercises
 Lunges and squats are
also good.

Shoulder stretchShoulder stretch
Hold raised elbow above
chest.
Pull arm across body with
opposite arm.
Keep shoulders square
ahead.
Apply enough pressure to
feel a stretch in shoulder.
Hold for ten to twenty
seconds, repeat with both
arms.

TRICEPS STRETCHTRICEPS STRETCH
Bend arm and pull it behind
head.
Reach as far down back with
the bent arm.
Apply pressure downward on
elbow with the opposite arm.
Should feel a stretch in the
triceps, shoulder, and the
middle of back.
Hold for ten to twenty seconds,
repeat with both arms.

SEATED SHOULDER STRETCHSEATED SHOULDER STRETCH
In a seated position,
place arms straight
behind you and reach as
far as you can.
Lean back slightly until
a stretch is felt in the
front of shoulder.
Hold for ten to twenty
seconds.

SEATEDSEATED
BUTTERFLYBUTTERFLY
Sit on the ground,
with back up tall,
pull heels as close
to body as possible.
Remain sitting up
tall and push out on
knees with elbows.
Do not bounce and
hold for 10 to 30
seconds.

HAMSTRING STRETCHHAMSTRING STRETCH
Sitting on the ground, with one leg
straight and the other one
comfortably bent in front of your
body, bend at the waist and lean
forward, keeping your back as
straight as possible.Don’t curve your
back. Reach with your arms towards
the foot until a stretch is felt under
your thigh. Hold each stretch for a
minimum of 30 seconds, any less
than 15 seconds and the muscle will
not conform to the new increase in
length.

 A cautionary note: before
doing any strength routine,
be sure that current health,
strength and flexibility
limitations are not there
 Be extremely cautious with
baby, and be sure that baby
has excellent head control
before attempting this
 As there is gain in
strength and balance,
increase the number of
repetitions in each exercise.
EXERCISES WITH
BABY

 The lunge is a dynamic exercise
that targets the muscles of the
thighs, back, and buttocks,
 Strengthening the bones in the hip
and spine. The wide leg squat
addresses the same muscles,
 But the lunge includes balance
and coordination as well.

FORWARD LUNGES :
Begin with legs spread in a wide
stance, hips facing forward, baby held
at your torso. Lunge forward with
right leg, keeping the right knee from
extending in front of the ankle.
Return to standing position. Repeat
with opposite leg.

SIDE LUNGES :
Begin with hips more than hip width apart,
holding baby at your torso.
Lean to one side, bending knee.
Do not extend your bent knee over your
ankle, and be sure to keep back straight.
Return to center standing position. Repeat
on opposite leg.

SQUATS
Start with legs slightly more than
hip width apart, baby held at torso.
Slowly crouch down as far as
you are comfortable without
extending your knees too much in
front of your ankles.
Return to upright, standing
position. Alternate which arms
hold front/under baby.

 Begin on back, knees bent, baby sitting on pelvis
 (1). Press hips up, do not let knees splay apart
 (2). Keep abdominals contracted. Hold onto the baby, but do not
use your arms or elbows to prop you up. Return to floor position
 (3). To make this exercise more difficult, straighten and extend
one leg
 (4). Press upward, keeping straight leg extended and hips as level
as possible
 (5). Return to floor position. Repeat with other leg (6).

PLANKS
Hold straight body position, facing down, propped on elbows and
toes. Tilt pelvis and contract abdominals to prevent butt from
sticking up or getting too much arch in low back (1). Hold position for
20-60 seconds, as one is able. Too increase difficulty, hold plank
position 1 and lift one leg (2)keeping hips and back level. Raise and
lower leg 10 times. Switch legs.
o add difficulty and strength.
Hold a straight body position (3) ,
ropped on one elbow and
ame side foot (or both feet one in front of
he other) for 20-60 seconds
oo increase difficulty, lift upper leg
while maintaining straight body
position (4)
aise and lower leg 10 times

Surya namaskar

SURGICAL HELPSURGICAL HELP
Pt who are morbidly obese BMI> 35
Have diabetes or co morbidities
Liposuction
Various Gastric by pass surgeries

conclusionconclusion
Diet and exercise
Motivation
Persistence
Will power
WOULD ACHIEVE
 YOUR SHAPE
 AGAIN

Cherish your health:Your firstCherish your health:Your first
Temple is your Body!Temple is your Body!
If it is good, preserve it.
 If it is unstable, improve it.
 If it is beyond what you can improve, get
HELP !
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HOST CHAIRPERSON
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Thank you

Getting into shape after delivery

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Editor's Notes