Aquatic Exercise for Pregnancy: A resource book for midwives and health and fitness professionals

2007

Aquatic Exercise for Pregnancy

a resource book for midwives and health and fitness professionals

Susan Baines and Susie Murphy

Aquatic Exercise for Pregnancy

Susan Baines, Susie Murphy

ISBN: 978-1-905539-42-0

First published 2010

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without either the prior permission of the publishers or a licence permitting restricted copying in the United Kingdom issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London, W1T 4LP. Permissions may be sought directly from M&K Publishing, phone: 01768 773030, fax: 01768 781099 or email: publishing@mkupdate.co.uk

Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages.

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

Notice

Clinical practice and medical knowledge constantly evolve. Standard safety precautions must be followed, but, as knowledge is broadened by research, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers must check the most current product information provided by the manufacturer of each drug to be administered and verify the dosages and correct administration, as well as contraindications. It is the responsibility of the practitioner, utilising the experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Any brands mentioned in this book are as examples only and are not endorsed by the publisher. Neither the publisher nor the authors assume any liability for any injury and/or damage to persons or property arising from this publication.

The Publisher

To contact M&K Publishing write to:

M&K Update Ltd · The Old Bakery · St. John’s Street

Keswick · Cumbria CA12 5AS

Tel: 01768 773030 · Fax: 01768 781099

publishing@mkupdate.co.uk

www.mkupdate.co.uk

Designed & typeset by Mary Blood

Illustrated by Mary Blood and Fliss Watts

Printed in England by Reed’s Printers, Penrith.

Contents

List of figures

Acknowledgements

Introduction

Part 1 Aquanatal exercise

Chapter 1   Water generally – aquanatal specifically

Chapter 2   The anatomy of movement

Chapter 3   Pool safety – risk assessment and management

Chapter 4   Getting the best out of your classes

Chapter 5   Aquanatal choreography

Chapter 6   Practical tips for more fun and interesting classes

Chapter 7   Contra-indicated aquanatal exercises

Chapter 8   The pelvic floor and aquanatal exercise

Part 2 Aquanatal exercise – the wider context

Chapter 9   Ethical considerations

Chapter 10 Public health, physical activity and aquanatal exercise

Chapter 11 Aquanatal exercise and parent education

Chapter 12 Nutrition during pregnancy and for physical exercise

Chapter 13 The law and aquanatal exercise

Chapter 14 Voice care for the aquanatal exercise coach

Chapter 15 Marketing within the NHS

Part 3 Developing your practice

Useful sources of information and contacts

Appendices

1 Main muscles of the body that you need to know

2 Aquanatal exercise participant screening form

3 Client information sheet

4 Sample risk assessment pro-forma

5 Blank session plan – aims of whole session

6 An example of a legal case study

7 Continuing professional development – observation of a pregnancy aquatic session

8 Aquanatal session plans

Index

List of figures

Acknowledgements

We would like to express our love and gratitude to Michael and Peter, our long-suffering but patient husbands, for their care of us and their support whilst we wrote this book.

Introduction

This book is the culmination of over a decade’s worth of interest in aquanatal exercise.

Our journey into all things aquatic has had its fair share of ups and downs since we embarked upon it in the summer of 1997. I, for my part, had been managing a maternity and women’s health project in Bolton, Lancashire and was looking at possible strategies to support maternal and fetal health during the antenatal period and Susie was simply doing what Susie does best, with her unquenchable enthusiasm for a new challenge!

We met, qualified as professional registrants of the now defunct UK Fitness Register and the rest, as they say, is history. But from the very beginning we said that one day we would write a book, one designed to be used and not just added to one’s book shelf, in need of occasional dusting and only to be opened in times of specific need. We wanted to compile a living book, which would get bent at the edges from being stuffed into a gym bag, get defaced (from all the notes scribbled on its pages) and like a faithful old dog, get rather wet at times from being too close to the water. Our book is for using. It is for offering help and support to our caring and compassionate midwifery colleagues throughout the UK and across the world, who like us share a passion for facilitating aquanatal exercise.

We are both now specialist Level 3 coaches for the Register of Exercise Professionals (UK), have won a Vice Chancellor’s research award at the University of Salford, have developed the UK’s first academically underpinned level 3 Pregnancy Aquatics, Nutrition and Health module at the University of Salford and have had the opportunity to travel to Australia to spread the word about pregnancy aquatic exercise.

We still live, breathe and sleep aquanatal and are so convinced of the wonderful health benefits of this activity for mothers that we feel like shouting from the rooftops! Surely, if its benefits could be bottled, then we feel women would be tipsy with health.

It is perhaps strange to some, but certainly not to Susie and me, that those midwives who like us become interested in aquanatal exercise, also become passionate about it…

We hope you enjoy your book!

Love to you all

Sue and Susie 2010

Part 1

Aquanatal exercise

Chapter 1

Water generally – aquanatal specifically

Be praised, my lord, through sister water; she is very useful and humble and precious and pure

From The Canticle of the Sun by Saint Francis of Assisi (1181–1226) (Circa 1225) (www.wikiquote.org)

Everyone understands that water is essential to life. But many are only just now beginning to grasp how essential it is to everything in life – food, energy, transportation, nature, leisure, identity, culture, social norms, and virtually all the products used on a daily basis

(World Business Council for Sustainable Development) (WBCSD 2006)

Throughout history, there is a strong human affinity with this natural medium. Theologian, Bernard Frank, offers:

You could write the story of man’s growth in terms of his epic concerns with water

(www.cyber-nook.com/water/p-quotes.htm)

The well known underwater explorer, Jacques Cousteau (1910–1997) observed that, from birth, man carries the weight of gravity on his shoulders. He is bolted to earth. But man has only to sink beneath the surface and he is free

(Time magazine 28 March, 1960) (www.wikiquote.org)

Pregnancy aquatics – aquanatal exercise

What is aquanatal exercise?

It is a term coined from aquarobics which according to Baum (2000, p 5) refers to a system of exercises to music performed in the water. Whilst aquarobics refers generally to any social group, aquanatal is more specific and refers to just one, that of pregnant women. It has therefore been afforded specialist status within the UK Register of Exercise Professionals (REP), the professional regulatory body that identifies and maintains coaching standards across the UK. The REP demands a high level of expertise and competency from all of the coaches listed on its register, but nowhere is this more evident than on that part of the register open to aquanatal coaches. Mainly, due to the nature of pregnancy exercise, this requires special consideration to be afforded to two persons, the mother and her unborn baby.

Aquanatal exercise combines the therapeutic properties of warm water with suitably chosen music, to create a unique medium for exercising the body. But unlike dry land exercise, which tends to work various parts of the body specifically, aquanatal exercise works the whole body and can therefore be considered as holistic.

There are therefore very real benefits from exercising in water during pregnancy, which the pregnant woman would simply not experience from engaging in dry land aerobic activity. For example, as the exercises work all the major joints and muscle groups, there is little likelihood of overworking a particular one and causing joint and muscular strain. Also, there is far less likelihood of creating maternal fatigue, a common problem during pregnancy, as the sessions are specifically designed to take account of women’s changing physiology so as to maximise safety for both mother and baby.

We shall be considering all the components of planning an effective aquanatal class in a later chapter, but for now we wish to look a little more closely at why we personally feel, as experienced aquanatal coaches, that women generally associate so well with an aquatic environment.

Over the last twelve years of providing aquanatal exercise classes, we have strived to make sense of both our feelings about and our observations of women in the water. Whilst acknowledging the human affinity to water, we cannot actually explain why women seem to gain so much from this type of environment. Nevertheless, women seem entirely comfortable and happy in a pool of deliciously warm water. (See Further reading for this chapter; Elaine Morgan’s theories are interesting on this point.)

The properties of water

Water is the only element that can exist in three very different forms: liquid (water), solid (ice) and gas (steam); and therefore its structure when a liquid is very different from when it becomes a solid. Obviously as aquatic exercise professionals, we need to focus on water when in its liquid form so that we can appraise its properties and therefore understand why it is such a positive medium for mothers to exercise in and how it enhances physical fitness and well being.

Water’s molecular make up can be described as a combination of three atoms: two of hydrogen and one of oxygen (Chaplin 2007). The overall molecular shape is not completely circular as perhaps might be expected, but it takes the shape of a V which maintains the molecules in a state of flux, ready for action. This unique composition, according to Graham and Sterry (2000), allows for the substance to take part in a simple chemical reaction; the molecules’ ability to form clusters and become sticky when something impacts on their mobility. So when an object breaks the surface of the water and becomes immersed, the molecules attach themselves to it. Consider yourself when immersed in a bath of water and take a moment to reflect on how the water is behaving on and around your body. Does the water not seem to feel like a film on the skin and also to exert a feeling of light pleasurable compression to the parts submerged within it? These feelings help to formulate a basic understanding of why it is an ideal medium to exercise in, as it demonstrates both protective and supportive qualities whilst exerting pressure (drag) on the body and therefore muscular resistance. It is almost as if an invisible force is attached to the body, explaining why aquatic exercise is not only powerful and efficient but also why these properties can be utilised to make it fun.

Figure 1.1 Oscillating water molecule

(courtesy Martin Chaplin, London South Bank University)

Considering the individual properties of water, there are three types of resistance: viscous resistance, frontal resistance and eddy resistance (drag).

Viscosity – viscous resistance

Viscosity refers to the friction between molecules of a liquid (or gas) causing them to adhere to each other (AEA 2006). This is termed cohesion and when applied to a submerged body in liquid water, adhesion. Water is thicker and therefore more viscous than air so it adheres to the body and a resistance to motion is created. Galileo found that a body falls more slowly through water than if it fell through air, so if this principle is applied to a body exercising in water, it can be seen that the size of the body and the speed it is moving, can affect the resistance to the movement caused by the viscosity (drag) of the water. The larger the surface area’ the more difficult movement is in the water. Individual body shape and the size of the woman and working either individually or in a large group setting will therefore create more or less resistance. This is essential knowledge when planning an aquanatal session, as the exercises need to be varied in order to effectively create and thus manage the degree of resistance provided in a session in order to ensure the woman does not become exhausted and thus at risk of injury. Resistance requires greater muscular effort and energy consumption, so making exercise in water much more effective if carefully considered.

It needs to be recognised that viscous resistance can be altered in the water to suit the needs of the individual woman. One such strategy might be to work more moderately in a streamlined way. This is a smoother way of moving through the water, more continuous,