Water Aerobics Reduces Sick Leave due to Low Back Pain During Pregnancy

doi:10.1111/j.1552-6909.2006.00066.x

Journal of Obstetric, Gynecologic & Neonatal Nursing

Volume 35, Issue 4, July–August 2006, Pages 465-471

https://doi.org/10.1111/j.1552-6909.2006.00066.x Get rights and content

Objective

To compare the effect of a land‐based, physical exercise program versus water aerobics on low back or pelvic pain and sick leave during pregnancy.

Design

Randomized controlled clinical trial.

Setting

Three antenatal care centers.

Participants

390 healthy pregnant women.

Interventions

A land‐based physical exercise program or water aerobic once a week during pregnancy.

Main Outcome Measures

Sick leave, pregnancy‐related low back pain or pregnancy‐related pelvic girdle pain, or both.

Results

Water aerobics diminished pregnancy‐related low back pain (p= .04) and sick leave due to pregnancy‐related low back pain (p= .03) more than a land‐based physical exercise program.

Conclusions

Water aerobics can be recommended for the treatment of low back pain during pregnancy. The benefits of a land‐based physical exercise program are questionable and further evaluation is needed.

Introduction

Pain from the pelvic area occurs often during pregnancy. The terms describing this condition vary, making study comparisons difficult (Stuge et al., 2003, Wu et al., (2004). Recently, the terms “pregnancy‐related pelvic girdle pain” (PPP) and “pregnancy‐related low back pain” (PLBP) have been proposed (Wu et al., 2004). More than one third of women experience back pain during pregnancy (Albert, 2001, Heiberg Endresen, 1995, Kristiansson et al., 1996, Mogren amd Pohjanen, 2005, Ostgaard and Andersson, 1991, Perkins et al., 1998, Rungee, 1993, Stuge et al., 2003, Wang et al., 2004, Wu et al., (2004, Young and Jewellw, 2002). This may interfere with work, daily activities, and sleep (Mens et al., 1996, Perkins et al., 1998; Young & Jewell). Low back pain (LBP) before pregnancy increases the risk for long‐standing LBP postpartum (Brynhildsen, Hansson, Persson, & Hammar, 1998). Long‐standing LBP begins during pregnancy in 10% to 15% of cases (Brynhildsen et al., 1998, Svensson et al., 1990).

Women with PPP will typically report fluctuating pain located at the sacroiliac joints, increased pain when turning in bed, and having a positive pain response to specific tests developed for PPP (Albert, Godskesen, & Westergaard, 2000). Management of pain from the pelvic area during pregnancy focuses on advice whereby no effective methods for treatment have been identified (Perkins et al., 1998). Low back pain may, of course, occur at any time and not just during pregnancy. Correct differentiation between PPP and PLBP is crucial for establishing correct care (Albert, 2001, Kristiansson et al., 1996; Perkins et al.; Wu et al., 2004). Pregnancy‐related pelvic girdle pain and PLBP symptoms may, however, overlap or occur simultaneously. Both PPP and PLBP can become long‐standing and prevention is important.

Moderate exercise is recommended at least three times a week during pregnancy to enhance maternal fitness and well‐being.

Based on the findings of Clapp et al. (Clapp, 1990, Clapp, 2000, Clapp et al., 2000), the American College of Obstetricians and Gynecologists (ACOG) recommends moderate exercise at least three times a week during pregnancy to enhance maternal fitness and well‐being (ACOG Technical Bulletin no. 189, 1994). In a randomized controlled trial, water aerobics seemed to reduce sick leave due to PLBP when compared to no physical exercise (Kihlstrand et al., 1996, Young and Jewellw, 2002). In the study by Kihlstrand et al. (1996), LBP was not defined and may have included women with pelvic pain as well. However, in present studies, it is unclear whether all physical exercise or only water aerobics are beneficial to women with PLBP or PPP (Brynhildsen et al., 1998, Perkins et al., 1998, Svensson et al., 1990).

The aim of this study was to compare the effect of land‐based physical exercise (LBPE) with water aerobics, on pain (PLBP and PPP) and sick leave in pregnant women.

Section snippets

Methods

Pregnant women were invited to participate in a study evaluating physical activity during pregnancy. Prior to inclusion, midwives provided verbal and written information about the study. Women were asked to fill out a registration protocol including written consent. Those responsible for antenatal care in the area and the Ethical Committee of Göteborg University approved the study.

Results

Out of 761 consecutively registered women, 325 did not meet the inclusion criteria (Figure 1). Of 436 eligible women, 89.5% (n= 390) participated. Average gestational age at inclusion was 19 weeks (range 16‐29). Most participants started after an ultrasound examination at the 17th gestational week. A later start was mainly due to interruption of activities during summer months. Dropouts had a higher prevalence of multiparity compared to those completing the study (p= .009) but did not differ

Discussion

The incidence of PLBP and PPP during pregnancy in the current study is comparable to another Swedish study (Kihlstrand et al., 1996) but lower than reported in a Norwegian study (Heiberg Endresen, 1995). Furthermore, the duration of sick leave in this study is comparable to other Nordic studies (Björklund & Bergström, 2000; Kihlstrand et al.; Heiberg Endresen). Hansen, Vendelbo‐Jensen, and Larsen (1996)reported less sick leave. However, direct comparison is difficult due to divergent study

Conclusion

Water aerobics has been shown to diminish sick leave and can be recommended to pregnant women. Some doubts regarding the benefits of LBPE have been be raised.

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Cited by (58)

The WATER study: Which AquaTic ExeRcises increase muscle activity and limit pain for people with low back pain?
2022, Physiotherapy (United Kingdom)
Aquatic exercise therapy is used for the treatment and management of chronic low back pain (CLBP). However, to the authors’ knowledge, no studies to date have compared muscle activity between different aquatic exercises performed by people with CLBP. As such, this study assessed and compared muscle activity, pain, perceived exertion and exercise intensity between different rehabilitative aquatic exercises.
Cross-sectional.
A 25-m indoor swimming pool within a university building.
Twenty participants with non-specific CLBP.
Twenty-six aquatic exercises in shallow water (1.25-m depth). Muscle activity was quantified bilaterally for the erector spinae, multifidus, gluteus maximus and medius, rectus abdominis, and external and internal obliques.
Mean and peak muscle activity, pain (visual analogue scale), perceived exertion (Borg scale) and exercise intensity (heart rate).
Hip abduction/adduction and extension/flexion exercises produced higher activity for gluteal muscles. Variations of squat exercises increased the activity of back extensors. Higher abdominal muscle activity was produced with exercises that made use of buoyancy equipment and included leg and trunk movements while floating on the back, and with some proprioceptive and dynamic lower limb exercises. Pain occurrence and intensity were very low, with 17 exercises being pain free.
This study provides evidence on trunk and gluteal muscle activity, pain, intensity and perceived exertion for people with CLBP performing aquatic exercises. The findings may be useful when prescribing exercises for rehabilitation, as physiotherapists seek to implement progression in effort and muscle activity, variation in exercise type, and may wish to target or avoid particular muscles.
- •
  This is the first study to compare trunk or gluteal muscle activity between 26 different aquatic rehabilitative exercises performed by people with CLBP.
- •
  Pain occurrence and intensity of aquatic exercises are very low, with most exercises being completely pain free.
- •
  The following aquatic exercises are particularly effective in increasing muscle activity: (a) hip abduction/adduction and extension/flexion exercises for gluteus maximus and medius; (b) squat exercises for back extensors (erector spinae and multifidus); and (c) exercises that make use of support buoyancy equipment and include leg movements while floating on the back for abdominals (rectus abdominis, and external and internal obliques).
Management of women with pregnancy-related pelvic girdle pain: an international Delphi study
2022, Physiotherapy (United Kingdom)
Pregnancy-related pelvic girdle pain (PPGP) contributes to significant prenatal and postpartum impairments; however, various clinical practices exist around the conservative treatment of this condition. This study sought to reach a consensus on the essential components of PPGP management through an international Delphi survey of experts in women's health.
Eighty-seven international experts in the field of PPGP were invited to participate and surveyed over three rounds. Round 1 of the survey utilised open-ended questions to gain feedback on 16 components of PPGP management previously identified by a focus group. Feedback from panel members guided modification and refinement of questions for Rounds 2 and 3. A 5-point Likert scale was used to rate level of agreement, with a minimum threshold for consensus of ≥75% agreement set across all survey rounds.
Forty-four of the 87 (50%) invited professionals agreed to participate in the panel, with 77% (34/44) of panellists contributing to all three rounds. Of the 16 initial components, 15 were included in Round 2. The final consensus was reached on 10 important components of assessment and management after Round 3: pain education, postural and ergonomic advice, social and lifestyle factors, psychological factors, cultural considerations, strengthening exercise, other exercise, exercise precautions, manual therapy and the use of crutches.
This study identified 10 key components that should be considered in the management of PPGP. In addition, these components provide a potential framework for future research around the conservative management of PPGP.
Effects of aquatic exercise on pregnancy, a systematic review
2022, Fisioterapia
El embarazo es una etapa plagada de cambios fisiológicos y mentales. El ejercicio físico es saludable y beneficioso, a pesar de ello, durante el embarazo se constata una disminución de la actividad física de las gestantes.
Evaluar los efectos del ejercicio físico acuático en las mujeres embarazadas.
Se llevó a cabo una búsqueda sistemática que se extendió desde enero a abril de 2020, en las bases de datos: Pubmed, Web of Science, Medline, Cinalh, Scopus y Cochrane.
Tras la aplicación de los criterios de inclusión (ensayos clínicos aleatorizados publicados entre 01/01/2015 y el 31/04/2020 e idioma castellano o inglés y exclusión (artículos duplicados, revisiones bibliográficas y que no se ajustasen al tema de estudio), se obtuvieron 11 artículos válidos.
La calidad de la metodología se evaluó mediante la escala Jadad, obteniendo una puntuación de 3, y el riesgo de sesgo siguiendo las indicaciones del Manual Cochrane de revisiones sistemáticas, adquiriendo un bajo riesgo de sesgo. Las variables evaluadas fueron calidad de sueño, peso del bebé, peso gestacional y posparto, dolor lumbopélvico, depresión posparto, estado del perineo, duración del parto, constantes hemodinámicas y la calidad de vida, obteniendo en algunos casos resultados dispares.
El ejercicio físico acuático produce cambios beneficiosos en las gestantes manteniendo la duración de la gestación, disminuyendo el peso de la madre sin alterar el del bebé y mejorando la calidad de vida.
Pregnancy is a stage that involves physiological and mental changes. Physical exercise is healthy and beneficial, however, during pregnancy there is a decrease in physical activity in pregnant women.
To evaluate the effects of aquatic physical exercise in pregnant women.
A systematic search was carried out from January to April 2020 in the databases: Pubmed, Web of Science, Medline, Cinalh, Scopus and Cochrane.
After application of the inclusion criteria (randomized clinical trials published between 01/01/2015 and 04/31/2020 and Spanish or English language and the exclusion criteria (duplicate articles, bibliographic reviews and those that did not fit the study topic), 11 valid articles were obtained.
The quality of the methodology was evaluated using the Jadad scale, obtaining a score of 3, and the risk of bias following the indications of the Cochrane Manual of systematic reviews, acquiring a low risk of bias. The variables evaluated were quality of sleep, baby's weight, gestational and postpartum weight, lumbo-pelvic pain, postpartum depression, perineal status, duration of labour, haemodynamic constants, and quality of life, obtaining mixed results in some cases.
Aquatic physical exercise produces beneficial changes in pregnant women, maintaining the duration of gestation, reducing the weight of the mother without altering that of the baby and improving quality of life.
Low back pain in pregnancy
2021, Revue du Rhumatisme Monographies
La lombalgie de la femme enceinte concerne le plus souvent une association de douleurs de la région lombaire et pelvienne. Elle est extrêmement fréquente (50 à 80 % des femmes) et universelle. La physiopathologie des douleurs n’est pas claire mais associerait probablement des causes mécaniques et biomécanique à des causes hormonales et vasculaires. En revanche les facteurs de risque sont mieux identifiés, les douleurs étant plus fréquentes pour les femmes ayant des antécédents de lombalgies, un IMC plus élevé et un manque d’activité physique. La lombalgie est commune dans la majorité de cas et le diagnostic consiste essentiellement à différencier une douleur d’origine rachidienne ou non rachidienne (sacro-iliaque, fissure osseuse…), éliminer les drapeaux rouges et les complications neurologiques. Il faut dans la mesure du possible éviter les imageries et si nécessaire, l’IRM sera à privilégier. L’évolution est le plus souvent favorable après l’accouchement mais un faible pourcentage de femmes décrit des douleurs récurrentes ou persistantes après plusieurs années. La prise en charge repose sur la prise en charge de la douleur, le maintien des activités avec comme objectifs de soulager et de maintenir une bonne qualité de vie.
Low back pain in pregnant women most often involves a combination of pain in pelvic and lumbar region. It is a common problem for all women around the world. The causes of pain are unclear but concern probably a multitude of mechanical, hormonal, and vascular changes associated with pregnancy. On the other hand, risk factors of pain are better identified, with pain being more common in women with a history of low back pain, higher BMI and lack of physical activity. The majority of pain are non-specific low back pain and diagnosis consists in differentiating between spinal and non-spinal pain (sacroiliac joints, bone fissures…), eliminating red flags and neurological complications. Radiological prescriptions must be avoided and if needed, MRI would be preferred. The clinical course of low back pain is often favourable after delivery, but a small percentage of women describe recurrent or persistent pain after several years. Management is based on improvement of pain, staying active with the objectives of relieving pain and maintaining a good quality of life.
Chiropractic Care for Adults With Pregnancy-Related Low Back, Pelvic Girdle Pain, or Combination Pain: A Systematic Review
2020, Journal of Manipulative and Physiological Therapeutics
The purpose of this study was to conduct a systematic review (SR) of the literature to assess the effectiveness of chiropractic care options commonly used for pregnancy-related low back pain (LBP), pelvic girdle pain (PGP), or combination pain for both experienced practitioners and students of chiropractic.
We included procedures that were commonly used by chiropractors and not requiring additional certifications. Outcomes were self-reported changes in pain or disability. We used the Scottish Intercollegiate Guideline Network checklists to assess outcomes. For strength of evidence, we used the adapted version of the US Preventive Services Task Force criteria as described in the UK report.
Fifty articles were included from 18 SRs, 30 randomized controlled trials (RCTs), and 2 cohort studies. Pregnancy LBP (7 SRs and 12 RCTs): moderate, favorable evidence for electrotherapy and osteopathic manipulative therapy; inconclusive, favorable strength for chiropractic care, exercise, and support devices; and inconclusive, unclear strength for spinal manipulative therapy. Pregnancy PGP (4 SRs and 4 RCTs): inconclusive, favorable strength for exercise; and inconclusive, unclear evidence for patient education, information, and support devices. Pregnancy LBP or PGP (13 SRs and 12 RCTs): moderate, unclear evidence for complementary and alternative medicine; moderate, unclear evidence for exercise; inconclusive, favorable evidence for multimodal care, patient education, and physiotherapy; and inconclusive, unclear strength for spinal manipulative therapy, osteopathic manipulative therapy, and support devices.
Although there is a lack of conclusive evidence, many of the interventions have moderate or unclear but favorable evidence.
Chiropractic Care of Adults With Postpartum-Related Low Back, Pelvic Girdle, or Combination Pain: A Systematic Review
2020, Journal of Manipulative and Physiological Therapeutics
The purpose of this study was to conduct a systematic review (SR) of the literature to assess the effectiveness of specific chiropractic care options commonly used for postpartum low back pain (LBP), pelvic girdle pain (PGP), or combination (LBP and PGP) pain.
A search strategy was developed. Interventions were those manual or other nonpharmacologic therapies commonly used by chiropractors (not requiring additional certifications). The outcomes were self-reported changes in pain or disability self-reported outcomes. We used the Scottish Intercollegiate Guideline Network checklists. Strength of the evidence (excluding cohort studies) was determined using an adapted version of the US Preventive Services Task Force criteria as described in the UK report.
Of the 1611 published articles, 16 were included. These were 5 SRs, 10 randomized controlled trials (RCTs), and 1 cohort study. Postpartum LBP (1 RCT): moderate, favorable strength for spinal manipulation therapy/mobilization. Postpartum PGP (4 RCTs): moderate, unclear strength for exercise; and inconclusive, unclear strength for patient education. Postpartum LBP or PGP (3 SRs and 4 RCTs): inconclusive, unclear strength for exercise, self-management, and physiotherapy; while osteopathic manipulative therapy was inconclusive, favorable.
No treatment option was identified as having sufficient evidence to make a clear recommendation. This SR identified a scarcity of literature regarding chiropractic care and back pain for postpartum women, as well as inconsistency among the terms LBP, PGP, and combination pain.

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Clinical ResearchWater Aerobics Reduces Sick Leave due to Low Back Pain During Pregnancy

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Conclusion

Obstetrics and Gynecology

American Journal of Obstetrics and Gynecology

Clinics in Sports Medicine

American Journal of Obstetrics and Gynecology

American Journal of Obstetrics and Gynecology

Journal of Nurse Midwifery

Exercise during pregnancy and the postpartum period

International Journal of Gynecology and Obstetrics

Treatment of pelvic and low back pain in pregnant and post partum women

Evaluation of clinical tests used in classification procedures in pregnancy‐related pelvic joint pain

European Spine Journal

Is pelvic pain in pregnancy a welfare complaint?

Acta Obstetricia et Gynecologica Scandinavica

Relaxin is not related to symptom‐giving pelvic girdle relaxation in pregnant women

Acta Obstetricia et Gynecologica Scandinavica

Pelvic pain and low back pain in pregnant women—An epidemiological study

Scandinavian Journal of Rheumatology

Clinical Research
Water Aerobics Reduces Sick Leave due to Low Back Pain During Pregnancy