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Jun 19

Exercise in pregnancy – FAQ

Many women fear exercising when pregnant. Is this fear justified? What would you say to women who expressed this sentiment?

Exercise is pregnancy is imperative! You often can’t do exactly what you were doing before you were pregnant; you may need to change exercises, or do it at a lower intensity over time, but if you are otherwise healthy, exercise in pregnancy will help keep you there. Continuing or even starting an exercise program is unlikely to have any adverse effects on either mother or foetus, and will be helpful in the mothers weight control, lowering her risk of gestational diabetes and even post natal depression. Stretching and gently mobilising aching joints can provide just the antidote to static work postures and a frame that is adjusting to so many changes in shape.

 

Pros of exercising when pregnant?
Exercising feels good! Stretching, releasing, moving, giving the muscles a chance to adapt to the weight gain and change in shape does wonders for a mum-to-be’s physical and mental well being. Medically, exercise in pregnancy can help keep maternal weight gain under control, can be useful in preventing and controlled gestational diabetes, and it has been shown to be helpful in reducing the risk or severity of post natal depression. As a physiotherapist, I find exercise particularly useful to manage the aches and pains often associated with this time in a woman’s life. In general, the fitter you are, the better you conceive, the better you cope with pregnancy, the better you cope with labour, and the better you recover from the delivery, and the better you cope with the life changes that occur with a new baby in the house.

 

Cons?
Not all exercise is created equally. From quite early in the pregnancy, there is a significant increase in blood volume, which means the heart has to work much harder to pump blood around. This is why many pregnant women feel puffed quite quickly – even after only a short flight of stairs. It’s important therefore to allow for that – go a little slower, so that the effort remains the same. As the pregnancy progresses and the foetus takes up more space in the abdomen, she may find that she can’t rotate well through her trunk, so her stride has to be a little shorter – any walking buddies have to slow down just a little! The baby is well protected during exercise in terms of its blood supply, so although mum is puffed, baby is doing just fine in there.
Most women find that lying on their back much after the first trimester is uncomfortable, as the baby within the uterus could put some pressure on the vena cava (the main vein returning blood from the legs and pelvis to the heart). If this happens, the mother will feel light headed, dizzy or nauseated. She should roll onto her side and wait for those symptoms to subside (which they will quite quickly), and then probably avoid lying on her back thereafter.
Exercise in pregnancy is contraindicated (you shouldn’t do it at all) if the mother has significant heart disease, restrictive lung disease, if she’s at risk of a premature labour, if she has persistent bleeding in pregnancy after the first trimester, placenta praevia after 26 weeks, she’s already experienced premature labour this pregnancy, she has ruptured membranes or she has pregnancy induced high blood pressure.
Care should be taken to monitor closely any exercise in pregnancy if the mother has severe anaemia, chronic bronchitis, poorly controlled heart arrhythmias, seizures, thyroid disease or type 1 diabetes, if she’s extremely underweight or morbidly obese or she’s a heavy smoker.
Warning signs to stop exercise when pregnant include: vaginal bleeding, shortness of breath before exercising, dizziness, headache, chest pain, muscle weakness, calf pain or swelling, pre term labour, if she’s not noticed much foetal movement that day or if she starts to leak amniotic fluid. She should see her Dr or midwife if any of these occur.

 

What to be mindful of?
Be careful of getting too breathless – working at a level that feels like a 12-14/20 of exertion – talking is getting difficult but you are comfortable, is ideal. If you do feel more short of breath, then just wind it back for a moment – walk slower or sit down for a moment.
Don’t get too hot. Most women feel a bit warmer in pregnancy anyway, so just be careful of overheating. In general, avoid exercising in hot, humid conditions and keep well hydrated. Fans are great to allow your sweat to cool you down!
Environments where you could fall heavily should be avoided. Horse riding isn’t recommended. There have never been any recorded instances of an impact in sport causing any problems to a foetus, however.
Scuba diving should be avoided.

 

Are some exercises better than others?
Aerobic exercise is great – walking, even running for some women, cycling (so long as you do it regularly, so that the shifting size and balance doesn’t become a risk if you are on the road. Stationary cycling if fine throughout pregnancy), rowing, swimming, yoga, dance, and classes based in a gym or in the pool.
Exercises where the legs are wide apart may be problematic for women that have some soreness in their pelvic joints, and as a physio who says many women with pelvic joint pain, I will usually recommend they cease doing these types of exercises early on (lunges, step ups).
Higher impact exercise isn’t recommended, from a couple of perspectives. High impact activities like jumping, running fast, bouncing on a trampoline and aerobics will put more stress on the pelvic joints, and as 80% of pregnant women will experience pelvic pain, I feel it is a condition best avoided. High impact exercise will also put more pressure on the pelvic floor muscles that are already coping with much more pressure from the weight of the foetus in the uterus above them. This load can cause some relative stretching of the muscles, and I see many women who have problems with continence or even with prolapse in pregnancy and soon afterwards. Reduce the amount of bounce and make sure that you can confidently squeeze and relax your pelvic floor muscles every day. About 40% of women can’t actually contract their pelvic floor muscles properly, so if you aren’t sure, contact your local women’s health physio to arrange an assessment.
Pelvic floor muscle exercise is very important during pregnancy. It has been shown to maintain pelvic floor muscle strength and improve continence, compared with not doing the exercises properly. But the key word here is properly. Many women are not able to exercise these muscles effectively, and some of these will even bear down rather than squeeze and lift. Light bladder leakage isn’t normal, and it can be helped enormously with correct training. The international continence medical community recommend well taught pelvic floor training as the first line treatment for stress incontinence problems.
Light weight training, so long as you absolutely avoiding breath holding or a ‘valsalva’ , is great as well. So again, the intensity might just need to come down a little.

 

Does the ability to exercise change across trimesters? Are there certain activities women should or shouldn’t do at certain points of pregnancy?
She should avoid lying on her back once she notices it isn’t comfortable. This may be as early as 16 weeks, or she may be comfortable throughout the pregnancy. Most women don’t like to do it after about 25 weeks.
In the first trimester, many women feel quite sick, or very tired, so maintaining a regular exercise routine is difficult. Walking a little, and doing the pelvic floor muscle exercises is a good start, and as she starts to feel better, she could incorporate pregnancy exercise classes, or get into a swimming pool, and add some simple home exercises.

 

Why is it important to remain fit and active while pregnant?
In pregnancy, a woman can expect to gain 10-15kg. Some women gain 30 kg, which makes for a tremendous change to her size, how she moves, how hard her heart works and happens in a really short time frame. It is a massive stress on the body. As with most types of stress, being physically fit and active will help the body to adjust and to cope, and some time out exercising will help most people cope mentally as well.
Within reason, being fit and active will help both body and mind adapt and cope with all of the changes of pregnancy, prepare for labour, manage the delivery, and recover well afterwards, in the challenging role of new motherhood (whether for the first time or for a further addition to the family).

 

Does a women’s fitness level prior to conceiving change what she can do while pregnant?
If a woman is not very fit before conceiving, she will need to start gently with an exercise program, but that is not a hindrance. Walking, pelvic floor muscle training, walking in water or swimming are all excellent exercise and require little background.
A woman who is very fit and active before pregnancy will often need to adjust her expectations of herself. Many women are shocked at how quickly they get puffed out, because of the additional blood volume and consequent load on her heart – it is normal to get puffed very early on, and is not a sign of being terribly unfit! Some more normal gym exercises will need to cease, such as strong abdominal work like planks, as well as hopping and other higher impact activities.
Pregnancy is not the time to start a heavy weights program, and most women will instinctively reduce the weight they are lifting. As mentioned, breathe holding and valsalva must be avoided, but so long as she has a good pelvic floor muscle contraction and can keep breathing throughout the lift, it is possible to weight train with heavier weights well into the pregnancy. As a women’s health physio, I would be concerned about her risk of prolapse, so I would want her to be very confident in her technique and coordination of her breathing, pelvic floor and lift.

 

Are there modifications women can make to their past fitness routines so it’s appropriate to continue while they are pregnant?
Usually, reducing the intensity and the impact will be sufficient. It is much easier to stay fit and pain free, than it is to wait until something hurts before modifying a fitness routine. Specific advice will vary on exactly what a woman is doing and what her back ground is, but I have seen women continue running throughout pregnancy, others who stop almost as soon as they confirm they’re pregnant. I’ve seen women row throughout their pregnancy – even competing at masters level the weekend before the baby arrived, as we all saw the footage of Jana Pittman at running training days before her baby daughter arrived. These examples are the exception, rather than the rule, however.
Strong abdominal work does need to stop, as we need the abdominal muscles to be able to lengthen and relax to accommodate the growing baby, rather than staying very short and tight.
I prefer to see most women stop doing exercises where they are asymmetrical, given that 80% of women will experience pelvic girdle pain in pregnancy. But we can do squats right up until the delivery!

 

Are there any limits to the frequency and/or intensity of workouts?
High intensity workout should stop quite early in pregnancy as the changes to blood volume occur mostly in the first trimester. Working to a ‘Perceived Rate of Exertion’ of 12-14/20, where 6 is very very easy and 20 is as hard as you can go, will see a woman through her pregnancy. The speed or intensity she can work out will change as her body changes, but the level of effort will remain constant. Measuring heart rate is less accurate as pregnancy will make a woman’s heart rate increase.
Daily exercise is appropriate for 30 minutes – a walk most days, perhaps a swim or a class during the week. I usually recommend at least 3 specific sessions per week, where she targets the muscles that need to cope the most – quads, glutes, postural muscles.

 

How can women tell if they are doing too much/working too hard?

If she is sore, or unduly tired, or feels she is working at a higher rate than 12-14/20, she should slow down. If she feels too hot, she should try to cool down – stop, drink cool water, use a fan.

 

When should women speak to their doctors?

A pregnant woman should contact her Doctor if she notices any vaginal bleeding, especially after the first trimester, or if she is short of breath when not exercising.
Exercise in pregnancy is contraindicated (you shouldn’t do it at all) if the mother has significant heart disease, restrictive lung disease, if she’s at risk of a premature labour, if she has persistent bleeding in pregnancy after the first trimester, placenta praevia after 26 weeks, she’s already experienced premature labour this pregnancy, she has ruptured membranes or she has pregnancy induced high blood pressure.
Care should be taken to monitor closely any exercise in pregnancy if the mother has severe anaemia, chronic bronchitis, poorly controlled heart arrhythmias, seizures, thyroid disease or type 1 diabetes, if she’s extremely underweight or morbidly obese or she’s a heavy smoker.
Warning signs to stop exercise when pregnant include: vaginal bleeding, shortness of breath before exercising, dizziness, headache, chest pain, muscle weakness, calf pain or swelling, pre term labour, if she’s not noticed much foetal movement that day or if she starts to leak amniotic fluid. She should see her Dr or midwife if any of these occur.
Most woman are able to exercise safely and well throughout their pregnancy, right up until the day of delivery.

 

Are there any specific exercises which pregnant women may benefit from?

I’ve given quite a lot of examples throughout – walking, swimming, pelvic floor muscle exercises.
Lovely stretches to do will include a cat/camel stretch (on all 4’s, arch the back as far as comfortable towards the ceiling, then let the belly sink towards the floor as you stick the bottom out and lift the head, and repeat perhaps 10x); ‘round the world stretch’ in side lying on the floor, let the top knee rest on the floor in front of you, start with the top hand on the top hip, let it slide down the thigh to the knee, then keep going around in a big circle with the hand staying as close to the floor as you can. Sweep it forward, then over the head, and behind, letting the head roll and letting the spine roll to keep looking towards the hand. Do 4 circles each direction 9down the thigh, then 4 circles up the thigh and around the back first), then change sides. Absolutely heavenly!
For strengthening: ‘clam’ exercises to strengthen the glutes – lying on her side with both legs bent, keep the heels together and lft the top knee about 6 inches above the bottom knee, then lower. Repeat 15-20x, then repeat on the other side. Squats – we use an exercise ball behind her back against the wall, to keep the knees back over the heels instead of coming further forward. This is more comfortable for the back and the knees than the usual squats. Aim for 50 reps.