Author: Justin Chipperfield, Registered Physiotherapist

It can be a common thought of not knowing what exercises are safe or effective when one becomes pregnant. With the internet having an infinite number of resources, it can be difficult of what information is reliable or scientifically based. This blog post will take you through the recent up-to-date research investigating exercise and pregnancy and hopefully help provide insight!

The American College of Obstetricians and Gynecologists recommends carefully reviewing the overall health, obstetric, and medical risks before prescribing an exercise program to a person who is pregnant. A thorough clinical evaluation should be conducted before recommending an exercise program to ensure that a patient does not have a medical reason to avoid exercise. Exercise during pregnancy is considered safe and beneficial for those without any contraindications. People with uncomplicated pregnancies should be encouraged to engage in aerobic exercise and strength conditioning before, during, and after pregnancy. The FITT guidelines for this population recommend:

·      Frequency: 3 or more days a week for aerobic activities and 2-3 non-consecutive days per week for resistance activities.

·      Intensity: moderate intensity (12-13 on the 6-20 Borg scale) for aerobic activities, resistance activities should be performed to the point of moderate fatigue (8-10 reps or 12-15 reps). Begin with low weights with multiple repetitions.

·      Time: 30 minutes of moderate-intensity aerobic activities, 2-3 sets of resistance exercises focusing on major muscle groups. (Beginners should start with 1 set and progress as able)

·      Type: Exercises that use large muscle groups in a continuous rhythmic manner are beneficial and have not been associated with adverse effects eg aerobic exercises, walking, hiking, jogging/running, aerobic dance, swimming, cycling, rowing, cross-country skiing, and dancing (extra caution should be taken with activities that increase the risk of falls)

Maternal cardiovascular dynamics follow normal response patterns – with moderate physical activity offering no greater physiologic stress to the mother other than the additional weight gain and encumbrance of fetal tissue. Research has found that regular physical activity during pregnancy can reduce maternal weight gain by an average 6.8 pounds compared to people who do not exercise regularly. It is encouraged to also focus on pelvic floor muscle training which should be done daily to reduce the risk of urinary incontinence. Some modifications to exercise may be necessary due to normal anatomic and physiologic changes and fetal requirements.

Why pregnant people should exercise:

·      To increase physical fitness and weight management

·      Boost one's mental health and well-being

·      Decrease risk of gestational diabetes, hypertension, and pre-eclampsia

·      Decrease risk of preterm, prolonged, and acute c-section delivery

The figure below illustrates the prevalence and pattern of different activities during pregnancy among pregnant and nonpregnant people in the U.S. It might be surprising to some, but about 40 percent of people participate in different forms of physical activity during pregnancy.

For both pregnant and nonpregnant people, walking has shown to be the most popular activity- with 52% of responses for pregnant people and 45% for nonpregnant people. The sample comes from pregnant people who engaged in either moderate or vigorous physical activity who were younger, non-Hispanic white, unmarried, and more educated. They also tend to be nonsmokers with higher incomes than their less physically active counterparts.

Physical Activity Effects on the Fetus and Newborn

Contrary to belief, there is some long-term evidence that indicates physical activity during pregnancy does not increase risk of fetal deaths or low birth weights, but instead, may significantly reduce the risk of preterm births. In fact, a moderate program of walking, jogging, or recreational activity early in pregnancy through delivery enhances placental growth and reduces preeclampsia risk – a pregnancy complication characterized by high blood pressure and signs of damage to other organs, often the kidneys.

Top Tips

• Setting your own pace. Ensure that you find what works best for you. Aiming to maintain a conversational pace and controlled breathing is a good goal.

• Maintain a schedule. Not only will this aid in benefiting one during the pregnancy, but by keeping to a schedule can transfer onwards to the postpartum phase and recovery. It is important to listen to the recommendations from the doctor (ie. recommended 6-8 weeks post-partum).

• Exercise on a flat, level surface.

• Consume enough calories to meet pregnancy needs (about 300 more calories per day than before pregnancy).

• Contact your healthcare provider if sinister symptoms are experienced such as irregular heartbeat, chest pain, decrease in fetal movement, or sudden swelling in the hands, face or pain in calves.

What to Avoid:

·      Deep-knee bends, full sit-ups, double leg raises, and straight toe touches

·      Bouncing while stretching

·      Waist-twisting movements while standing

·      Heavy activity spurts followed by extended periods of inactivity

·      Physical activity in hot, humid weather

·      Holding your breath during any activity

·      Any activity in which falling is likely (skiing, horseback riding)

·      Any contact sport (softball, basketball, volleyball)

In summary, exercise is deemed safe and even beneficial for most people during their pregnancy. There are some conditions (such as gestational diabetes, morbid obesity, and chronic hypertension) where an unsupervised exercise program poses a risk, however when provided with suitable health professional monitoring, an exercise program would be of benefit.

References

1. Barakat, R., et al. 2015. “Exercise during pregnancy. A narrative review asking: What do we know?” British Journal of Sports Medicine; 49(21):1377.

2. Daley, A.J., et al. 2015. “The effectiveness of exercise for the prevention and treatment of antenatal depression: Systematic review with meta-analysis.” British Journal of Obstetrics and Gynecology; 122(1):57.

3. Di Mascio, D., et al. 2016. “Exercise during pregnancy in normal-weight women and risk of preterm birth: A systematic review and meta-analysis of randomized controlled trials.” American Journal of Obstetrics and Gynecology; 215(5):561.

4. Elliott-Sale, K.J., et al. 2015. “Exercise interventions for weight management during pregnancy and up to one year postpartum among normal weight, overweight, and obese women: A systematic review and meta-analysis.” British Journal of Sports Medicine; 49(20):1336

5. Katch V. Pregnancy And Physical Activity( 2017, February, 5). Retrieved from http://michigantoday.umich.edu/pregnancy-and-physical-activity/.

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