Exercise in Pregnancy Handout

Exercise during pregnancy can be a very beneficial experience if you are conscious of the precautions to take and knowledgeable about the effects that exercise can have on you and your baby. Pregnancy is a natural condition rather than an illness requiring confinement and is being recognised as a unique time for women to make positive decisions regarding their health and lifestyle habits which could improve their health for the rest of their life. In a normal healthy pregnancy there is no reason why a woman cannot participate in regular exercise. Advanced Physiotherapy strongly urges all women who are planning to continue or commence exercise or sport while pregnant to discuss the specifics with their medical practitioner as well as following these general guidelines. How does pregnancy affect my body and physical ability? Increased body weight: During normal pregnancy your body weight can increase on average by 10-15kg. This normal increase changes the way weight is distributed and your overall body shape. This means that your centre of gravity is moved forward and your spine develops an increased curvature. Combining the increase in body weight with changes in your body shape means that some activities become more uncomfortable (i.e. jogging/running), it also alters your sense of balance and coordination. This reduction in balance and coordination makes activities requiring sudden change of direction or a degree of balance (i.e. rollerblading, skiing) less advisable. Ligament laxity (loosening): As pregnancy progresses, ligaments become more lax to create increased flexibility in joints to prepare for the birth of your baby. This occurs as the hormone relaxin increases in your system. This begins from 20 weeks onwards, particularly in your sacroiliac joint and pubic symphysis. Caution is encouraged with physical activities that involve jumping, frequent changes in direction and excessive stretching. Resting heart rate increases: During pregnancy your natural resting heart rate increases and your maximum heart rate decreases. This makes monitoring your exercise intensity through you heart rate difficult. The recommendation from Sports Medicine Australia (endorsed by the Royal Australian and New Zealand College of Obstetrics and Gynaecology) is to monitor your intensity levels by the rate of perceived exertion (see Borgs Rating of Perceived Exertion Scale). Blood pressure decreases: Blood pressure drops in the second trimester as blood vessels develop to supply the growing placenta. From approximately the fourth month, it is recommended that you avoid rapid changes in position, from both lying to standing and vice versa this will reduce your experience of dizzy spells. Stopping suddenly can also cause dizziness as the cardiovascular system has a delayed response which may result in dizziness or fainting. Prolonged lying on your back should also be minimised from the fourth month onwards as the weight of the foetus can slow the return of blood to the heart. Try to modify any exercises that require lying on your back to laying on your side. Motionless standing should also be avoided. Pelvic Floor: The pelvic floor is an important sling of muscles which support the abdominal contents and the foetus while pregnant. With this extra load the pelvic floor can weaken during pregnancy and can also be damaged during a normal vaginal delivery. Exercises to strengthen and improve pelvic floor control are essential for keeping you most importantly continent (i.e. no bladder/bowel leakage) but also fit and active as it is also part of your core muscles.

These exercises are best prescribed by your physiotherapist and are essential both during pregnancy and as soon as is comfortable after the birth to prevent incontinence following pregnancy and also with aging.

theoretical as no studies to date have proven there to be a risk. Risk to foetus: Some areas that have been raised as a potential concern when exercising to the foetus include: 1. Effects on birth weight current research has shown there to be no significant difference in birth weight when comparing an exercising vs nonexercising population. Some evidence has shown that women undertaking strenuous exercise in their third trimester had smaller babies, which were healthy at time of delivery but there are some concerns over the long term health of a low birth weight baby. A reduction in exercise intensity and frequency (three sessions or less) in the third trimester is recommended. 2. Contact sports there is no research to support risk to the foetus while playing contact sport (i.e. netball). The accepted advice is that each woman consults with her treating medical practitioner. This discussion needs to consider the type of sport, pregnancy status and her history of participation in sport. For example it would be ill advised for a woman who has never water skied to attempt it for the first time at 30 weeks pregnant. 3. Over-heating some studies of animals have shown that overheating of the mother could cause an increase in the risk of neural tube defects. Humans do have different heat dissipation methods to the animals studied, but following common sense when exercising should prevail i.e. do not exercise in the heat of the day or in humid conditions, stay well hydrated while exercising, wear loose comfortable clothing, take regular breaks and avoid prolonged aerobic exercise (limit more strenuous phase to 15mins).

Image from: http://www.netdoctor.co.uk/womenshealth/sui/pelvicfloor_005167.htm

What TYPE of exercise is safe? Aerobic exercise: Low impact moderate intensity aerobic exercise is commonly accepted as the safest way to keep up or even start to exercise whilst pregnant. Activities such as swimming, walking, jogging, hiking, aerobic dance, rowing, cross country skiing, dancing, rope skipping and cycling (stationary later in pregnancy) are accepted. Generally activities that increase the risk of falls such as skiing or those that can involve excessive joint stress like jogging or tennis should not be attempted, especially if the activity is not a regularly undertaken prepregnancy. However it can be evaluated in terms of suitability on an individual basis by the treating medical practitioner. Resistance (weight) training: Individually and professionally, prescribed light-to-moderate weight training exercises are safe during pregnancy. It is recommended to perform these using free weights, weight machines or a combination of both and to perform multiple repetitions at these low loads. Does exercise have any associated RISKS during pregnancy? There are theoretical risks associated with exercise during pregnancy to the mother and to the foetus; however these are considered

Risks to mother: Risks to the mother have been discussed in the physical adaption section. What are the BENEFITS of exercise during pregnancy? 1. Maternal weight control some studies have shown women that exercise before and during pregnancy weigh less and gain less weight. As stated above weight gain during pregnancy is on average 10-15kg and this is normal. Weight loss is not advised during pregnancy nor is excessive weight gain. For clarification please consult your medical practitioner. 2. Improved mood can possibly (not proven) reduce the incidence of post natal depression. 3. Maintenance of fitness levels. 4. Prevent Gestational Diabetes Mellitus The American Diabetes Association endorses exercise as a helpful adjunctive therapy for gestational diabetes mellitus when not controlled by diet alone. How MUCH exercise is safe? The American College of Obstetricians and Gynaecologists guidelines for exercise during pregnancy and the post-partum period state that There are few instances that should preclude otherwise healthy, pregnant women from following the same recommendations when referring to recommendations of 30mins of accumulated moderate intensity exercise (equivalent to brisk walking) daily. The Sports Medicine Australia guidelines also endorse pregnancy being a safe time to START exercising in healthy women with non-complicated pregnancies and in consultation with their medical practitioner. There are no studies which have determined the safe upper level of exercise but common sense along with the natural progression of pregnancy (increased weight, change in body shape and fatigue) tends to cause most women to lessen their physical activity

levels. As previously mentioned, once the pregnancy has progressed to the third trimester no more than three vigorous exercise sessions per week are advised. When should exercising? a pregnant woman STOP

Exercise should be ceased immediately and not recommenced until clearance from your medical practitioner has been attained if you experience: Vaginal bleeding Uterine contractions/preterm labour Dizziness Unusual shortness of breath Headache Amniotic fluid leakage Chest pain Decrease foetal movements Sudden swelling of ankles, hands and face Muscle weakness Calf pain or swelling (need to rule out clot) Exercise during pregnancy is not advised if you have the following health conditions, unless cleared by your medical practitioner: Heart disease Restrictive lung disease Pregnancy induced hypertension (high blood pressure)/ Pre-eclampsia Incompetent cervix/cerclage Multiple gestation at risk of premature labour Persistent second or third trimester bleeding Placenta praevia after 26 weeks Premature labour Ruptured membranes Severe anaemia Cardiac arrhythmia Diabetes Extreme morbid obesity Extreme underweight Intrauterine growth restriction Poorly controlled seizure disorder Poorly controlled thyroid disease Heavy smoker/extremely sedentary