exercise in pregnancy - handout

7/28/2019 Exercise in Pregnancy - Handout

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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 requiringconfinement 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 tocontinue 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 co-ordination. This reduction in balance and co-

ordination 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 inyour 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 heartrate 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 Borg’s 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 youmost 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.

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 pre-

pregnancy. 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

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 non-

exercising 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 longterm 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 anincrease 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 prolongedaerobic exercise (limit more strenuous

phase to 15mins).



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 (notproven) 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 a pregnant woman STOP

exercising?

Exercise should be ceased immediately andnot 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

exercise in pregnancy - handout

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