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Family Health Magazine
CHILDBIRTH

Exercise During Pregnancy
Use common sense while staying fit

Many women start or continue exercising during pregnancy. If there are no medical or pregnancy complications, regular exercise is very helpful. The changes that take place in the body during a normal pregnancy can cope with the demands of regular moderate exercise. Most women can exercise to maintain and improve their fitness throughout their pregnancies. Such exercise should not harm mother or baby, or create problems for the pregnancy.

A woman’s body goes through many changes during pregnancy. There is more weight at the front of the body and a change in the center of gravity. Joints become more relaxed because of the influence of hormones. The body’s metabolism increases and needs more oxygen.

These changes may lead to an increased risk of injury to both mother and baby. One of the main concerns is reduced blood flow to the uterus (which the baby relies on for development). Other concerns include not eating enough calories, mother or baby becoming overheated, falls, and joint and muscle injuries.

Despite the possible problems of exercise in pregnancy, there are many benefits. Exercise can increase self-esteem and the sense of control women have over their changing bodies. Compared to women who do not exercise, those who do report that their labours are easier and recovery faster after delivery. Active women seem to report fewer physical concerns during pregnancy, such as heartburn, leg cramps, nausea, and insomnia. Exercise can decrease depression and anxiety. It can help prevent and treat gestational diabetes (diabetes that develops during pregnancy).

A mother’s exercise does not seem to affect baby distress, birth weight, chance of miscarriage or length of labour. In fact, some studies have found that a woman who has exercised may need less intervention during her labour.

Before starting or increasing an exercise program, a pregnant woman should have a thorough medical evaluation to be sure there are no medical reasons for not exercising. If her doctor approves, some general guidelines will help her enjoy exercise safely.

• If a woman has already been exercising, then she may continue her routine. In the first three months she should not increase the intensity or frequency of exercise. Previously inactive women are encouraged to start an exercise program, but not until after the first three months. It is important that the exercise be regular, but that she not overexert herself.
• To avoid becoming overheated, she should check her temperature, avoid exercising in hot environments, and drink enough fluids. Six to eight glasses of fluid, including water, each day is recommended. Having a drink before, during and after exercise is helpful.
• A woman should increase appropriately the number of calories she eats and monitor her weight gain during her pregnancy. Around 300 more calories a day are needed during pregnancy. Canada’s Food Guide to Healthy Eating provides helpful guidelines. Dieting to lose weight is not recommended during pregnancy. Consult your maternity care provider about the weight gain appropriate for you.
• A woman should choose activities she enjoys. Exercising with a partner or group can help.

More specific considerations of an exercise program include exercise type, frequency and intensity.

Exercise Type

Activities that should be avoided at any stage of pregnancy include those where there could be blunt or penetrating injury to the abdomen. For instance, volleyball, basketball, horseback riding, and gymnastics are not safe. Exposure to too much pressure (like scuba diving), too little oxygen, or too much heat should be avoided. High impact activities, excessive stretching of joints, and activities requiring quick changes in motion are not recommended.

It is important to warm up before and cool down after exercise with range of motion exercises for all the joints, including the neck, shoulder, back, arms, hips, knees, and ankles. All major muscle groups should be stretched with care taken not to overstretch.

Exercise of all major muscle groups is important both during and after pregnancy. Strength exercises may be continued or started after the first three months. Exercises for strengthening the body core, posture and pelvic area should be emphasized. Weights should not be so heavy that you hold your breath during an exercise. Avoid exercises that require lying on your back, especially after the first three months.

For aerobic conditioning, no impact, low-impact or weight-supported activities are preferred to running or high-impact type activities. Good activities include bicycling, water running, water aerobics, and swimming. Water aerobics or swimming are great since body weight is supported by the floating effect of water. Cool water temperatures help control body temperature. As well, compared to weight-bearing activity the effort expended feels less. Women who run regularly should decrease their distance to less than three kilometres per run. Five kilometres of brisk walking is a good substitute.

An aerobic workout should include a warm up to start and a cool down to finish, each lasting 10 to 15 minutes. Low intensity calisthenics, stretching and relaxation exercises are a good choice.

Exercise Frequency

Aerobic activity should be done regularly, allowing enough time to recover between sessions. A pregnant woman beginning to exercise should start with a routine of three days a week, alternating days of rest and exercise. Over time, this can be increased to up to five days a week.

The best time to increase exercise is during the second three months. The risks and discomforts of pregnancy are lowest at this time. Aerobic exercise should start at a minimum of 15 minutes per session, three times per week. Increase gradually to a maximum of about 30 minutes per session, up to five times per week. All of this exercise should be at the woman’s appropriate target heart rate or at her own sense of her level of exertion (called rating of perceived exertion or RPE). (See the next section for information on heart rate and RPE.)

Exercise Intensity

During pregnancy avoid exercise routines requiring maximum exertion. There are many ways to estimate exercise intensity. The simplest measure is the talk test. An exercising mother-to-be should be able to comfortably carry on a conversation when exercising at the correct intensity. A more precise measure of exercise intensity is a range for heart rate for her age, modified for pregnancy. This shows the safe range of heartbeats per minute (BPM) during exercise.

Another way to monitor exercise is by combining the heart rate and the rating of perceived exertion (RPE). The RPE scale can be used by a pregnant woman to decide how difficult she finds the exercise. A range of about 12 to 14 (somewhat hard) is appropriate for most pregnant women. She can check the accuracy of her heart rate target zone by comparing it to the RPE scale. She can compare her heart rate to how hard she finds an activity.

A pregnant woman should stop exercising and consult a doctor if she has:

• bleeding or fluid ‘gush’ from the vagina (birth canal)
• steady and continuing contractions (more than six to eight per hour)
• unexplained pain in the abdomen
• absence of usual baby movement
• sudden swelling of ankles, hands and face
• persistent unexplained fainting, dizziness, headache, or vision problems
• swelling, pain, and redness in her calf
• not enough weight gain

In conclusion, most pregnant women can exercise regularly at moderate levels of intensity without harming themselves or their baby. Use common sense when exercising and be aware of your own limitations. If you are just starting to exercise, you may find an exercise program designed for pregnant women at your community fitness centre.

Advice for Active Living During Pregnancy

During pregnancy, women can help their unborn babies by developing smart health habits. Along with a regular exercise routine, improving eating habits, abstaining from smoking and not drinking alcohol give your baby the best chance for a healthy life. Pregnancy is a great time to improve your lifestyle and all of these changes can be carried over into the postnatal period and beyond.

Healthy Eating

• Choose healthy foods from the following groups: whole grain or enriched bread or cereal, fruits and vegetables, milk and milk products, meat, fish, poultry and alternatives.
• Salt intake should not be restricted.
• Limit caffeine intake (ie coffee, tea, chocolate, and cola drinks).

Positive Self and Body Image

• Remember that it is normal to gain weight during pregnancy.
• Accept that your body shape will change during pregnancy.
• Enjoy your pregnancy as a unique and meaningful experience.