Exercising Safely during Pregnancy

Natal-pilates-landscape-shot

It is now well known that exercise is beneficial during your pregnancy. Being fit and active during pregnancy can help you better adapt to the change in your shape and weight gain and it could also help you to cope better during labour. However many women are still unsure about what types of exercise are best, what should be avoided and how intensely they should push themselves when exercising. This blog will look at recommendations for exercise in pregnancy based on research and medical guidelines.

It is important to note that all this information relates to a single foetus uncomplicated pregnancy. If you are carrying more than one baby or you have any complications related to your own health or the pregnancy you should consult your medical team first for more specific exercise guidelines for you.

Are you already exercising?

During the first trimester it is generally safe to continue with most forms of exercise which you were comfortable with before you were pregnant. Even if you were not exercising before you can still benefit from starting an exercise programme during pregnancy although it is probably not the best time to take up a new impact exercise or a contact sport.

What types of exercise are best?

Pregnancy Pilates and Yoga are growing in popularity. Pilates particularly focusses on the abdominals and pelvic floor which are important during and post pregnancy. Pregnancy specific classes are available which help to ensure the instruction and advice are appropriate for your condition. They are often a good way to meet other women at similar stages in pregnancy, which can help create a support network once you have had your baby.

It is wise to avoid contact sports such as martial arts which could potentially involve direct trauma to the abdomen and care should be taken with sports which carry a risk of falling such as skiing or horse riding.

What about impact exercise?

Impact exercises such as running or aerobics can still be safe during the first trimester, especially if it is a form of exercise, which your body is used to. However you should remember that hormone changes are already occurring in your body and the result of these can make your ligaments laxer and less able to support your joints in heavy weight bearing. Listen to your body and if you notice more discomfort in areas such as your back, pelvis, knees or feet during exercise then it may be that you need to scale back the intensity. By the second trimester exercises such as swimming or aqua aerobics, where the water supports the increased weight of the pregnant uterus can feel more comfortable.

What about intensity?

An important aspect of pregnancy is the regulation of core temperature. Experts recommend that pregnant women avoid large increases in their body temperature during exercise as there may be a link to foetal growth and development, particularly during the first trimester. Saunas and steam rooms are not recommended.  Luckily hormones during pregnancy help women to adjust to avoid overheating; for example; pregnant ladies often find they sweat more easily, a method of cooling the body during exercise.

The American College of Sports Medicine notes that women who are regularly active during pregnancy and keep themselves hydrated during exercise are better able to adjust to changes in core temperature than those who are more sedentary. It recommends exercising in loose fitting clothing in a cool environment and avoiding exercise at altitude. Another good guideline for judging the right exercise intensity during pregnancy is to ensure you could hold a conversation whilst you are exercising i.e. the intensity is never such that you are out of breath.

What positions should I avoid?

The most obvious position to avoid is lying on the tummy and usually by the end of the first trimester or the start of the second trimester this position will have become too uncomfortable to sustain.

Exercising on your back can also start to become problematic after the first trimester. This is due to pressure from the baby on the inferior vena cava, which is the main blood vessel from the legs. Sustaining this position for prolonged periods in an exercise class can lead to dizzy spells if you occlude this vessel. For this reason guidelines recommend avoiding exercise in supine (on your back) after the first trimester.

Many exercises can be adapted into a quadruped, sitting or standing position or even by using a Swiss ball. Taking a pregnancy specific class at this stage means you will be able to participate more fully.

Can I exercise my abdominals?

Lots of pregnant women are still keen to exercise their abdominals to help them regain their form more quickly after they have given birth. Appropriate abdominal exercises can also be useful to support the back and pelvis and avoid injury and they may also help to avoid excessive rectus abdominus diastasis (separation) post pregnancy. However exercises must be adapted as appropriate for the stage of pregnancy. For example standard abdominal crunches on your back are no longer recommended after the fourth month due to the pressure on the inferior vena cava in this position mentioned above. When performing abdominal exercises in other positions it is important to be mindful of posture, particularly the lumber spine, which can become excessively curved due to the additional weight of the baby in front.

Useful abdominal exercises include:

  • Pelvic tilts in standing- Stand with your feet 10-15cm from a wall and your knees slightly bent, press the small of your back into the wall, tilting your pelvis and contracting you abdominals, hold for a few seconds then relax.
  • Exercises in quadruped (4 point kneeling)-in this position work on drawing your belly button towards your spine, without moving your back from a flat position
  • Sitting on a Swiss ball –Perform balance exercises, lifting alternate legs whilst drawing in your abdominals to help maintain good back posture.

Are there any exercises which are more beneficial?

If you have struggled with back or pelvic pain in early pregnancy your physiotherapist may recommend exercise such as Pilates. You should make sure to do a pregnancy specific class or a class with adaptations for pregnant women. Pregnancy Pilates includes exercises to strengthen the abdominal, pelvic floor, gluteal and back muscles.

Additional exercises for the pelvic floor muscles in isolation may help to control incontinence issues both during pregnancy and after delivery. Pelvic floor contractions, also known as Kegel exercises, involve squeezing the muscles which you usually use to stop your flow of urine 10-15 times in a row and then gradually increasing the time of each squeeze. This should be done without tensing other muscles such as the abdominals and gluteals.

Finally..

Exercising appropriately can make your pregnancy more comfortable and help you to recover form more quickly postnatally. However If you experience any discomfort during an exercise you should consult your doctor, midwife or physiotherapist before continuing.

After your baby is born it is generally recommended to wait 6 weeks before returning to exercise if you have had a standard vaginal delivery with no complications. If you had a caesarean delivery you will usually be advised to wait longer. Your midwife or doctor can advise you on safe time to return to exercise based on your individual experience. It is a good idea not to rush back to impact exercise too quickly and guide lines suggest waiting up to 3 months. During this time specific post natal Pilates classes can be a good way to further strengthen your pelvic floor and regain tone in your abdominals particularly. Your physiotherapist can advise you individually on other exercises which are appropriate.

References

http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/pregnancy-exercise.aspx#close

http://www.acsm.org/docs/current-comments/exerciseduringpregnancy.pdf

http://www.nct.org.uk/parenting/exercise-after-birth

By Nikki Richards MPHYTY(Sports), BSC(Hons)Physio