So you are going to have a baby, or maybe just thinking about having one. Either way it is important to be aware of some important considerations when it comes to exercise and pregnancy. The following is designed to help you ensure that you are aware of any risks associated with exercising whilst pregnant as well as recommendations for the health of you and your baby. Is exercise safe for all pregnancies? You should consult your obstetrician or specialist before engaging in any exercise especially if you have one or a combination of the following:
What changes does pregnancy create in a woman’s body and what does this mean for exercise? One of the most obvious changes that a pregnant mother will experience is change in body size. As the baby grows, the change in size has implications not only for the mother but for the type of exercise as well. The growing abdominal area will cause alterations in balance, center of gravity and hence the type of exercise that should be carried out. When body weight does not have to be lifted, as in sitting exercise, pregnancy does not appear to make any appreciable difference to the cost of exertion. However where body weight influences the cost of exercise (eg. walking on a treadmill) then energy cost is proportional to increases in body weight. The maximum rate of weight gain occurs about or before mid pregnancy. The abdomen, back and upper thighs progressively increase in skin thickness up to about 30 weeks by about 20-30%. This means that you will be starting to become increasingly uncomfortable and it is important to make sure that you are as comfortable as possible whilst exercising. Therefore it has been recommended by The American College of Obstetricians and Gynecologists (ACOG) that exercises which are non-weight bearing are the best for mothers with increasing weight and size (eg, swimming, stationary bike riding). Other changes in a pregnant mother include: a. alterations in lung volumes due to an increasing abdominal area impacting on the lung area b. decreased oxygen available for exercise. There is a shift in oxygen from the mother to the baby therefore pregnant mothers should modify the intensity of their program accordingly; c. increased cardiac output (amount of blood pumped from the heart in one minute). This results from an increase in both heart rate and stroke volume (amount of blood expelled from the heart in one contraction). This increase in blood flow is important for heat dissipation when exercising or when in hot environmental conditions; d. Edema (swelling) especially in the lower limbs becomes apparent. This condition worsens with high blood pressure. Recommendations for exercise in pregnancy The following guidelines should ensure safety and well being for mother and baby: 1. For regular participants of exercise prior to pregnancy, carrying out normal activity should be possible. 2. Non-regular participants of exercise should obtain clearance from an obstetrician or medical professional. Exercise should begin slowly and the mother should be careful not to over-exert. 3. When exercising, you should be careful to avoid overheating and allow for proper heat dissipation by drinking lots of fluids, wearing appropriate loose clothing and exercising in suitable environments. Overheating (especially in the first trimester) may lead to birth 4. Caloric intake needs to increase to meet demands of exercise and pregnancy. An additional 300cal/day is recommended. 5. Pregnant mothers should cease exercising when fatigued and not at exhaustion. 6. Morphological changes mentioned previously mean that any loss of balance could be detrimental to maternal and/or fetal well being (especially in the third trimester). 7.The physiological and morphological changes that occur in pregnancy can persist for 4-6 weeks after the baby is born. As a result, pre-pregnancy exercises can be resumed gradually based upon the mother’s capability. 8. Frequency - Three to four times a week is appropriate in the early stages of pregnancy. However, in the third trimester, pregnant mothers should not be exercising more than four times a week as this has been linked with lower birth weights, which can lead to complications in 9. Intensity - Pregnant women when exercising should always wear a heart rate monitor to increase awareness of heart rates. As a general rule, the heart rate when exercising should not exceed 150bpm as this has been linked with fetal distress, however the latest guidelines released from ACOG no longer include heart rate or temperature recommendations. Nevertheless, expecting mothers should be aware of their own limitations and use common sense as a way to monitor intensity. 10. Time - 25 minutes of aerobic exercise is recommended. Intense short bursts of exercise should also be avoided 11. Type - Contact sports such as water skiing, surfing, basketball, netball, hockey, skiing as well as any sport, which has a high risk of falling, are not recommended in pregnancy. In addition to this, jerky movements or deep flexion or extension of joints should be avoided due to joint instability. Any trauma to the abdominal region may cause damage to the fetus and may lead to miscarriage. This applies as soon as you find out you are pregnant. As mentioned earlier, non-weight-bearing exercises such as swimming and cycling will minimize the risk of injury and facilitate the continuation of exercise during pregnancy. Strength training can be carried out, but the mother must be aware of several factors: a. lifting heavy weights (especially above the head) increases blood pressure; b. isometric contractions (where there is no change in muscle length eg, pushing against a wall) also increase blood pressure; c. lunges and squats may facilitate injury in the sacroiliac/pubic region due to increased joint laxity during pregnancy, and d. abdominal exercises are good for trunk stabilization and good posture. This is especially important to counter the changing shape and center of gravity of the pregnant mother. However, care must be taken to ensure that in the later stages of pregnancy the supine position (lying flat on your back) is avoided at all times. This is due to the possibility of the enlarging uterus pressing against a major vein and decreasing the amount of blood coming back to the heart. Such a position can lead to hypotension (low blood pressure) and may result in dizziness and even ACOG recommends certain abdominal exercises for each trimester. They are as follows: First Trimester – Practice deep breathing in a supine position with knees bent (if dizziness occurs, then roll onto side until recovered). On inhaling the stomach should rise; on exhaling the stomach should lower. While exhaling pull in the stomach in so the navel is press into the spine. Place emphasis on not to push the lower back into the floor. Second Trimester – To avoid the supine position, learn to perform abdominal compression on all fours. The abdomen will expand to the floor on inhalation and pull upwards during exhalation (ie. contracting abdominals upon inhalation). Be sure to maintain the spine in a neutral position and avoid hyperextension as a result of the extra weight. Aim to do about 10-20 repetitions. Additional exercises include seated abdominal curls, as well as side lying side bends. Always make sure the movements are controlled and take extra special when standing up to avoid hypotension. Third Trimester – The addition of the extra weight is enough of an abdominal workout. Making sure that the normal curves of the spine are maintained and that lower back pain does become an issue is the main focus in the final trimester. Any abdominal exercise should be done Good Luck! REFERENCES Bell, RJ et al. Aust NZ Journal Of Obstetrics and Gynecology, 1995. Vol 35, p 46-51 |
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