As a physiotherapist who teaches exercise to women who are pregnant or just had a baby, I get asked many questions about the ins and outs of exercise. Most women are aware that exercise is probably good for them in pregnancy, but just aren’t sure how to go about it.
- Is it good for me?
Oh my goodness, yes. Exercise has SO many benefits for women who are pregnant, that in fact many of the guidelines are changing because the risks of exercising in pregnancy are so low in comparison to the huge benefits that can be gained.
If we start with the physical and psychological side, exercise in pregnancy can help
- reduce your risk of gestational diabetes
- relieve some aches and pains
- improve your quality of sleep (reduce insomnia)
- prevent excessive weight gain if you are overweight/obese
- maintain (or improve) your muscle strength and cardiovascular fitness
- improve body image and self esteem
- manage anxiety and depression
- improve your mood
Now if those aren’t enough reasons to exercise, how about this?
Women who exercise in pregnancy have better labours – they have fewer rates of c-sections and instrumented deliveries .
And…they have quicker recoveries from birth.
Sounds pretty good huh?
2. When should I start and when should I stop?
Many years ago, we used to recommend that women didn’t start any new form of exercise in pregnancy. Now those recommendations have changed and women are encouraged to start exercising in their pregnancy as long as there are no medical reasons against it.
Some women find that they are too tired or nauseous in the first trimester and prefer to wait until the second trimester, but that is totally up to you.
If you have never been a regular exerciser, I would encourage you to seek out a health or fitness professional to help guide you in this journey. That way you will learn exercises that work well with your body and how to progress or regress your program as needed.
In terms of when to stop, it really depends on how you feel. I have many ladies exercise right up until the day they give birth (literally!) and you can do that as long as you are feeling well.
There are times when you should stop exercising and most of the signs are obvious, such as if you have bleeding, chest pain, contractions, headache or leaking of fluid. There is a full list in the ACOG guidelines (link), but really if anything doesn’t feel right to you, then make sure that you follow up with your health care professional.
Many women suffer musculoskeletal pain, especially in the low back, pelvis and wrists, during pregnancy. Most women can continue to exercise despite these problems, but adaptations are often made to the program to make the exercises more comfortable. I recommend my clients have treatment of pain during pregnancy, as often pain is received or reduced with things such as manual therapy, acupuncture or massage.
3. Is it ok for the baby?
I saw a video earlier in the year that showed a very athletic pregnant woman doing some boxing and weights. The comments from the general public were scathing – “how could she be so selfish? She’s going to kill that baby? The umbilical cord will wrap around it’s neck.”
I’m not sure where some of these beliefs come from, but there is no evidence that that kind of exercise is dangerous for the baby in utero. Of course we don’t put women on treadmills or bikes and push them to maximum heart rates for long periods of time to see what happens…but most women self limit their exercise in pregnancy anyway. What I mean by that, is that the majority of women back off during pregnancy because they physically can’t push themselves that hard and because it doesn’t feel right. Remember that you have an increase in blood volume of 40% and your lungs are working harder too (poor diaphragm is getting some resistance!).
There are a few guidelines to follow when thinking about safety for your baby:
- be mindful of temperature – avoid hot yoga/pilates, saunas and spas and be careful when exercising in the height of summer.
- don’t scuba dive or water ski
- don’t do contact sports past the first trimester
- avoid sports that have a high risk of falls
- avoid exercises lying on your baby after 16 weeks (the baby can lie on one of the major blood vessels returning blood to the heart.)
If you stick to those guidelines, the risk to baby is incredibly low.
Previously there was some ambiguity about whether or not doing aerobic exercise might lead to women having smaller babies. A recent literature review in the American Journal of Obstetrics and Gynaecology showed that women who exercise regularly did NOT have smaller babies and were NOT more likely to go into premature labour than those that didn’t.
4. What is the best kind of exercise to do?
My personal view is that the best kind of exercise that you should do in pregnancy…is one that you enjoy, that makes you feel good and is convenient (ie that you will actually do!).
The most common forms of exercise are probably walking, yoga, pilates, swimming, hydrotherapy and gym exercises.
Current guidelines recommend that you try and fit in 150 minutes of moderately intense exercise per week, preferably with a combination of aerobic and strengthening exercise. We use the “talk test” to monitor intensity – if you can continue with a conversation, you are working at a good level. If you are so breathless that you can’t talk, then you should back off a bit.
I think group classes are fantastic in pregnancy, as the psychological benefits of exercising with other women who are pregnant are fabulous and the instructor can guide you through appropriate exercise in pregnancy. A good instructor will also be able to adapt the exercises to accomodate wrist pain, pelvic pain or any other specific requirements that you have.
5. Is exercise in pregnancy good for the pelvic floor?
Great question…and the answer is “it depends!”
Generally speaking, exercise is good for pelvic floor muscles. Inactivity and obesity are both significant risk factors for things like prolapse and incontinence.
If we talk about pelvic floor exercise itself, there is pretty good evidence for doing specific pelvic floor training in pregnancy. Some studies have shown that it can significantly reduce the risk of having incontinence during pregnancy and after birth.
But what about other types of exercise? What we have to take into account during pregnancy are the hormonal changes that occur in the muscles and connective tissue, as well as the increase weight of the baby sitting on those tissues. Some women manage to run, jump and lift during pregnancy without issues. Others find coughing to be enough pressure to cause leakage.
So what do you do? If you are having any issues related to the pelvic floor, such as pain, heaviness or leaking of urine/faeces, then you should go and see a Women’s Health Physiotherapist. They will check the function of your pelvic floor and guide you as to the best exercises for you. You may even have an overactive pelvic floor that needs relaxation, so this individual management is best.
For those who are not having any pelvic floor symptoms, monitor your body and continue exercise if it feels good. Any of the above symptoms are signs that the pelvic floor is not coping with that load, and it needs to be reduced or the technique adapted. I recommend avoiding a breath hold when lifting weights. Use the exhale and pelvic floor activation through the challenging part of the lift, and get your technique assessed if you are not sure.
Want to learn more about exercising in pregnancy?
Head to our Pregnancy Club (link) where you can sign on and receive regular exercise programs and education sessions specific for where you are at in your pregnancy.
These exercise programs have been designed by a physiotherapist and include adaptations for common issues in pregnancy.