Last year I wrote a blog regarding back pain during pregnancy (see the blog here), which busted some myths, addressed some misconceptions and offered some practical advice on how to manage back pain should it occur during pregnancy. This year I thought I’d continue the pregnancy theme and discuss exercise during pregnancy- an area many mums and patients of mine appear unsure and confused about.This blog summarises the current guidance for mums-to-be wishing to exercise during their pregnancy. Needless to say, it isn’t meant as a replacement for the advice provided by your midwife and obstetrician, so please consult your obstetric professional before embarking on an exercise programme.
Why should I exercise during my pregnancy?
There are significant benefits of regular exercise throughout pregnancy, from conception through to delivery (and after). These benefits range from improved sleep, enhanced mood, control of body weight, improved fitness, reduced back pain, preventing gestational diabetes and reducing high blood pressure. With these benefits in mind, the risks of not regularly exercising when pregnant are significant.
Who shouldn’t exercise during pregnancy?
Generally speaking, most mums-to0be should be encouraged to exercise, however for a relatively small number of woman exercise during pregnancy is not advised. For example, if you have a history of premature labour, have pre-eclampsia, multiple pregnancy (e.g. triplets) or other serious cardiovascular respiratory disorders. If you think you might have any of these absolute contraindications then its likely fine for you to continue the usual activities of your daily life, but you should not participate in more strenuous exercise. If you are unsure whether these contraindications apply to you, then you should discuss them with your obstetric professional.
There will be other times when exercise during pregnancy isn’t absolutely contraindicated, may carry excessive risk of harm to mum and baby (e.g. gestational high blood pressure, twin pregnancy after the 28th week, mild/moderate cardiovascular or respiratory disease. Pregnant women with these relative contraindications should discuss the advantages and disadvantages of moderate-to-vigorous intensity physical activity with their obstetric care provider.
What are the recommendations for exercise during pregnancy?
Current guidelines provide six clear recommendations for pregnant woman who wish to exercise and are safe to do so. These are:
- Recommendation 1– All women without contraindications should be physically active throughout pregnancy.
- Recommendation 2– Pregnant women should accumulate at least 150-minutes of moderate-intensity physical activity each week to achieve a meaningful benefit. This equates to 30mins five days per week.
- Recommendation 3– Physical activity should be accumulated over a minimum of 3 days per week; however, being active every day is encouraged.
- Recommendation 4– Pregnant women should incorporate a variety of aerobic exercise and resistance training activities to achieve greater benefits. Adding yoga and/or gentle stretching may also be beneficial.
- Recommendation 5– Pelvic floor exercises (eg, Kegel exercises) may be performed on a daily basis to reduce the odds of urinary incontinence. Instruction on the proper technique is recommended to obtain optimal benefits.
- Recommendation 6– Pregnant women who experience light-headedness, nausea or feel unwell when they exercise flat on their back (supine) should modify their exercise position to avoid the supine position (such as lying on the left side instead or lying on an incline rather than completely flat).
A bit of myth busting
An area which is often of concern for pregnant mums is that exercising during the first trimester will be harmful to their baby. Fortunately, the latest research has found that physical activity during the first trimester does not increase the chances of miscarriage. Importantly, the research shows that not exercising in the first trimester increases the odds of developing complications during your pregnancy (e.g. gestational diabetes, pre-eclampsia, gestational high blood pressure, excessive weight gain and severity of depressive symptoms)- see here. So, the take home message is that generally speaking, exercise is safe with respect to miscarriage and harm to the baby, and if you’re able to exercise then it’s advised that you do so.
Other Safety Precautions
Some general safety advice for pregnant mum’s prior to taking up exercise, include:
- Avoid physical activity in excessive heat, especially with high humidity
- Avoid activities which involve physical contact or danger of falling (e.g. horse riding or downhill skiing).
- Avoid scuba diving.
- Lowlander women (ie, living below 2500 m) should avoid physical activity at high altitude (>2500 m).
- Isn’t a magic fix.Those considering exercising at a high-intensity should seek supervision from an obstetric care provider.
- Maintain adequate nutrition and hydration—drink water before, during and after physical activity.
- Know the reasons to stop physical activity and consult a qualified healthcare provider immediately if they occur (see below).
What else do I need to know before exercising?
Before you embark on your prenatal exercise programme, it’s important to be aware of reasons to stop exercising and consult a your healthcare provider, these include but are not limited to: persistent excessive shortness of breath that does not resolve on rest, severe chest pain, regular and painful uterine contractions, vaginal bleeding, persistent dizziness or faintness that does not resolve on rest. If you experience any of these symptoms, then you should stop exercising and consult your obstetric professional.
You’re not in the army and it’s not meant to be torture – listen to your body
Exercising during pregnancy is meant to enhance your physical and emotional well-being so that you can enjoy your pregnancy and the period afterwards as a mother. However, there will be days when you’re tired, sore and just don’t feel like exercising. It’s important to listen to your body and rest. Once you feel up to it, it is advised to commence your exercising as soon as possible. If you cannot manage the advised 30 mins in one go, then try splitting it up, e.g. a 15-minute brisk walk in the morning and then another after lunch.
How should I start being physically active during my pregnancy?
Previously inactive women are encouraged to start physical activity in pregnancy but may need to begin gradually, at lower intensity and increase the duration and intensity as their pregnancy progresses.
Pre-natal exercise needn’t be overly complicated, expensive or ‘fancy’- much of the research which shows exercise to be beneficial have looked at just briskly walking, so pounding the streets of lovely NW3 is great way to get your exercise in! It’s advised that all pregnant mums who which to embark on physical exercise during their pregnancy consult their midwife or obstetrician.
Where can I find out more?
The NHS have some useful guidance on exercise and pregnancy here
Here’s a helpful 20 minute podcast on exercise during pregnancy here
The full guidance published in the British Journal of Sports Medicine is free to download here