Exercise during pregnancy? YES!

Pregnancy is an extremely unique period of time in a woman’s life, which brings about a plethora of physiological and psychological changes to the mother in each trimester. An average pregnancy lasts around 280 days, which is 9 months, broken down to three trimesters roughly 13 weeks each.

During these trimesters, pregnant women experience musculoskeletal structure changes and adaptations, decreased glucose sensitivity, hormonal changes, and gestational- related weight gain. Moreover, pregnancy can sometimes be associated with a number of possible negative health outcomes for the mother, including but not limited to: morning sickness, gestational diabetes mellitus, gestational hypertension, pre- eclampsia, excessive gestational weight gain (GWG) and depressive symptoms. These conditions may impede women from participating in physical activity, where at the same time is the exercise regimen that prevents and/or alleviate the negative health outcomes related to pregnancy. In fact, regular exercise is one of the best things you can do for  yourself and your child.

Resistance training, alone and in combination with aerobic activity, has been associated with numerous benefits to mother and growing fetus.

Recommendations on exercising during pregnancy and postpartum have evolved over past decades. Previously, physical activity during pregnancy was discouraged due to false beliefs that physical effort can harm the unborn child. However, in 2002 American College of Obstetricians and Gynecologists (ACOG), revealed much less stringent exercise guidelines for this special population group. It is advised that all women with low-risk pregnancies should exercise at moderate intensity for 30 minutes or more, most of the days if not every day! What is moderate intensity? The American Heart Association generally recommends a target heart rate of moderate exercise intensity: 50% to about 70% of your maximum heart rate. Easily measured by talk test:  you should be able to talk but not sing during the activity.

Majority of pregnancies are considered to be low-risk. However, all pregnant women need to get a clearance from the doctor before starting a training routine. Despite the benefits, less than 15% of women are actually meeting the recommended pregnancy exercise guidelines of 150 min of moderate physical activity per week. To find out more about the exercise guidelines, please visit websites of American College of Obstetricians and Gynaecologists, American College of Sport Medicine, Harvard Medical School, World Health Organization, the Institute of Medicine, Centre for Disease Control and Prevention and National Strength and Conditioning Association, as leading authorities on this topic, which boast the most extensive and recent research in the field.

MULTITUDE OF BENEFITS 

Worth saying loud and clear, exercise will prepare you for the most intense physical event: childbirth! The benefits of training during pregnancy is well-studied and documented in numerous research. Pregnant women who engage in properly designed prenatal exercise benefit from: 

• Improved physical fitness and functionality, 
• Increased energy, 
• Improved sleep, 
• Injury prevention, 
• Decrease in back pain, 
• Better posture,
• Enhanced muscular endurance and strength, 
• Exercise strengthens the heart and blood vessels,  
• Better mood,
• Decreased risk of depression in prenatal and postpartum period, 
• Better self-esteem & body-image, 
• Better weight control; promotes adherence to gestational weight gain (GWG) recommendations, especially when combined with nutritional advisory
• Exercise eases constipation, 
• Exercise helps to prevent thromboembolism, and improves circulation in the pregnant woman,
• Improved fetal development, prevents the incidence of lower birth weight in babies and fetal macrosomia (this term describes newborn much larger than average)
• Decreased incidence of preterm birth and easier labor with less pain; higher probability of natural vaginal delivery and lower incidence of Cesarean Section. Fewer obstetric interventions;
• Faster recovery, faster return to pre-pregnancy weight, strength, and flexibility levels
• Reduced postpartum belly
• Decreased incidence of GDM (Gestational Diabetes Mellitus), 
• Decreased incidence of gestational hypertension; 
• Increased likelihood of adopting permanent healthy lifestyle habits

As mentioned before, prior to engaging in an exercise routine, each pregnant woman should obtain clearance from the doctor.  Unfortunately, although the guidelines are clear and easily accessible, not all the doctors seem to be updated and some of them still have traditional beliefs in this topic, especially older population.

If your pregnancy is low-risk and your doctor tells you not to exercise, reach out for second or even third opinion. Regardless of your current fitness level, having low-risk pregnancy makes you free to safely start a physical activity. The most significant is to be screened by your medical practitioner and, afterwards, by sport professional (SP) regarding your medical and fitness history so that SP can individualize the training prescription to your unique needs. Correctly prescribed and delivered training program will help you reap most benefits and enjoy the pregnancy time to the fullest without posing risk to the growing baby.

Athletes and experienced exercisers

There is a discrepancy in case of fit and athletic female population, where physical capacity is different to an average. Sometimes we see in the media opinions regarding athletes, who train until the very last days before the delivery. At times, the public opinion seems to be particularly severe, blaming mothers-to-be for selfishness and carelessness. However, let’s not forget that athletic and sporty individuals show higher levels of fitness and their bodies are used to more intense exercise. For instance, for someone who trains for years and have a lifting history of regular 120 kg deadlift, and during pregnancy reduces the intensity of exercise to 60-70%, she would still be lifting 72-84 kg in her max days, which can be something impossible for non-pregnant woman who does not train regularly. Context is crucial. 

A pregnant Alysia Montano runs in the opening round of the women’s 800 meter run during day 2 of the USATF Outdoor Championships at Hornet Stadium in Sacramento, California on on June 26, 2014.

For these subjects perception of a physical activity exhaustion is substantially different to the sedentary individuals. It should be taken into account while designing a pregnancy training routine that maintains (or possibly even increases) strength and aerobic fitness, which is necessary for this special phase of life and later on, for the delivery. Hence, it is of utmost importance that every individual, trained or untrained is being interviewed and evaluated properly and accordingly before and during pregnancy.

A birth can be compared to a marathon and there is no athlete out there who would participate in such event without a preparation.

What is advised

That can largely depend on the trimester of pregnancy and it is always in relation to what an individual health status, fitness history and level are. General guidelines support light endurance exercises, like swimming, brisk walking, elliptical trainer, stationary biking or even running, if someone was a runner prior to the pregnancy. 

Resistance training is highly recommended as it helps to maintain the strength level, or even build it up in case of beginners. You can safely start a mild resistance training even without having experience and you will benefit massively from this form of training. 

What matters is correct prescription, surveillance and delivery of the program. Do not trust any personal trainer out there and search carefully for qualified sport professional for maximal safety for a mother and the unborn child. 

Core training and pelvic floor strengthening are significant for the mother, as they help with functionality (for example, working on your core promotes better posture and decreases back pain), help with labor, decrease the labor time, help with recovery, among others. It is a must when designing a training routine.

Lastly, flexibility sessions that focus on maintaining comfortable movement through the range of motion (ROM) attained prior to the pregnancy. Increasing ROM in the course of pregnancy is a bad idea due to the increased laxity of the joints and therefore higher risk of injury. Prenatal yoga, hatha yoga and restorative yoga, such as B.K.S. Iyengar or yin yoga are great examples of flexibility training during pregnancy. What is an additional advantage, yoga classes provide you with cues about breathing techniques, which are extremely useful during the labor and help with easing the pain sensation, among others.

 

For more information do not hesitate to contact us. 

References

1. American College of Obstetricians and Gynecologists (ACOG). Physical Activity and Exercise During Pregnancy and Postpartum Period. Published April 2020, accessed online: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/04/physical-activity-and-exercise-during-pregnancy-and-the-postpartum-period
2. Centre for Disease Control and Prevention, accessed online (July 2020) https://www.cdc.gov/pregnancy/index.html , Weight Gain During Pregnancy: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-weight-gain.htm
3. British National Health Service (NHS) https://www.nhs.uk/conditions/pregnancy-and-baby/pregnancy-exercise/
4. Harvard Medical School, article: How safe is exercise during pregnancy? https://www.health.harvard.edu/blog/how-safe-is-exercise-during-pregnancy-2020012818760
5. National Academy of Medicine, formerly named Institute of Medicine contributes to numerous research published by NCBI, ACOG, and more.
6. National Center for Biotechnology Information (NCBI). NCBI is part of the United States National Library of Medicine, a branch of the National Institutes of Health. Articles accessed online July 2020, Exercise in Pregnancy. Clinical Review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4622376/ , Association of Prenatal Physical Activity and Gestational Weight Gain: Results from the First Baby Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3742311/ , The Influence of Prenatal Exercise on Offspring Health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5075987/ . NCBI is a great resource for many pregnancy-related topics.
7. World Health Organization WHO recommendations on antenatal care for a positive pregnancy experience (2016), accessed on July 2020: https://apps.who.int/iris/bitstream/handle/10665/250796/9789241549912-eng.pdf?sequence=1 , Global recommendations on physical activity for health, accessed online July 2020: https://www.who.int/dietphysicalactivity/factsheet_recommendations/en/
8. National Strength and Conditioning Association (NSCA),  NSCA’s Essentials of Personal Training, Second Edition, published by Human Kinetics. Benefits of Exercise during Pregnancy: https://www.nsca.com/education/articles/kinetic-select/benefits-of-exercise-during-pregnancy/ , accessed on July 2020.
9. Strength and Conditioning Journal, Guidelines and Practical Tips for Training the Prenatal Client, Erica Ziel, August 2017 https://journals.lww.com/nsca-scj/Abstract/2017/08000/Guidelines_and_Practical_Tips_for_Training_the.11.aspx
10. Strength and Conditioning Journal, Special Populations: Training the Pregnant Client. Smith, Katie M. PhD, RDN, LD, ACSM EP-C¹; Ziel, Erica BS², https://journals.lww.com/nsca-scj/Abstract/2017/08000/Special_Populations__Training_the_Pregnant_Client.10.aspx
11. Strength and Conditioning Journal, Brad Schoenfeld, October 2011, Resistance Training During Pregnancy: Safe and Effective Program Design: https://www.researchgate.net/publication/232139815_Resistance_Training_During_Pregnancy_Safe_and_Effective_Program_Design
12. Strength and Conditioning Journal, April 2007, Tom LaFontaine, PhD, ACSM RCEP, CSCS, NSCA-CPT, Article: Resistance Training During Pregnancy.
13. Training Clients during Pregnancy- Modifications and Considerations. Stephanie Paplinskie, MA, May 2019, https://www.nsca.com/education/articles/ptq/training-clients-during-pregnancy-modifications-and-considerations/
14. Strength and Conditioning Journal, Core Training Exercise Selection During Pregnancy, February 2012, Piper, Timothy J MS, CSCS*D; Jacobs, Emily MS, NSCA-CPT, CHES; Haiduke, Mike BS, Waller, Mike PhD, CSCS*D; McMillan, Cathy MS, https://journals.lww.com/nsca-scj/fulltext/2012/02000/core_training_exercise_selection_during_pregnancy.9.aspx