Anna: There is a lot of confusion around exercise in pregnancy. Some women don’t know what is safe so avoid exercise altogether, while others carry on doing what they did pre-pregnancy. Neither is the right answer! This blog will shed light on the truth about exercise in pregnancy so that you can stay fit & strong with confidence.
1. Every pregnant woman should exercise (following medical clearance)
Exercising in pregnancy has so many benefits for you & your unborn baby. Once you gain medical clearance to exercise from your Medical Practitioner, it’s important to start exercising as soon as you can, and for as long as you can.
Some of the many benefits of exercising in pregnancy are:
- Reduces your risk of maternal-fetal diseases such as gestational diabetes, hypertension, pre-eclampsia & pre-term birth.
- Decreases fetal resting heart rate, increases viability of placenta & increases amniotic fluid levels.
- Increases your strength & fitness to have an active labour, helping to reduce length of labour & intervention.
- Facilitates your postpartum recovery.
2. High-impact exercise (e.g. running) is NOT safe for your pelvic floor
Despite what you may see on social media, high-impact exercise during pregnancy is NOT safe. The problem is not the cardiovascular output on your body (if you stay at a safe intensity) or negative effects on your unborn baby, but rather the pressure it places on your pelvic floor!
You see, your pelvic floor can already weaken during pregnancy due to the increased weight it has to support, not to mention the strain of childbirth, so the last thing your pelvic floor needs is the additional pressure of high-impact exercise.
Because the pelvic floor holds up your internal organs, too much downwards pressure can lead to incontinence or prolapse (the descent of a pelvic organ causing vaginal heaviness or bulge). These are 2 conditions I want every woman to avoid!
So regardless of what your personal trainer or anyone else tells you, make sure you avoid any activity that involves running, jumping, skipping or cross-fit past your first trimester.
3. Choose low-impact cardio options instead
Safe exercise options during pregnancy are ones that are low-impact for your body & pelvic floor. These are:
- Swimming (avoid breastroke if you have pelvic pain)
- Aqua aerobics
- Fast pace walking
- Stationary bike
- Elliptical machines (avoid if you have pelvic pain)
- Low impact aerobics or gym class
4. Use the ‘Talk Test’ to exercise at safe intensity
It’s important to increase your heart rate during exercise, but within safe limits. To measure this, use the ‘Talk Test’. This is your ability to have a conversation during exercise. So if you can still talk during your workout, you are working at a safe intensity. However, if you are too out of breath to talk then you have pushed yourself too much & need to slow down.
5. Heavy weights are NOT safe for your pelvic floor
Lifting heavy weights increases intra-abdominal pressure and therefore places strain on your already stretched abdominal muscles & pelvic floor. Like high-impact exercise, this can lead to pelvic floor weakness, potential prolapse or incontinence, & worsening stomach separation.
The exception to this is if you have a toddler at home who needs lifting. Just do your best to minimise how often you pick them up & carry them, making sure you activate your pelvic floor before lifting them.
6. Stick to light strength training
Safe strength training is still really important during pregnancy. Great options are light machine weights (<10-12kgs), dumbbells, resistance bands and bodyweight exercises.
When you are using machine or free weights make sure you don’t feel any strain in your stomach muscles and you can maintain normal breathing. Always focus on your technique, posture & core activation.
Prenatal Pilates and Yoga are great options for strength training that also incorporate safe core exercises & stretching.
7. Exercise most days
The most recent guidelines from the American College of Obstetricians and Gynecologists recommend 20-30mins per day (or most days). If you exercise >30mins make sure it’s in a thermoneutral climate or controlled environment (i.e. air conditioned).
I recommend doing low-impact cardio exercise 3 x week and strength training (including Pilates) 3 x week.
8. Stop advanced abdominal exercises >1st trimester
Advanced abdominal exercises are NOT safe past the first trimester. These include – sit ups, crunches, planks, table top, double leg lowers or boat pose (V-sitting).
This is because these types of ab exercises create intra-abdominal pressure & place strain on your abdominal muscles, worsening your stomach separation (diastasis). Any movement or exercise where you notice doming of your stomach should be avoided.
You also don’t want to overstretch your ab muscles so make sure you avoid back bends in yoga.
9. Do daily core activation exercises
Learning how to correctly activate your transversus abdominis (deep abdominal muscles) and pelvic floor muscles is fundamental to:
- Minimise abdominal separation
- Prevent prolapse
- Prevent incontinence
- Increase spinal & pelvic stability
- Facilitate your postpartum recovery & return to exercise
To check you are doing these exercises correctly, I recommend every pregnant woman has a consult with a Women’s Health Physiotherapist in her second trimester (or 3rd trimester if you are already there).
10. Don’t forget about stretching
At the end of every exercise session, I recommend doing 10 minutes of stretching. Your muscles are working harder during pregnancy to carry around increased weight and provide stability, so they can easily become tight & tense. To help avoid pelvic/back pain & leg cramps make sure you stretch your calves, hamstrings, quads, ITB, hip flexors, glutes & back.
A spikey ball & roller are also good additions to the end of your workout.
11. Your personal trainer needs to be qualified in prenatal exercise
A major bugbear of mine is pregnant women being given unsafe exercises by their personal trainer or fitness instructor. Before you sign up to a class or trainer, please make sure they are well qualified in prenatal exercise.
My advice is to stick to prenatal specific classes as often as you can and consult a Women’s Health Physiotherapist to ensure the exercises you are doing in the class are safe.
12. Other exercise you need to avoid
- Contact sport- your risk of injury is higher due to having increased laxity in your ligaments
- Any exercise involving a risk of falling e.g. road cycling, horse riding & water/snow skiing
- Any exercise with risk of abdominal or breast trauma e.g. any ball sports, (hockey, soccer, tennis), boxing, fencing
- Any exercise involving motionless prolonged standing
- Any exercise in hot/humid conditions- e.g. Hot or bikram yoga, spas, saunas, or in hot/humid climates
- Scuba diving
- Exercise at high altitudes >2500m
For more information on exercise in pregnancy, pelvic floor & core exercises, abdominal separation and online Pilates, head to my online pregnancy program https://www.thepregnancyacademy.com.au. Use the code 180NUTRITION to get 50% discount off the program!
References:
- American College of Obstetricians and Gynecologists (2015) Physical activity and exercise during pregnancy and the postpartum period. Committee Opinion No. 650. Obstet Gynecol 125: 135-142.
- Downs et al (2012) Physical activity and pregnancy: past present evidence and future recommendations. Res Q Exerc Sport 83: 485-502.
- Evenson et al (2014) Guidelines for physical activity during pregnancy: comparisons from around the world. Am J Lifestyle Med 8: 102-121.
- Karmarka and Dwyer (2018) High impact exercise may cause pelvic floor dysfunction. BJOG Debate.
- Kehler A, Heinrich K (2015) A selective review of prenatal exercise guidelines since the 1950s until present: written for women, health care professionals, and female athletes. Women Birth 28: 93–98.
- Moyer C, Reoyo O, May L (2016) The influence of prenatal exercise on offspring health: a review. Clinical Medicine Insights Women’s Health 9: 37–42.
- Paisley t, Joy E, Price R (2003) Exercise during pregnancy: a practical approach. Current Sports Medicine Reports 2: 325–330.
- Persinger R et al (2004) Consistency of the talk test for exercise prescription. Med Sci Sports Exerc 36: 1632-6.
- Prather H, Spitznagle T, Hunt d (2012) Benefits of exercise during pregnancy. Physical Medicine and Rehabilitation 4: 845-850.
- Price B, Amini S, Kappeler K (2012) Exercise in pregnancy: effect on fitness and obstetric outcomes – a randomized trial. Med Sci Sports Exerc 44: 2263–69.
- Stefani L, Mascherini G, Galanti G (2017) Indications to promote physical activity in pregnancy. Journal of Functional Morphology and Kinesiology 2: 1-7.
- Wolfe L, Mottola M (2002) Physical Activity Readiness Medical Examination for Pregnancy: PARmed-X for Pregnancy; Canadian Society of Exercise Physiology & Health Canada: Ottawa, ON, Canada.
- Wolfe L and Weissgerber T (2003) Clinical physiology of exercise in pregnancy: a literature review. Journal of Obstetrics and Gynecology Canada 25: 473-483.
- Van Geelen et al (2018) A review of the impact of pregnancy and childbirth on pelvic floor function as assessed by objective measurement techniques. Int Urogynecol J 29(3): 327-338.
