What you need to know about exercise during pregnancy

So you are pregnant? Congratulations! There is no better time than a positive pregnancy test to get yourself active and moving. You are now responsible for not only the health of yourself but also the health of your baby. What you eat, drink and the activities you participate in will directly affect that little nugget growing inside of you. For example, when a pregnant woman participates in aerobic exercise (aka cardio) not only does her heart rate increase but so does the baby’s heart rate. That means that before the baby is even born, you are strengthening his cardiovascular and circulatory system. Go you! Unfortunately, many women are afraid to begin exercising because they were not active before the pregnancy and many women are unsure about how far to push themselves. Let’s discuss why exercise is beneficial and how to keep yourself and your baby safe.

Exercise Health Benefits for Mom

1. Decreased risk of gestational diabetes.
2. Decreased risk of hypertension and pulmonary emboli
3. Psychological benefits: Exercise is proven to boost your mood, reduce anxiety and allow for better sleep. Your spouse and your fluctuating hormone levels will thank you!
4. Better body image
5. Decreased complaints of low back pain and pelvic girdle pain
6. Lower rate of C-Sections
7. Shorter second stage of labor

Let’s discuss #7. The second stage of labor is when you are actively pushing to deliver the baby. Research shows that pushing over two hours is directly related to trauma to your pelvic floor. By shortening this stage of labor, you are keeping your vagina and all of the muscles, tissues, and ligaments safe from possible dysfunction in the long run. I have treated many middle-aged women with pelvic organ prolapse or stress urinary incontinence who have told me that they pushed for 3-8 hours over 25 years ago! They are always surprised and frustrated that an event that occurred over two decades ago is now causing them a lot of problems.

Exercise Health Benefits for Baby

1. Lower Fetal Resting Heart Rate (HR). The lower the HR, the healthier the heart.
   
   
2. Higher Heart Rate Variability (HRV). HRV is the span between heart beats which is an indication of heart health. Th higher the HRV, the healthier heart.
   
   
3. Lower Infant Birth Weight. This is debatable depending on the research you read but there is no denying that if the mom is not eating healthy and lives a couch potato lifestyle, the infant will most likely put on some extra poundage. Babies weighing more than 9 lbs can do a lot of damage to your pelvic floor as they pass through the birth canal.

What Should Exercise Consist Of?

A typical exercise regimen should include both an aerobic component and a strength training component.

At the very least, you should be engaging in 150 minutes per week of moderate to intense aerobic activity (ex: brisk walking). Furthermore, women who engaged in high-intensity aerobic activity such as running or cross fit before pregnancy can continue doing so as long as their body responds positively to it (Szymanski, 2012).

When choosing an exercise program there are two things you should ask yourself:

1. Am I in control of this exercise?
2. Am I keeping my baby and myself safe in this position?

Basically, waterskiing or plunging down a mountain on a snowboard is not advised. According to the American College of Obstetricians and Gynecologists, here is a list of safe versus unsafe exercises:

Safe Exercises During Pregnancy

• Walking
• Swimming
• Stationary Cycling
• Low-impact Aerobics
• Modified Yoga or Pilates**
• Running
• Strength Training

Unsafe Exercises During Pregnancy

• Contact Sports
• Activities with a high risk of falling
• Scuba Diving
• Sky Diving
• Hot Yoga
• Hot Pilates
• Racquetball

**You will notice in the list above that yoga and Pilates are “modified.” The poses that need to be eliminated are any positions that make you feel lightheaded, breathless, nauseous, or winded.

Sometimes mamas experience these symptoms laying on their back for a prolonged period of time. Pilates on your back is okay as long as you feel okay!

Engage in Proper Breath

During any exercise, avoid breath holds to protect your organs and pelvic floor. When lifting weights or performing a dynamic movement (i.e. a lunge) you should breathe in through your nose and slowly exhale out through your mouth.

Keep your shoulders and chest relaxed during the inhale, focusing on your belly and lower rib cage expanding. Exhale during the most strenuous part of the exercise. Improper breathing techniques and body mechanics put women at risk for pelvic organ prolapse, especially when you are pregnant. Don’t be the Crossfitter who holds her breath to gain extra momentum during a Push Press. She may look super fit, but I worry about the amount of load she is putting on her vagina.

Rule of thumb: Inhale to start, exhale during the most difficult part of the exercise.

What Conditions Put Me At Risk During Exercise?

If you have any of the conditions listed below, you should definitely not exercise unless cleared by a physician:

Contraindications to Exercise when Pregnant

• Restrictive lung disease
• Hemodynamically significant heart disease
• Incompetent cervix
• Multiple gestatation at risk for premature labor
• Severe anemia
• Placentia Previa after 26 weeks gestation
• Premature labor during the current pregnancy
• Ruptured membranes
• Preeclampsia

What Signs and Symptoms Indicate I Should Stop Exercise?

• Vaginal bleeding
• Regular painful contractions
• Amniotic fluid leakage
• Dizziness
• Headache
• Chest pain
• Muscle weakness affecting balance
• Calf pain or swelling

The Take Home

Mama! I get it. You’re busy. I’m busy. WE ARE ALL SO BUSY!

But even a brisk walking 30 minutes for 5 days/week will fulfill the requirement of 150 minutes/week. Maybe your brisk walk is simply chasing your toddler around. You do YOU.

In closing, it is always important to discuss exercise with your OBGYN and/or Midwife before initiating an exercise regimen. I would love to hear what you did during pregnancy to stay fit! What worked and what didn’t work? How many of you were able to run past the first trimester?

-Dr. Betsey Stec PT, DPT

Follow me on Facebook and Instagram to keep your pelvic floor happy!

References:

1. Andersen, L. K., Backhausen, M., Hegaard, H. K., & Juhl, M. (2015). Physical exercise and pelvic girdle pain in pregnancy: A nested case–control study within the Danish National Birth Cohort. Sexual & Reproductive Healthcare,6(4), 198-203.
   
   
2. Campbell, M. K., & Mottola, M. F. (2001). Recreational exercise and occupational activity during pregnancy and birth weight: a case-control study.American journal of obstetrics and gynecology, 184(3), 403-408.
   
   
3. Haakstad, L. A., & Bø, K. (2011). Exercise in pregnant women and birth weight: a randomized controlled trial. BMC pregnancy and childbirth, 11(1), 66.
   
   
4. May, L. E., Glaros, A., Yeh, H. W., Clapp, J. F., & Gustafson, K. M. (2010). Aerobic exercise during pregnancy influences fetal cardiac autonomic control of heart rate and heart rate variability. Early human development, 86(4), 213-217.
   
   
5. Moffett, A., Hiby, S. E., & Sharkey, A. M. (2015). The role of the maternal immune system in the regulation of human birthweight. Phil. Trans. R. Soc. B,370(1663), 20140071.
   
   
6. Perales, M., Santos-Lozano, A., Ruiz, J. R., Lucia, A., & Barakat, R. (2016). Benefits of aerobic or resistance training during pregnancy on maternal health and perinatal outcomes: A systematic review. Early human development, 94, 43-48.
   
   
7. Stages of Labor (2015). American Pregnancy Association. Accessed: http://americanpregnancy.org/labor-and-birth/second-stage
   
   
8. Szymanski, L. M., & Satin, A. J. (2012). Exercise during pregnancy: fetal responses to current public health guidelines. Obstetrics and gynecology,119(3), 603