Safe Exercise While Pregnant

I’ve been an athlete all of my life. I have played soccer since the age of 3, through high school and even ended up playing in college. My college team actually had the best year in LVC women’s soccer history while I was there. It was one of the best parts of college for me. After my fourth year of eligibility, I was still in school for 2 years and had access to the fitness center, so I was able to continue to work out on a very regular basis. I was also on a pretty steady schedule through the end of school, so it was easy to fit in gym time. Since graduation, it has been much more difficult for me to find a regular time to hit the gym. Part of that is the schedule I’ve built for myself. The other part is the “effort” of driving to a gym to get a thorough workout v. staying home and taking the dog for a walk or run. Furthermore, most gyms aren’t free, and I just didn’t have the heart to pay to belong to a gym. When I was hired by LGH in November of 2016, I was granted access to their fitness center. For free. It is also a 24-hour gym, so I could easily fit time into my schedule to get there. I was able to go pretty regularly from the beginning of December the whole way through the beginning of March. Unfortunately, the first trimester jumped in the way of my regular gym time, and I am just totally fried! I have absolutely no desire to get up and go, and even on the days that I do get there, I step on the treadmill, run for about 3 minutes and feel totally exhausted! As usual, curiosity got the best of me and I did a good amount of research on safe exercise programs while pregnant. On top of not being motivated and feeling exhausted from relatively nothing, I was also so worried that jacking my heart rate up was going to hurt our growing baby. Totally false! So here’s some great info on exercising with a couple exercise program ideas towards the end to help get you started if you need some new ideas!

First of all, a TON of studies have been done recently on exercise and pregnancy. It was originally thought that increasing the maternal heart rate could potentially place undo stress on the fetus’s cardiovascular system and therefore harm your baby. This theory has been totally discredited. One study looked at two groups of women, one group of previously inactive women and the other of previously active women. Both groups performed moderate exercise during the second trimester. This study found that there was no difference in APGAR scores or birth weights, suggesting that inactive women can safely begin an exercise program while pregnant. This study also looked at vigorous exercise up to 90% of a maximum heart rate and found that although it may slightly decrease blood flow to the fetus, it resolves almost immediately after exercise stops and has no link to negative fetal outcomes.

The American College of Obstetricians and Gynecologists (ACOG) updated recommendations for activity level in pregnant women in 2002 and re-confirmed these recommendations in 2009. These new recommendations encourage pregnant women to remain pregnant throughout pregnancy. The guidelines state that women should be physically active for 20-30 minutes on most to all days of the week. Physical activity is considered to be activity that increases your breathing so that talking in normal conversation is more difficult and you should not be able to sing. Sounds easy right? Some of the most common, easy to perform activities that would fall into this category are walking, jogging, swimming (NOT in a hot-tub), yard work, vacuuming, performing light resistive exercises, yoga and other aerobic classes.

Here’s a great chart of exercises and their specific benefits.

Types of EX.png

The ACOG recommends against exercises lying on your back after the first trimester. They also recommend terminating any exercise that increases your risk for falling and contact such as all contact sports (soccer, field hockey, ice skating), horseback riding and other high-risk sports. They also recommend against exercise at greater than 5250-foot altitudes and scuba diving due to increased risk for fetal hypoxia. You should also avoid hot-yoga due to increased risk for elevated body temperatures.

Interestingly, studies have found that in 2009, only about 40% of currently practicing physicians and OBG-YN’s are familiar with these new guidelines. A different study performed in 2011 found that only about 14% of currently practicing physicians and OBG-YN’s are familiar with these new guidelines. Furthermore, only about 26% of females living in the US meet these guidelines pre-pregnancy. In 2000, it was estimated that only 10% of pregnant women living in the US met these guidelines, where-as in 2009, about 16% of women met these recommendations.

Some things may limit you from exercising during pregnancy. You should not exercise if you have gestational hypertension, preeclampsia, ruptured membranes, an incompetent cervix, bleeding in the second and third trimesters, at risk for premature labor, or placenta previa. You should consult your physician before exercising when pregnant if you have intrauterine growth restriction, are either extremely obese or underweight, or have poorly controlled medical conditions such as diabetes, hypertension, seizures or thyroid disease.

Some precautions to take when exercising

  1. Drink plenty of water
  2. Don’t exercise in extreme heat or humidity
  3. Wear a sports bra that has plenty of support for your growing breasts
  4. As pregnancy progresses, you may want to consider a belly support belt (//ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ac&ref=qf_sp_asin_til&ad_type=product_link&tracking_id=baby08160-20&marketplace=amazon&region=US&placement=B01N0NT52Q&asins=B01N0NT52Q&linkId=63bf1dff6c82046a7fda773df1cf8527&show_border=false&link_opens_in_new_window=false&price_color=333333&title_color=0066c0&bg_color=ffffff” target=”_blank” rel=”noopener noreferrer”>try this one!)
  5. Avoid heavy ballistic (jumping) movements
  6. Avoid laying on your back for exercises after the first trimester
  7. Limit crunches/sit-up’s due to increased stress on the uterus
  8. Avoid standing still for prolonged periods of time

Physical activity during pregnancy has been linked to decrease in low back pain, decreased risk for gestational diabetes, decreased risk for hypertension and preeclampsia, decreased risk for large-for-gestational age newborns, improved sleeping, improved energy levels, decreased constipation, easier labor and delivery, decreased risk for C-section, more appropriate weight gain, improved circulation to the fetus, decreased risk for incontinence during and after pregnancy and decreased risk for postpartum depression. Physical activity during pregnancy has also been linked to improved physical activity and cardiorespiratory fitness in 16 year olds. No studies have found an adverse link between physical activity during pregnancy and fetal birth weight, gestational age or fetal size. This chart shows some specific research on benefits of physical activity while pregnant.

 

Newton 5.png

One type of exercise that has been researched well is pelvic floor exercises. Specifically, strong pelvic floor muscles have been linked to decreased risk for urinary incontinence as well as shorter and easier labor and delivery. Here’s how to do them!

  • Sit upright on a firm surface with good posture
  • Squeeze as if trying to stop flow of urine. It should feel like the muscles are lifting off of the surface you’re sitting on. Also, you should not be contracting your butt muscles or abdominal muscles while performing this exercise.
    • One way to test to see if you’re getting a good contraction is by inserting a CLEAN finger or two into the vagina and then squeezing. It should feel like your fingers are being squeezed
    • Another way to test your contractions is by trying it while you’re peeing (not the first pee in the morning). You should be able to stop the flow and then start it back up again with ease. This should not be performed regularly as this may increase risk for UTI’s.
  • Hold for 5 seconds and then slowly release. Try these slow contractions 10 times
  • Then try a quicker contraction or pulsing 20 times
  • After you feel comfortable with these, you can increase reps until fatigued.

Research describing the frequency at which to perform these exercises is extremely controversial. One theory is to try 60 fast contractions and 30 slow contractions a day. Another theory is to try 8-12 slow contractions 3 times a day. Even another theory is to try 200 fast contractions daily. Pick your poison!

Another study looked at stability ball exercises for pregnant women. Here’s the chart that they used to strengthen not only the pelvic floor and core muscles but also maintain flexibility in the major muscle groups of the body.

Yan.png

If you’re new to exercise, take it slow! Consult with your health care professional before beginning a program. Try starting with one to two 5-minute brisk walks per day, progressing up to a 30-minute walk and then branch out from there. If you are looking to begin resistive exercises, again, start with a light enough weight that you can perform at least 10 repetitions. Try building up until you can perform 30 repetitions (in 2-3 sets) before increasing the weight.

Here’s a great chart that has some example exercises and how to get started on a program.

EX program.png

And lastly, here’s the program that I (try to) follow! Enjoy!

Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
OFF!
20 Minute run/elliptical
20 Minute run/elliptical
20 Minute run/elliptical
20 Minute run/elliptical
20 Minute run/elliptical
Lifting Routine
Lifting Routine
Lifting Routine
Lifting Routine
Alternate
Side plank dips
Dips
Plank up-down’s
Bicep curl (hammer) with shoulder press
Suitcase squats
Step-ups
Walking lunges
Crab walk with t-band around knees
10 each progressing to 15
10 each progressing to 15
10 each progressing to 15
10 each progressing to 15
3 sets progressing to 4
3 sets progressing to 4
3 sets progressing to 4
3 sets progressing to 4

Regardless of the type of exercise you attempt, STOP IMMEDIATELY if you have any of the following symptoms

  1. Bleeding or fluid leaking from the vagina
  2. Regular and painful contractions of the uterus
  3. Chest pain
  4. Dizziness or feelings of faintness
  5. Severe headache
  6. Shortness of breath prior to beginning exercise
  7. Calf pain or swelling
  8. Decreased fetal movement that doesn’t resolve within 30 minutes or after a small glass of orange juice or a cracker

 

 

 

 

 

 

Kader, Manzur and Saira Naim-Shuchana. “Physical Activity and Exercise during Pregnancy.” Eurpean Journal of physiotherapy; 2014: 16.
http://www.acog.org/Patients/FAQs/Exercise-During-Pregnancy
Tikanmaki, Marjaana et. al. “Prenatal Determinants of Physical Activity and Cardiorespiratory Fitness in Adolescence – Northern Finland Birth Cohort 1986 Study.” BMC Public Health; 2017: 17.
Childers, Christine. “Protecting the Pelvic Floor During Pregnancy.” International Journal of Childbirth Education; 2016: 31 (4).
Newton, Edward R and Linda May. “Adaptation of Maternal-Fetal Physiology to Exercise in Pregnancy: The Basis of Guidelines for Physical Activity in Pregnancy.” Clinical Medicine Insights: Women’s Health; 2017: 1-12.
Hinnman, Sally K et. al. “Exercise in Pregnancy: A Clinical Review.” Sports Health; 2015: 7 (6).
Binkley, Helen M. et. al. “Land-Based Exercise During Pregnancy.” International Journal of Childbirth Education; 2015: 30 (3).
https://www.fitpregnancy.com/exercise/prenatal-workouts/exercise-guidelines

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