Do I, don’t I? Exercise and pregnancy

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When it comes to exercising during and after pregnancy, there is an overload of differing opinions and advice. Two-time personal trainer of the year Alison Storey tackles some of the research and shares helpful guidelines for new mums, to help ensure a safe, healthy pregnancy and recovery.

Pregnancy is recognised as a unique opportunity for behavioural change and the fact that these changes can affect a woman for the rest of her life.

pregexcer2 Even bearing in mind that pregnancy creates profound anatomical and physiological changes, there seems limited reasons that a healthy, pregnant woman cannot follow the standard guidelines for exercise in order to remain at a healthy level of physical activity.  That being said, on delving deeper there appears to be some slightly conflicting, professional advice on exercise during such an important change.

In 2002 guidelines for exercise during pregnancy were released by the American Council of Obstetrics and Gynaecology (ACOG) that recommended for the first time that regular exercise has a possible role in the prevention of gestational diabetes.

It highlights the positive effect on health, both physical and mental, the decrease in pain, and lowering of both blood pressure and stress with specific forms of exercise, but no surprise that it cautions against contact sport, and specifically recommends the avoidance of scuba diving….

In 2006 the Royal College of Obstetricians and Gynaecologists (RCOG) released guidelines that encouraged strength training during pregnancy as it may help reduce labour times and delivery complications but advises against exercise at more than 2500m until acclimatised…

pregexcer3The 2015 publication by the Association of Chartered Physiotherapists in Women’s Health (ACPWH) as to be expected, focuses on pelvic floor exercises and also advises elite athletes that become pregnant to follow the advice given to regular exercises – to complete 20-30mins of moderate exercise three times per week. Good luck with that.

ACPWH also suggests avoiding exercise over a mere 1850m in altitude, and gives no training heart rate advice only ‘the talk test’ levels of perceived exertion as a guide to how ‘moderate’ the exercise actually is.

To its immense credit it advises seeking out a registered exercise professional (www.reps.org.nz) as a guide for the antenatal exercise journey.

Avoiding exercises lying flat on the back after 16 weeks is advised by all parties as blood flow can be restricted, however contrary to popular belief, running and skipping can safely play a part in ante natal exercise routines. Back pain and loss of balance are par for the course, however there are plenty of forms of postural stability and balance exercises that can help make these less of an issue.

The rule of thumb lectured into exercise professionals is to not let the training heart rate exceed 140bpm during pregnancy, although there seems to be some evidence that 150bpm is still safe. In fact one meta-analysis study of exercise and pregnancy, showed exercise intensities of 81 percent of heart rate maximum (theoretically 160bpm for a 25-year-old) had no significant adverse effects on the foetus.

As with all human beings, exercise history would also need to be factored in and so monitored and professional advice from a qualified exercise professional is paramount.

Core temperature is another issue often talked about.  A non-pregnant woman’s core temperature rises about 1.5 degrees in the first 30 minutes of sustained physical activity and plateaus.

This heat produced, as long as it is dissipated in similar amounts, poses no problem. It appears likely that the pregnant woman can follow the same rules, bearing in mind foetal core temperature sits one degree higher than mum’s anyway.

Although the takeaway is to avoid exercise in hot, humid conditions (until acclimatised), which is why the pull to the pool is so ubiquitous for expectant mothers.

It is often advised that pregnant women, especially during the third trimester when the female body releases ligament loosening hormones by the truckload, avoid dynamic movements and flexibility-based activities.

There is however a lack of clear evidence that exercising women have experienced an increased risk of musculoskeletal injury and data on any increase in joint injury is also lacking; one would assume the sudden increase in weight and consequent load on joints would make this more likely.

This then puts into question the oft dispelled advice to take things easier in the third trimester.

However anecdotal evidence would suggest that with increasing fatigue as the term wears on, taking it easier becomes a welcome option anyway.

Another clear and important message is that even if a woman hasn’t exercised regularly before, being pregnant is no hindrance to starting an exercise programme and can in nearly all cases prove hugely beneficial to both mother and baby.

Pregnancy should not be a state of confinement, and pregnant women with no complications should be encouraged to continue and/or engage in physical activities.

Recreational and competitive athletes with uncomplicated pregnancies can remain active during pregnancy, and modify their usual exercise routines as advised by their team of health and exercise professionals.

So in the interest of offering up some do’s and don’ts;

Absolute contraindications to aerobic exercise during pregnancy (with permission from ACOG)
•     Significant heart disease
•     Restrictive lung disease
•     Incompetent cervix (although other professionally monitored exercise may be possible, e.g specific weight training)
•    Persistent second or third trimester bleeding
•     Placenta praevia after 26 weeks gestation
•     Pregnancy induced hypertension

Relative contraindications to aerobic exercise during pregnancy (with permission from ACOG1)
•     Severe anaemia (low iron stores)
•     Unevaluated maternal cardiac arrhythmia
•     Chronic bronchitis
•     Poorly controlled type I diabetes
•     Extreme morbid obesity
•     Extreme underweight (body mass index <12)
•     History of extremely sedentary lifestyle
•     Poorly controlled hypertension
•     Heavy smoker

Warning signs to terminate exercise while pregnant
•     Vaginal bleeding
•     Dizziness
•     Headache
•     Chest pain
•     Muscle weakness
•     Calf pain or swelling (need to rule out thrombophlebitis)
•     Preterm labour
•     Decreased foetal movement

And now for the good stuff;

Eat more! Pregnant women need to increase food intake by an additional 300 calories per day, building up to 500 by the third trimester and that’s without the added fuel needs of exercise. So regular exercise means you can eat more of the good stuff.

You can swap free weights for machines if you want; balance issues, and advice against the supine position will make the seated bench press a more comfortable option, not necessarily an inferior option
Yoga has been shown to decrease blood pressure and stress and help with a breathing focus and controlled stretching with a good instructor is unlikely to cause damage.

You don’t need to stop running, just rugby; if it’s comfortable enough and you’ve been doing it for years, there appears little reason to stop jogging, though there is obvious reason to avoid contact sport.

If you’re an athlete all studies point to being able to continue training for competition albeit with adjustments for increased nutrition and hydration needs.

And eventually adjustments to performance expectations…
Monitoring with a heart rate monitor is a useful tool if you’re not good at self-monitoring exertion, though no need to keep it below 140bpm if you’re a seasoned exerciser under supervison.

So just in case the message hasn’t yet become crystal clear – best consult your exercise specialist/personal trainer for individual advice.

Alison Storey is a personal trainer who has represented New Zealand in three different sports (beach volleyball, rowing and rhythmic gymnastics). She has been awarded New Zealand Personal Trainer of the Year twice and runs Storey Sport, a mobile personal and sports training business which provides a range of services that optimise the fitness and wellbeing of its clients. www.storeysport.co.nz

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