Battling Gravity with Exercise During Pregnancy
|Associate Director, Amy Rauworth|
Along with my testimonial, you can read Ginni Buller’s comments on being a first time mom with spastic cerebral palsy at First-Time Mom with Spastic Cerebral Palsy
What should you consider when exercising during pregnancy and postpartum?
Many women may question the safety of exercising during pregnancy. In 1985, the American College of Obstetricians and Gynecologists (ACOG) provided a conservative recommendation on exercise based on the limited evidence available at that time. More recently updated ACOG guidelines released in 2002 suggest that physical activity can be beneficial for virtually all women experiencing normal pregnancies. The Society of Obstetricians and Gynecologists of Canada and the Canadian Society of Exercise Physiologists also agree that the effects of exercise on the maternal-fetal unit are beneficial. Research suggests that for normal pregnancies exercise can decrease the risk of gestational diabetes during pregnancy and long-term obesity risk due to excess weight gain during pregnancy. In fact, a recent roundtable consensus statement released in 2006 and produced by the American College of Sports Medicine, Impact of Physical Activity during Pregnancy and Postpartum on Chronic Disease Risk, and found at http://www.acsm.org suggests that the focus for enhancing women's health is now on the impact that physical activity can have during pregnancy and postpartum in the prevention of future chronic disease risk. Exercise has also been linked to improved energy levels, psychological status, posture, muscle strength and endurance during pregnancy. It also assists in relieving those all-too-common complaints that I can currently relate to such as backaches and swelling.
If you are a woman with a disability, what should you consider?
Regardless of your specific disability, you should consult your primary care physician and your obstetrician. Your primary care physician may know the details of your medical history and can communicate any concerns to you and your obstetrician. Most importantly, you should consider how you feel physically and express this to your healthcare professionals. This decision should be a collaborative effort between your health care team and yourself. Actively participating in this decision will empower you to take charge of your healthy lifestyle choices during pregnancy. According to Jasmine Jafferali, MPH, ACE-CPT, Healthy Moms(R) Perinatal Master Trainer, "Exercise is an opportunity to gain not only physical strength, it empowers and encourages the mental and emotional component of who we are so we can endure each stage of pregnancy and beyond."
What type of exercise is best?
Weight bearing and non-weight bearing exercise can both be an option during pregnancy. Swimming and stationary cycling are examples of non-weight bearing exercises that can be considered. Walking and low-impact aerobics are examples of weight bearing exercises. Other options can include:
- Specialized prenatal exercise classes (The instructors are trained to monitor your response to exercise and can share important knowledge-Healthy Moms Perinatal Fitness).
- Floor work (Note: avoid exercising on your stomach or back after the first trimester. It is also important to remember that during pregnancy you may experience increased joint laxity, which requires caution when stretching and strength training).
- Strength and endurance training (If you have never performed resistance training exercises prior to conception, it is recommended that you begin this activity postpartum. If you are continuing your program, focus on low resistance levels and increased repetitions).
What exercises should be avoided?
Avoid exercises that challenge balance such as riding a bicycle outdoors or exercising on an uneven surface, especially during the third trimester. Any sport that poses a risk to abdominal injury such as racket sports or contact sports should not be considered. Exercising in extreme temperatures is not recommended and proper hydration and clothing should always be considered.
How frequently should you exercise?
A general recommendation for exercise frequency during pregnancy is 3 to 4 days a week. However, as each exercise program should be tailored to the individual, you must consider your fitness level prior to conception and base your frequency of exercise on your individual characteristics. Some women can exercise at a low to moderate intensity most days of the week. It is also important to remember your nutritional needs. It is suggested that an additional 300 kcal/day are needed to maintain an adequate nutritional status for mother and child.
At what intensity should you exercise?
In the past, women were instructed to keep their heart rate below 140 beats per minute. This recommendation did not consider their current fitness levels or ages. It is now recommended that you utilize the rate of perceived exertion (RPE) scale instead of a target heart rate. It is recommended that during pregnancy a woman should maintain a level of exercise that she considers to be fairly light to somewhat hard (RPE of 11 to 13 on the Borg 6 to 20 scale). Exercising to exhaustion is not recommended during pregnancy. It is important that you monitor your fatigue levels and assess the physical demands that will be placed on your body throughout the day to determine the cumulative effect of all forms of physical activity. This includes household chores and other activities of daily living which may have an effect on your body and fatigue levels.
How long should each bout of exercise last?
If you have been sedentary prior to conception, it is important to begin any exercise program gradually and progress slowly. Listen to your body and adjust each new exercise bout to how you feel at that time. The duration should be tailored to your individual needs and may vary daily and throughout the pregnancy.
When should you stop exercising?
If you experience any of the following warning signs, you should discontinue exercise and consult your physician:
- Vaginal bleeding
- Shortness of breath prior to exertion
- Chest pain
- Muscle weakness
- Calf pain or swelling
- Preterm labor
- Decreased fetal movement
- Amniotic fluid leakage
What should you consider postpartum?
Following the delivery of your baby, you will no doubt be anxious to regain your former physique. However, it is important to remember that the effects of pregnancy on your body last up to 4 to 6 weeks after delivery.
Separation or diastasis of the rectus abdominal muscle from the linea alba is common in pregnancy and can persist following delivery. This vertical separation can be determined through a simple test which requires you to lie on your back with your knees bent and your feet flat on the floor. Place your fingertips just above or below your belly button. Lift your head and shoulder off the floor and at the same time press your finger firmly against your stomach, feeling for any separation between the bands of your abdominal muscles (the bands that run vertically). If the separation is greater than two fingers' width, you should be careful not to strain your abdominal muscles as you exercise; also avoid sit-ups. Speak to your health care professional as persistence of this condition may require physical therapy or medical intervention.
Following delivery you may also experience urinary incontinence. Exercises designed to strengthen the pelvic floor can be beneficial. Programs such as Total Control offer women an exercise program that is developed specifically for this issue. You may also wish to speak to your doctor and determine if physical therapy or medical intervention may be necessary.
All of the issues that follow pregnancy may seem extensive, not to mention the sleepless nights, but the good news is that research suggests that regular exercise and healthy nutritional choices can successfully remove the excess weight gained during pregnancy. Just like your new commitment to taking care of that beautiful bundle of joy that you brought home from the hospital, the commitment to a healthy lifestyle can bring you great pleasure. You must now set the example for your child to follow and ensure that healthy life style choices will be a family affair.
To read more about exercise during pregnancy view NCPAD’s factsheet on Exercise During Pregnancy at:http://www.ncpad.org/17/94/Exercise~During~Pregnancy.
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