Exercise During Pregnancy - 'Mums To Be' On The Move...

"When I fell pregnant with my first child six years ago, there wasn’t a great deal of information around about what was considered safe exercise, when pregnant. Being a club level runner at the time, I thought I would have ran as normal throughout most of my pregnancy, until it was too uncomfortable to do so."

However, I had a scare at 8-weeks and took the personal decision not to run at all during my first and second pregnancy. Both were low risk, and uncomplicated but fear of harming my baby meant I didn’t feel comfortable to run or do high impact exercise. This is a common theme amongst women and one of the biggest barriers to exercising during pregnancy as identified in a recent systematic literature review in The Journal of Physiotherapy. It was found that women identified that physical activity in pregnancy was beneficial and important, with acknowledgement of safety considerations. However intrapersonal factors of maternal health and well-being such as fatigue, energy levels, pregnancy symptoms, and safety of self and baby were the most frequently identified barriers and enablers to physical activity in pregnancy.

Despite well-documented health benefits, 60-80% of pregnant women do not participate in physical activity as recommended. This is a huge amount. I didn’t feel comfortable doing high-intensity training and was used to doing 6 sessions per week. I knew all the benefits of exercise so I needed to get my exercise fix from somewhere else, so I turned to walking, Pilates with some strength work thrown in too! The key to remember is that everyone’s body is different and every pregnancy is different, but listening to your body is the best thing you can do. There are many benefits to safe exercise during pregnancy.

Hot off the press this month, The Canadian Society for Exercise Physiology (CSEP) have produced a 'Get Active Questionnaire' for Pregnancy intended to easily identify pregnant individuals who may have a condition where physical activity is not recommended. It enables a pregnant individual to make an informed decision whether they should seek further advice from their health care provider or a qualified exercise professional before becoming or continuing to become physically active.

This is a fantastic resource and should help empower women and increase confidence in their own safety to exercise. It has been classed as a first step in ensuring a safe and enjoyable experience. There is a real drive to encourage women to exercise during their pregnancy due to the many benefits. So what are the benefits to exercise in pregnancy?

• Increases endorphins – the hormones that give us that ‘feel-good’ factor. This can help you to sleep better which in turn reduces stress & anxiety which you may be feeling about life or the birth of your new baby. Thus improving your overall mental health.

• Increases self-esteem and confidence.
  
  

• Decrease incidence of Gestational Diabetes Myelitis by improving energy and blood sugar levels.
  
  

• Helps support the health of your heart and lungs, maintaining blood pressure, thus reducing the risk if gestational hypertension.
  
  

• Decrease chance of needing caesarian-section & instrumental deliveries
  
  

• Decrease Pelvic Girdle Pain (PGP) & musculoskeletal discomfort
  
  

• Decrease diastasis recti (separation of the abdominal muscles)
  
  

• Decrease incontinence - if you undertake Pelvic floor muscle exercises (PFME). These are a must!
  
  

• Maintain healthy weight & decreased risk of obesity
  
  

• Maintain muscle length & flexibility
  
  

• Faster post-natal recovery

As you can see from the Infographic , the current recommendations for exercise during pregnancy, published by the CMO in 2019, are 150 minutes of moderate-intensity activity per week for a low-risk pregnancy. That’s 30 mins 5 x per week. It also states that this can include all activity in bouts of at least 10 minutes activity. The Active Pregnancy Foundation have been working hard to promote this message of safe exercise and actually prefer to call it ‘activity’ rather than exercise as it may sound less intimidating to some. Activity can mean walking up and downstairs, gardening, doing the shopping. We are all more active than we think but research suggests we need to do more and more frequently. These guidelines are actually the same for all adults.

Muscle strengthening activities are advised 2 x per week. This makes sense right? As when you give birth you’re going to be carrying a baby, car seat and lots of other baby paraphernalia, around with you not to mention probably lifting a pram in and out of the car. Your body needs to be prepared.

What if I've never exercised before....Can I start now? Absolutely yes! It’s really important to exercise during pregnancy and no one should feel intimidated by this if they’re not used to doing any pre-pregnancy. You can start small and build up gradually. What it’s not advisable to do is take up high-intensity training if you’ve never done it before as your body won’t be used to it and won’t be conditioned for it. If you are new to exercise, it is recommended that you start with some low impact exercise first such as walking, swimming, static bike, for 15mins 3 x week and build up from there, increasing to 30mins 4 -5 x week.

If you were a frequent exerciser or keen runner before becoming pregnant, and it’s a low-risk pregnancy then it is fine to continue running if it feels right for you.

I would bear in mind, however, in the first trimester, you may be more fatigued and lack the energy and the ‘get-up-and-go’! Listen to your body.

Also, remember to give yourself a break- you are growing a tiny human! As your bump grows bigger you may need to slow down a little and adapt by using a cross trainer or exercise bike, but this is all normal.

Environmental factors such as not overheating are important too, so think about the clothing and the environment you exercise in. Keep cool, comfortable and hydrated throughout the activity. Always remember to drink plenty of fluids. Whatever exercise you do, a support bra is most definitely key! Your boobs will grow during pregnancy even in the first trimester, and this can take some getting used to!

One simple way of measuring the intensity of the physical activity you do is using the ‘talk test’. If you are able to maintain a conversation while exercising without feeling out of breath or uncomfortable, this is the right level of activity. This will give you the power to know what level is appropriate to you by listening to your body. However, remember you cannot compare yourself to anyone else, “Comparison is the thief of joy”!

All of the above relates to an uncomplicated pregnancy. This is classed as not having any condition that is caused or aggravated by the fact you are pregnant. However, it is important to acknowledge that several conditions require medical supervision and would be classed as a more complicated pregnancy such as: placenta previa < 28 weeks, severe respiratory disease, uncontrolled Type 1 diabetes, severe pre-eclampsia, and vaginal bleeding. In such cases, it is recommended that moderate to vigorous high-intensity exercise is best avoided as the risks outweigh the benefits. However, you should always seek further advice regarding exercise from your midwife, Gp, consultant or physiotherapist working with you. If you are in any doubt as to what is safe, always ask. For any women who have congenital heart disease, placenta previa >28weeks, or an eating disorder then they need to exercise with caution and be monitored by their health care team.

I have included a list of useful resources below that are definitely worth a read.

So what types of exercise are safe?

Pelvic floor muscle exercises (PFME): I’ve included these first as they are important and should never be underestimated. Fast and slow contractions are needed. These should be performed 3-4 x daily. Try incorporating them into your day. For example: waiting at traffic lights, waiting for a bus or train, adverts on tv.

The ‘Squeezy App’ is a great app for information and as a little reminder to do these. Sue Croft, a Physiotherapist who specialises in this area states that the evidence is compelling that what we do through pregnancy, can make a difference to the outcomes for your pelvic floor, bladder and bowel function following delivery. So understanding how to correctly contract the pelvic floor muscles and how to engage the muscles prior to increases in intra-abdominal pressure of pregnancy, is important to learn about and do.

Walking is easy and cheap and you can do it anywhere! It is ideal if you are new to exercising.

Gym: Always let your class instructor know that you are pregnant before the class starts and they can adapt any exercises as required. Be cautious with gym equipment if it’s not familiar to you and always ask for help if unsure.

Running: If you normally run pre-pregnancy and feel up to running without any complications then it is ok to run. When you become bigger and ligaments become laxer, it may be uncomfortable to do so. Just remember the key rule that you should be able to talk when running/exercising which will ensure you do not push yourself too hard. Keep yourself cool.

Swimming: this is a great form of exercise as it’s non-weight bearing so there is less stress on joints.

Yoga: As your bump grows some poses may prove more challenging! There are lots of mummy yoga classes aimed at meeting other mums at a similar stage in pregnancy and yoga if yoga is something you enjoy.

Pilates: This is best to do after your first trimester and scan. This is great to focus on strengthening Pelvic Floor Muscles, deeper abdominal muscles, and muscles around your pelvis to aid stability. Some exercises may need to be adapted to prevent abdominal doming.

Lying on your back after 19-weeks should be kept to a minimum as advised by the POGP and alternative positions should be considered such as 4-point kneeling particularly if there are any complications in the pregnancy. If during exercise and laying on your back you feel dizzy or unwell then you should change to lying on your left side or into a sitting position or stop until you feel better. This is because the weight of the bump presses on the main blood vessel bringing blood back to the heart and this can make you feel dizzy. For this reason, it may be beneficial to go to an antenatal class.

Aqua-natal classes: Great to take the weight off your body using the buoyancy of the water.

It is not advisable to do any exercises that could pose potential harm to your baby such as extreme or contact sports such as kickboxing, judo or squash. For this reason, competitive, new sports or combat sports may be risky and best avoided. You may have heard the term ‘don’t bump the bump’! Similarly, scuba diving should be avoided as there is no protection against decompression sickness and gas bubbles in the bloodstream.

Exercise at altitude should also be avoided as you and your baby would be at risk of altitude sickness. Exercises with a potential risk of falling should be done with caution such as: horse riding, downhill skiing, ice hockey, gymnastics, and cycling. Falls carry a risk of harm to your baby. This does also depend on how familiar you are with the sport.

Advice & Guidelines to remember:

• Always inform your class instructor you are pregnant and what stage you are at in your pregnancy. They should then modify the exercises for you if necessary.
  
  
• What exercise is safe, depends on what type of exerciser you were pre-pregnancy: sedentary (little or no exercise), moderate, or vigorous.
  
  
• Be aware that in the first trimester you may not feel like doing much exercise due to tiredness & or nausea. Remember this is ok to feel this way!
  
  
• As you become bigger you may find running for example too much strain due to the increasing size of baby bump and ligament laxity. A cross trainer may be more comfortable, or pool running.
  
  
• If it’s a hot day ensure you drink plenty of water, and ensure the location you are exercising in is sufficiently ventilated to prevent over-heating.
  
  
• Ensure you can still talk when exercising.
  
  

Some exercises may need to be adapted to ensure you can do them correctly and with good form. There should be no ‘doming’ of your abdominal muscles and you should not be leaking faeces or urine.

If you have any concerns or questions, always consult your Consultant, Midwife, Physiotherapist or Gp.

Any exercise that causes significant pain should be avoided. If it’s comfortable and enjoyable continue. If it’s painful or uncomfortable stop and seek help.

Don’t ‘bump the bump’!

Find an activity that you enjoy.

In summary, there is a lot of fear around exercising during pregnancy but as explained above, this needn’t be the case. The recent questionnaire is available as a useful guide. Pregnant women should be encouraged to exercise, be supported in doing so and stay active as much as possible. If in doubt, ask.

Remember…

Enjoy your pregnancy. It is a magical time. Stay fit, stay healthy.

Louise Mitchell

Useful references

www.activepregnancyfoundation.org

https://pogp.csp.org.uk/system/files/publication_files/POGP-FFPregnancy.pdf

UK Chief Medical Officer ‘Exercise during Pregnancy’ 2019

https://www.csep.ca/getactivequestionnaire-pregnancy/CSEP-PATH_GAQ_P_Guidelines.pdf

Squeezy App

www.squeezy.com

Here you can locate specialist physiotherapists working in pelvic health in your area.

“Why Did No-one Tell Me”, Emma Brockwell.

https://www.amazon.co.uk/Why-Did-One-Tell- motherhood/dp/1785043366/ref=sr_1_1?dchild=1&keywords=emma+brockwell&qid =1614966483&s=books&sr=1-1

Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review

Anne L Harrison, Helena C Frawley et al 2018. Journal of Physiotherapy, 64, 1, p 24-32.

https://www.csep.ca/getactivequestionnaire-pregnancy/CSEP-PATH_GAQ_P_Guidelines.pdf

www.activepregnancyfoundation.org