Exercise & Pregnancy.

2024 Update

The fitness industry has historically categorised pregnant women as a ‘special population.’ However, pregnancy is a natural and common experience that requires us as fitness professionals to possess specialised knowledge, rather than viewing it as a limitation. Pregnancy is not a disease, but a condition that warrants specific, appropriate exercise guidance.

Assessing Exercise Experience

One of the first considerations when developing an exercise plan for a pregnant woman is whether she is new to exercise or already a regular exerciser. This distinction significantly impacts:

1. Exercise Prescription: The intensity, duration, and type of exercises recommended may vary depending on the individual’s previous fitness level.
2. Mental Attitude: Regular exercisers are often more motivated and may be inclined to continue their routine unless advised otherwise. In contrast, new exercisers may be more cautious and require additional support and encouragement.

Regular exercisers are typically committed to maintaining their fitness routine, often questioning why they shouldn’t continue as long as they feel well. On the other hand, new exercisers may approach fitness during pregnancy as a means to improve both their health and the baby’s, as well as to ease labour. However, they may underestimate the combined physical demands of exercise and pregnancy, necessitating careful and empathetic guidance from knowledgeable trainers.

The Importance of Specialised Training for Instructors

It is crucial that we are trained in pre- and post-natal care. Pregnancy is a common occurrence, and it is inevitable that as a trainer, we will work with pregnant clients. Therefore, being prepared with the right knowledge and skills is essential.

Updated Guidelines from RCOG

The Royal College of Obstetricians and Gynaecologists (RCOG) has long been a leading authority on exercise during pregnancy. Their most recent guidelines, reviewed and reaffirmed in 2019, emphasise the importance of staying active throughout pregnancy. The RCOG encourages regular physical activity as it can offer numerous health benefits, including reducing the risk of gestational diabetes, improving psychological wellbeing, and aiding in postpartum recovery.

Some key points from their guidance include:

• Pregnant women who were physically active before pregnancy should continue their activities, with adjustments as needed.
• For those who were not active before pregnancy, starting with gentle activities like walking or swimming is recommended.
• Activities that carry a risk of falling or abdominal trauma should be avoided, especially in the later stages of pregnancy.

These guidelines have been developed to ensure that exercise during pregnancy is safe and beneficial.

Postpartum exercise also has significant benefits after childbirth for both recovery and overall wellbeing. Their recommendations encourage new mothers to gradually resume physical activity as soon as they feel comfortable, with consideration to individual circumstances such as the type of delivery and any complications during childbirth.

Key Recommendations

• Pelvic Floor Exercises: These should begin as soon as possible after birth to strengthen the pelvic muscles and reduce the risk of incontinence.
• Light Activities: Activities such as walking can usually be resumed within a few days after delivery, depending on how the mother feels.
• Gradual Return to Exercise: More strenuous activities, like running or weightlifting, should be gradually reintroduced, typically around six weeks postpartum, but only if the mother feels ready and has had no complications.
• Listening to the Body: It’s important for new mothers to listen to their bodies and not rush the process. If there is pain or discomfort, it’s advisable to slow down and consult a healthcare professional if necessary.

Exercise and Pregnancy: Current Recommendations

RCOG now encourages pregnant women to engage in 30 minutes or more of moderate exercise on most, if not all, days of the week. This recommendation is contingent upon any specific advice given by a healthcare provider based on individual assessments.

Earlier guidelines were often seen as conservative, particularly for pregnant women accustomed to regular exercise. Research has since shown that women who were already physically active before pregnancy can safely maintain higher levels of physical activity, with appropriate adjustments.

Contraindications to Exercise During Pregnancy

Here is a list of absolute and relative contraindications to aerobic exercise during pregnancy:

Absolute Contraindications:

• Significant heart disease
• Restrictive lung disease
• Incompetent cervix or cerclage
• Multiple gestations at risk of premature labour
• Persistent second or third-trimester bleeding
• Placenta previa after 26 weeks of gestation
• Premature labour during the current pregnancy
• Ruptured membranes
• Preeclampsia or pregnancy-induced hypertension

Relative Contraindications:

• Severe anaemia
• Uncontrolled maternal cardiac arrhythmia
• Chronic bronchitis
• Poorly controlled type 1 diabetes
• Extreme morbid obesity or underweight
• History of sedentary lifestyle
• Intrauterine growth restriction in current pregnancy
• Poorly controlled hypertension, seizure disorder, or hyperthyroidism
• Heavy smoking

Signs to Stop Exercise Immediately

Exercise should be discontinued immediately if any of the following occur:

• Vaginal bleeding
• Dizziness or faintness
• Increased shortness of breath
• Chest pain
• Severe headache
• Muscle weakness
• Calf pain or swelling
• Uterine contractions
• Decreased fetal movement
• Fluid leakage from the vagina

Addressing Common Concerns

There are several concerns regarding exercise during pregnancy, including the potential for elevated core temperature, depletion of carbohydrate stores, and redistribution of blood flow away from vital organs. However, recent research suggests that regular, moderate exercise can protect the foetus and provide numerous benefits to the mother, such as improved cardiovascular function and reduced risk of gestational diabetes.

Specific Exercise Considerations

• Heart Rate Monitoring: The increase in maternal heart rate during pregnancy can make traditional heart rate monitoring less accurate. Instead, perceived exertion scales are recommended for gauging exercise intensity.
• Exercise Positioning: After the first trimester, lying on the back (supine position) is not recommended due to the potential for reduced venous return and cardiac output. Alternative positions such as sitting, kneeling, or on all fours are preferred.
• Abdominal Exercises: The type of abdominal exercises performed should be adjusted to avoid exercises that cause the abdomen to dome, which may exacerbate diastasis recti (separation of the abdominal muscles). Instead, focus on compression exercises that engage the core without excessive strain.

High-Risk Activities

Certain activities are considered high-risk during pregnancy, such as scuba diving, due to the risk of decompression sickness to the foetus. Similarly, activities with a higher risk of abdominal trauma, such as contact sports or horseback riding, are not advised.

Pelvic Floor Health

Recent studies have emphasised the importance of pelvic floor muscle training during pregnancy. Intensive pelvic floor exercises have been shown to prevent urinary incontinence both during pregnancy and after delivery.

Current evidence strongly supports the benefits of exercise during pregnancy for most women. The key is to tailor exercise programmes to the individual, considering both the type and intensity of activity. Regular physical activity, including activities like swimming, cycling, and walking, is generally encouraged. Ultimately, the exercise regimen should be guided by common sense, individual feedback, and professional advice.

References

1. Royal College of Obstetricians and Gynecologists (RCOG). (2019). Physical Activity and Pregnancy. Click here to review the full research article
2. Mottola, M. F., & Artal, R. (2016). Fetal and Maternal Responses to Physical Activity During Pregnancy. Click here to review the full research article
3. Hesketh, K. R., & Evenson, K. R. (2016). Prevalence of U.S. Pregnant Women Meeting 2015 ACOG Physical Activity Guidelines. Click here to review the full research article
4. Davenport, M. H., et al. (2018). Impact of prenatal exercise on maternal harms, labor and delivery outcomes: a systematic review and meta-analysis. Click here to review the full research article
5. Clapp, J. F. III. (1996). The Course of Labor After Endurance Exercise During Pregnancy. American Journal of Obstetrics and Gynecology, 174(3), 1399-1403. Click here to review the full research article
6. Sperstad JB, Tennfjord MK, Hilde G, Ellström-Engh M, Bø K. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med. 2016 Sep;50(17):1092-6. doi: 10.1136/bjsports-2016-096065. Epub 2016 Jun 20. PMID: 27324871; PMCID: PMC5013086.Click here to review the full research article
7. Mørkved, S., Bø, K., Schei, B., & Salvesen, K. Å. (2003). Pelvic Floor Muscle Training During Pregnancy to Prevent Urinary Incontinence: A Single-Blind Randomised Controlled Trial. Obstetrics & Gynecology, 101(2), 313-319. Click here to review the full research article

Design Pre & Post Natal Exercise Programmes

Elevate your fitness career with the Level 3 Award in Adapting Exercise for Antenatal and Postnatal Clients from TRAINFITNESS. This comprehensive course equips you with the specialised knowledge needed to safely and effectively guide pregnant and postpartum clients through their fitness journey. With the latest guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG) and evidence-based practices, you’ll learn to tailor exercise programmes that enhance maternal health, prevent common issues like urinary incontinence, and support overall wellbeing during pregnancy and beyond. Become a trusted expert in this vital area of fitness and help your clients achieve their health goals safely during one of the most significant times of their lives.

Exercise for Ante & Post Natal Clients Course – Distance Study

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