Exercise during Pregnancy - The 411

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The 411

On exercise during Pregnancy

If you thought I had been avoiding you wonderful pre and postnatal women on my youtube channel; you’d be right. The reason being is that I don’t like to teach anything that I haven’t yet experienced first hand. However, I have trained and coached many pregnant women throughout my time as a personal trainer and yoga teacher so I am definitely able to share what I do know about staying fit and healthy during pregnancy, along with contraindications (the reasons to avoid exercise)

Now; there are overwhelming amounts of research on exercise during pregnancy and contrary to early hypothesis, it is advised to maintain exercise during pregnancy - in fact here is the exercise guideline for healthy pregnancies from The American College of Sports Medicine:

In the absence of either medical or obstetric complications, 30 minutes or more of moderate exercise a day on most, if not all, days of the week is recommended for pregnant women.*

The benefits of exercising during pregnancy include:

  • Better Management of Gestational Diabetes Mellitus - "Women diagnosed with gestational diabetes at 24 to 34 weeks of pregnancy who performed resistance exercise were less likely to require insulin during the remainder of their pregnancy as compared with women with gestational diabetes in the control group.”**
  • Hypertension and Preeclampsia - There is conflicting evidence here, however, the conflict is based on the amount of exercise per week. A population-based study in North Carolina (of 3348 participants between 2004-2006) suggests that physical activity, particularly during pregnancy, was associated with a lower risk of hypertensive complications during pregnancy***. However there are obvious flaws in population-based studies and conversely, another study involving 85,139 Danish women between 1996-2002 showed an increased risk of developing preeclampsia with greater than 270 minutes of exercise per week****. Approximately 40 minutes per day. 
  • Maternal-Fetal Circulation and Fetal Growth - Blood flow is not significantly inhibited or altered to the foetus during moderate exercise***** 
  • Labor and Delivery - Regular exercise may shorten the duration of labour and reduce the risk of Cesarean section and operative-assisted vaginal delivery^/^^

It also goes without saying that exercise can prevent excessive weight gain during pregnancy, which will also support post-pregnancy weight loss. 

Exercise may also help to reduce Perinatal depression (however as with many psychological based studies, there is conflicting evidence around this statement). 

Here is a table that outlines some of the precautions for Muscular Training that are really important to be aware of:

Body Position
Lying on your back can decrease the flow of blood returning from the lower half of the body and/or to the abdominal aorta, as the enlarged uterus presses on the Inferior Vena Cava (a major vein).
After month 4 of pregnancy lying on ones back should be avoided, this also means avoiding exercises or yoga postures in the supine position.


Joint Laxity
Due to an increase in the Hormone Relaxin; ligaments are more relaxed (duh) and are therefore more prone to injury. 
Static stretching should be avoided and instead, controlled but active mobility drills should be employed.


Abdominal Muscles
Diastasis Recti is a common condition during pregnancy in which there is a tearing of the connective tissue along the front of a pregnant abdomen. This can be further exacerbated by abdominal training.
Avoid abdominal exercises that involve rectus abdominus (6 pack) activation and instead work on TVA (transverse abdominus exercises) - If Diastasis Recti occurs, avoid all isolated abdominal exercises and work on other methods of core training eg. Squats, Deadlifts etc.


Posture
There are many postural changes that occur during pregnancy due to the enlarging of both the abdominal area as well as the breasts. This changes the centre of gravity and increased lordosis of the lower back. It can also lead to rounded shoulders.


This is where weight training is a God-Send because it’s perfect for posture correction particularly helping to strengthen muscles of the upper back. Maintenance of hip and in particular gluteal strength to support the lower back is key. 


When it comes to resistance training breath awareness is imperative!
You must make sure there is continuous breathing throughout exercise (exhale on exertion, inhale on relaxation). Valsalva Manoeuvre (holding breath while working against a resistance) causes a change in blood pressure and therefore should be avoided - this is why it’s important to avoid trying to hit PB’s during pregnancy. Now is not the time!

 

Now that I have covered the good news; let’s just have a look at the contraindications for exercising during pregnancy. I would really like you to pay close attention to these because in a few weeks I will be releasing some pregnancy safe workouts - I DO NOT WANT YOU TAKING PART IN THESE IF YOU HAVE EVEN THE SLIGHTEST CONCERN THAT YOU FIT THE CONTRAINDICATIONS BILL. I’m sorry to yell, but it’s really important that you value your health and your babies health overtraining and exercise (after all, the whole point of exercising during pregnancy is to support your whole experience, not detract from it).

 

Contraindications^^^ - Do not exercise if you experience the following:

Vaginal bleeding
Dyspnea prior to exertion
Dizziness or faintness
A headache or visual disturbance
Unexplained abdominal pain
Muscle weakness
Swelling of ankles, hands, or face
Swelling, pain, and redness in the calf of one leg
Preterm labor, persistent contractions (> 6-8/h)
Decreased fetal movement
Amniotic fluid leakage
Elevated pulse or blood pressure persisting after exercise
Fatigue, palpitations, chest pain
Insufficient weight gain(<1.0kg/month during last two trimesters)


Remember, if you are concerned that you have experienced any of the symptoms listed in the contraindications then please speak with your physician and ask them about your training. 

When I work with Pre and Postnatal clients, I have them fill out a Pregnancy PARQ (Pre Activity Readiness Questionnaire) if you have my book you’ll notice that I also asked you to fill this out for me. Here is a sample of the one I have used for my Pre/Post Natal Clients:

PARQ for Pregnancy

Have you experienced any of the following, past or present? 

Shortness of Breath
Chest Pain
Miscarriage
Eating Disorder
Seizures
Vaginal Disorder
Blood DIsorder
Major Surgery in the last 10 years
Minor Surgery in the last 10 years
Heart Disease
Hypoglycemia
Pelvic/Abdominal Cramps
Arthritis
Incompetent Cervix
Multiple Gestations
Diabetes
Multiple Births
High Blood Pressure
Low Blood Pressure
Knee Problems or Pain
Back Problems or Pain
Neck Problems or Pain
Osteoporosis
Vaginal bleeding
Dyspnea prior to exertion
Dizziness or faintness
A headache or visual disturbance
Swelling of ankles, hands, or face
Swelling, pain, and redness in the calf of one leg
Preterm labor, persistent contractions (> 6-8/h)
Decreased fetal movement
Amniotic fluid leakage
Elevated pulse or blood pressure persisting after exercise
Fatigue, palpitations, chest pain
Insufficient weight gain(<1.0kg/month during last two trimesters)

If you have selected One or More of the above conditions:
Please speak to your doctor by phone or in person before you undertake further exercise or attend a fitness assessment, show them the questionnaire and seek permission from the doctor to begin exercise. The doctor may advise that you restrict certain activities or that you avoid certain exercises. 

Please note; if you have not selected any of the above conditions you may begin pre/postnatal specific exercise, however, should your condition change and you subsequently tick YES to any of the above conditions you MUST advise your Trainer and stop exercise until you have spoken with and obtained permission from your doctor. 

If you are clear to exercise, please continue to answer the following questions in as much detail as possible:

What type of exercise did you participate in before your pregnancy?

How many times per week did you exercise prior to pregnancy?

Is there any other medical history (injuries, conditions etc) that you experienced prior to pregnancy (this includes your childhood)?

Are you taking any medication? If yes please list below:


Have you had previous pregnancies? If yes - were there any complications?

Are there any concerns you have regarding pregnancy, birth, postnatal period?

PRENATAL ONLY:

Due Date:
Which Trimester are you currently in?

Has your doctor given you medical clearance to exercise during pregnancy?

POSTNATAL ONLY:

Date of babies Birth?
Type of delivery?
Did you have an Episiotomy?
Are you breastfeeding?
Are you getting up at night?
Are you napping during the day?

At the end of the form, I will ask for your signature and any further notes from your doctor, along with their contact details. If there are any complications I would always want to be able to get in contact with your doctor. 

The truth is that I am on the cautious side when it comes to pregnancy - why? Because I am not inside your body, I am unable to feel what is going on and so I require YOU to be really aware of, not just these potential risks, but also the feeling that you are experiencing within your body. Sadly my experience as a trainer says that most people are UNAWARE of their bodies - now that is not a criticism, it’s just that if you have spent most of your life sedentary, it’s very common to lose proprioceptive abilities and disconnect from important sensations in your body. 

This is very much why the Vertue Method was created - not just to help you feel better, but be much better at ‘Feeling’ what your body requires.

If you have never exercised before, pregnancy isn’t the ideal time to start, however, it doesn’t mean you CAN’T begin. Just pretty please make sure you get permission from your doctor, don’t try to be some alpha-aggressive tough ‘guy’ about it - be kind to your body and baby- AND pay close attention to what is going on within your body.

Please forward this to anyone you think needs it and stay tuned for pregnancy based workouts coming to my YouTube channel shortly.

Oh and CONGRATULATIONS! 

References:
*https://www.ncbi.nlm.nih.gov/pubmed/11777528
**https://www.ncbi.nlm.nih.gov/pubmed/20864072
***https://www.ncbi.nlm.nih.gov/pubmed/20887536
****https://www.ncbi.nlm.nih.gov/pubmed/19055653
*****https://www.ncbi.nlm.nih.gov/pubmed/22825089
^https://www.ncbi.nlm.nih.gov/pubmed/22715981
^^https://www.ncbi.nlm.nih.gov/pubmed/19562561
^^^https://www.babymed.com/daily-living/contraindications-exercise-during-pregnancy
 

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