Is it Safe to Exercise During Pregnancy?
Exercise During Pregnancy
Exercise should be an integral part of a woman's prenatal care and is completely safe for most. For woman without contraindications exercise is safe during pregnancy. Before beginning exercise you need to talk to your healthcare provider to ensure regular exercise and physical activity would be safe for you. Receiving the green light as most woman do means you can reap the benefits of exercise. However, it's important to remember to always listen to your body (this will be discussed in further detail momentarily). Let's begin our discussion on exercise during pregnancy.
Pre Pregnancy Exercise and Physical Activity
Being active throughout life has an abundance of health benefits. Exercise can manage blood pressure, blood sugar, improve cholesterol levels, increase bone density and may even help an individual to live longer. Therefore, it is highly recommended by most professional societies (ACSM, AHA, NSCA) to stay active and exercise throughout life. Remember it is never too late to start and even during pregnancy this remains true. While it would not be recommended to begin a new "high intensity" exercise regimen. Engaging in activities such as walking, body weight exercise and swimming are highly recommended. Often times, if a woman is not already engaging in these types of activities, starting to do so could have positive health benefits for both mother and baby (1, 2, 3). If you are already active and exercising regularly, it is typically OK to continue activities performed pre pregnancy - assuming that these activities do not cause negative symptoms such as severe chest pain or excessive shortness of breath (with rest post-activity). The symptoms listed above only skim the surface, therefore it is recommended to talk to your medical professional if anything seems "off". Additionally, engaging in activities that are performed in one or more of the following environments would be recommended to be avoided during pregnancy - a contact sport environment (i.e. hockey), a high fall risk (i.e. ballet or surfing) and/or in hot and humid environments (i.e. hot yoga). These activities only skim the surface - for a full list of contraindicated activities during pregnancy you should ask a medical professional.
Exercise and Regular Physical Activity During Pregnancy
A 2016 systematic review looked at 61 randomized control trials (RCTs) and found that the combination of resistance and aerobic exercise appeared to be most favorable during pregnancy (2). If you are unsure where to start, a 2016 study provided some groundwork. Using the FITT principle they suggested the following, Frequency (3 to 4 times per week), Intensity (appropriate target heart rate zone, rating of perceived exertion scale, or the talk test), Time (start at 15 min progressing to 30 min), and Type (moving large muscles groups such as walking, swimming, and cycling) of physical activity (3). In 2018 the American Congress of Obstetricians and Gynecologists (ACOG) recommended at least 150 minutes of moderate intensity exercise per week (4). These recommendations held true for all pregnancies unless the physician found it to be unsuitable or unsafe for the women to begin or continue her exercise routine.
Additionally, the American College of Sports Medicine recommends that pregnant women engage in physical activity and/or exercise daily, however in cases that this is not manageable the minimum recommended number of days per week is three. And a variety of activities are preferred as this will challenge the body's aerobic, anaerobic, strength and balance systems.
Importance of Warming Up
To reduce your risk of injury, it's important to include a warm-up prior to jumping into any type of exercise. Warming up has been shown to have the following benefits;
1) Faster muscle contractions and relaxation of the agonist and antagonist muscles
2) Improvements in muscular strength and power
3) Lower viscous resistance in muscles and joints
4) Improved oxygen delivery due to the Bohr effect, which translates to a higher oxygen disassociation from hemoglobin within the muscles
5) Increased blood flow to active muscles
6) Increased psychological preparedness for the activity
In summary research shows that warming up prior to exercise can evoke temperature, metabolic, neural and psychology-related effects that improve the physiological, psychological and biomechanical demands that exercise and physical activity place on the body.
Importance of Cooling Down
Including a cool down after exercise is integral part of any exercise program. Exercise is a stressor, and while it is a "good stressor", it is still a stressor none the less. (woah - that is a lot of stress) Therefore, it's important to include a proper cool down and recovery. In a previous blog titled "using breath to de-stress" I discussed the autonomic nervous system (ANS). In summary, there are two major systems that make up the ANS, the sympathetic (fight or flight) and the parasympathetic (rest and digest). As previously discussed during a warm up the goal is to ease into the fight or flight as to avoid "shocking the body". On the other hand, the cool down/recovery is designed to help ease the body back into the rest and digest phase. By winding down, the body can more easily return to baseline which benefits both physical and mental health.
Hydration
Hydration is often an overlooked variable when it comes to maintaining optimal health. Water is often taken for granted until someone becomes thirsty. While it is important to avoid becoming over hydrated, one should not necessarily wait until they have become thirsty to drink. This is especially true during pregnancy as there is an increased demand for water. Throughout pregnancy these increased demands are result of numerous physiological changes that are occurring - such as creation of amniotic fluid and increased blood volume. The exact quantity of water varies from woman to woman, and generally it is recommended to consume more than what you would normally, which normal should be between 8-12 cups of water per day. With that being said, intake during pregnancy should be higher - but how much higher it is sort of unknown. On the other hand, too little water could cause adverse outcomes for both mother and baby - I'm interested to see the results from a 2020 study on 380 pregnant woman which is designed to measure the relationship between hydration status and pregnancy outcomes (5). Data on hydration status during pregnancy is pretty scarce, so this study could be one of the first to show the relationship and thus I can not wait to see the results.
Secondary factors regarding hydration status that will impact fluid intake demands are the environment the individual lives in, exercise and physical activity performed, foods consumed and side effects of pregnancy such as morning sickness resulting in vomiting.
In summary, there is no exact science to the quantity of water that is needed to be consumed during pregnancy. However, one thing is for certain be sure it is the highest quality of water you can find - meaning free from toxins, chemicals, etc that could cause harm to mother and baby.
Health Benefits of Exercise and Physical Activity During Pregnancy
Studies show that regular exercise and physical activity can be used to address an array of symptoms that arise during pregnancy. Exercise has been shown to improve mood, reduce aches and pains, assist with sleep, prevent excess weight gain, and strengthen muscles. While an exercise routine may not be at the top of the prenatal list, for most women it should. As previously mentioned in exercise is extremely beneficial throughout pregnancy - I felt it was necessary to break up the benefits of exercise into four categories, as seen below. In an effort to keep the blog at a reasonable length - I'll do my best keep each category one paragraph or less.
1) Aches and pains
2) Enhanced mood
3) Sleep
4) Miscellaneous benefits
Aches and Pains
Low back and pelvic pain tends to bother most women throughout pregnancy. A 2018 meta analysis found that exercise has a protective effect against low back pain (6). Additionally, exercise was demonstrated to prevent reoccurring low back pain(6). Another common theme is that the frequency, intensity and duration of exercise should tailored to the stage of the pregnancy. Assuming the exercise is done properly (meaning controlled and in the correct form) - research suggests there should be reduced evening pelvic pain or lumbo-pelvic pain more than usual care alone (7,8). Additionally, quite a few studies mentioned acupuncture as an effective method to reduce pregnancy aches and pains specifically - lumbo-pelvic pain, low back pain, and pelvic pain (8,9,10,11).
Enhanced Mood
You may be familiar with the term "runner's high" - the brief euphoric state caused by the body's release of endorphins following a bout of exercise. There are hundreds of peer reviewed articles on the benefits of regular physical activity and mental health. Most of the articles support the use of physical activity to assist with mental health conditions such as depression, anxiety and stress. When checking the database for using pregnant women as the subjects, the database is not nearly as robust. What articles do exist typically cover depression, which demonstrates a positive effect (meaning a reducing effect) on depression throughout pregnancy and postpartum time (12). Additionally, there are a few studies on yoga - which has been demonstrated to be an effective method to reduce anxiety during pregnancy (13, 14). I suspect it's the combination of light to moderate movement and breathwork that reduces feelings of anxiety - regardless of the reason yoga is a wonderful addition to anyone's exercise and physical activity routine.
Sleep
Unfortunately sleep disturbances during pregnancy can happen. No matter the cause, over time not receiving a rest night of sleep could negatively impact both physical and mental health. Fortunately, exercise has been demonstrated to assist in promoting greater continuity of sleep and improving sleep quality (15, 16). However, timing and intensity matters. This is due to the fact exercise stimulates the fight/flight response also known as the sympathetic nervous system. If exercise is too close to bedtime (90 - 120 minutes prior to bedtime) it has been shown to suppress melatonin secretion and thus makes it more difficult to fall asleep. With that being said, a light walk before head should be more than OK.
Miscellaneous benefits
There are quite a few surprising benefits of regular exercise during pregnancy - for example regular movement reduces the risk of constipation. Additional benefits include lower risk of gestational diabetes, shortened labor time, reduced risk of having a C-section, reduced likelihood of being induced (17), lessen likelihood of extra weight gain (18), reduced risk of preterm birth and low birth weight (19).
Conclusion
For most women, the health benefits of regular physical activity and exercise are vast. However, before beginning or maintaining an exercise routine it is paramount to talk to your health care provider to ensure physical activity would be safe for you and future baby. Ideally women should be active daily, if that is not possible at least 150 minutes of moderate intensity activity should be performed weekly. Being safe during pregnancy is key to a success and thus it is recommended to have a warm-up and cool down included within the exercise routine. And above everything is remember to listen to your body - if it is "not feeling right" move onto the next exercise and it is still "not feeling right" - maybe it is time to "call it a day". And of course remember when in doubt of any symptoms during your pregnancy it's always recommended to call your health care provider.
I'd love to learn what exercise and physical activity routines worked for you during your pregnancy!
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References:
1) Moyer, C., Reoyo, O. R., & May, L. (2016). The Influence of Prenatal Exercise on Offspring Health: A Review. Clinical medicine insights. Women's health, 9, 37–42. https://doi.org/10.4137/CMWH.S34670
2) Maria Perales, Alejandro Santos-Lozano, Jonatan R. Ruiz, Alejandro Lucia, Ruben Barakat, Benefits of aerobic or resistance training during pregnancy on maternal health and perinatal outcomes: A systematic review, Early Human Development, Volume 94,64 2016, Pages 43-48.
3) Mottola MF. Components of Exercise Prescription and Pregnancy. Clin Obstet Gynecol. 2016 Sep;59(3):552-8. doi: 10.1097/GRF.0000000000000207. PMID: 27135872.
5) Zhang, N., Zhang, F., Chen, S. et al. Associations between hydration state and pregnancy complications, maternal-infant outcomes: protocol of a prospective observational cohort study. BMC Pregnancy Childbirth 20, 82 (2020).
6) Davenport MH, Marchand AA, Mottola MF, Poitras VJ, Gray CE, Jaramillo Garcia A, Barrowman N, Sobierajski F, James M, Meah VL, Skow RJ, Riske L, Nuspl M, Nagpal TS, Courbalay A, Slater LG, Adamo KB, Davies GA, Barakat R, Ruchat SM. Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis. Br J Sports Med. 2019 Jan;53(2):90-98. doi: 10.1136/bjsports-2018-099400. Epub 2018 Oct 18. PMID: 30337344.
7) Gallo-Padilla D, Gallo-Padilla C, Gallo-Vallejo FJ, Gallo-Vallejo JL. Lumbalgia durante el embarazo. Abordaje multidisciplinar [Low back pain during pregnancy. Multidisciplinary approach]. Semergen. 2016 Sep;42(6):e59-64. Spanish. doi: 10.1016/j.semerg.2015.06.005. Epub 2015 Aug 1. PMID: 26239672.
8) Stuge B. Evidence of stabilizing exercises for low back- and pelvic girdle pain - a critical review. Braz J Phys Ther. 2019 Mar-Apr;23(2):181-186. doi: 10.1016/j.bjpt.2018.11.006. Epub 2018 Nov 17. PMID: 30471967; PMCID: PMC6428920.
9) Gutke A, Betten C, Degerskär K, Pousette S, Olsén MF. Treatments for pregnancy-related lumbopelvic pain: a systematic review of physiotherapy modalities. Acta Obstet Gynecol Scand. 2015 Nov;94(11):1156-67. doi: 10.1111/aogs.12681. Epub 2015 Jun 16. PMID: 26018758.
10) Mühlemann D, Mühlemann MB. Rückenschmerzen in der Schwangerschaft: Diagnose, Behandlungsoptionen, Outcomes [Low Back Pain in Pregnancy: Diagnosis, Treatment Options and Outcomes]. Praxis (Bern 1994). 2015 May 20;104(11):565-74. German. doi: 10.1024/1661-8157/a002014. PMID: 26098153.
11) Martins ES, Tavares TMCL, Lessa PRA, Aquino PS, Castro RCMB, Pinheiro AKB. Acupuncture treatment: multidimensional assessment of low back pain in pregnant women. Rev Esc Enferm USP. 2018 Jun 11;52:e03323. Portuguese, English, Spanish. doi: 10.1590/S1980-220X2017040303323. PMID: 29898168.
12) Perales M, Refoyo I, Coteron J, Bacchi M, Barakat R. Exercise during pregnancy attenuates prenatal depression: a randomized controlled trial. Eval Health Prof. 2015 Mar;38(1):59-72. doi: 10.1177/0163278714533566. Epub 2014 May 28. PMID: 24872442.
13) Field T, Diego M, Delgado J, Medina L. Tai chi/yoga reduces prenatal depression, anxiety and sleep disturbances. Complement Ther Clin Pract. 2013 Feb;19(1):6-10. doi: 10.1016/j.ctcp.2012.10.001. Epub 2012 Nov 24. PMID: 23337557; PMCID: PMC3730281.
14) Davis K, Goodman SH, Leiferman J, Taylor M, Dimidjian S. A randomized controlled trial of yoga for pregnant women with symptoms of depression and anxiety. Complement Ther Clin Pract. 2015 Aug;21(3):166-72. doi: 10.1016/j.ctcp.2015.06.005. Epub 2015 Jun 9. PMID: 26256135.
15) Baker JH, Rothenberger SD, Kline CE, Okun ML. Exercise during early pregnancy is associated with greater sleep continuity. Behav Sleep Med. 2018 Sep-Oct;16(5):482-493. doi: 10.1080/15402002.2016.1228649. Epub 2016 Oct 14. PMID: 27739877; PMCID: PMC6124311.
16) Yang SY, Lan SJ, Yen YY, Hsieh YP, Kung PT, Lan SH. Effects of Exercise on Sleep Quality in Pregnant Women: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Asian Nurs Res (Korean Soc Nurs Sci). 2020 Feb;14(1):1-10. doi: 10.1016/j.anr.2020.01.003. Epub 2020 Feb 1. PMID: 32006719.
17) Ferreira CLM, Guerra CML, Silva AITJ, do Rosário HRV, Pereira MBFLO. Exercise in Pregnancy: The Impact of an Intervention Program in the Duration of Labor and Mode of Delivery. Rev Bras Ginecol Obstet. 2019 Feb;41(2):68-75. English. doi: 10.1055/s-0038-1675613. Epub 2018 Nov 14. PMID: 30428489.
18) Barakat R, Refoyo I, Coteron J, Franco E. Exercise during pregnancy has a preventative effect on excessive maternal weight gain and gestational diabetes. A randomized controlled trial. Braz J Phys Ther. 2019 Mar-Apr;23(2):148-155. doi: 10.1016/j.bjpt.2018.11.005. Epub 2018 Nov 17. PMID: 30470666; PMCID: PMC6428908.
19) Berghella V, Saccone G. Exercise in pregnancy! Am J Obstet Gynecol 2017;216:335–7.