What exercise should I do in Pregnancy?
As a physio specialising in womens health I’m asked this question a lot. There’s loads of information online and stacks of opinions out there as to whats right and wrong in pregnancy so I’ve taken a look at the official advice from the Department of Health (DoH) in the UK, the American College of Obstetrics and Gynaecology (ACOG) as well as the recently published Canadian Guidelines for those of you with a straight forward pregnancy. If I’m totally honest most women I see want to do more rather than less… what was it one of my pregnancy clients said? If I want to ride my horse I’m just going to google “how to ride my horse safely in pregnancy”. Now thats another discussion…
The key benefits to exercising in pregnancy
Most of us know the benefits of exercise in pregnancy. The proven benefits are improved cardio-vascular fitness, lower weight gain, and a lower risk of developing pregnancy related diabetes. Its also thought to help with back pain and improved mood as well as easing constipation and helping you lose weight after you baby is born. Physical activity hasn’t been shown to effect the size of the baby or increase the risk of preterm birth.
So in what circumstances is exercise unsafe?
Firstly, lets look at the conditions or pregnancy complications which mean exercise is deemed UNSAFE:
Certain types of heart and lung diseases
Cervical insufficiency (structural problem with the cervix related to premature birth)
Being pregnant with twins or triplets (or more) with risk factors for preterm labor
Placenta previa (low lying placenta) after 26 weeks of pregnancy
Early labour or ruptured membranes (your water has broken) during this pregnancy
Preeclampsia or pregnancy-induced high blood pressure
Recurrent pregnancy loss
Eating disorders or malnutrition
History of spontaneous pre-term birth
The infographic at the top of the page is from the Department of Health and illustrates the latest UK guidelines we have on physical activity in pregnancy. It recommends 150 minutes of ‘moderate activity’. Whats moderate? Well its exercise that makes you breathe faster while still holding a conversation, but not sing!
Courses I’ve been on have recommended not to start anything new in the first 12 weeks so if you’re already doing it you should be fine to continue. The DoH doesn’t suggest this, it just says to start gradually.
No detrimental effects have been seen with light to moderate muscle strengthening and so the recommendation is the same as the adult guidance- pregnant women should perform 8-12 reps of muscle strengthening activities x2 per week.
There is a lack of evidence around strenuous strength training for pregnant women.Vigorous activity is not recommended within the infographic because there was insufficient evidence to support it. The suggestion is to adjust activity to find the most suitable and comfortable for them. ACOG suggest if you were very active before pregnancy, you can keep doing the same workouts with your health care professional’s approval. However, if you start to lose weight, you may need to increase the number of calories that you eat.
What exercise to avoid during pregnancy?
Quite simply you want avoid activities putting you at increased risk of injury- hence the DON”T BUMP THE BUMP slogan from the DoH. Here’s a list to avoid:
Contact sports and sports that put you at risk of getting hit in the abdomen, including ice hockey, boxing, soccer, and basketball
Activities that may result in a fall, such as downhill snow skiing, water skiing, surfing, off-road cycling, gymnastics, and horseriding
“Hot yoga” or “hot Pilates,” which may cause you to become overheated
Activities performed above 6,000 feet (if you do not already live at a high altitude)
Lying on your back after the first 12 weeks due to increased risk of reduced cardiac output and orthostatic hypotension (this is included in the UK guidelines but not the American) My experience of this is most women are fine in this position for a short time BUT I always give them an alternative. The Canadian advice is to avoid supine (laying on your back) if a pregnant woman is light-headed, nauseous or feels unwell.
If you’re not already active before your pregnancy avoid running, jogging, racquet sports and strenuous strength training due to a reduced capacity to cope with exercise intensity.
What are warning signs that I should stop exercising?
Stop exercising and call your a member of your health care team if you have any of these signs or symptoms:
• Vaginal bleeding
• Feeling dizzy or faint
• Shortness of breath before starting exercise
• Chest pain
• Muscle weakness
• Calf pain or swelling
• Regular, painful contractions of the uterus
• Fluid leaking from the vagina
All women with an uncomplicated pregnancy and who have no pre-exisiting health problems should be physically active in their pregnancy
You should aim to accumulate at least 150 minutes of moderate intensity exercise for meaningful benefit.
Being active every day is encouraged, ideally x3 per week
Exercise should incorporate a variety of aerobic and resistance training exercise. Gentle stretching may also be of benefit.
Pelvic floor exercises can be added daily to reduce the risk of leaking.
If you feel light-headed, nauseous or unwell lying on your back you should change position.
SO LISTEN TO YOUR BODY, there will be times when you’re tired or uncomfortable. Just do what you can and get back to it when you can. It might feel like an age but you will get back to your former self.
If you have pregnancy or medical complications you will need specialist advice. I’m not a no pain no gain person. If you’ve been crazy busy then don’t stress your body more, adapt your workout and do something that makes you feel great. Light a candle, lay on your bed and take 10. Maybe do some mindful breathing, gentle stretches and replenish the system. Remember you won’t be pregnant forever!
Mottola M et al (2018) Canadian Guideline for physical activity throughout pregnancy. Br J Sports Med 52: 1339-134
Liz is a Womens Health Physio and Stott certified Pilates instructor. If you would like more information on what exercise is right for you, or you’re struggling with pregnancy related pain book to see Liz for a Pregnancy Pitstop or join her in Pregnancy pilates.
She works from New Energy Fitness in Winchester on Wednesdays 930-4 & Fridays 930-1230. Her Pregnancy Pilates classes are held in Shawford Hall just outside Winchester.