PREGNANCY & EXERCISE
PREGNANCY & EXERCISE:
Exercise recommendations during pregnancy remain consistent with those of healthy adults, as long as there are no obstetric or medical complications. All pregnant women should consult with their physician prior to beginning an exercise program and should be educated on warning signs to know when to stop exercise.
Benefits to exercise during pregnancy (5)
○ May reduce the occurrence of pre-eclampsia
○ Improved risk factors for gestational diabetes, such as excessive weight gain and glucose intolerance
○ May reduce the occurrence of urinary incontinence with pelvic floor muscle strength training
○ Reduce depression
○ May prevent chronic musculoskeletal conditions associated with pregnancy, such as pelvic girdle pain and low back pain
Absolute Contraindications to Exercise (5)
○ Heart problems
○ Restrictive lung disease
○ Incompetent (week) cervix
○ Multiple gestations at risk for premature labor
○ Persistent vaginal bleeder
○ Placenta previa after 26 weeks
○ Premature labor during the current pregnancy
○ Ruptured membranes
○ Preeclampsia
○ Health conditions such as hypertension and intrauterine growth retardation
Exercise Guidelines (3)
○ 30 min of moderate intensity aerobic exercise at least 3-5x/week (such as walking, running, swimming, stationary cycling)
○ 2-3 days of strength training. Due to joint laxity 10 reps (<70%1RM) is recommended to avoid joint-related stress.
○ At least 2-3 days of flexibility exercises (such as yoga, Pilates)
○ Intensity based on prior level
■ Previously sedentary: mild to moderate
■ Previously active: moderate to high
○ During second trimester RPE can be significantly underestimated.
■ If an athlete is trying to stay at a safe intensity, and HR monitor is recommended to calculate
○ Screen for diastasis recti regularly when implementing core exercises
Warnings Signs to Terminate Exercise Session (5)
○ Vaginal bleeding
○ Muscle weakness
○ Dyspnea before exertion
○ Dizziness
○ Headache
○ Chest pain
○ Calf pain or swelling
○ Preterm labor
○ Decreased fetal movement
○ Amniotic fluid leakage
Exercise Considerations (3)
○ Avoid exercises with increased risk of falling and contact sports (e.g. soccer, basketball, horseback riding, snowboarding, scuba-diving)
○ Avoid supine exercises after week 16 as pressure from the fetus resting on the vena cava can lead to reduced venous return and lead to orthostatic hypotension.
○ Women should avoid breath holding. Women should be taught to exhale during the concentric portion and inhale during the eccentric portion of exercise.
Thermoregulatory adaptations and recommendations (1)
○ Avoid exposure to increased temperatures (body temperature 103 deg F) during neural tube development (35-42 days)
○ Strenuous exercise in a hot and humid environment should be avoided
○ Moderate exercise (VO2max 60-70%) for 60 min in a controlled environment does not increase core body temp above 100.4 deg F
Competitive and elite sports (2)
○ Competing in competitive and elite sports is safe as long as the sports do not have a high potential for contact or falling (i.e. ice hockey, soccer, horseback riding, gymnastics, skiing, etc.)
References
(1) Bø K, Artal R, Barakat R, et al. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1—exercise in women planning pregnancy and those who are pregnant. Br J Sports Med 2016;50:571-589.
(2) Erdener U, Budgett R. Exercise and pregnancy: focus on advice for the competitive and elite athlete. Br J Sports Med. May 2016. 50:10.
(3) ACSM’s Guidelines for Exercise Testing and Prescription. 10th ed. Lippincott Williams & Wilkins; 2018
(4) Physical activity and pregnancy. Physiopedia.https://www.physio-pedia.com/Physical_Activity_and_PregnancyAccessed May 2, 2019
(5) 2019 Canadian Guideline for Physical Activity throughout Pregnancy. CSEP. 2019.
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