Just found out you are pregnant? This is often a time when women assess their lifestyle, make sure they are eating healthily, getting enough sleep and exercise. But do you know what exercise you should or shouldn’t be doing? A google search on this subject can cause a lot of confusion, there is a range of advice and opinions out there but often these aren’t based on any evidence. Here I review the official guidelines to reassure you that most exercise is completely safe, better still it is encouraged!
The Guidelines
The current UK guidelines were produced as an infographic in 2017, commissioned by the Chief Medical Officers. It is based on a complete review of the research, including the association between exercise in pregnancy and birth outcomes. If you don’t have time to read the whole blog, have a glance over this infographic as it covers all the main points.
Why is exercise recommended in pregnancy?
Research supports starting or continuing with exercise whilst pregnant. It has been shown to improve cardiovascular health (contrary to some myths that this will be compromised) and reduce incidences of insomnia, stress, anxiety, depression, pelvic girdle pain and other musculoskeletal pain, gestational diabetes by 30%, rectus diastasis abdominus (abdominal muscle separation), incontinence and faster postnatal recovery. There are some studies which have shown reduced caesarean and instrument deliveries, a shorter labour, an increase in foetal heart rate and emerging evidence is suggesting long-term cardiovascular benefits for the baby. And contrary to some beliefs there are no adverse effects on the baby in exercising women.
What type of exercise should I do?
We are all different and there is no advice that will fit every pregnant woman. The answer will largely depend on what you were doing before pregnancy, but also how your body is coping. The recommendation is 150 minutes per week of moderate intensity but of course this is not set in stone, it is just a guideline.
If you did no exercise before pregnancy this is a good time to start but you will need to begin gently. Start with 10 minutes and build up. Walking and swimming are a good way to begin improving your cardiovascular health. There are also specific pregnancy exercise classes around such as Pilates and yoga which are ideal as they are low impact. General aerobic classes are also fine but its best to wait until the second trimester. Try to avoid prolonged periods of being sedentary; regular movement is key.
If you were exercising before you were pregnant, you are fine to continue but you my need to make some adjustments. Exercise needs to be moderate, so avoid any intense sessions. The way to judge this is the ‘talk test’ – you should be able to hold a conversation whilst exercising. You should also limit your moderate exercise sessions to less than 45 minutes. You may need to rethink some activities if they are ‘contact’ sports (see below) or if they are causing more pain than normal.
The impact of exercise on joints during pregnancy is often misunderstood. With hormonal changes, ligaments become extra stretchy to allow for the growing baby and to prepare the body for childbirth. However just how stretchy your ligaments become is very individual and will depend on the amount of flexibility you had pre-pregnancy. When I became pregnant I fully intended to keep up my running for as long as possible, however at just 10 weeks I was getting pelvic pain after a gentle run that was very different from my normal post-run aching so made the decision to switch to low impact exercise. The impact on my body was clearly a lot more than some other women who can keep on running pain free. These women probably have a lot more stability through their joints to start with. So there is no standard advice here, it will be an individual experience and you should adjust your exercise to suit you.
What are the risks?
Sensible, moderate exercise comes with no risk. It goes without saying that if there is an increased risk of trauma, it should be avoided, such as gymnastics, water-skiing, off-road cycling, boxing – I think this is all stating the obvious. However a few other things to consider are that during pregnancy balance can be affected, so take care with jumping or one-legged stretching for example. For active women, you should be aware of the changes to your body’s ability to regulate heat. Take care to stay hydrated, avoid humid, hot conditions and do not exercise for more than an hour.
Of course, irrespective of being pregnant, if you feel dizzy, breathless, have chest pain, headaches, swelling or calf pain after minimal exertion you should seek medical advice. And those with pre-existing medical conditions may need to follow different advice.
Lying on your back
Currently UK advice states that you should avoid exercising on your back during the second and third trimester. Any pregnancy specific class will adapt exercises for this reason. Interestingly, Australia recently changed their guidelines on this to the third trimester only, suggesting that there is mixed evidence.
Take home messages
After a review of all the current evidence, there were three key messages:
There are no adverse maternal or infant outcomes for healthy, exercising women in pregnancy
Listen to your own body and adapt activity as needed
Avoid contact sports or activities with risk of trauma
Visit the gov.uk guidance page on physical activity for full information
As always, I am happy to discuss any concerns or answer queries by phone or email, or you may wish to book an appointment