EXERCISE DURING PREGNANCY: WHAT ARE THE RULES?

Alright, this one goes out to you ladies! Whether currently pregnant, or thinking about becoming pregnant, this is a post you will want to pay close attention to.

Maybe even print it off and post it on your mirror at home

…and of course, subscribe to this blog for more content (shameless plug, I know)…

So, where did this conversation regarding exercise during pregnancy start?

Roughly 60 years ago, the conventional viewpoint of research was that women should refrain from most high-level structured physical activity, sticking with simple gardening, housework, walks, etc. for their daily exercise.

With high activity, blood flow in the mother’s body is re-routed largely to her muscles and some organs (such as the heart and lungs), which takes away some amounts of oxygen from the fetus.

There were concerns that this could have negative implications on the fetus.

However, though the physiology behind that approach remains true, the research produced in the last 20 years has proven the negative implications to not necessarily be as severe as first believed.

Furthermore, the research has even suggests that it is unhealthy to NOT exercise while pregnant.

ALL INFORMATION HAS BEEN TAKEN FROM RECOMMENDATIONS VIA THE ACOG AND ACSM FOR GUIDELINES TO EXERCISE DURING PREGNANCY

ACOG - AMERICAN COLLEGE OF OBSTETRICS AND GYNECOLOGY

ACSM - AMERICAN COLLEGE OF SPORTS MEDICINE

Now don’t let Hollywood try and fool you…as a male, I can never get pregnant.

Ultimately I cannot and never will know the stressors or feelings of pregnancy. Thus, I don’t know the most pressing questions that pregnant women have regarding exercise and general health during those magical 9 months.

But what I can do is present you with what I believe to be the most important points that you should know as a someone who is either currently pregnant or planning to be pregnant and is interested in beginning or maintaining and exercise program.

Without further ado, let’s jump into it!

WHAT ARE THE BENEFITS OF EXERCISING WHILE PREGNANT?(1, 2)

Exercise can prevent gestational diabetes, an ailment in which the mother develops diabetes during the middle of pregnancy, resulting in a host of associated risks to the fetus, such as low birth weight, elevated risk for cardiovascular disease, and increased risk for childhood obesity.

Exercise decreases the risk of preeclampsia. Preeclampsia is a condition in which there is an unexplained increase in the mother’s blood pressure, commonly resulting in swelling of the feet and hands, liver and kidney damage, and significant effects on blood flow to the fetus.

Exercise reduces the risk of low birth weight for the baby. Low birth weight can result in a vast array of complications for the baby, due to their body not being big enough or strong enough to fight off what would be routine stressors to a typical sized baby.

Exercise reduces the amount of unhealthy maternal weight gain. Weight gain for a mother during pregnancy is 100% normal. In fact, it is reported that roughly 20-30 lbs of weight is entirely normal to gain during pregnancy, sometimes more (3).

However, I can’t stress enough that weight gain is HIGHLY variable from mother to mother, thus you should not be concerned if you are gaining a little more than 30 lbs.

Now ladies, I get that you have cravings and such, so please don’t rain down your arrows at me. But, weight gain of 40 or 50 lbs or more is generally not healthy (again, highly variable from mother to mother).

So if at all possible, maybe try to limit the 2 am ice cream grocery store runs…and note that as I say this, my wife is currently yelling at me from the other room to mind my own business.

As you begin to gain weight, it is absolutely crucial that you not increase your workout intensity in attempts to lose that weight. As you can read in the recommendations, increasing your exercise intensity is directly against the recommendations of ACOG and ACSM.

Exercise has significant positive effects on mood, reducing the rate of partum or post-partum depression. This, however, is not a fact that is exclusive to pregnant women.

Don’t worry, I will be detailing exercise’s effects on mental health more deeply in the coming posts.

So, you should definitely subscribe (another shameless plug…I know).

WHEN IS EXERCISE UNSAFE DURING PREGNANCY?(1, 2)

Exercise can be unsafe if you have heart or lung disease. If you are someone who has conditions such as these, you absolutely should not begin to exercise until you consult with your physician.

They will most likely instruct you to refrain from all exercise, or, at the least, limit you to very-low intensity exercise program.

Exercise can be unsafe if you are experiencing cervical insufficiency or weakness. When your cervix is weakened and begins to widen, it can actually result in a multitude of severe problems such as incontinence or early-trimester miscarriage or delivery.

If your physician has discussed cervical insufficiency with you, they may have discussed limitations to your physical activity levels as well.

Exercise can be unsafe in cases of placenta previa, especially after 26 weeks of pregnancy. Placenta previa is a condition in which the placenta is placed dangerously low in the uterus, at times even covering the opening of the cervix itself.

Exercise can be unsafe if you are experiencing preeclampsia. We have already discussed the effects of preeclampsia above.

Now you may be saying “whoa whoa whoa, I thought exercise was supposed to reduce my risk for preeclampsia”. Well, yes, it is.

However, if you develop high blood pressure from preeclampsia prior to beginning exercise, it is absolutely crucial that you consult with a medical professional before your new program begins.

Additionally, this is why it is so important to begin exercising (SAFELY, mind you) early on in the pregnancy, as to reduce the risk for developing preeclampsia.

Exercise can be unsafe if you are highly anemic. If you are indeed anemic, then you will most likely have already been educated by your physician on the fact that you have lower levels of oxygen in your blood.

Naturally, if you have low levels of oxygen in your blood, then your fetus in the womb will have low levels of oxygen delivered to it.

When you exercise, you have slightly more blood re-routed to your muscles and organs, taking some blood away from the fetus momentarily.

Though this effect alone is not necessarily dangerous (as we have seen above), when combined with already lowered levels of oxygen delivery to the fetus, it can at times put the fetus at unnecessary risk.

ARE THERE ANY TYPES OF EXERCISES TO STAY AWAY FROM? (1, 2)

According to the guidelines from ACOG and ACSM, there are only a handful of exercises that should be removed from your workout program.

Refrain from any exercises that come with an obvious risk for abdominal trauma. For example, you probably shouldn’t be participating in any community football games while pregnant. Really any contact sport is highly frowned upon.

Following the trend of avoiding trauma, you should avoid exercises which might cause you to lose balance and fall. For example, outdoor cycling, skiing (water or snow), jumping activities, or any exercises that might be accompanied by a risk for taking a tumble should be removed from your workout program.

Avoid any kind of exercise that requires you to be in extreme temperatures, especially extreme heat and humidity.

For example, we all love yoga, and it is highly recommended when pregnant, but avoiding “hot yoga” is crucial. Intense levels of heat can have a variety of negative effects on the fetus.

This being said, you should additionally be wary of exercising in environments of extremely hot temperatures or high humidity levels.

It is critical that you hydrate before, during, and after exercise to ensure proper hydration and temperature regulation.

Avoiding activities that include highly jerky, bouncy, or high impact movements is recommended. When pregnant, the enormous influx and sway of hormones causes the ligaments of your body to become slightly more lax, which results in less stability to your joints.

When you perform high impact exercises of jerky or bouncy quality, you risk damage to the joints…and yes, I’m talking to you crossfitters…

But in all seriousness, those that participate in Crossfit should be cognizant of the risks associated with that type of exercise, and thus may want to decrease the intensity level of their workouts.

In fact, I plan on writing an additional post in the future specifically tailored to pregnancy and Crossfit, so you should subscribe if you want to read more on that....(oh yeah, I’m full of shameless plugs today).

A general recommendation is that you should not exercise at intensity levels in which you are no longer able to audibly formulate a simple sentence. If you are running, lifting, or stretching at an intensity that causes you to be unable to speak (wow that would be some crazy stretching), there is a chance you are not getting sufficient oxygen in your system.

As you exercise, your breathing rate increases. This is completely normal. However, if the change in your breathing is so high that you are unable to say words out loud, then there is a chance that you are working out at an intensity level that is too high.

As the 2nd trimester nears, avoid exercises that require you to lie flat on your back. When lying on your back, the new fetus in your womb can apply undue pressure on a major abdominal vein located behind the uterus, sometimes obstructing this blood vessel.

If you remember from your anatomy classes in school, veins return blood from the body back to the heart. Thus, if you cut off the flow of this major vein, your heart won’t receive a significant amount of the systemic blood flow returning to it.

Anatomy 101: If your heart isn’t receiving blood, then your heart isn’t going to be pumping blood either. Thus, occlusion of this vein can have significant negative impacts on both maternal and fetal blood flow.

SO WHAT ARE THE KEY TAKE HOME POINTS? (1, 2)

1. For those of you who were relatively sedentary prior to becoming pregnant, it is completely safe to begin a new program. Just be sure to consult with your physician and choose low-level aerobic and resistance training exercises to begin with.

Be sure not to progress the intensity of your workouts too quickly, and of course refrain from any of the dangerous activities mentioned above.

2. For those of you who were highly active before becoming pregnant, it is completely safe to maintain your current workout program. However, be sure that you are not increasing your intensity of exercises.

As you progress throughout the pregnancy, you may even need to lower the intensity slightly, especially in the 2nd and 3rd trimesters.

And as always, be aware if any of your specific exercises fit the criteria of the risky exercises listed above.

3. Keep in mind that high-level, high-intensity lifting programs are still not 100% cleared of risks. The research that is out there is not yet conclusive to fully clear heavy lifting exercises, due to the unknown effects on fetal blood flow.

That being said, there isn’t enough evidence either way to say that heavy lifting is good or bad when pregnant, thus use common sense judgement, following the ACOG and ACSM guidelines as closely as possible.

However, what IS known about lifting exercises is that you should never (and I mean NEVER EVER) use the valsalva maneuver to “brace” when lifting.

The valsalva maneuver is that funky breath holding technique that you see some people using at the gym, where prior to lifting, they will inhale fully and then hold their breath as they push the bar up as hard as possible.

Essentially, if you’ve ever seen those dudes at the gym with puffed out cheeks and tomato-red colored faces as they are doing bicep curls, they are most likely performing the valsalva maneuver.

This maneuver is highly, highly dangerous and compromising to fetal blood flow.

4. Be aware of some common signs that indicate you should immediately cease exercise and contact your physician.

The ACOG states that you should look out for vaginal bleeding, faintness or dizziness, shortness of breath or chest pain prior to/during exercise, significant headache, painful contractions of the uterus, and fluid leaking from the vagina (1).

Should you experience any of these during or as a result of an exercise session, it is absolutely critical that you cease all exercise and contact your physician.

5. Finally, as a general rule, the ACOG recommends that you attempt to achieve roughly “150 minutes of moderate intensity aerobic activity" per week, preferable spacing that activity out equally over the 7 days(1).

This recommendation is not that dissimilar to the recommendations given to normal, non-pregnant individuals. Actually, it’s not dissimilar at all.

The ACSM recommends 150 mins of moderate intensity aerobic activity to all individuals (depending on health status, of course).

There you have it, a simple guide to the basics of starting or maintaining an exercise program during pregnancy. As you have hopefully garnered from this post, it is important that you SAFELY begin exercising (really whether pregnant or not), as there are countless benefits for you and your baby.

And as always, this post is not meant to be medical advice. You should specifically consult with a health care professional with experience in developing working programs prior to exercising while pregnant.

Everyone is different, and your physician may have a few exercise concerns given your medical situation.