Pregnancy Exercise

Prenatal Fitness

Being fit and healthy may sound like too much to worry about when you are pregnant, but don't think of it as an option. Staying healthy increases your chances of remaining low-risk. Being low-risk allows you the most options possible for labor and giving birth.

Benefits

A 1992 study by Lois Jovanovic-Peterson found that mothers who were experiencing gestational diabetes could lower their blood sugar levels to the point that they no longer needed insulin shots by doing aerobic exercise for 20-30 minutes three times a week.

Dr. Tanya K. Sorensen reported in a poster session at the 2002 annual meeting of the Society for Maternal-Fetal Medicine that vigorous exercise during pregnancy appears to reduce the risk of pre-eclampsia.

As for labor, a study reported in the Family Practice Research Journal in 1991 showed that mothers who exercised 20 minutes three times a week for at least 20 weeks of their pregnancy had shorter second stages and fewer complications during labor than mothers who didn't exercise.

James Clapp, M.D. reported in 1996 that women who exercised during pregnancy had their babies an average of 5 days earlier than non-exercisers and had less need for medical intervention. In his paper to The American Journal of Sports Medicine he stated, "The active phase of their labors is about 2 hours shorter, clinical and laboratory evidence of fetal stress is decreased, and the incidence of operative delivery (forceps or cesarean section) is reduced from 48% to 14%. "

Staying fit and healthy can also improve the outcomes for your baby. In 1993 Maureen C. Hatch and her coworkers at Columbia University in New York City found that mothers who exercised tended to have bigger babies, which can mean that the babies are better fit to handle illnesses.

In a 1997 study out of Case Western Reserve University in Cleveland James Clopp, M.D. found that by age 5, the babies of mothers who exercised for at least 30 minutes three times a week had lower levels of body fat and scored higher on the Wechsler test of general intelligence and coordination as well as on tests of oral language skills.

In 2003 Dacosta and colleagues published a study in the Journal of Psychosomatic Obstetrics and Gynecology showing that mothers who exercised during pregnancy reported less depression, daily hassles, state-anxiety and pregnancy-specific stress while in the first and second trimesters.

Exercise is also good for your brain. One study comparing an exercise program of swimming 20 minutes per day five times per week found the pregnant rats who exercised had less reduction in their long-term memory.

Changing Body Mechanics for Pregnancy

During pregnancy, your body must adjust to the many physical changes to carry the load of your body and your baby. As your uterus grows, your center of gravity is changed. In addition, your pelvic floor is under increased stress to support the growing weight of the uterus. As your pregnancy progresses, you will find your joints loosen in response to hormones. These changes make good posture key to comfort and fitness.

In response to the changing center of gravity, many women hyper-contract the back muscles by pulling the shoulders back. This posture shortens and weakens the back muscles while stretching and weakening the muscles of the stomach. Strong abdominal muscles are needed to support the torso and maintain digestion. Weakened muscles in the torso cause back pain and increase overall discomfort in pregnancy because the bones and joints are under increased strain without the strong muscles supporting the torso. Further discomfort can arise if the pelvic floor is allowed to lose its tone, misaligning the pelvic structures.

Whole Body Fitness

There are three types of activity important for your overall fitness. Cardiovascular or aerobic training, strength training and flexibility training.

Cardiovascular training

This is the rhythmic movement of large muscle groups such as walking and running, swimming, biking, dancing or playing sports. This type of activity helps keep your circulatory system healthy, increases your endurance, helps maintain a healthy weight by burning calories and speeding your metabolism and improves the way you feel. You should participate in these types of activities three or four days a week for 20 minutes at a time for general health maintenance. For weight loss after your baby is born you will want to be active 4 or more days a week working up to 45 minutes of activity each time. Be sure to work at a pace allowing you to maintain a conversation to ensure proper intensity.

Strength training

This is the intentional working of specific muscle groups to improve their ability such as working with free weights, exercise bands, or Pilates. This type of activity helps build bone mass, increases your muscle mass which will increase your resting metabolic rate and tones the body for an overall slimmer appearance. Be sure to start with a weight level comfortable for you and allows you to complete 8 repetitions with proper form. You can build your strength to allow you to complete more repetitions or sets of repetitions. Aim to exercise each muscle or group of muscles twice a week, allowing two days between strength training.

Flexibility training

This is the intentional stretching of muscles and muscle groups such as yoga or the stretching done before a workout. This type of activity decreases your risk for injury, helps prevent muscle soreness, promotes relaxation and increases your circulation. Stretch to the point of comfort, holding the stretch for 10 to 30 seconds while breathing normally. Do not overstretch, which can cause injury. Be sure to stretch all the major muscle groups three times a week.

Your pregnancy fitness routine should address the issue of posture and support for the changing abdomen. Include exercises which strengthen the abdominal muscles without adding excessive pressure (which can cause diastasis recti). In addition, include pelvic floor exercises to keep the pelvic floor strong and tone.

The physical demands on your body during pregnancy increase fatigue. Cardiovascular exercise is an essential element in maintaining or improving your stamina during pregnancy. Not only will it give you more energy while pregnant, the extra endurance may help you manage pain during labor.

In addition to keeping the body comfortable and properly aligned during pregnancy, your fitness program should increase the strength and flexibility the muscles you will need for labor. Abdominal breathing exercises will help you strengthen your diaphragm, a muscle used for breathing during first stage and involved in pushing during second stage. Squatting moves will improve the flexibility and strength of your legs and hips, preparing them for good 2nd stage pushing positions.

Continuing Workouts While Pregnant

Unfortunately, most women decrease thier activity during pregnancy. While women report an increase in time spent walking, it is off-set by an overall decrease in the amount of time spent exercising and the overall intensity level of the exercise.

Most healthy women should be able to continue a pre-pregnancy fitness routine with a few adjustments. There is currently no indication a woman should limit her intensity or lower her target heart rate to avoid adverse effects. However there are some cautions you should be aware of.

Avoid exercise while lying on your back after the first trimester. This position can reduce your heart rate and decrease the flow of blood to your baby. Look for alternative exercises or alternative positions for favorite exercises. You may find working while reclining at a 45 degree angle on a ball a good substitute for arm exercises previously done while on your back.

Listen to your body to determine intensity and when to rest. Your increased demands for oxygen while pregnant can cause you to feel "out of breath" sooner than you did pre-pregnancy. If you begin to feel tired, modify the exercise or take a rest. If you can not hold a conversation while exercising, the intensity is too high.

Avoid any activity that risks abdominal trauma, such as downhill skiing and contact sports.

Make sure you eat enough to stay healthy. Pregnancy uses 300 extra calories a day.

Stay hydrated and wear appropriate clothing to prevent over heating. This is most important during the first trimester when excessive temperatures can cause neural tube defects for your baby.

Prepare for your balance to change as your center of gravity shifts. Adjust your workout to give you good support, especially with single leg exercises.

Also, make sure you are familiar with the contraindications to exercise, and modify your routine around any other health conditions you may experience during pregnancy (such as increased blood pressure).

References

Amezcua-Prieto, C., Oledo-Requena, R., Jimenez-Mejias, E., Hurtado-Sanchez, F., Mozas-moreno, J., Lardelli-Claret, P. And Jimenez-Moleon, J.J. (2013). Changes in leisure time physical activity during pregnancy compared to the prior year. Maternal and Child Health Journal, 17(4):632-638.

Exercise Builds Big Babies American Journal of Epidemiology, May 1993; cited in AAP News, Sept 1993, p. 2)Science News, 7/17/93, Vol. 144 Issue 3, p36, 1p

Bean, Adam 1997 Running Mom = smart kid. Runner's World 32:6 p28

Clapp, James F. 1996 The effect of continuing regular endurace exercise on the physiologic adaptations to pregnancy and pregnancy outcome. (Third IOC World Congress on Sports Sciences) The American Journal of Sports Medicine 24:6 p 28(2)

Kim, K., Chung, E., Kim, C.J., Lee, S. (2012). Swimming exercise during pregnancy alleviates pregnancy-associated long-term memory impairment. Physiology & Behavior, 107(1):82-86.

Physical activity during pregnancy improves psychological well-being Obesity, Fitness & Wellness Week, Sept 6, 2003 p6

Walsh, Nancy 2002 Prenatal Exercise Cuts Peeclampsia Risk by 34%. Family Practice News 32:12 p 33

Diabetes in Pregnancy? Pump Iron not Insulin Health, Oct92, Vol. 6 Issue 6, p17, 2p