PREGNANCY
Gynaecology (10), lists a host of benefits including maintenance of cardiovascular fitness, muscle length and flexibility, a healthy weight, improved circulation, co-ordination and body awareness and assistance in post-natal recovery. It may also help in the preparation for labour and has been linked to a reduced rate of gestational diabetes.
These benefits can only be good for the baby as well. Studies to date show no increase in adverse neonatal outcomes associated with maternal exercise (11). Furthermore clinical evidence of stress in newborns (e.g. APGAR scores, baby heart rate) is less in women who exercised at around 50% of preconception level throughout pregnancy. Simply exercising or attending a class may also be beneficial psychologically. Exercise participation has been linked to an improved subjective pregnancy experience, self confidence and body image (12).
It is too often forgotten that a pregnant woman still benefits from the commonly described effects of exercise! These benefits include improved oxygen transfer to the heart and brain, as well as exercising muscles, boosts to the immune system, maintenance of good posture and general wellbeing.
What precautions should be observed? The best advice should be practical, useful, individual and adaptable. General exercise should be conducted in a cool, well-ventilated environment, with access to water and while wearing natural fibre clothing to allow the skin to sweat (13). These recommendations are to help avoid overheating, as a maternal core temperature of > 39.2o Celsius has been considered teratogenic (could lead to abnormalities).
gentle stretching, regularly changing positions and following the adage ‘little and often’.
Who should NOT exercise in pregnancy? While most women can, and should, exercise safely throughout pregnancy there are some who may need extra monitoring and guidance (relative contraindications) and those who should not be allowed to continue (absolute contraindications).
Relative contraindications to exercise in pregnancy l Severe anaemia
l Unevaluated maternal l Extremely cardiac arrhythmia l Chronic bronchitis
l Poorly controlled type 1 diabetes
underweight
l History of an extremely sedentary lifestyle
C
The RCOG (14) guidelines are quite prescriptive, instructing women to keep their heart rate to 60-70% of their age-adjusted max. This could be difficult if the woman did not know her HR maximum and/or if she was previously fit, as she may find this level produces no effect. They also state to begin with 15 minutes x 3 a week, progressing to 30 minutes daily.
First trimester During the first trimester, reduced blood pressure can increase the risk of fainting. Tiredness and nausea are also common. Hormones are already having an impact. Warning about the effect of these changes is necessary.
The foetus however is still protected by the pelvic ring meaning most sports and exercise positions are considered safe.
Second trimester Women are often beginning to feel better now. Nausea and tiredness (usually) wear off and blood pressure may return to more normal limits. The foetus is higher and larger now and has to be considered with exercise prescription and position.
Third trimester Women generally feel more cumbersome and tired. Fluid retention may become pronounced and restrictive particularly in the extremities. Prolonged standing can become a problem, fluid can pool in the feet and lead to an increased risk of fainting, dizziness and falls. The focus for women may become more about relaxation,
www.exerciseregister.org
Absolute contraindications to exercise in pregnancy l Haemodynamically significant heart disease l Restrictive lung disease l Incompetent cervix l Multiple gestation at risk for premature labour l Persistent 2nd or 3rd trimester bleeding l Placenta previa (low lying) after 26 weeks gestation l Premature labour during current pregnancy l Ruptured membranes l Pre-eclampsia or pregnancy induced hypertension
What should we be prescribing? Gentle cardiovascular exercise is important. What is chosen should reflect the woman’s past history and current desires. Walking and swimming are commonly advocated as safe and beneficial from the beginning to the end of pregnancy.
Specifically excluded sports (15) include heavy weights, scuba diving, downhill skiing, horse riding, gymnastics and martial arts. Limited contact sports are considered safe in the first trimester and possibly into the second (e.g. netball, racquet sports), while potentially unlimited contact sports are safe only in the first trimester (e.g. basketball, soccer). Impact sports such as running also carry a theoretical increased risk to the joints, secondary to increased ligamentous laxity. Again my advice usually centres around the woman’s enjoyment, pain and comfort levels.
Post-natal exercise The first question, usually, is when can I resume exercising? The answer is dependent upon the woman, the events of labour and a medical all-clear at 6 weeks. As a fitness professional, it is vital to ascertain the method of delivery and any complications that had arisen, to mother or baby. Testing for a rectus diastisis is also easy and important. In crook lying, instruct her to lift her head
“The best advice should be practical, useful, individual and adaptable”
19
l Extreme morbid obesity
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