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Ultimate guideline for exercise during normal pregnancy

Despite the benefits of exercise during pregnancy, the majority of pregnant women do not exercise and many of those who do fail to follow guidelines putting themselves and the fetus at risk. It is important that women and professionals know the guidelines 

Pregnant woman during a routine of exercise

Pregnant woman during a routine of exercise / Reference image / Pixabay

LatinAmerican Post Staff

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Pregnancy is the ideal opportunity to adopt a healthy way of living if this has not been done previously. Behavioral changes, such as cessation of smoking, reduction of alcohol and caffeine intake, improvement of dietary habits, and physical exercise all contribute to both the improved health of the mother and optimal fetal development. 

Leer en español: Guía para ejercitarte durante el embarazo

A group of researchers reviewed a substantial number of scientific studies on the relationship between pregnancy and exercise and recently published their review in the journal Hormones.

In general, the reports titled “Guidelines for exercise during normal pregnancy and gestational diabetes: a review of international recommendations” states that scientific studies have shown that regular exercise is beneficial for maternal and fetal health. 

Specifically, the main benefits for the pregnant woman include improvement of physical condition, control of body weight, shorter duration of labor, quicker recovery after childbirth, prevention of health conditions such as gestational diabetes, pregnancy-induced hypertension and pre-eclampsia, and reduced risks of premature birth.

Also, some of the reviewed studies showed psychological benefits for the pregnant woman who adopts an exercise program, such as reduction of anxiety and depression, as well as an improved sense of well-being. An essential fact that concerns long-term health is that women who systematically exercise during pregnancy have a 75% higher probability of continuing exercise after delivery.

Concerning the fetus, because regular exercise reduces the mother’s body fat, this enhances the transfer of oxygen and reduces the diffusion of carbon dioxide through the placenta, thus having a positive impact on fetal development. 

The report also showed that exercise during pregnancy improves the resistance of the fetal arteries and reduces the risk for any heart condition during later life. In addition, sounds and vibrational stimuli accompanying exercise can accelerate the development of the fetal brain. There is evidence that the offspring of mothers who exercised during pregnancy score higher in IQ tests and exhibit higher verbal abilities at the ages of 1 and 5 years.

A number of international organizations recommend exercise during pregnancy, provided there are no complications during the gestational period. However, despite these recommendations, the majority of pregnant women do not exercise and many of those who do fail to follow recommended guidelines putting themselves and the fetus at risk.

For example, in the USA and Norway, 56 and 59% of pregnant women, respectively, exercise; in Canada, this percentage is as much as 85%. On the other hand, in the USA and Canada, although women do exercise, only 23% of them actually follow the suggested guidelines, while in Norway, the rate is also low, at 28%. In the following sections,  the guidelines to follow if exercising while pregnant.

Before starting the exercise program

Before a woman starts a systematic exercise program, a full checkup must be performed to determine possible medical or obstetric contraindications. The exercise must be adjusted to the needs of the pregnancy and personalized according to the needs of each woman. 

Useful tools for the prescription of exercise are questionnaires, filled in by the pregnant woman, physician, and trainer, such as the Adult Pre-Exercise Screening System (APSS) and the Physical Activity Readiness Medical Examination for Pregnancy (PARmed-x for Pregnancy), which are recommended by the Canadian Society for Exercise Physiology (CSEP). The questionnaires collect useful information on the woman’s medical record before and during pregnancy, her level of physical condition, and her daily activities and obligations. This information makes the planning of the program more well-grounded. Most of the questionnaires are public and searchable online.

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General instructions for designing prenatal exercise programs

The report lists what is advisable and what is not advisable to include in your exercise program.

 

It is advisable to include the following activities:

• Gradual warm-ups and cooldowns to enhance circulation and prevent blood pooling

• General muscle strengthening, focusing on muscles such as pelvic floor and core

• Modified programs of muscle strengthening

• Modification of exercises from the supine or standing position, such as “four-point kneeling,” sitting on a fitness ball, and lying on one side

• Flexibility training, limited to a comfortable range of movement

• Relaxation

• Exercises for labor preparation

• Appropriate, low-impact exercises

• Modified exercise programs, to avoid overheating

• In the case of pregnancy-related musculoskeletal conditions, exercises must not deteriorate the condition

It is advisable to avoid the following activities:

• Exercises of high intensity, requiring sudden or throwing movements

• Exercises whose intensity or duration make the woman feel hot, exhausted, or excessively sweaty. Avoid hot yoga!

• Sudden changes in intensity and/or position

• Any exercise that requires breath-holding or the Valsalva maneuver

• Any exercise that places a significant load on the abdominal or pelvic floor muscles, including abdominal curls, sit-ups, planks, and hovers

• Stretching beyond a comfortable range of movement, due to increased ligament laxity caused by hormonal changes

• Weight lifting, beyond a comfortable range of movement

• Exercises requiring supine position, after the 16th week of pregnancy

• Exercises requiring prolonged standing, especially in combination with upper body muscle strengthening (increased risk of fainting)

• Sports requiring physical contact, to minimize the risk of falls and blows to the abdomen

• Any exercise that may cause or worsen any pregnancy-related condition

What type of exercise?

Both aerobic and resistance exercises are considered safe and do not exert any adverse effects during pregnancy [16].

Resistance exercise

To prevent high blood pressure, it is generally suggested that isometric exercises, like planks or bridges, should be avoided as well as exercises with heavyweights and numerous repetitions. The Norwegian guidelines strictly warn against exercises with heavy loads. The Canadian guidelines suggest exercises with light weights and more repetitions and avoidance of exercises that require the supine position and holding one’s breath with techniques such as the Valsalva maneuver. An interventional resistance program (1 set, 12 repetitions, several muscle groups, gestational week 28–38) reported that the fetal heart rate was not affected.

Aerobic Exercise

Every exercise that mobilizes large muscle groups in one continuous, rhythmic movement can be considered aerobic exercise. Characteristic examples are walking, running, jogging, dancing, swimming, bicycling, rowing, skiing, skating, and climbing [36]. Aerobic exercise is safe during pregnancy, but pregnant women must avoid sports requiring physical contact between players to minimize the risk of falls and blows to the abdomen.

Exercise in water is considered safe during pregnancy. Due to buoyancy, any musculoskeletal burdens due to weight gain are considerably decreased. Care must be taken as to the cleanliness and the temperature of the water, which should not be above 32 °C. In the case of a swimming pool, pregnant women should move slowly from the deep to the shallow end before coming out to avoid a sudden drop in blood pressure.

Frequency, time and intensity

The Canadian and UK guidelines suggest 15 min of exercise, three times a week, and a progressive increase of the duration to 30 min; frequency should be set at four times a week, even if the intensity is reduced. The guidelines from Denmark and Norway recommend that pregnant women exercise daily for at least 30 min at average intensity. The guidelines from Japan recommend aerobic exercise, to be done for over 60 min two to three times a week, while the guidelines from Spain recommend exercise two to three times a week, without, however, specifying the duration.

In summary, a frequency of two to four times a week and exercise duration of 30 min is, overall, considered to be efficacious and safe. Finally, the report concludes that Intensity constitutes the most difficult but most important parameter to consider when designing an exercise program for pregnancy.

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