Saturday, 28 August 2010

Exercise during Pregnancy

Considering I just had a baby, this topic is quite relevant and fresh in my mind. As a physio, exercise is second nature to me. I found it rather enjoyable to exercise during my entire pregnancy, and as my body changed throughout the different trimesters, I just simply modified the type of activity I did to suit. (In fact, I exercised even up to the day of giving birth - going for a nice 90min walk in the middle of the day during my early labour contractions, and made me feel so much better!).

Simply put, it is important to exercise during pregnancy. It brings many benefits for the mother's physical, emotional and social health. Although physical activity is beneficial for most people, I must state that under some circumstances, physical activity is not recommended for the health of the mother and baby, and the obstetrician's instructions must be carefully adhered to.  

Body changes during pregnancy
Many changes occur to your body during pregnancy.
  • Ligaments become more loose, due to hormones that are released during pregnancy (in particular, relaxin). This may affect the stability of your joints, such as low back, pelvic girdle, sacroiliac joints, and increases the chances of muscle strain/ligament sprain injuries.
  • Your pelvic floor supports the uterus, bladder and intestines. The added weight of the uterus, increased fluid and tissue laxity may affect your pelvic floor muscles, leading to problems with incontinence. It is important to perform regular pelvic floor exercises to maintain and improve the control and strength of the pelvic floor muscles.
  • Your weight will increase as pregnancy progresses, which will alter your body shape and weight distribution. As your tummy grows forward, your centre of gravity will also shift forward, affecting your sense of balance and coordination
  • Your resting heart rate will be increased during pregnancy, so it is important to monitor your heart rate during physical activity. As a general rule, do not exercise above 140bpm. Another way of monitoring your exercise intensity is to use the Borg's Rating of Perceived Exertion Scale (RPE). You should be able to still talk and exercise at the same time. 
  • The amount of fluid and blood in your body increases as your pregnancy progresses and so does your core body temperature. Make sure you don't exercise in hot/humid environments, and avoid sudden changes of position as that can cause sudden drops in blood pressure leading to fainting and dizziness.

Benefits of regular exercise during pregnancy
  • Improve overall health
  • Manage some symptoms of pregnancy such as nausea, tiredness, fatigue
  • Reduce back and pelvic pain by strengthening back/abdominal/pelvic muscles (especially as the tummy grows)
  • Maintain strong pelvic floor muscles to reduce incontinence
  • Maintain pre-pregnancy cardiovascular fitness
  • Control swelling (especially arms and legs) due to increased fluid in the body
  • Improve posture
  • Control healthy weight gain
  • Relieve stress and anxiety
  • Facilitate better sleep
  • Prepare for the physical demands of labour 
  • Assist recovery following labour and contraction of uterus
  • Facilitate return to pre-pregnancy weight and fitness
  • Assist in coping with the physical demands of motherhood

Exercise suggestions
Activities that are generally safe during pregnancy include:
  • Walking
  • Swimming
  • Cycling
  • Exercise in water (aquarobics/hydrotherapy)
  • Pilates
Swiss ball exercises
  • Yoga 
  • Pelvic floor exercises (very important, as the pelvic floor muscles are weakened during pregnancy and birth - so it is crucial to perform these pre/during/post-pregnancy)
  • Abdominal/Core stability exercises (very important, as the abdominal muscles support the lumbar spine and pelvis - the core)
  • Back strengthening exercises 

Activities that are not advised during pregnancy include:
  • Sit-ups or stomach crunches (as this may worsen the diastasis recti) 
  • Contact sports (eg. basketball, soccer, netball)
  • Jumping sports (eg. trampolining, gymnastics)
  • Competitive sports 
  • Activites requiring sudden and frequent changes of direction and speed (skiing, snowboarding, football) 
  • Activites that increase your heart rate too much 

It is a good idea to consult a physiotherapist for a customised exercise program. They can also educate you on pelvic floor and core stability exercises, advise you on exercise progressions, and supervise you to ensure the movements are performed correctly.

Final words
  • Exercise is important and beneficial during pregnancy
  • Make sure you have variety in your exercise program to keep it interesting and include strengthening and fitness components 
  • Drink lots of water
  • Monitor your heart rate and temperature during exercise
  • Watch for warning signs (such as headache, dizziness, chest pain, heart palpitations, abdominal cramps, vaginal bleeding, sudden change in baby's movements) and consult your doctor immediately
  • Consult a physiotherapist for an individualised exercise program and advice on any other problems or questions. Contact us if you would like to be referred to a specialised physiotherapist.

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