For many women maintaining a regular exercise regime during pregnancy can be challenging. For some it's hard to find the balance between family, work and personal commitments. For others exercise is limited by pain and injury. Many mums ask me similar questions about safe exercise during pregnancy and how to know what is going to benefit them specifically, so let's go over some of the important points.
What changes happen to the body during pregnancy?
There are many natural changes occurring in the body as you go through pregnancy. It is important to be aware of these changes and how they may impact on your current exercise regime or how your body may feel on a daily basis.
- Increased body weight 10-15kg.
- The centre of mass moves forward as your tummy grows which results in increased curvature in your lumbar spine (Okanishi, et al., 2012).
- Often the upper back becomes more rounded as bust size increases, the lower back more arched and the pelvis rotated anteriorly. This can result on sore and sensitised muscles and ligaments around the spine and pelvis from the increased strain and load.
- Although postural changes in pregnancy are natural and normally not painful, its still a great idea to consult with a health professional about some safe stretches to help offload your spine and loosen tight structures.
- Cardiovascular changes included increased resting heart rate, decreased blood pressure, and increased haemoglobin levels. Therefore, during pregnancy you need to be mindful of quick postural changes and monitoring how hard you are exerting yourself.
- Pregnancy hormones.
- One of the more renown hormones which increase in concentration during pregnancy is relaxin. Along with other sex hormones relaxin helps to increase ligamentous laxity which is required to help the pelvis and body accommodate for the postural changes needed in the pelvis and back as the baby grows.
- Relaxin is not the cause of pelvic girdle pain and recent research has shown that other pro-inflammatory and pain modulating chemicals are at play in the presence of pregnancy-related pain conditions (Aldabe et al, 2012).
- Pelvic floor muscle weakness can occur from increasing weight of pregnancy and damage during birth. It is really important to discuss with your health professional about pelvic floor muscle exercises to keep them strong.
- Abdominal muscles naturally stretch and a separation between the two halves of the six pack muscle occurs. It is called a DRAM (diastasis rectus of the abdominal muscles) and its normal! But as the gap widens you need to be mindful of the increase load on the abdominal wall and also work required by back muscles to support the weight of the stomach. Most DRAMS naturally recover within the first 6-12 weeks post pregnancy but its a great idea to know how to strengthen your deep abdominal muscles to help with recovery.
- If during pregnancy, when leaning slightly backwards or getting out of bed you notice a coning shape or pronounced ridge down your stomach, you should seek advice from a physio. This means your stomach muscle are becoming too weak to support your tummy and usually exercises and a support band are recommended.
- Ribs expanding and changing orientation is common and mums often complain of feeling like 'there is no room to eat or for the baby to squish up under the ribs'. Back stretches and positions that promote tummy space and rib opening will help if this becomes uncomfortable. (I've put some pics below for safe exercises to help at home).
- Fluid balance can increase in the later stages of pregnancy and make it uncomfortable to exercise. My advice for when this happens is to try water exercise as it can help reduce the weight of your body and let your limbs move more freely. And it feels great!
So coming back to the question above, all of these changes naturally occur during pregnancy but as much as they are natural, it does means is that exercise needs to be modified to account for the change in posture, muscle strength and ligamentous laxity. Adopting a lower impact exercise regime with help reduce the risk of exposing your body to excessive or uncontrolled forces.
What are the benefits of exercise?
- Maintain healthy weight.
- Maintain muscular strength.
- Prepare for the requirements of a new mum - carrying bubs, bending over cots, pushing prams, changing nappies etc.
- These daily activities which are both new and highly repeated are a potential for sustaining hip, back, and wrist injuries (just to name a few).
- Developing upper body strength for carrying prior to birth will significantly help with the transition for carrying.
- Developing a routine for mobilising your upper and lower back will help with the comforts of breast feeding.
- Developing strong legs with good squat and lifting technique will help you to avoid straining your lower back when lifting the pram in/out of the car, pushing the pram up hills and lifting bubs in/out of a cot.
- Keeping your muscles strong and your body fit to cope with the body shape changes and the increase demands on your body.
- Exercise improves circulation and helps to reduced swelling.
- Exercise increases metabolism and helps digestion, resulting in reduced constipation.
- Exercise helps to enhance your balance, coordination, flexibility and strength.
- There is often an improved sense of wellbeing associated with regular physical activity.
- Reduction in post natal depression.
- Reduction in low back and pelvic girdle pain, reduction in incontinence and reduced risk of developing gestational diabetes.
- No associated risk with foetal development.
(Norman, et al., ; Nascimento, et al., 2012; Stafne, et al., 2012; Stafne, et al., 2012)
How do you know it is safe to exercise?
You should always consult with your doctor or health professional monitoring your pregnancy to discuss the risks and benefits of exercise. Generally if there are no complications with your pregnancy then a monitored exercise program is safe for you and your baby.
If you ever experience the following symptoms during exercise, you should stop exercising and seek a medical opinion (Sports medicine Australia):
- High heart rate
- Uterine contractions
- Vaginal bleeding
- Amniotic fluid leakage
- Shortness of breath
- Back or pelvic pain
- Decreased foetal movements
- Sudden swelling of ankles, hands and face.
How do you know what type of exercise to choose?
There is no strict guideline on how to exercise but listening to your body and knowing what your personal preferences are will help ensure you stay motivated and get the most out of physical activity.
The American Heart Association recommends a minimum of 30 minutes of moderate exercise on 5 days of a week to help prevent chronic diseases. This is a general guideline applicable to most ages and populations. Aim for 150 minutes each week.
There are many different types of exercise which are safe and low impact during
exercise, which include (in no particular order);
- Pregnancy pilates
- Stationary bike riding
- Gentle weights
- Hydrotherapy and swimming
- Pregnancy yoga.
Pregnancy pilates is a great option for maintaining your strength, flexibility, balance and coordination. Don't worry about the floor exercises either, most exercises can be adjusted so that you get a great workout without spending too much time lying on your back. My favourites are to work on upper body strength and posture with the chariot series on the reformer and using the cadillac to stretch the upper and lower back. Another lovely benefit of pilates is that pelvic floor exercises can be incorporated into almost every exercise.
Stationary bike riding is safe and an awesome way to get some cardio while not loading your joints too much. Sometimes in the later stages of pregnancy mums like a lower impact form of cardio and using the stationary bike helps to maintain leg strength and also offload the pelvis and hips. If you're trying to spice things up a bit, why not try adding some arm weights or intervals during your ride.
Walking is safe throughout pregnancy and its fine to walk as much as you like. Just be mindful to keep your hydration levels up and eat small snacks regularly. That advice is across the board for exercise. Also, wearing loose and comfortable clothes is important to keep your body temperature at a good level.
Pregnancy water aerobics is a great choice if you love the pool and enjoy the assistance of the water in reducing your body weight. Sometimes women just feel too heavy or swollen to exercise on land in the later stages of pregnancy and transitioning to the water is a great way to continue moving. Swimming is definitely allowed but as your tummy grows certain strokes may become more challenging to achieve.
Exercising at home is always a great option and should never be overlooked. All you need is some floor space, a ball, hand weights or theraband and some exercises to complete. Here are a few lovely stretches which are safe through pregnancy and will help to mobilise you back.
And finally, how do you know how hard to push your body?
This is such a great question, and again one for your doctor, midwife or other health professional to answer. "Due to the increase in resting heart rate and decrease in maximal heart rate during pregnancy, it is not recommended using target heart rate to determine intensity of exercise" (Sports Medicine Australia, 2015). Instead, perceived rate of exertion is a recommended scale for determining how hard to work.
But the general guideline is that you can get a little puffed, a little hot and sweaty, but if you can't continue a conversation because you're breathing is too hard, then you're working too hard. Exercising with a buddy is always an easy way to ensure you're breathing and conversation rate remains at a constant level. :)
I hope you are now inspired and confident to get out there and increase your activity levels during pregnancy. Stay tuned for future blogs where I hope to chat about my ideas around posture and shoulder strength for a breast feeding mum, how to know if you pelvic floor and stomach are strong enough for return to sport, and some more suggestions for working out at home.
If you're interested in developing a personalised pilates program during pregnancy or post-partum please contact me as firstname.lastname@example.org and if you have any recommendations for posts please leave a comment below.
Special thanks to Rose for volunteering for the pics -- you are an inspiration to all mums-to-be.
Aldabe, D., Ribeiro, D. C., Milosavljevic, S., & Bussey, M. D. (2012). Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review. European Spine Journal, 21(9), 1769-1776.
American Heart Association. Recommendations for exercise for physically active adults. https://www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/FitnessBasics/American-Heart-Association-Recommendations-for-Physical-Activity-in-Adults_UCM_307976_Article.jsp accessed April 25th 2015.
Nascimento, S. L., Surita, F. G., & Cecatti, J. G. (2012). Physical exercise during pregnancy: a systematic review. Current Opinion in Obstetrics and Gynecology, 24(6), 387-394.
Norman, E., Sherburn, M., Osborne, R. H., & Galea, M. P. (2010). An exercise and education program improves well-being of new mothers: a randomized controlled trial. Physical Therapy, 90(3), 348-355.
Okanishi, N., Kito, N., Akiyama, M., & Yamamoto, M. (2012). Spinal curvature and characteristics of postural change in pregnant women. Acta obstetricia et gynecologica Scandinavica, 91(7), 856-861.
Sports Medicine Australia. Exercise in Prenancy. http://sma.org.au/wp-content/uploads/2009/10/WIS-ExPreg.pdf accessed April 25th 2015.
Stafne, S. N., Salvesen, K. Å., Romundstad, P. R., Stuge, B., & Mørkved, S. (2012). Does regular exercise during pregnancy influence lumbopelvic pain? A randomized controlled trial. Acta obstetricia et gynecologica Scandinavica,91(5), 552-559.
Stafne, S. N., Salvesen, K. Å., Romundstad, P. R., Eggebø, T. M., Carlsen, S. M., & Mørkved, S. (2012). Regular exercise during pregnancy to prevent gestational diabetes: a randomized controlled trial. Obstetrics & Gynecology,119(1), 29-36.