Exercise During Pregnancy
With the rise of social media and internet access over the last few years we have been bombarded with information regarding exercise and pregnancy. It is often confusing for women to understand what is safe and effective during this important stage. As physiotherapists we are trained in the specific needs of the body with respect to hormonal, anatomical and functional requirements of women throughout pregnancy and post birth.
Every woman and every pregnancy is different and therefore exercise requirements during this time can change. This can depend on the level of exercise prior to becoming pregnant, the number of children that a woman already has as well as her general health. The discussion below is a general outline and can be adapted to each individual as required.
Exercise during First Trimester
This is a difficult time as women have generally not announced their pregnancy publicly but may be feeling the effects of morning sickness and hormonal changes. The hormone relaxin is produced throughout pregnancy and it results in increased laxity of ligaments throughout the body as well as cardiovascular and renal changes. We recommend a reduction in bouncing and/or jumping type movements mainly due to stress on the pelvic ligaments. We also recommend taking care when performing deep stretches.
At this stage it is important for women to be comfortable during exercise and to monitor heart rate/exertion levels. A simple way for you to ensure you are not working too hard is to use the Borg Scale of Perceived Exertion as shown below:
Pregnant women should be aiming for a maximum score of 5 on this scale. Heart rate should not exceed 140bpm.
In the first trimester your physiotherapist will be able to assess your pelvic floor and lower abdominal muscles and ensure that you are using them correctly when you are exercising. You will also receive advice regarding posture, anatomy and changes to expect. If you are experiencing any pain or discomfort at this stage then a hands on approach such as massage, mobilisation or taping may be of benefit.
Exercise during Second Trimester
This period results in noticeable changes in a women’s body. The baby is growing quickly, blood flow increases, resting heart rate increases and body temperature rises. Therefore the monitoring of exertion and heart rate continues to be important during exercise.
From 18-20 weeks pregnant we recommend that women avoid exercise while in a supine position (lying on your back). This is due to the position of the growing uterus over the vena cava which is a large vein returning blood to the heart. Potentially blood flow can be impaired during supine exercise leading to dizziness and nausea. There are many safe and comfortable exercises that can be performed while sidelying, kneeling or standing that are a great alternative to supine.
As the baby grows and the abdominal muscles stretch; a women’s body goes through significant postural changes. The centre of gravity changes from centred to anterior, the lumbar spine develops an increased curve and the ribs are stretched wider and pushed upward.
As a result of these changes we recommend that women avoid exercises that put strain on the lower back such as leaning backward or pressing heavy weights overhead. Due to the change in length of the abdominals we recommend avoiding exercises such as crunches and sit ups, instead focus on gentle bracing while performing movements with the arms and legs. Side-stretching the thoracic spine and breathing techniques can be a fantastic relief for painful ribs and tightness.
During the second trimester your physiotherapist can modify your exercise program to suit your needs. Exercises will focus a lot more on stability particularly through the lumbopelvic region and scapular stabilisers as well as overall postural control. Again hands-on treatment can be utilised if you are experiencing pain or discomfort.
Exercise during Third Trimester
During this stage women can start to feel slightly uncomfortable with a big belly, swollen legs and pressure through the pelvis. This is the stage where we begin to reduce the intensity of exercise and concentrate on maintaining strength and preparing for birth and the postnatal period. Each woman is different and each pregnancy is different so the level of exercise appropriate is completely individualised.
Your physiotherapist will aim to keep you moving throughout the third trimester with focus on preparation for your birth and post-natal period. Exercises will aim to promote strength through the pelvic floor, lower and upper limbs while maintaining pelvic stability. You will also receive ongoing advice about return to exercise post birth and what to expect in the post-natal period.
A percentage of women will experience back pain, rib pain or pelvic pain during pregnancy. This can be due to a number of reasons associated with hormonal, postural and anatomical changes. It is important to get any pain assessed by a qualified practitioner and then to modify your exercise program appropriately.
As discussed previously resting heart rate, blood flow, and body temperature all change during pregnancy. These can affect how a woman copes with exercise and may cause feelings of nausea, dizziness or lightheadedness. Always ensure that you are adequately hydrated in preparation for a workout and stop if you feel any of these discomforts.
Any complex medical issues associated with pregnancy should be monitored by your obstetrician, GP and/or midwife and your medical team should be able to communicate effectively to maximise your care during this time.
Pelvic Floor Exercises
My favourite muscle! The pelvic floor is an often overlooked area of the body until it becomes an issue! It is a vital group of muscles for maintaining continence, supporting the pelvic organs and controlling posture.
Throughout pregnancy the pelvic floor takes on not only the weight of the baby but also the placenta, the uterus and the increased blood and fluid travelling through the body. Due to the increase in laxity of the pelvic ligaments women require active support from the pelvic floor muscles to maintain pelvic stability and help with control of intraabdominal pressure.
The pelvic floor also undergoes trauma during a vaginal birth when it is stretched and potentially can tear or be cut during an episiotomy. We recommend that pelvic floor exercises are done daily even before you become pregnant. I often explain to my patients that if you are good at using your pelvic floor before birth then you should find it easier to reactivate and strengthen it after birth.
Up to 70% of women do not know how to contract their pelvic floor correctly and as a result can be doing more harm than good when they try pelvic floor exercises. This is when it becomes important to see a women’s health professional for advice and facilitation with pelvic floor exercises. Your pelvic floor can be assess at any time during pregnancy. Usually a physiotherapist in the hospital will give you advice immediately after your birth regarding pelvic floor exercises and you can return to us for a check-up 2-4 weeks post the birth depending on your doctor’s advice.
Domain Health Pregnancy Exercise Classes
At Domain Health we run individual and small group pregnancy exercise classes for pregnant women. These classes are individualised to the client and therefore can be adapted to any stage of pregnancy. We can include mat and equipment Pilates, weight training and targeted stretching for each trimester. We can work with other practitioners such as personal trainers and yoga instructors to ensure that you receive optimum care throughout this important time. We can also provide hands on treatment as part of our in-rooms services.
If you would like to join a small group it is important to undergo and initial assessment prior to starting with us. This ensures that we are up to date with your pregnancy and also that you are comfortable with our equipment. If you have questions regarding classes please call reception on (03) 9696 1597 or use the form above.
Benefits of exercising while pregnant
The benefits of exercising during pregnancy are numerous. Research shows that women who exercise regularly throughout pregnancy have a higher rate of return to exercise after the birth of the baby. It has also been shown to reduce excessive weight gain during pregnancy. Most women that attend our Pilates classes while pregnant enjoy the sessions and feel the benefit of strength, postural control and fitness. It is also a great stress reliever and can assist with mental health and sleep patterns.
Remember that generally exercise is fantastic for you and the baby! Be aware of any signs of discomfort, pain, feeling unwell, dizzy or lightheaded and see a professional if you are concerned. Common sense is vital and listen to your body!