- Christine MacMillan, PT
The truth about exercise during pregnancy
As a mother of 3, I am no stranger to the incredible life event that is pregnancy. I know firsthand how exciting it can be, and how motivating it is to make healthy choices.
I also know just how uncertain you start to feel…. about everything. I don’t know how many times I opened up google and started to type “is it safe to……”
Is it safe to [drink coffee] during pregnancy?
Is it safe to [eat spicy food] during pregnancy?
Is it safe to [ride on roller coasters] during pregnancy?
etc etc etc!
And one of the big questions I know women are asking: Is it safe to exercise during pregnancy?
So many moms I meet love to exercise or engage in some type of physical fitness and they wonder if they need to give that up upon becoming pregnant.
Many other moms I meet are not particularly active people and wonder about whether it’s safe to start an exercise program while pregnant, or if they’d be better off tackling their physical fitness after baby is born. (And although this last question deserves a blog post of its own, spoiler alert: it’s not the wisest to save the conditioning for afterward!)
These are really normal things to wonder and worry about. And I am happy to have a fairly clear-cut answer to the question of exercise during pregnancy.
In 2019 a guideline was published in the Journal of Obstetrics and Gynaecology Canada which lays out clear recommendations regarding physical activity during pregnancy. The recommendations are based largely on the results of more than 600 studies that looked at the effects of exercise during pregnancy, and have been approved by the Board of the Society of Obstetricians and Gynaecologists of Canada (SOGC).
The first and arguably most important takeaway from the publication is: “physical activity is not associated with miscarriage, stillbirth, neonatal death, preterm birth, preterm/prelabour rupture of membranes, neonatal hypoglycaemia, low birth weight, birth defects, induction of labour or birth complications.”
For the moms worried that exercise might harm their baby, there is no evidence to suggest that this is the case. The authors state that “concerns over harms have not been substantiated by research and the risks of not engaging in prenatal activity have not been adequately emphasized”. What this means is, moms have been made to fear the risks of exercising, without considering the risks of NOT exercising! For the mother, exercise during pregnancy is actually associated with decreased odds of developing things like gestational diabetes, pre-eclampsia, hypertension (high blood pressure), depressive symptoms, and back/pelvic pain. Women who are physically active during pregnancy are also less likely to have a c-section or instrument-assisted delivery (i.e. vacuum or forceps).
To sum it up, being physically active during pregnancy is associated with huge health benefits for mom (in general, the more active the greater the benefits), without increasing risk to baby. WIN, WIN!
So what exactly are the “guidelines” that you should follow? While I encourage you to read the full guideline (find it here: 2019 Canadian Guideline for Physical Activity Throughout Pregnancy), below is a summary of the recommendations.
1. WHAT TYPE of exercise is best?
A combination of aerobic exercise and resistance training seems to be the most effective at optimizing maternal health. That means rather than just hopping on the elliptical or going for regular walks, throw in some thera-band exercises or free weights to round out your workout. The guideline mentions that Yoga (but not "hot yoga", as it can lead to dehydration) and stretching are also beneficial.
What about “kegels”?
It shouldn’t come as a shock that the guideline also recommends seeing a pelvic health physiotherapist to learn how to strengthen your pelvic floor during pregnancy. Pelvic floor muscle training reduces the risk of developing urinary incontinence (aka bladder leakage) both during pregnancy and post-natally. There are of course loads of additional benefits to conditioning your pelvic floor during pregnancy that are not mentioned in the guideline, but that’s a story for another blog post ;)
The only types of exercise you need to avoid are activities that put you at risk for falling or being hit hard. Activities like horse-back riding and downhill skiing would be best avoided, as would sports like hockey. You might consider a stationary bike instead of cycling on the road. (And definitely don’t go scuba-diving, as baby isn’t protected from the changing pressure.)
2. HOW INTENSE should my workouts be?
The guideline recommends “moderate-intensity” exercise, which should feel similar to light jogging. You can check-in with your body by doing a simple “talk-test” while you exercise. If you are unable to talk or maintain a conversation while exercising, you are working at a higher intensity than is recommended.
3. HOW OFTEN should I exercise?
The guideline recommends 150 minutes of exercise spread over at least 3 days in the week. Getting physical activity every day is definitely best, but if you can’t find time every day of the week, try to spread it out over at least 3 days.
Does that mean there’s no point in trying if you only have time to exercise once per week? Absolutely not! The guideline makes it clear that some exercise is definitely better than none. Even a small amount of exercise is beneficial.
4. How do I know if I’m OVERDOING IT?
Every body is different, and even if you’re doing everything “right”, your body may give you some signs that you should stop what you’re doing. If you experience symptoms including: Significant dizziness, lightheadedness or shortness of breath that persists at rest, severe chest pain, regular uterine contractions or bleeding or loss of other fluids vaginally, stop exercising and check in with your doctor.
There are countless types of activity you can do that fit within the guidelines above. A hike outdoors, an exercise video in your living room, or a Zumba class with a friend. Just listen to your body and do what feels good to you.
Lastly, keep in mind that these guidelines are for women without “contraindications” to exercise. (Contraindications are medical reasons that exercise might not be safe.) Below is a list of absolute contraindications to exercising during pregnancy:
• ruptured membranes
• premature labour
• unexplained persistent vaginal bleeding
• Placenta praevia after 28 weeks’ gestation.
• Incompetent cervix.
• Intrauterine growth restriction.
• High-order multiple pregnancy (eg, triplets).
• Uncontrolled type I diabetes.
• Uncontrolled hypertension.
• Uncontrolled thyroid disease.
• Other serious cardiovascular, respiratory or systemic disorder.
If any of these apply to you, the guideline suggests you can carry on with your regular activities of daily living but should avoid more strenuous activities like exercise.
The following are relative contraindications to exercise, which means they are reasons to approach exercise with caution, and discuss with your doctor.
• Recurrent pregnancy loss.
• Gestational hypertension.
• A history of spontaneous preterm birth.
• Mild/moderate cardiovascular or respiratory disease.
• Symptomatic anaemia.
• Eating disorder.
• Twin pregnancy after the 28th week.
• Other significant medical conditions.
So to sum it up: "all women without contraindications should be physically active during pregnancy". If you would like some guidance in selecting a program or ideas of helpful types of exercise, there are lots of great professionals out there with loads of knowledge on the subject. Physiotherapists – especially Pelvic Health or Women’s Health physiotherapists (shameless plug) – are a great resource for you during your pregnancy, and I encourage you to find someone in your area who can help you develop a plan for staying active and healthy during your pregnancy and beyond.
If you have other questions or want to get in touch with me, send me a message here or email me at firstname.lastname@example.org. To book a Pelvic Health Physiotherapy assessment with me, call Cooper Physiotherapy Clinic at (613) 821-1662.