News

16-04-2018

Exercise is not dangerous in pregnancy, there is some evidence that active women are less likely to experience problems in later pregnancy and labour. The advice remains that the more active and fit you are in pregnancy, the easier it is to adapt to the demands of pregnancy, cope with labour and return to shape after delivery. Exercise also provides well studied benefits to psychological wellbeing and confidence.  A general rule has been that you should be able to hold a conversation as you exercise when pregnant, if you become breathless as you talk, you may be exercising too vigorously. It is usual to need to slow down as pregnancy progresses due to ligament change and changes to your centre of gravity or if your obstetric team advises reduced activity.

Before starting an exercise programme in pregnancy, check with your doctor or midwife to make sure you do not have any health issues that may prevent you from participating.

Guidelines recommend 30 minutes of moderate daily exercise daily for most pregnant women on current evidence, with reductions in pregnancy weight gain, risk of gestational diabetes, hypertension, pre-eclampsia and postpartum weight . Benefits are also to the foetus, with a reduction in large for dates babies and perhaps associated obesity in later life. Little sound evidence exists focusing specifically on higher intensity exercise during pregnancy, with many theoretical concerns regarding problems due to diminished blood flow to the uterus, exercise-generated heat stress causing congenital malformations, preterm delivery and abnormal maternal and foetal heart rates. Running also generates forces through the limbs and pelvis with potential effects affecting the cervix causing premature labour. The few studies published focus on small groups of experienced athletes, with no adverse outcomes found in those exercising during pregnancy, but one very small study of 6 elite athletes concluding that running at very high intensity could cause reduced blood flow through the placenta to the baby and reduce foetal wellbeing. Pregnancy is not a time for serious competition or aiming to reach peak lifetime fitness.

The BMJ has published an international retrospective study of running habits during pregnancy of more than 1000 women, recruited from Parkrun ( weekly runs involving 1.25 million runners worldwide). Continuing to run during pregnancy did not appear to be associated with premature delivery  or low birthweight regardless of mean weekly distance or stage of pregnancy. Assisted vaginal delivery rates were higher in women who ran, possibly due to increased pelvic floor muscle tone. Importantly the participants of the study were all regular runners before pregnancy and the study did not prove that any level of running is safe during pregnancy

Exercise advice when pregnant includes : trying to keep active on a daily basis, include a gradual warmup and slow sustained cool down with each session, avoiding strenuous exercise in hot weather, drink plenty of water, inform the instructor in classes about your pregnancy, exercise with a risk of falling should be done with caution after 12 weeks due to risk of injury to the baby and swimming is a good option as the water acts as a support for increasing weight. Comfortable, non-restrictive clothing, a well-fitting bra and appropriate footwear remain important during pregnancy.

Those exercises to avoid in pregnancy include those requiring you to lie flat on your back for prolonged periods, contact sports such as judo and kickboxing, scuba diving as the baby is not protected against decompression sickness and embolism and exercise at altitudes about 2500 metres. As pregnancy progresses, ligaments are softer and more lax, the centre of gravity shifts and resting heart rate increases and those participating in exercises requiring a high degree of balance or rapid changes to direction may be advised by their doctor to see an exercise physiologist to arrange an individually tailored programme to reduce the risk of injury or heat stress

BMJ open Sport & Exercise medicine. Published online April 4 2018.

RANZCOG Exercise during pregnancy guidelines gives a very detailed outline of the ratings of exertion and what is considered excessive and not advised during pregnancy

Sports Medicine Australia have a useful information summary of exercise in pregnancy, again with an effort/intensity rating

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