There was much criticism of Michelle Bridges for posting her workout, which included over 50 minutes exercise and of jogging, on Instagram one month after giving birth . She also noted that she was an experienced trainer who had been training for 30 years. It is important for women to be encouraged to be physically active and pregnancy is an ideal time for behaviour modification and for adopting a health lifestyle because of increased motivation and frequent access to medical supervision. Exercising during pregnancy and immediately following childbirth does need to be individualised and depends very much on pre-pregnancy levels of fitness and activity and obstetric and musculoskeletal variations.

 There are no specific national recommendations for pregnancy and after delivery for otherwise healthy women.

 No safe upper level of exercise intensity during pregnancy has been determined, there is little evidence that regular moderate intensity exercise during pregnancy will harm the baby's development or birth weight or increase the incidence of preterm birth or raises maternal body temperature enough to impose risk. Examples given of moderate exercise include walking, swimming, aqua-aerobics, stationary cycling, low-impact aerobics, modified yoga, modified pilates, modified strength training, running and jogging. The general advice given against running for three months after birth has no evidence to back it up, and is more appropriate following surgical interventions or following musculoskeletal injury has occurred.

 Usual exercise routines will require higher than normal efforts to complete, and should be altered to a lighter intensity based on how the individual feels, particularly as shape and physiology adapts to pregnancy. The aim is to maintain or improve fitness , not train for competition. Blunted and normal heart rate responses to exercise have been reported in pregnant women, the use of perceived exertion may be a more effective means to monitor exercise intensity, using the "talk test" is another way to measure exertion. as long as a woman can carry on a conversation while exercising, she is unlikely to be overexerting herself.

 High intensity exercise or prolonged exercise over 45 minutes can lead to hypoglycaemia and athletes need to seek advice regarding avoiding hyperthermia, maintaining hydration and sustaining adequate calorie intake, more specialised guidance is advised for these athletes choosing to continue their high intensity activities.

Although exposure to heat from sources like hot tubs and saunas or fever has been associated with foetal abnormalities, exercise is not considered to increase core body temperature into the range of concern.

 Warning signs to stop exercising include vaginal bleeding, regular painful contractions, amniotic fluid leakage, breathlessness before exertion, dizziness, muscle weakness affecting balance and chest pain.

 Some pregnant women such as those with heart or lung disease, incompetent cervix, twins, pre-eclampsia require specialised advice regarding their activity and exercise.

 In normal pregnancy, there is general agreement that the benefits of exercise far outweigh any risks. Contact or high-risk physical sports should be restricted after twelve weeks ( as the baby grows and the womb is present in the abdomen) There also is a possible risk of damage to the placenta with a significant abdominal trauma as a result of a direct blow to the abdomen from a body part or, ball or racquet in later pregnancy. Scuba dinving should be avoided because of the inability of the foetal pulmonary circulation to filter bubbles. For those usually living at sea-level, altitudes to 2000 meters are considered safe for physical activity.

 The most common sports-related injuries in pregnancy are musculo-skeletal related to joint laxity and oedema.

 Exercise helps reduce weight gain, reduces the risk of gestational diabetes, helps control hypertensive disorders and reduces the need for medical interventions during birth, including caesarian section.

 The latest guidelines suggest that physical activity can be resumed gradually after birth, depending on the mode of delivery and the presence of other health issues. Even after an uncomplicated vaginal birth, there is a need for rest and recovery due to the physically demanding nature of the experience and associated hormonal changes required to return the uterus to its pre-pregnant state and to undertake breast-feeding.

 Consideration of stresses placed on the pelvic floor is required when returning to activity after childbirth. Pelvic floor exercises can be commenced in the immediate postpartum period. After a normal vaginal delivery, non-impact exercises can be commenced as soon as comfortable. Activities such as running and high- impact aerobics should be delayed until some of the hormonal and physical effects of pregnancy and birth have settled. This is usually after 6 weeks

 Returning to exercise should be gradual and with input from a health care professional. This usually takes the form of short walks several times a day initially, gradually building up to longer and harder sessions of 20 - 30 minutes. Returning to pre-pregnancy exercise regimes or sports should be done gradually over weeks and months and depends on personal circumstances. Resumptions of moderate activity in the absence of complications has not been associated with and adverse effects on breast milk composition or quantity or infant development.

Exercise has been shown to help control weight and reduce postnatal depression rates, particularly when undertaken in groups.

 For further details see the American College of Obstetricians and Gynaecologists ( ) update from December 2015, Physical activity and Exercise During Pregnancy and the Postpartum Period


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