Exercise During Pregnancy

In December of 2015, The American Congress of Obstetrics and Gynecologists published there latest guidelines regarding exercise in pregnancy contained in Committee Opinion Number 650.  What follows is a summary of some of these guidelines.

Here are their recommendations:

-Physical activity in pregnancy has minimal risks and has been shown to benefit most women, although some modifications to exercise routines may be necessary because of normal anatomic and physiologic changes and fetal requirements.

-A thorough clinical evaluation should be conducted before recommending an exercise program to ensure that a patient does not have a medical reason to avoid exercise

-Women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength-conditioning exercises before, during and after pregnancy

-Obstetrician-gnecologists and other obstetric care providers should carefully evaluate women  with medical or obstetric complications before making recommendations on physical activity participation during pregnancy.  Although frequently prescribed, bed rest is only rarely indicated and, in most cases, allowing ambulation should be considered.

-Regular physical activity during pregnancy improves or maintains physical fitness, helps with weight management, reduces the risk of gestational diabetes in obese women, and enhances psychologic well-being.

Additional research is needed to study the effects of exercise on pregnancy-specific outcomes, and to clarify the most effective behavioral counseling methods and the optimal intensity and frequency of exercise.  Similar work is needed to create an improved evidence base concerning the effects of occupational physical activity on maternal-fetal health.

Observation studies have shown benefits of exercise in pregnancy such as decreased gestational diabetes, decreased cesarean section and operative vaginal deliveries, and decreased postpartum recovery time.  However it is important to state that evidence from large randomized trials regarding benefits of exercise in pregnancy is limited.  However the risks from exercise seem minimal compared to the possible benefits.

The following are contraindications to Aerobic Exercise During Pregnancy:

  • Hemodynamically significant heart disease
  • Restrictive lung disease
  • Incompetent cervix or cerclage
  • Multiple gestation at risk of premature labor
  • Persistent second or third trimester bleeding
  • Placenta previa after 26 weeks of gestation
  • Premature labor during the current pregnancy
  • Ruptured membranes
  • Preeclampsia or pregnancy-induced hypertension
  • Severe anemia

The Following are relative contraindications to Aerobic Exercise during pregnancy and should be discussed with your doctor:

  • Anemia
  • Unevaluated maternal cardiac arrhythmia
  • Chronic Bronchitis
  • Poorly controlled type 1 diabetes
  • Extreme morbid obesity
  • Extreme underweight (BMI less than 12)
  • History of extremely sedentary lifestyle
  • Intrauterine growth restriction in current pregnancy
  • Poorly controlled hypertension
  • Orthopedic limitations
  • Poorly controlled seizure disorder
  • Poorly controlled hyperthyroidism
  • Heavy smoker

 

The following are examples of safe and unsafe Physical activities in Pregnancy

The following are safe to initiate or continue in an uncomplicated pregnancy after consultation with your Obstetrician:

  • Walking
  • Swimming
  • Stationary cycling
  • Low-impact aerobics
  • Yoga, modified (Positions that result in decreased venous return and hypotension should be avoided as much as possible.)
  • Pilates, modified
  • Running or jogging (In consultation with your obstetrician, running or jogging , racquet  sports, and strength training may be safe for pregnant women who participated in these activities regularly before pregnancy.  I do not recommend initiating these during pregnancy)
  • Strength training

The following activities should be avoided:

  • Contact sports (eg, ice hockey, boxing, soccer, and basketball)
  • Activities with a high risk of falling(eg. downhill snow skiing,water skiing, surfing, off-road cycling, gymnastics, and horseback riding)
  • Scuba diving
  • Sky diving
  • “Hot yoga” or “hot Pilates”

 

The following are warning signs to discontinue exercise during pregnancy:

  • Vaginal Bleeding
  • Regular painful contractions
  • Amniotic fluid leakage
  • Dyspnea before exertion
  • Dizziness
  • headache
  • Chestpain
  • Muscle weakness affecting balance
  • Calf pain or swelling

 

The exercise program should gradually work up to an eventual goal of moderate-intensity exercise for at least 20 to 30 min/day on most or all days.  For a moderate intensity program the best way to monitor the level of the work out may be through patient perceived level of exertion or difficulty.  On the Borg scale below a rating of “somewhat hard” 13 to 14 may be most appropriate.  Another wasy to monitor the level of exertion is the “talk test”.  As long as a woman carry on a conversation during pregnancy then she is probably not overexerting herself.  A high intensity or prolonged exercise of 45 minutes can lead to hyperglycemia and should be avoided.  Adequate caloric intake before pregnancy is important as is adequate hydration before and during exercise.  Avoid lying on your back for prolonged periods of time.  Exercise should be performed in a controlled temperature environment to help prevent dehydration and other effects of the elements.   Pregnant women with back pain would be best served to engage in water exercises as an alternative.

Borg scale of Preceived exertion:

  • 6
  • 7     Very, very light
  • 8
  • 9     Very light
  • 10
  • 11    Fairly Light
  • 12
  • 13    Somewhat Hard
  • 14
  • 15    Hard
  • 16
  • 17    Very Hard
  • 18
  • 19    Very, very hard
  • 20

 

Bottom Line:  Exercise in moderation seems good for the uncomplicated pregnancy for many reasons.  Discuss this with your doctor to individualize your own program

 

Keith Reisler, MD, Plano, Tx – author