- Physical exercise is very important for pregnant women, as they help them to ease the state, prepare muscles to the stress of labor and to the loads of the last trimester of pregnancy.
- Conditions in which physical activity should be avoided are also listed.
- It is also a good idea to include the recommended types of physical activity into daily life, while excluding certain other types. The experience of previous generations is also described in brief.
Physical Activities during Pregnancy
General routine for women during pregnancy mostly remains the same as it was before it. However, a pregnant woman doesn’t go for the night shifts and doesn’t do such works that may be harmful to her health and the health of the future child. In the normal course of pregnancy women need exercise. Benefits of physical activity during pregnancy are obvious: exercise helps strengthen the muscles, improve circulation and blood flow to all the internal organs, including the utero-placental system, increasing the delivery of oxygen and nutrients to the fetus.
Exercising during pregnancy also helps the establishment of proper breathing - woman develops the types of respiratory movements that she needs during labor (1). In addition, one of the necessary skills acquired in the course of physical activities for pregnant women is the ability to relax one muscle group, while tensing the others. It is particularly important in labor. Physical exercises reduce the risk of complications during childbirth and help women to recover faster after delivery of the baby.
In general, all physical exercises that are recommended for pregnant women prepare the expectant mother to a considerable load and work that awaits her in labor. It is a generally accepted fact that childbirth is a hard work for any woman, which is why to do this job, they need regular exercise throughout the period of expecting child.
Even various chronic diseases in pregnancy, such as diabetes, heart disease, hypertension, thyroid pathology, obesity, musculoskeletal system, though requiring careful choice of the physical activity, do not serve as an absolute contraindication for the exercises. In such cases, the decision is made jointly by the attending obstetrician and specialist in pathology observed in pregnancy (2). Women most often are recommended to do light aerobic exercise (which enriches the body tissues with oxygen): walking at a moderate pace, swimming, water aerobics, and light gymnastics, preferably under the supervision of an instructor in physical therapy. It is required to constantly monitor the pulse, blood pressure, and general well-being.
Necessary Restrictions
Another common extreme, which is also a fallacy, is the notion that because pregnancy is a normal, physiological state, women can continue to have an active life, not limiting themselves. However, following some restrictions is appropriate for any woman expecting baby. Any physical activities, accompanied by shaking of the body, vibration, weight lifting, risk of falls, blows: mountain climbing, horse riding, diving, all kinds of wrestling, team sports, skiing are contraindicated in the time of pregnancy. Also, expectant mothers do not need professional sports, sports competitions. High intensity exercise during pregnancy can lead to poor blood supply to the fetus, causing delay in its development and can cause miscarriage and premature birth.
Typical scenario requiring limitation of physical activity during pregnancy is the presence of obstetric and gynecological pathology: abnormalities of the uterus structure, uterine fibroids, hormonal disorders, and burdened obstetric and gynecological history (previous miscarriage, missed abortion, premature birth), etc. (3). Level of admissible physical activity and its relevance in such cases is determined by doctor. It is recommended to significantly reduce the length of stay in a standing position in such cases, as it is a risk factor for miscarriage. In certain situations, all the physical activities are contraindicated, since the possibility of serious complications is very high, and any, even low tension can lead to irreparable consequences.
Recommendations of Doctors
A necessary condition for determining the permitted level of physical activity for pregnant women is consultation of a gynecologist. For those women who were active in sports before pregnancy, in the absence of obstetrical contraindications it is allowed to do more intense exercise, than in case of untrained and unsporting expectant mothers. In all cases, during pregnancy, especially within the first trimester, when the risk of miscarriage is high, the level of physical activity is recommended to be reduced to 70-80% of the one before pregnancy.
Optimum kinds of sports are: walking, swimming, cycling on the horizontal exercise bike (pedals are located in front and legs are in a horizontal position – in this way physical load is minimal). Today yoga for pregnant women also gains more and more popularity. It is better for expectant mothers to do non-durable, but regular exercise, at least three times a week (4). It is significantly more efficient than rare debilitating loads that can do more harm than good: irregular exercise conducted from time to time, is a major stress to the body.
The intensity of physical activity also varies depending on the duration of pregnancy, the characteristics of its course, as well as on the individual physical culture of a woman. Exercise should be carried out 2 hours after a meal. During physical activity it is necessary to avoid overheating and dehydration. The risk of overheating is increased in case of excessive wrapping, activities in humid and hot areas. Exercise room should be ventilated. It is also necessary to pick up convenient, water-absorbing, providing freedom of movement clothes and shoes for physical training. Between exercises women should drink small amount of liquid, and after exercise drink at least half a liter of water or fruit drinks.
When doing any exercise it is necessary to carefully monitor the state of health, the pulse rate. To calculate the permissible pulse rate: it is 70-75% of the maximum recommended for the age of the pregnant women. The maximum value of the heart rate is calculated by the formula: 220 - age (in years). Thus, the average value of the pulse allowed for women of childbearing age is 130-140 beats per minute. After 5 minutes of rest (recovery period) pulse should get normal again (back to values before the load - 60-80 beats per minute). If the full restoration of blood flow parameters did not happen, then probably the load was excessive, and in order to avoid complications in the future intensity of exercise should be reduced.
Total exercise duration should be about 10-15 minutes at the beginning of pregnancy and gradually (over 3-4 weeks) should be increased to 25-30 minutes. If a woman feels weakness, dizziness, nausea, headache, shortness of breath, sudden disruption of sight during the load, exercise should be immediately discontinued (5).
In case of discharge from the genital tract after the exercise, dull pains in the stomach, intense contractions, feeling of very strong heartbeat, change in fetal movements in the later stages of pregnancy, it is necessary to immediately consult a doctor for the state of pregnancy and the appropriateness of the exercise.
When exercise is contraindicated for pregnant women?
Contraindications to physical exercise are the following (6):
- Observed signs of threatened miscarriage (increased uterine tone, presence of bleeding from the genital tract) and treatment in this regard;
- Bleeding and its threat;
- Full or partial placenta previa (when the placenta partially or completely blocks the birth canal);
- Increased blood pressure caused by pregnancy;
- Intrauterine development retardation;
- Polyhydramnios.
In case of any acute diseases, inflammation, exacerbation of chronic diseases it is also recommended to refrain from physical activity.
Gestational Age - an Important Factor
The first trimester of pregnancy is one of the most responsible ones. During this period all the organs of the baby are formed and take its places, the placenta is formed, through which the fetus gets blood supply during the subsequent period. Often pregnancy is not completely stable in the first trimester: excessive physical activity, weight lifting can result in a threat of miscarriage. Therefore, the need for physical activity during this period is determined strictly individually. Some obstetricians are opposed to physical activity in the first trimester, considering the optimum start time for physical exercise the beginning of the second trimester (13-15th week of pregnancy). If a woman was doing exercise before pregnancy, in the absence of contraindications, she can just reduce the level of physical activity to 70-80% of the original, without abandoning the gym since getting pregnant (7).
During the first 13 weeks of pregnancy a woman is recommended to do breathing exercises and simple exercises for the hands and feet. Gradually increasing the complexity of the exercise, avoiding jumps, jerks, load, which increases intra-abdominal pressure (e.g., exercise, causing tension of the abdominal muscles and aimed at training the abdominal muscles, weight training, including exercise equipment, gym). Moms-to-be should master slow breathing (with full inhalation and exhalation), promoting relaxation, as well as do exercises that strengthen the shoulders, the muscles of feet.
Long-term exercise in the standing position increases the risk of miscarriage, which is why the longer stay in a standing position is not recommended for pregnant women (8). It is important to note that the majority of obstetricians and gynecologists agree that in the first 3 months of pregnancy physical activity during the corresponding menstrual period should be limited in duration and intensity.
In the second trimester placenta begins to function, pregnancy is usually stabilized, toxicosis stops. However, starting with the second trimester, the size of the uterus significantly increases. Due to this, the center of gravity shifts, increasing the load on the spine and back muscles (especially in the standing position). Muscles and vessels of the legs (mostly veins) start to experience more tension. In general, the second trimester is the safest period for exercise and sports.
At this time, the exercises complex for pregnant women is expanded to include exercises that strengthen the muscles of the back, prelum, legs, improving joint mobility (9). During the period of maximum tension of the cardiovascular system (26-32 weeks), increasing pressure in the veins of the legs reduces the intensity of the load by reducing the number of repetitions of each exercise, increasing the relaxation time. In a standing position not more than a third of exercises should be done from the second trimester of pregnancy.
In the third trimester of pregnancy, the growing fetus significantly limits physical activity of future mothers, fatigue increases. Due to shifting the aperture up by enlarged uterus, pregnant women often experience shortness of breath. During this period, the intensity of physical activity should be reduced. Load in the standing and lying on the back positions should be significantly reduced. Exercise should be done in slow motion, to the extent where the load does not cause a woman's discomfort. Special attention should be paid to the movements and skills required immediately at birth, training various types of breathing, and the ability to relax the muscles of the perineum at the time of tension of the abdominal wall, relaxation exercises, providing effective pain relief and relaxation during childbirth.
Rules of Physical Activity in Daily Life
It has long been observed that certain kinds of household work are favorable for pregnancy and subsequent childbirth, while others have a negative impact on them. In the past it was considered that pregnant women should do a lot of walking, turning, bending, squatting, movement in the position on all fours, as they ease the delivery (10). Indeed, leans, turns, motions on all fours train the muscles of the lumbar belt, give them elasticity and reduce fatigue, while walking and squatting strengthen the tendons and muscles of the legs, which in the second half of pregnancy and during labor experience very heavy loads . Therefore pregnant women were going to works associated with these movements (8). Such works were the following: harvest, washing (leans, turns); washing floors (squats, position on all fours); collection of berries and mushrooms (walking, bending, turning, crouching).
There also were restrictions for pregnant women on some jobs. Lifting weights, running, jumping, pulling were forbidden, as these movements could lead to miscarriage or premature birth. Of these household recommendations and prohibitions the rules of physical activity during pregnancy were formed. These rules, modified for the current period of time can be presented in the following way:
- Walking in the fresh air up to the birth should be at least 2 hours a day. Let the walk take place in the rhythm, which suits a pregnant woman, and takes place in areas where there is room for a short rest.
- Systematic cleaning of floors on all fours or on laps without a mop. Periodically, it is also possible to rinse the clothes manually without using washing machine.
- Bending and squatting for which it is necessary to use any opportunity.
- For pregnant women it is very useful free dance. Free rhythmic movements to music not only train the muscles, but also develop coordination and rhythm of movement for the mother and the unborn child (6).
- Eliminate jumping, running, abrupt movements, situations where injury and fall is possible. If women have to jump, they should land on their fingers to soften the landing, if they happened to fall it is necessary to protect the stomach.
- Completely eliminate heavy lifting and pulling up with hands (horizontal bar).
For the modern woman it is necessary to add the following prohibitions: pregnant women should avoid repetitive rhythmic movements, such as when doing aerobics or shaping; massage is contraindicated. There is acupuncture for pregnant women, but this procedure can be done only by very experienced doctors who specialize in treating pregnant women.
Thus, exercise is recommended for all women with a normal course of pregnancy. Undeniable benefits and necessity of physical activity during pregnancy is confirmed by many years of obstetric practice. However, in each case, the question of the possibility and the intensity and duration of physical activity of the future mother is solved individually.
References
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- Jukic AMZ, Evenson KR, Daniels JL, Herring AH, Wilcox AJ, Hartmann KE. A Prospective Study of the Association Between Vigorous Physical Activity During Pregnancy and Length of Gestation and Birthweight. Matern Child Health J. 2012;16(5):1031-1044.
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