How Women’s Health Physio Can Help Keep You Moving In Pregnancy.
It can be really confusing to know what is and isn’t safe to do during pregnancy particularly when it comes to exercise.
In the past women were encouraged to remain physically inactive. However, this was due more to cultural and societal expectations as opposed to based in any evidence.
We are now getting more and more evidence about the benefits of remaining active during pregnancy. And we also believe that women can exercise at a higher level than what we initially thought.
I would always recommend getting an assessment done with your women’s health physio to help guide your exercise choices.
Why is it so important to stay active in pregnancy?
Regular exercise has been shown to have numerous benefits for women’s health during pregnancy. Basically, if it were a pill, we would all be taking it.
Regular exercise has been shown to:
be associated in a shorter less complicated labour
decrease the risk of instrumental delivery
reduce the risk of developing and helps to manage conditions such as gestational diabetes and pre-eclampsia.
help with maternal fitness
have psychological benefits and improved perceived health status and reduced symptoms of depression
decrease the severity of lower back pain and pelvic girdle pain in pregnancy (when done specifically for this
So what should we be doing?
Most guidelines agree that in uncomplicated pregnancies women or pregnant people should be active most days. It is thought that a combination of aerobic and strength work is best.
If you have been relatively inactive before pregnancy you can start during pregnancy! Pregnancy should not be seen as a barrier to get moving. However we would generally recommend starting with lighter exercise before progressing. Aka now is the time to maybe start power walking, not signing up to the Melbourne Marathon.
Start with light exercise every other day. This may include a short walk or a gentle home exercise program with strength based exercises (this squats, calf raises, wall push ups) for around 15-20 minutes. Once this becomes easy you can start to increase your intensity. If you’re not sure where to start, book in with your local women’s health physio to help get you moving.
If you are currently exercising, there is no real reason to change what you are doing in the first trimester.
Unless you are into high risk sports such as tight rope walking, fencing, BMX or horse riding… In which case, we would actively recommend against sports where these is a high change of injury risk for you and baby.
*** Note how the recommendations are for uncomplicated pregnancies, if you are experiencing complications in your pregnancy, seek approval from your midwife or obstetrician about safety of continuing exercise or necessary modifications needed for exercise.
What is meant by aerobic and strength based exercise?
Aerobic training essentially is exercise where you get your heart rate up. Think power walking, stationary bike, swimming.
This is important to maintain health of our cardiovascular system.
If you are new to exercise, a good guide to say you are working at a good enough intensity is where you may feel slightly puffed but you can still hold a conversation.
If you are a seasoned exerciser, there is some evidence to say that working up to 90% of your maximum heart rate is safe.
Granted towards the end of your pregnancy, even going up a flight of stairs may send us up to that 90%.
We don’t actually have any studies yet that we can exercise at our maximum heart rate, so we cannot comment on it’s safety.
Strength based exercises are more Pilates or gym based exercises aim to improve our muscle strength.
These are hugely important for maintaining strength. This is particularly important as the demands on your body during pregnancy and in the postnatal period are going to be wildly different to what you have done before. Keeping strong through pregnancy not only helps us adapt to the demands of pregnancy but can help you feel strong after carrying and lifting bub.
What about running?
If you are a runner, I get it, you love to run. I’m the exact same.
In all honesty we don’t have any evidence to guide us in regards to whether it is ok to keep running from a pelvic floor perspective. I have had clients who have been able to run up until around 38 weeks with no issues, and some which find it difficult after 12.
So what are the hypothetical risks?
Our pelvic organs are supported not only by the pelvic floor muscles but connective tissue which help to keep things sitting high in the pelvis. If there are any changes or damage to this connective tissue this can cause the pelvic organs to sit lower and result in prolapse. If you are running while pregnant you do have extra pressure down onto the pelvic floor.
The hypothetical risk is that with increased pressure could lead to changes in the supportive connective tissue and result in prolapse. However, this is a hypothetical risk not an absolute one (aka we could never say that this is going to happen), it is just an increased risk.
What signs should you be looking out for that the pelvic floor isn’t coping?
Any signs of heaviness or leaking of urine or bowels during, after and the following day after running. If this is happening, I would recommend booking in with your local women’s health physio. They can assess your pelvic floor strength, tone and it’s position to see where you are at. They may also be able to offer other ways to help support your pelvic floor while running or discuss whether it may be time to move onto another form of exercise.
What are the guidelines for prevention of Gestation Diabetes and Hypertension:
The latest research that shows the minimum levels of exercise for reducing the risk of gestational diabetes is 25.3 minutes of light intensity exercise for 2.1 days per week.
The minimum exercise threshold to reduce the risk of gestational hypertension is 23.5 minutes of moderate intensity for 3.1 days of the week.
You can see that the number of minutes and intensity of exercise is quite low to help prevent gestational diabetes and hypertension.
Sometimes it can be difficult to start exercise because we think we need to be hitting the high targets of 30 minutes most days of the week. However, if you have previously been inactive, just a small amount of exercise a few days a week can have huge benefits.
Obviously exercise is great (see above). But there are absolutely signs you need to look out for where you need to stop exercise and seek medical attention:
If you experience any of the following please stop exercise and seek medical attention:
chest pain
dizziness, feeling faint of headaches
muscle weakness
calf pain, swelling, redness or tenderness to touch
sudden swelling of your ankles, hands and/or face
vaginal bleeding or amniotic fluid loss
unexplained shortness of breath
decreased baby movement
uterine contractions or sudden pain into lower back, pelvic area or abdomen (aka signs that could potentially indicate preterm labour)
Our thoughts on yoga.
I’m a big fan of yoga, especially for first time mum’s.
It is an amazing balance of breath work (which is essential in labour), stretching (pelvic mobility for labour) as well as strength (Please see benefits above).
So if you have the time and capacity to add in prenatal yoga to your workout. I think it comes with hugeee benefits.
Also, who doesn’t love going to a place of exercise where they tell you that you have done a good job just by showing up.
Not sure where to start?
I appreciate the above information is a lot. At Kin Physio in Geelong we love helping women and pregnant people stay active during their pregnancies. We think it can be hugely beneficial not only for their labour and birth but also their postnatal recovery. So pop on in for an assessment and we can help build your confidence with movement.
References:
Exercise during pregnancy: 2022 RNAZCOG Guidelines.
Beetham KS, Giles C, Noetel M, Clifton V, Jones JC, Naughton G. The effects of vigorous intensity exercise in the third trimester of pregnancy: a systematic review and meta-analysis. BMC pregnancy and childbirth. 2019 Dec 1;19(1):281.
Davenport MH, Ruchat SM, Poitras VJ, Garcia AJ, Gray CE, Barrowman N, Skow RJ, Meah VL, Riske L, Sobierajski F, James M. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis. British journal of sports medicine. 2018 Nov 1;52(21):1367-75.
Davenport MH, Ruchat SM, Sobierajski F, Poitras VJ, Gray CE, Yoo C, Skow RJ, Garcia AJ, Barrowman N, Meah VL, Nagpal TS. Impact of prenatal exercise on maternal harms, labour and delivery outcomes: a systematic review and meta-analysis. British journal of sports medicine. 2019 Jan 1;53(2):99-107.
This blog post was by written by the director Jessie, Jessie holds a doctor of physiotherapy and a post-graduate certificate in pelvic floor. She worked in sports and musculoskeletal physio before moving into women’s health and combines these skills to help keep women active in pregnancy.
