An Update on Exercise in Pregnancy
In 2020, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) reviewed and updated their recommendations for Exercise in Pregnancy.
During the summer months and as we head into the new year many of us are thinking about making positive lifestyle changes around increasing physical activity and what better motivation than for the benefit of your growing baby!
Pregnancy is hard work and engaging in regular exercise can help us cope with the increased physical demands on our heart, lungs and musculoskeletal systems. There are lots of known positive benefits around sleep, lowered anxiety, improved body image and emotional well-being related to exercising during your pregnancy. Research is showing that exercise in pregnancy can protect us against pregnancy-related low back pain and reduce sick leave related to back pain (Shiri et al 2017).
Regular exercise during pregnancy has also been associated with shorter and less complicated labour, as well as fewer neonatal complications. We now know that exercise in pregnancy can also lower incidence of instrumental delivery like forceps and vacuum extraction by as much as 24%. We can be reassured that no links have been shown with pregnancy exercise and increased musculoskeletal injury, preterm delivery or rates of c-sec delivery (Davenport et al 2019). In an uncomplicated pregnancy we are reassured that exercising at the right intensity is not harmful to you or your baby.
What type of exercise?
RANZCOG encourages regular aerobic and strength conditioning exercise. Walking, swimming, low impact pregnancy classes and stationary cycling are great low impact exercise options to see you through your pregnancy. New research supports the idea of water-based exercise increasing comfort by reducing body weight loading and joint impact forces (Alberton et al 2019). Exercising in water is a viable and often preferable alternative to exercising on land especially towards the latter stages of pregnancy and may enable women to still achieve a moderate exercise intensity without worry or risk of musculoskeletal injury. Another great benefit of water exercise is reducing the swelling and oedema often associated with pregnancy. This is due to the redistribution of extra-vascular fluid by the “hydrostatic pressure” we experience proportionate to our depth of water immersion. We all know that a warm water dip or soak feels wonderful for alleviating those pesky aches and pains after a long day on your feet! When water exercise is participated in for 30 minutes weekly in the second half of your pregnancy, it has been shown to reduce incidence of low back pain in the first week after delivery (Davenport et al 2019).
However, we do need to be mindful of water temperature when exercising in aquatic environments and ensure it’s not too high. Water temperatures of up to 33.4 degrees celcius have been shown to be safe for aquatic or aquaerobic exercise safe (typically swimming and hydrotherapy pools range from 28-34 degrees).
Strength training is an important part of a well-rounded exercise program and can help build muscle conditioning and preparation for the physicality of labour and caring for a new baby. A couple of sessions a week working the large muscle groups providing resistance with light weights, resistance bands or body weight exercises is beneficial. Correct technique is important to ensure appropriate posture, breathing and to avoid straining so is best commenced under guided supervision.
How much and how often?
Exercise in pregnancy needs to be individualised to take into account baseline fitness, exercise experience and your unique health profile. Athletes accustomed to vigorous exercise should discuss any changes in comfort or tolerance and be cautious about excessive exertion, dehydration or over-heating especially as we approach summer months. Those with painful problems or pelvic floor considerations may be offered lower impact options to reduce joint stress and improve exercise confidence and comfort. Similarly, if you are overweight, previously inactive or starting at a low fitness level, be reassured that you can build up gradually towards a moderate intensity of exercise to achieve those health and well-being benefits.
Reassuringly, studies have shown a minimum threshold of 25 minutes of light exercise performed on 2 days of the week can lower your risk of developing gestational diabetes by 25%. If we reach a moderate intensity of exercise performed towards 3 days of the week we are afforded further protection against gestational diabetes as well as for conditions like pre-eclampsia and gestational hypertension which is pretty motivating! (Davenport et al 2018).
Where do I start?
Your doctor or midwife will need to give you the all clear prior to commencing or continuing your usual exercise programme in pregnancy. We want to make sure the baby is growing nicely and that there are no underlying or uncontrolled health problems that could be made worse by exercise. Your Women’s Health Physiotherapist can then assess your medical and obstetric health profile and you can discuss the type and frequency of your usual exercise as to whether this is still appropriate or whether special precautions need to be considered. For example, we need to be cautious about lying on our backs for exercise as we know that supine exercise should be discontinued after your first trimester.
To enjoy a healthy and active pregnancy for you and your baby get in touch with our Women’s Health Physiotherapy team. We specialise in safe, suitable and supervised exercise options including our Beautiful Bumps Pilates-based core conditioning classes as well as running aquatic physiotherapy in heated pools in Adelaide and Mt Barker.
Written by Sarah Guille (Associate Physiotherapist: Women’s Health and Aquatic Physiotherapist for MyPhysioSA for Her
RANZCOG (2020): Statement on Exercise in Pregnancy.
For complete clinical guidance and full list of references see:
Cristine Lima Alberton, Roberta Bgeginski, Stephanie Santana Pinto, Gabriela Neves Nunes, Luana Siqueira Andrade, Bruno Brasil, Marlos Rodrigues Domingues. Water-based exercises in pregnancy: Apparent weight in immersion and ground reaction force at third trimester Clin Biomech (Bristol, Avon) 2019 Jul;67:148-152.doi: 10.1016/j.clinbiomech.2019.05.021. Epub 2019 May 11.
Davenport MH, Ruchat SM, Poitras VJ, Jaramillo Garcia A, Gray CE, Barrowman N, Skow RJ, Meah VL, Riske L, Sobierajski F, James M, Kathol AJ, Nuspl M, Marchand AA, Nagpal TS, Slater LG, Weeks A, Adamo KB, Davies GA, Barakat R, Mottola MF. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis. Br J Sports Med. 2018;52(21):1367-1375.
Davenport MH, Kathol AJ, Mottola MF, Skow RJ, Meah VL, Poitras VJ, Jaramillo Garcia A, Gray CE, Barrowman N, Riske L, Sobierajski F, James M, Nagpal T, Marchand AA, Slater LG, Adamo KB, Davies GA, Barakat R, Ruchat SM. Prenatal exercise is not associated with fetal mortality: a systematic review and meta-analysis. Br J Sports Med. 2019;53(2):108-115.
Rahman Shiri, David Coggon, Kobra Falah-Hassani. Exercise for the Prevention of Low Back Pain: Systematic Review and Meta-Analysis of Controlled Trials . American Journal of Epidemiology, Volume 187, Issue 5, May 2018, Pages 1093–1101,