During pregnancy, the body goes through a lot of changes. Some changes may limit the ability to perform different movements or require modification in the workout program. Changes in hormones and the production of the Relaxin hormone can weaken ligaments, and increase the risk of joint damage (such as sprains). As the pregnancy advances, the center of gravity shifts forward, affecting both balance and coordination. The resting heart rate rises and blood pressure can drop during pregnancy.
It can be challenging to understand what to focus on when training during different phases of pregnancy. To have a better understanding of the most crucial aspects, exercise dosing ( the amount of physical activity performed) is important to build confidence rather than acting as a barrier to an active pregnancy. Exercise dosing is addressed by many international guidelines.
Main Goals of Exercise Dosing & Selection:
- Prevent or reduce abdominal Doming/coning
- Maintain or improve pelvic floor strength
- Keep joints, muscles, and ligaments strong for labor and cardiovascular
- Keep lower body, core, and thoracic strong for postural improvements to reduce lumbar pain
- Improve mental health during pregnancy
- Train around/modify for contraindications related to exercise e.g. SPD ( Symphysis pubis dysfunction) pain
Frequency and Duration of Exercise
It is recommended to do 150–300 minutes of exercise each week, with sessions of at least 20–30 minutes on most days of the week (three days). There is no current research on an upper limit. The aim is to be physically active MOST days of the week. In the case of sedentary or overweight/obese women, a frequency of 3-4 days of nonconsecutive exercise is recommended and the duration should be built up gradually from 15-20 mins.
Intensity of Exercise
Intensity depends upon the current fitness level. It is recommended for previously INACTIVE women to maintain low- moderate intensity and should follow a gradual progression of exercise. Those who are already engaged in some physical activity can continue exercising at moderate intensities and can maintain intensities.
There is limited research on high-intensity exercise in pregnancy. There is no evidence-based on a “safe” upper limit and women performing high vigorous activity need to be ceased if prior high fitness level. Limited research doesn’t mean it is advised. Evidence shows that excessive exertion may affect fetal well-being above a high threshold of intensity. Some evidence shows transient fetal heart rate decelerations and alterations in umbilical and uterine dopplers post-exercise. Modifications can be done as per the comfort/tolerance/pregnancy complications.
Perceived Exertion Level
Instead of using target heart rate parameters, women should use the Borgs scale, rate of perceived exertion (RPE) scale to monitor exercise intensity. During pregnancy, it is advised that an active woman maintain a level of activity that she feels to be moderate to hard (RPE of 11-13 on the Borg 6-20 scale).
It can be changed based on the changes during the pregnancy e.g. movement from low to moderate risk, based on the trimester, energy levels, and changes of the individual.
It can be used utilize for both cardiovascular and strength training. But this requires some experience with internal intrinsic connection with perceived exertion. Talk Test is another effective tool to monitor exercise dosing. If a woman can carry on a conversation while exercising, she is probably not overexerting herself.
Contraindications
A complete clinical examination should be performed before proposing an exercise regime to ensure that there are no medical or obstetrical reasons to avoid or alter exercise. In case of
ruptured membranes, premature labor, unexplained vaginal bleeding, placenta praevia after 28 weeks gestation, PE, incompetent cervix, intrauterine growth restriction, high-order multiple pregnancies (e.g. triplets), uncontrolled type I diabetes, uncontrolled hypertension, uncontrolled thyroid disease, and other serious cardiovascular, respiratory, or systemic disorders are all absolute contraindications to exercise. It is important to consult with your gynecologists before and during the pregnancy for any contraindications.
Summary
- It is individual-based as no two pregnancies are the same.
- Complete a screening is required and a heads up by the doctor.
- Staying active body daily/most days, 30-60 min mod intensity exercise or 15-20 min vigorous exercise.
- Avoid long periods of sitting/standing still.
- Perform Kegel exercises daily.
- Stay hydrated, keep temperatures under control.
- Indulge in strength training at least twice per week.
- Listen to the body for contraindications of over or under-exercising, modify for complications.
References:
- American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription . 10th ed . Philadelphia, PA : Wolters Kluwer ; 2018 .
- World Health Organization. Global recommendations on physical activity for health . Geneva : WHO ; 2010 .
- American College of Obstetricians and Gynecologists, 2015. ACOG Committee Opinion No. 650: Physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol, 126 (6), pp.e135-42.
- Ruchat, S.M., Mottola, M.F., Skow, R.J., Nagpal, T.S., Meah, V.L., James, M., Riske, L., Sobierajski, F., Kathol, A.J., Marchand, A.A. and Nuspl, M., 2018. Effectiveness of exercise interventions in the prevention of excessive gestational weight gain and postpartum weight retention: a systematic review and meta-analysis. British journal of sports medicine, 52 (21), pp.1347-1356.
- Bø, K., Artal, R., Barakat, R., Brown, W.J., Davies, G.A., Dooley, M., Evenson, K.R., Haakstad, L.A., Kayser, B., Kinnunen, T.I. and Larsen, K., 2018. Exercise and pregnancy in recreational and elite athletes: 2016/2017 evidence summary from the IOC expert group meeting, Lausanne. Part 5. Recommendations for health professionals and active women. British journal of sports medicine, 52 (17), pp.1080-1085.
