exercise during pregnancy

by Joanna Clouden, Bachelor of Physiotherapy (Otago) 1997.
Post Graduate Diploma in Sports Manual Therapy
(University of Western Australia).

During pregnancy our bodies adapt to changes in spinal curves and hormonal effects. Today, we recognise that pregnancy makes physical and emotional demands on you, and exercise is one way to help you stay as healthy as possible.

A well balanced exercise programme can minimize the discomforts typically associated with pregnancy and may allow for an easier delivery of the baby with a faster post-natal recovery.

There is a growing body of research that demonstrates that moderate physical exercise during pregnancy is not only safe but beneficial for both the baby and the mother-to-be.

Benefits:

Exercise during pregnancy has an impressive list of benefits (9):

• Reduces the incidence of stress and depressed moods during pregnancy and in the post-partum period(2)
• Enhances fetal and placental growth in the first and second trimesters. (3 & 5)
• Decreases the incidence of pregnancy related complications such as pre-eclampsia and gestational diabetes. (4), (8).
• Results in a lower incidence of operative deliveries (both caesarian and vaginal). (5)
• Shortens the period of active labour (5)
• Reduces the incidence of back pain during the third trimester(6)
• Decreases the likelihood of urinary incontinence developing in the pre and post-natal periods. (7)

Exercise Advice:

SPARC, Aotearoa recommend that ‘moderate physical activity taken regularly during pregnancy is safe and beneficial for most women’. The American College of Obstetricians and Gynaecologists (ACOG), 2002 recommend that ‘pregnant women should avoid supine positions (back lying) during exercise as much as possible’. Motionless standing is also associated with a significant decrease in cardiac output so time spent standing in one position without movement should be reduced.

Don’t spend more than a couple of minutes in one position, especially supine.

Warnings:

There are very few conditions where exercise should not be undertaken during pregnancy. For expert advice, please discuss your health with your GP, midwife or lead maternity carer.

Nutritional Requirements:

After the 13 th week of pregnancy, about 300kcal per day are required to meet the metabolic needs of pregnancy(1).  This energy requirement may increase further when exercise is undertaken. Pregnant women use carbohydrates at a greater rate both at rest and during exercise than do non-pregnant women.

Pilates and Stability training:

With an emphasis on good core control, muscle balance and postural alignment Pilates exercise programmes readily adapt to the needs of the expectant mother. Along with a reduction in discomfort associated with pelvic and lumbar instability, two of the major areas that Pilates type exercise programmes may help with are:

Diastasis:

Separation of the 2 halves of the anterior abdominal wall during pregnancy.

Sit-ups are contra-indicated during pregnancy and the post pregnancy phase (minimum 12 weeks post natal, but best to check with your physiotherapist that any diastasis has resolved).

Continence:

There are predominantly type 1 (slow twitch) muscle fibre types in the pelvic floor, this means that they are designed for low grade endurance type activities.

Specific low activation level recruitment is emphasized throughout Pilates or stability training programmes, and research supports the effectiveness of specific training for reducing the occurrence of continence problems.

Try this simple exercise to improve your pelvic floor and core abdominal activation:

Check for good postural alignment (neutral spinal position)

• Sit upright.
• Rock backward and forward until you find your balance point.
• Elevate up through the crown of your head as if you have a helium balloon lifting your head from your shoulders.
• Relax the upper abdominal wall with diaphragmatic breathing
• Set your shoulder blades, with a gentle roll up and back – relax following this movement.
• Contract pelvic floor muscles (PFM) with ‘zip up and hollow’ pattern.
• Maintain breathing throughout.
• Slowly release abdominal wall then PFM (zip down).
• Focus on the quality of the movement, starting with short holds only. Use your breath to control effort – if you can’t breathe normally you’re contracting too hard.
• Allow adequate rest time between contractions.
• Aim for 30+ contractions per day.

Alternatively your may like to sit on a small towel or swiss ball: ‘lift your pelvic floor away from the towel/ball’

References:

1. Artal R, O’Toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. B J Sports Med 2003;37:6-12.
2. Da Costa et al 2003, Nordhagen & Sundgot-Borgen 2002.
3. Clapp J. & Rizk, K. 1992. Effect of recreational exercise in midtrimester placental growth. American Journal of Obstetrics and Gynecology 167(6):1518-1521.
4. Bung, P & Artal, R. 1996. Gestational Diabetes and Exercise: a survey. Seminars in Perinatology. 20 (4):328-333.
5. Clapp, J. 2002. Exercising through your pregnancy. Addicus Books. Nebraska
6. Garshsbi, A & Faghih Zadeh, S. 2005. The effect of exercise on the intensity of low back pain in pregnant women. International Journal of Gynaecology and Obstetrics. 88(3): 271-275.
7. Morkved, S. Bo, K., Schei, B. & Salvesen, K. 2003. Pelvic floor muscles training during pregnancy to prevent urinary incontinence: a single blind randomized controlled trial. Obstetrics and Gynecology 101: 313-319.
8. Weissberger et al 2004. The role of regular physical activity in preeclampsia prevention. Medicine and Science in Sports and Exercise. 36(12):2024-2031.
9. Polestar Pilates Education. 2005. Women’s Health: A Pilates-based Approach.

About Joanna Clouden:

Joanna graduated with a Bachelor of Physiotherapy from the University of Otago, NZ in 1997. She has a post graduate diploma in Sports Manual Therapy from the University of Western Australia.

She has undertaken a Body Control Pilates specialist workshop in Pilates Mat training, whilst working in London as the National Physiotherapy Manager for private healthcare company BUPA.

Since returning to Wellington, New Zealand, Joanna continues to work as a musculoskeletal physiotherapist and has taught both Beginners and Intermediate level Pilates mat classes. Her interest in the Pre and Post natal period led to attendance at a Polestar Pilates Education Women's Health training course.