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Exercise During Pregnancy

What You Should Know About Exercise During Pregnancy
Views on exercise during pregnancy have swung like a pendulum from one extreme to the other. Until the latter half of the 20th century, most doctors thought that any type of physical activity during pregnancy could harm both mother and fetus. Over the past 50 years, however, doctors have recognized not only that exercise poses no great threat to pregnant women, but that it may actually be helpful-leading some authorities to make exaggerated claims about its benefits for pregnancy, labor, and delivery. Today, most experts agree that although no particular exercise regimen can guarantee a problem-free pregnancy and a fast, painless delivery, the overall benefits of exercise apply to pregnancy too.

Should I exercise during pregnancy?
Check with your doctor first. Provided you are in reasonably good health and have no problems with your pregnancy, you should be able to exercise. However, no evidence to date suggests that you must exercise during pregnancy.

Suppose I wasn't exercising beforehand?
If you're planning to become pregnant, it's best to institute a regular exercise program before you conceive. However, if your doctor agrees, you should be able to begin a reasonable exercise routine during pregnancy. If you've been sedentary, choose a moderate activity such as walking.

Will the pregnancy affect how I exercise?
Normal physical changes associated with pregnancy have a definite impact on movement and balance. For example, weight gain can make any activity more difficult to perform. During pregnancy, the ligaments are looser--especially in the hips and pelvis. Your center of gravity moves forward, which can impair your balance. Your lower spine "bows" inward, predisposing you to low back pain. Shortness of breath on exertion is also common. All of these changes become more pronounced as pregnancy progresses, forcing you to reduce your activity level.

What are the benefits?
Overall positive effects of exercise include burning excess calories, helping digestion, preventing constipation, decreasing backache, reducing stress, enhancing body image, increasing energy levels, improving sleep, and promoting emotional well being. Benefits related directly to pregnancy include improving circulation, thus helping to prevent fluid retention and varicose veins; maintaining muscle tone to aid in delivery and recovery after birth; shortening the duration of labor; lowering the risk of preterm delivery; and possibly decreasing the need for cesarean section.

What are the risks?
Although moderate exercise usually doesn't harm the fetus, engaging in strenuous exercise or endurance-type sports can reduce fetal blood supply and cause oxygen deprivation. For this reason, babies of mothers who exercise excessively may be somewhat smaller and have a little less body fat at birth. In extreme cases, vigorous exercise may even lead to preterm delivery. Thus, if your doctor detects that fetal growth is lagging, it may be advisable to curtail your activities. Please note that some studies have suggested that women who exercise have larger babies.

Is exercise ever forbidden?
If you have diabetes or heart disease, exercise may be too dangerous for you. Also, exercise is ill-advised for pregnant women with any of these conditions: second- or third-trimester vaginal bleeding, failure to gain enough weight, history of preterm labor or delivery, pregnancy-related high blood pressure (pre-eclampsia), premature labor or rupture of the membranes in the current pregnancy, incompetent (weak) cervix, and multifetal pregnancy (twins or more).

What are the basic guidelines?

• Regular exercise sessions (at least 3 times per week) are better than sporadic activity.
  
• Avoid outdoor exercise when it's hot and humid. Wear loose-fitting, lightweight clothes that allow heat and moisture to escape.
  
• Include warm-up and cool-down routines. Stop when you're mildly fatigued-don't exercise to the point of overheating and exhaustion.
  
• Listen to your body. Your energy levels can fluctuate from day to day during pregnancy, so tailor your activities to how you feel.
  
• Drink lots of water (it's better than sports drinks) while exercising, as dehydration is a serious danger for both you and your fetus.

What are the best types of exercise?
If you're already a trained athlete, you can probably continue your preferred activity throughout pregnancy, but check with your doctor. You may need to decrease the intensity during the latter half of the third trimester. For non-athletes, brisk walking is fine. Swimming is especially beneficial: The water makes you feel 90% lighter. Also, the risk of injury is small, and the resistance of the water helps to improve muscle strength and tone. Yoga is also great for strength and flexibility, and familiarity with the deep breathing exercises will help during labor.

What are the worst types of exercise?
Avoid activities that involve jarring or bouncing, that depend on precise balance, or that can cause abdominal trauma or falling. Be careful not to over-flex or over-extend your knees, and don't do exercises that require you to lie flat on your back after your first trimester. Specific activities that are ill-advised during pregnancy include sit-ups, toe-touches, and push-ups; contact sports such as basketball, field hockey, ice hockey, and soccer; gymnastics; horseback riding; in-line skating; downhill skiing or water skiing; snowboarding; ice skating; scuba diving; and surfing.

How can I tell if I'm doing it right?
Fitness experts recommend that you exercise at 50% to 60% of your maximum heart rate (MHR) for 20 to 30 minutes, 3 times per week. To calculate your target heart rate, first figure out your MHR (subtract your age from 220) and then divide the result by 2. For example, if you're 30 years old, the formula would be 220 - 30 = 190, and then 190 ¸ 2 = 95 beats per minute, your target heart rate. To measure your heart rate, take your pulse for 10 seconds while you're exercising, and then multiply the result by 6 to determine the number of heartbeats per minute.

Let your body guide you to an appropriate activity level. This means exercising until you begin to tire-not until you're exhausted.

What are the danger signs?
A persistent lag in your weight gain-or in fetal growth-may mean that you're exercising too strenuously. Although it's normal to find your exercise routine more tiring and difficult as pregnancy progresses, ask your doctor to test you for anemia if you're always feeling tired. Stop exercising immediately if you have chest pains, vaginal bleeding, or uterine contractions, or if your water breaks.

Any final words?
You might consider joining an exercise class for pregnant women. Along with ensuring that you exercise regularly and safely, attending the class will enable you to socialize and exchange information with other pregnant women.

*This Patient Handout was prepared by Patricia G. Van Horn using material from drkoop.com, OBGYN.net, and WebMD.