The Dos and Don’ts of Exercise During Pregnancy

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  • The Dos and Don't of Exercise During Pregnancy

The Dos and Don’ts of Exercise During Pregnancy

There is a plethora of information (and often mis-information) when it comes to what is considered safe exercise during pregnancy. Frequently, women do themselves a disservice by avoiding exercise altogether out of fear of doing harm.

Of course, each individual is unique and should receive input from their physician, but here are some general guidelines for women to consider when exercising while pregnant:

Things to avoid

  • Supine position (on your back) after first trimester
  • Prolonged periods of motionless standing
  • Hot/humid exercise environments
  • Valsalva maneuver (bearing down)
  • Exercises  involving a high risk of falling or potential abdominal trauma, especially in the third trimester
  • Scuba diving
  • Exercise above 6000ft elevation

Relative contraindications

  • Severe anemia
  • Cardiac arrhythmia
  • Chronic bronchitis
  • Poorly controlled type I diabetes
  • Extreme morbid obesity
  • Extreme underweight (BMI<12)
  • Intrauterine growth restriction in current pregnancy
  • Poorly controlled hypertension or seizure disorder in hyperthyroidism
  • History of heavy smoking
  • Orthopedic limitations (see “Physical changes” above)

*Discuss any of the above limitations with your physician prior to beginning an exercise regimen

Absolute contraindications:

  • Pregnancy induced hypertension
  • Premature rupture of membranes
  • Pre-term labor during pregnancy
  • Multiple gestation at risk for premature labor
  • Incompetent cervix
  • Placenta previa after 26 weeks
  • Persistent bleeding
  • Intrauterine growth retardation
  • Restrictive lung disease

*Do NOT engage in exercise if any of the above are present during pregnancy

Warning signs to STOP exercise:

  • Vaginal bleeding
  • Shortness of breath prior to exertion
  • Dizziness
  • Headache
  • Chest pain
  • Sudden muscle weakness
  • Calf pain or swelling
  • Decreased fetal movement
  • Amniotic fluid leakage

Red flags that require immediate medical attention during pregnancy:

  • Chest pain that is not improved after 20 minutes of rest
  • Chest pain with nausea, vomiting, and profuse sweating
  • Shoulder pain worst with lying down; relieved by sitting or leaning forward
  • Shortness of breath when lying down
  • Vaginal bleeding
  • Confusion or lethargy in women with history of gestational diabetes

Type and intensity of exercise:

Consider your pre-pregnancy exercise regimen – Women who exercise regularly before becoming pregnant can typically remain active throughout their pregnancy. It is not advised that a woman initiate exercise after becoming pregnant if she was not active prior to becoming pregnant. Women are encouraged to participate in moderate intensity exercise and should avoid overexertion and overheating. Using the Rate of Perceived Exertion (RPE) or the Talk Test (can you speak a full exercise without gasping for air?) are good ways to monitor the intensity of exercise.  Talking to a physical therapist can ensure that you select the appropriate form of exercise, especially if you are having pain!

Physical changes that affect exercise:

Decreased lung capacity

This is related to elevation of the diaphragm to accommodate the space taken up by the growing baby. Thus, healthy women may complain of shortness of breath as the baby starts to grow.

Increase in blood volume

The effects of this include: increased resting heart rate, increased lower extremity pressure (which may lead to swelling in the feet and legs, as well as hemorrhoids and varicosities).

Postural changes

The body goes through a lot of hormonal and structural changes during pregnancy in order to accommodate the baby. A hormone called relaxin leads to laxity of all connective tissue and therefore, joints are more mobile.  Women can experience pain in their low back, sacroiliac joints, pubic symphysis, hips, knees and even wrists due to the increased mobility in these joints during pregnancy.  For this reason, it is important to keep in mind that you may seem more flexible while you are pregnant and should therefore avoid stretches at end range.

Common postural changes include:

  • Forward head posture
  • Increased thoracic spine (rounded upper back)
  • Increased lumbar curve (sway back)
  • Anterior pelvic tilt
  • Increased base of support as center of gravity moves forward

*Read more about avoiding injury during pregnancy!

Separation of abdominal muscles (Diastasis rectus abdominis)

Ligament laxity and increased volume in the abdominal cavity are responsible for the separation of the most superficial abdominal muscle (rectus abdominis). Physical therapy can help to strengthen the deepest layer of your abdominal muscle (transverse abdominis) in order to prevent and/or correct abdominal separation!

*Read more about Diastasis Recti!

Pelvic floor dysfunction

The pelvic floor can become dysfunctional during this time, which can cause pain, as well as urinary or bowel problems. Women frequently experience stress urinary incontinence and painful intercourse (dyspareunia) while pregnant. These symptoms are indicative of pelvic floor dysfunction and would benefit from physical therapy!

Ultimately, women are encouraged to participate in exercise while pregnant, as there are significant benefits for both mom and baby – The American College of Obstetricians and Gynecologists (ACOG) recommends it: “In the absence of either medical or obstetric complications, 30 minutes or more of moderate exercise a day on most, if not all, days of the week is recommended for pregnant women.” (ACOG 2002).  Physical therapy can facilitate pain-free exercise and allow women to remain active throughout their pregnancy as their body changes!

Amanda Osborne PT, DPT

Image via Flickr by Vanessa Porter.

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About the Author:

Amy Osborne PT, DPT
Amy received her Doctorate in Physical Therapy from Northwestern University in Chicago. Previously, she has worked for the Chicago Hospital, treating patients with spinal cord injuries and neurological pathologies.

Today, Amy focuses her practice on the treatment of pelvic floor dysfunction and musculoskeletal impairments associated with pregnancy. Her experience also includes exercise prescription for the prenatal and postpartum populations. She is an ACE-certified personal trainer and teaches courses for correction of diastasis recti.

Location: N2 Physical Therapy Denver