Is Exercise Safe During and Following Pregnancy?
Is it safe to exercise during pregnancy?
When is it ok to start exercising after having a baby?
Whether it’s running, lifting weights, or yoga, there is confusion on what is safe to do during pregnancy, as well as how to safely return to exercise following delivery.
“Only about one-third of women are receiving guidance on how to safely run or exercise.”
The truth is that exercise can be performed safely in nearly all cases. It is even recommended to exercise before, during, and after pregnancy for many women. The American College of Obstetrics and Gynecologists (ACOG) recommend women should get at least 150 minutes of moderate intensity aerobic activity per week during pregnancy and the postpartum period based on guidelines established by the American College of Sports Medicine (ACSM) and World Health Organization (WHO). Although there has been research supporting that exercise is safe for this population, only about one-third of women are receiving guidance on how to safely run or exercise.
Below we share some considerations for exercising during pregnancy, how to return after pregnancy, and when you should avoid exercise and consult a professional.
When Should You DEFINITELY NOT Exercise
A good place to start is knowing the short list of when you should NOT exercise during or after pregnancy. This lists the most common reasons but be aware that there are other reasons you should not exercise. If you are concerned about any of these factors, consult your physician, OB/GYN, or pelvic health therapist.
Instruction by health care professional to stop exercise
Restrictive lung disease
Hemodynamically significant heart disease
Incompitent cervix
High risk pregnancy
Persistent second or third trimester vaginal bleeding
Placenta previa after 26 weeks gestation
Preeclampsia
What are the Benefits of Exercise During Pregnancy?
Increased rate of vaginal delivery
Decreased maternal weight gain
Decreased risk of gestational diabetes and preeclampsia
Lower chance of preterm birth
Lower chance of low birth weight
Improved mood
How to Exercise During Pregnancy
As mentioned above, it is important to get at least 150 min of light to moderate exercise per week. An easy way to monitor your exercise intensity is using the rate of perceived exertion (RPE), a scale ranging 1-10 used to measure your effort. This scale has been researched to be directly correlated with the percentage of your maximum heart rate you are exercising at. It is a good idea to consider this scale while exercising to make sure you do not over-do exercise or go too easy and miss out on the benefits. Devices such as the Apple Watch or Fitbit can help you monitor and analyze your heart rate.
During the first trimester of pregnancy you may be able to participate in any activity you were performing prior to becoming pregnant. When using the RPE scale, you can aim for a 5-7 out of 10 during exercise. This may include running, strength training, yoga, etc. During this time it is great to familiarize yourself with the precautions and contraindications to exercise for the upcoming trimesters. In addition, working on proper core control and strength can be beneficial with help of a physical therapist. This is especially important if you are experiencing any musculoskeletal pain such as low back pain.
During the second trimester of pregnancy, there may be some exercise modification needed in order to reduce discomfort or risk of injury. Limiting time lying on your back is more common from this point on during your pregnancy because the baby is growing and placing more pressure on your abdominal blood vessels. This can cause difficulty breathing. An easy modification is side lying or elevating your upper body slightly. This will reduce pressure and allow for venous return to your heart. Continuing postural strengthening and endurance is important to support your spine, especially as your abdominal muscles change with the growth of your baby. A physical therapist can be very helpful to ensure that this is performed safely and effectively. This is a great time to review any precautions or contraindications and clarify any questions you may have with your trusted health care practitioner in order to stay safe during exercise.
Some variables that a Physical Therapist will be able to help you manage are:
Adjusting workout tactics tailored to your current situation. Example: using interval work versus steady state.
Tips to avoid overheating.
Considering calorie intake to prevent weight loss and ensure proper fetal growth, especially with higher levels of physical activity or athleticism.
Exercise modification for your current stage and situation
Exercise modification based on current or past injury history
During the final trimester of pregnancy it is recommended to aim for lower intensity exercise (a 1-4 on the RPE scale). You may need to supplement higher impact cardiovascular exercise by cross training such as walking, biking, or swimming in order to keep up your fitness while reducing strain on your ligaments. Using various types of exercise to accumulate your weekly cardiovascular exercise will decrease your risk of potential injuries. Emphasis should be placed on pelvic floor relaxation (sometimes called downtraining) exercise in order to prepare for labor and delivery. This can help reduce risk of pelvic floor injury such as perineal tearing. You can also go over birthing positions to feel more prepared and comfortable. It is also advised to limit activities that increase risk of falling, blows to the belly, or contact from other people. Other less common activities have specific precautions, for example, scuba diving should be avoided due to risk of decompression sickness to the fetus. Regardless, if you are cleared to participate in physical activity but experience any of the symptoms listed below, it is advised to stop the activity and consult with your doctor.
Warning Signs to Stop Exercise During Pregnancy
Vaginal bleeding
Difficulty breathing prior to initiating exercise
Dizziness
Headache
Chest pain
Sudden muscle weakness
Calf pain/swelling
Preterm labor
Decreased fetal movement
Amniotic fluid leakage
Exercise During the Postpartum Period
The most common advice provided is to perform “pelvic floor exercise” which most people know as “Kegels”; however, this advice is far too general and does not suit every mother’s needs! Not all women need to do Kegels, and in some cases it can make symptoms worse. There are factors other than the pelvic floor which need to be addressed prior to safe return to activity such as: joint mobility, joint stability, and core strength. Research has shown that receiving exercise guidance postpartum increases the likelihood of women returning to running/exercise. Interestingly, pelvic health physical therapists are among the most common resources for mom’s looking to exercise!
“The most common advice provided is to perform “Kegels”; however, this advice is far too general and does not suit every mother’s needs!”
The most important goal during the first two weeks following the delivery of your baby is to facilitate healing of any tearing or surgical incisions. Education on body mechanics for transitions such as getting in and out of bed, as well as handling your baby are important to protect any injuries and reduce pain.
Any physical activity should be low (0-2 on RPE scale) and in 10-15 minute increments. If that activity is tolerated well, you can gradually increase that interval over the next day or two. Within 3-4 weeks of delivery, you should be able to reintroduce gentle abdominal and pelvic floor muscle training as long as it is not painful. Your “prehab” will make this process much smoother. You can begin a low level walking program (less than 15 minutes at a time) to make sure everything feels ok. By week six you may be able to walk for up to 30 minutes. Usually, this is the time period where an internal physical therapy assessment is cleared by the OB which can be helpful in addressing pelvic floor dysfunction that can occur during the labor/delivery process. Exercise will focus on functional movements and muscular endurance using lower resistance (<10 lbs or baby).
Over the next 7-12 weeks, with clearance for your MD, you should continue to progress strength and endurance training, introduce power and plyometrics (jumping/running) as appropriate. Strength and power training is especially important if your goal is returning to impact exercise such as running. Your physical therapist will determine what level of physical activity that is safe for you to participate in. Usually an outcome measurement such as the Run Readiness Scale is able to determine if you are ready for the task. Some precursors to running safely are calf raises, single leg hops, and planks. Some people will progress through their program and may be ready to return to their prior level of function eight weeks postpartum. Many factors such as prior level of function and any complications during delivery determine this time frame. If you cannot tolerate walking for 30 minutes, running may not be a good option.
Don’t forget to drink water!!! Hydration is also important especially with prolonged exercise or high temperatures. This is especially important for lactation.
Returning to exercise is important for many health reasons including decreasing risk of postpartum depression. Exercise is helpful for both the body and mind, so returning to the activities you love to do is good for your overall well being. Always check with your physician to make sure you are cleared for physical activity, especially if you are new to exercise.
Need help figuring out whether exercise or physical therapy can help you?
As a team of physical therapists, we assess the whole body to address your individual needs, and work with your physician to make sure you are prepared to return to your prior level of fitness. Do you want to know more? Request an appointment now or call our office at 908-598-9009.
References
“Physical Activity and Exercise during Pregnancy and the Postpartum Period.” ACOG, https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/04/physical-activity-and-exercise-during-pregnancy-and-the-postpartum-period.
Selman R, Early K, Battles B, Seidenburg M, Wendel E, Westerlund S. Maximizing Recovery in the Postpartum Period: A Timeline for Rehabilitation from Pregnancy through Return to Sport. IJSPT. Published online October 1, 2022.