In Support of (Individualizing) Exercise During Pregnancy

Exercise during pregnancy.  Everyone seems to have an opinion, but who and what information can you trust?  A sampling of advice may include “walking only”, “no impact”, “no twisting”, “stick with yoga”, “don’t get your heart rate above 140 bmp”, “and the always popular, “just do what you’ve been doing for exercise.”  Well, what if the woman has been training for Ironman Triathlons or perhaps she hasn’t been exercising at all?  Where does that leave her other than a bit lost and if she’s motivated, searching for more answers?  With all these conflicting and confusing guidelines, it’s no wonder that pregnant women may feel overwhelmed and frustrated when it comes to knowing how to exercise safely and effectively throughout pregnancy.

A 2010 study of 93 healthcare providers found that although the providers’ beliefs about exercise during pregnancy were positive, not all were knowledgeable about or followed current ACOG recommendations, in fact 64% did not (1).  When outdated recommendations are coupled with misinformation from the internet, family, friends and myths passed down from previous generations, it’s easy to understand why women may feel helpless and may ultimately may default to inactivity because that feels “safer.”  The helpless mindset and sedentary body do not help to well prepare a woman for pregnancy, labor or postpartum!  It is vital that we begin to dispel the myths, encourage the broad dissemination of current research, and advocate for appropriate, mindful movement throughout pregnancy.  In turn, empowering women to trust themselves and their bodies, while enhancing the health of future generations.

Exercise plays a vital role in the promotion of overall health for both the mom and baby.  Clapp reports some of the benefits for exercising women include improved cardiac function, decreased risk for gestational diabetes and hypertension, limited weight gain/fat retention,  improved mental state, improved fitness and overall shorter, easier and less complicated labors (2).  A sampling of benefits for baby include improved placental growth and function, enhanced fetal stress tolerance, advanced neurobehavioral maturation and improved intrauterine oxygenation.  According to Clapp, both mother and baby demonstrate an enhanced physiological ability to deal with the expected and unexpected physical stresses of labor (2).

Following clearance from the woman’s medical provider, the woman should be educated in ways to maintain safety while exercising throughout her pregnancy.  The educator should present general prenatal exercise guidelines and make the woman aware of reasons to cease exercise and call her provider, such as those (reasons) set forth by ACOG (3).  The exercising woman should understand the importance of listening to feedback from her body with all exercise and should be knowledgeable about those exercises that are contraindicated during pregnancy, such as contact sports, scuba diving and water skiing.

Despite all of the enumerated benefits, an exercise program must be devised with great care.  It is this author’s opinion that there is not a one-size fits all prescription.  Each woman brings her unique medical background and health history, injuries, pre-existing conditions, her current fitness level and exercise experience, current health and pregnancy, her unique concerns, goals, fears, support systems and an evolving perception of her own self as she shares her body with the baby.  All of this calls for an individualized program from someone who specializes in prenatal fitness and preferably with the collaboration from the woman’s medical team.

If one was to train for a marathon, the mode of training would naturally be running.   Preparing for labor and delivery isn’t accessible in the same way.  However, a comprehensive exercise program designed with the challenges faced by the pregnant, laboring and postpartum woman can be similarly effective.  An appropriate program should include a proper warm-up,

an exercise period of moderate intensity cardiovascular work, overall strength training and flexibility exercises, an emphasis on connection to and strength of the core and pelvic floor and a cool-down.

A truly beneficial supplement is completing the program with diaphragmatic breathing and visualization/meditation.  Relaxation is a crucial skill for labor and delivery.  Establishing this practice during pregnancy can help facilitate relaxation during delivery with greater ease.

A comprehensive program of this nature helps to reduce muscle imbalance, instability and discomfort as the weight of belly grows.  It can prepare the woman for labor and delivery as she learns to listen to the feedback from her body during exercise; learning when she can push harder and when she needs to moderate.  The woman can find great confidence in the strength of her body and mind as she practices staying calm despite a body that is working physically hard.  All of this translates directly to preparation for the impending work.

As you can see, there are many considerations when planning or embarking upon a prenatal exercise program.  Without proper guidance, education and instruction, it can be a task too overwhelming for a woman to undertake on her own.  As most women go to their provider for the final recommendation of what to do/not to do, this calls for widespread dissemination of current research and ACOG guidelines for all providers.  Even when given this information, it may be a slow transition for providers as they are being asked to abandon old ways of thinking and previous recommendations.

The benefits of exercise during pregnancy have been well-documented, although there is still a need for more large-scale studies to truly distill the nuances of prenatal exercise.  In the meantime, what we do know is encouraging for both mother and baby.  Barring contraindications and following medical clearance, the pregnant woman should remain active throughout              pregnancy.  The woman’s program should be a comprehensive one—including strength training, flexibility, breathing, core awareness and meditation/visualization.  The program should be individualized for maximum effectiveness and safety.

If we can provide greater accessibility to both good information and comprehensive instruction, we have the capacity to greatly impact the health of future generations.  With this, we have the responsibility to share what we know, to arm women with knowledge.   This knowledge can then directly translate to confidence, empowerment and strength in mind and body during pregnancy.  This knowledge can directly translate to confidence, empowerment and strength in mind and body during labor and delivery.  This can and often does, carry over right into postpartum and motherhood.  Taken as a whole, all of this can lead to better birth outcomes, healthier moms, healthier babies and healthier generations.

Cited Works/References:

1. Patricia W. Bauer, Clifford L. Broman, and James M. Pivarnik. Journal of Women’s Health. February 2010, 19(2): 335-341. doi:10.1089/jwh.2008.1295.

2. Clapp III, J. F., & Cram, C. (2012). Exercising Through Your Pregnancy: A compelling case for exercise before, during, and after pregnancy (2nd ed.). Omaha, NE: Addicus Books.

3. The American College of Obstetricians and Gynecologists. “Frequently Asked Questions FAQ0119 Pregnancy.”  The American Congress of Obstetricians and Gynecologists. The American College of Obstetricians and Gynecologists, 2011. Web. 8 Sept 2015.

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