The Practising Midwife February 2014

Being fit in pregnancy Deborah Hazeldean explains why midwives need to encourage women to access fitness information during pregnancy

SUMMARY: There is a substantial body of evidence to suggest that exercise during pregnancy is not only safe but beneficial, yet many women remain unsure about what exercise is appropriate or indeed whether it is safe to exercise at all, opting instead for inactivity. The purpose of this article is to explore the benefits of maintaining or improving fitness during pregnancy. It explores some of the more appropriate and accessible exercise options to help encourage women to achieve the recommended level of 30 minutes of physical activity a day (National Institute of Health and Care excellence (NICE) 2010). The article also recognises the need for accessible information regarding exercise and highlights some of the resources that pregnant women might find useful.

Keywords Prenatal exercise, safe exercise during pregnancy, exercise Author Deborah Hazeldean, co-founder of a company which provides resources for women regarding exercise and wellbeing in pregnancy

Background

However, the message does not appear to be

It is widely accepted that regular exercise has a

reaching a lot of women. There seems to be

positive impact on overall health; but only 28.5

confusion not just about what type of exercise

per cent of adult women in the UK report being

is safe to continue, but whether it is safe to

active at a level that will benefit their health

exercise at all. In the face of mixed messages

(British Heart Foundation (BHF) 2012). The

regarding the safety of different activities and

picture for pregnant women is equally bleak,

any potential risk to mother and fetus, it

despite recommendations that ‘all women

appears that many women err on the side of

should be encouraged to participate in aerobic

caution and opt for inactivity.

and strength-conditioning exercise as part of a

There seems to be confusion not just about what type of exercise is safe to continue but whether it is safe to exercise at all

healthy lifestyle during pregnancy’ (Royal

Benefits of exercise in pregnancy

College of Obstetricians and Gynaecologists

Maintaining fitness during pregnancy helps the

(RCOG) 2006a: 1). The RCOG also states that: ‘A

mother both physically and psychologically. It

review of the evidence suggests that, in most

can alleviate discomfort as well as preparing

cases, exercise is safe for both mother and

the mother physically for labour and promoting

fetus during pregnancy’ (RCOG 2006a: 6). The

a speedier postpartum recovery. Regular

American Congress of Obstetricians and

exercise can help to reduce many common

Gynecologists (ACOG) supports this view,

complaints such as lower back pain, tiredness,

saying: ‘Pregnant women should be encouraged

varicose veins and swelling of feet and ankles.

to engage in regular, moderate-intensity

Blood flow can be improved; a stronger heart

physical activity to continue to derive the same

will improve circulation; and increased supplies

associated health benefits during their

of oxygen result in the feeling of enhanced

pregnancies as they did prior to pregnancy’

energy levels.

(ACOG 2002: 1).

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The Practising Midwife | February 2014

The RCOG states: ‘Recreational exercise

Pregnancy fitness

and brain and can be counter-productive in inducing sleep. Some sources suggest that the optimum time for sleep-promoting exercise is the late afternoon or early evening, allowing time for the body to cool down before bedtime (Harvard Medical School (HMS) 2007; National Sleep Foundation (NSF) 2013).

In addition, exercise can lead to better posture and body awareness, which in turn can improve self esteem, self image and confidence (Coulson and Bolitho 2012).

Maintaining and improving fitness The aim of recreational exercise should be to stay fit and maintain levels of fitness rather Photo courtesy FittaMamma

than to reach peak fitness. Length and intensity of exercise sessions should decrease as the pregnancy progresses and a common sense approach should be adopted: warm up, cool down and listen to your body. Women who exercised regularly before pregnancy should be able to continue with no adverse effects and there is no reason why recreational exercise such as swimming, jogging, brisk walking or strength conditioning exercise shouldn’t be introduced. If women have not exercised routinely, they should begin with no more than 15 minutes of continuous exercise three times per week, increasing gradually to 30-minute sessions per day (NICE 2010).

Should even this modest level of physical during pregnancy may help to prevent medical

assumed to be happy and positive, which

activity be difficult, women should be

conditions such as gestational diabetes

means that many cases might go undiagnosed

encouraged to start walking and to build

mellitus and hypertension,’ adding that exercise

and therefore untreated, increasing the risk of

physical activity into daily life, for example by

‘also reduces the risk of developing colon

postnatal depression. But even a modest level

taking the stairs instead of the lift.

cancer and may reduce the risk of developing

of recreational exercise promotes a sense of

breast cancer later in life’ (RCOG 2006b: 3).

wellbeing, releasing beneficial endorphins,

Staying safe

lifting mood and making sleep easier, reducing

The RCOG cites various sports (such as downhill

stress, anxiety and depression.

skiing, for example) that should be undertaken

Estimates suggest that almost one in three pregnant women experience some type of depression (Price 2007). One of the major

Whilst exercise can promote sleep, the time

with ‘particular care’ due to the danger of

issues for women who experience antenatal

of day when you exercise can make a

falling during such activities and in recognition

depression is a reluctance to admit to feeling

difference for some people. Vigorous exercise

of the greater possibility of losing balance as a

depressed at a time when they are generally

prior to bedtime will stimulate heart, muscles

woman’s centre of gravity changes; contact

The Practising Midwife | February 2014

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Pregnancy fitness

sports are not recommended for fear of injury; and scuba diving should be avoided as the baby has no protection against decompression sickness (RCOG 2006a).

As both pregnancy and exercise raise the metabolic rate it is important to take care not to overheat; maternal core temperatures above 39.20 Celsius are potentially teratogenic in the first trimester (RCOG 2006a). However, increased sweating and vasodilation to the skin dissipate heat (Coulson & Bolitho 2012), offsetting the potential hyperthermic effects

point them towards appropriate resources to

Even a modest level of recreational exercise promotes a sense of wellbeing, releasing beneficial endorphins, lifting mood and making sleep easier

of exercise. Exercise is usually safe as long as

inform and educate them to benefit themselves and their baby. Women who exercise regularly are better able to cope with labour, recover more quickly afterwards and are less likely to be overweight when they conceive their next child. Furthermore, fit and active women are more likely raise active children and encourage their families to embrace a culture of exercise. Encouraging women to help themselves and guiding them towards appropriate information can only be of benefit.

tpm

sensible precautions are taken (RCOG 2006a): wherever possible exercising outdoors is

techniques practised help during labour and

Deborah Hazeldean is co-founder of a company

beneficial, though not in hot and humid

some poses are especially beneficial in

which provides resources for women regarding

conditions; plenty of water is essential; and

preparing for the birth.

exercise and wellbeing in pregnancy

maternity clothes will also help to maintain a

Information for pregnant women

References

more normal body temperature.

Information about appropriate levels of

ACOG (2002 reaffirmed 2009). ‘Exercise during pregnancy

wearing appropriately designed fitness

Whilst some sources (including the RCOG)

exercise, safe exercise in pregnancy and easy to

and the postpartum period’. Obs Gyn, 99(1): 171-173.

raise doubts about whether it is safe to cycle

follow exercise workouts are readily available

BHF (2012). Physical activity statistics 2012, London: BHF.

during pregnancy and suggest that ‘care

to pregnant women from a variety of

Coulson M and Bolitho S (2012). Complete guide to

should be taken’, there are many countries

accessible sources.

where a bicycle is the accepted mode of

There are a number of books and other

pregnancy and fitness, London: Bloomsbury Publishing.

CED (2013). Facts about cycling in Denmark,

transport. In Denmark, for instance, where 36

resources around pregnancy fitness which

per cent of adult females use a bicycle to get

guide users through simple and easy exercises

to work or place of education, it is normal for

that can be safely carried out at home, or

pregnant women to cycle (Cycling Embassy of

present information on the physiological

NSF (2013). Diet, exercise and sleep, Arlington: NSF.

Denmark (CED) 2013). Again a ‘common sense’

changes to a woman’s body during pregnancy

Price S (2007). Mental health in pregnancy and

approach would avoid intense mountain biking

to provide a deeper understanding as to why

and suggest that a ‘sit up and beg’ style bike is

exercise is beneficial. The RCOG has

more comfortable as pregnancy progresses.

information for pregnant women available as a

Copenhagen: CED. HMS (2007). Twelve simple tips to improve your sleep, Harvard: HMS.

childbirth, Oxford: Churchill Livingstone.

NICE (2010). Weight management before, during and after pregnancy, London: NICE.

downloadable PDF. Published in 2006, it

RCOG (2006a). Exercise in pregnancy, London: RCOG.

swimming makes this an excellent activity

provides useful support with regard to safe

RCOG (2006b). Recreational exercise and pregnancy,

during pregnancy, although again the same

exercise during pregnancy, and exercise post

guidelines regarding warming up and cooling

partum, as well. Enjoying an active pregnancy

down should be followed and women suffering

is endorsed by the government’s Change4Life

Further resources

from symphysis pubic dysfunction should

campaign which recommends exercise but

• www.rcog.org.uk/womens-health/patient-

avoid breast stroke. Yoga has long been

does not provide comprehensive information

considered one of the more ‘acceptable’

on different activities.

The support provided by the water when

exercises during pregnancy with the added benefit that the breathing and relaxation

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The Practising Midwife | February 2014

Information is paramount. Midwives need to discuss fitness with women and, in addition,

London: RCOG.

information • www.nhs.uk/conditions/pregnancy-andbaby/pages/pregnancy-exercise.aspx#close