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