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Regular exercise is an important part of life for many women, and most wish to continue exercising during pregnancy. Some women feel that pregnancy is a good time to start a gentle program. An informed and sensible exercise routine can be enjoyable and beneficial during pregnancy. Regular exercise throughout pregnancy helps to keep the heart and blood vessels healthy, Improves muscle tone and promotes well-being. Exercise may help to relieve some discomforts and complications of pregnancy, including tiredness, leg cramps, constipation and excessive weight gain. A program of back-strengthening exercises for the pregnant woman is desirable because backache is common during pregnancy.
The body undergoes many physical changes during pregnancy. These changes affect the way a woman’s body responds to physical activity, as follows:
- The most obvious changes are increased weight and change of body shape. These can alter a woman’s sense of balance and co-ordination, so it is important to avoid activities that increase the risk of falls or injury to the abdomen. Contact sports and some other activities that involve unexpected stress such as horse riding and skiing, require caution, particularly after 28 weeks gestation.
- Throughout pregnancy, the body releases a hormone called relaxin. Relaxin softeners the ligaments, allowing the pelvis to expand and preparing it for the birth. However, all joints become less stable, and the risk of injury to the joints increases. Strapping or support of the previously injured joint may be helpful.
- Pregnancy places extra demands on a woman’s heart. More blood is pumped around the body each minute to ensure an adequate supply of oxygen to the baby. The resting heart rate and exercising heart rate increase throughout pregnancy.
- As pregnancy progresses, the expanding uterus pushes the diaphragm (the large muscle between the chest and the abdomen) upwards. This crowds the chest area and may make breathing more difficult.
- Pregnancy hormones can contribute to breathlessness.
- The body uses carbohydrates more quickly during pregnancy, so more frequent food intake may be necessary.
- Core temperature of the body rises about 1 degree during pregnancy. This, coupled with an increase in core temperature during exercise, means pregnant women must be cautious not to overheat. Prolonged and excessive overheating can be harmful to the fetus, especially in the first three months. Follow the exercise guidelines in the newsletter to reduce the risk of overheating.
Exercising safely during Pregnancy
Women who have not followed an exercise routine before pregnancy should consult Dr Metawa before starting a mild program. Regular exercise (about 3 times per week) is recommended. Low-impact activities such as walking, swimming, water aerobics and using an exercise bike are considered safe throughout pregnancy.
Most pregnant women can continue established routines but, may need to moderate their activities as the pregnancy progresses. During the first trimester (first three months of pregnancy), many women feel tired and unwell, and may feel frustrated when they have the desire to exercise but little energy. These feelings typically pass as women enter the second trimester (the middle months of pregnancy)
- Drink plenty of water during and after exercise.
- Be aware of your limitations. Discuss an exercise plan with Dr Metawa
- Do warm-up and stretching exercises before any vigorous routine. Follow with a gradual cool-down period, keeping the legs moving to help blood return to the heart. Be careful not to over-stretch. It may cause back injury and pain.
- Stop exercising if you start to become breathless or fatigued.
- Exercise cautiously in hot or humid conditions. It is important that you and your baby do not become over-heated.
- To assist cooling of the body, wear clothing that allows evaporation from the skin. A well-fitting bra is also recommended.
- Avoid exercising during the hottest or most humid parts of the day.
- Exercise in a well-ventilated area.
- Avoid excessively hot tubs, spas and saunas , and do not exercise in water above 28 degrees
- Do not deep-sea dive beyond three meters underwater or water ski.
- Do not exercise if you have a fever or feel unwell.
- After the first 18 weeks of pregnancy avoid exercise that involves lying flat on your back. The weight of the uterus can put pressure on a major vein in the abdomen and interfere with blood flow back to the heart; the result is to feel faint.
- Avoid long periods of standing.
- Exercises involving sudden movements such as bouncing, jumping or changing direction should be avoided, especially in the third trimester (after 28 weeks).
- Avoid exercise where it may be hard to keep your balance.
- Do pelvic-floor exercises. The pelvic-floor muscles support the bladder, the uterus and the intestines. Pregnancy can weaken and stretch these muscles, possibly leading to bladder and bowel control problems. A physiotherapist with expertise in pelvic-floor exercises may be helpful.
- If playing team sports, substitute and rest frequently. It is a good idea to tell your coach that you are pregnant. Don’t put interests of the team ahead of your well-being, especially during competition.
- Eat nutritious and regular meals.
Complications during Pregnancy
Some complications that develop during pregnancy may affect a women’s ability to exercise. These include:
- Anaemia – usually due to low levels of iron in the blood, resulting in less oxygen being transported around the body. This can cause breathlessness and fatigue while exercising. An iron-rich diet should be followed with extra vitamin C to help iron absorption.
- Back pain- many women experience back pain during pregnancy. Inappropriate exercise, especially weight-bearing exercise, may increase back pain and place further stress on joints. Swimming and simple yoga exercises may be preferable for women with backache.
- Preterm contractions – these increase the risk of premature birth. Avoid exercise if you are prone to preterm contractions.
A woman may be advised not to exercise during pregnancy or may have to limit her activities if she has any of the following conditions:
- The onset of high blood pressure during pregnancy
- Persistent vaginal bleeding
- Placenta praevia (part of the placenta is covering the opening of the uterus)
- Preterm labour- all exercises should be avoided
- Poor growth of the baby (intra-uterine growth restriction)
- Twin pregnancy
- Heart disease
- Pelvic-girdle laxity
Exercise after the birth
During the first six to eight weeks after the birth women should follow the same guidelines for exercise as they did during pregnancy.
Women who have had a caesarean section or a difficult birth may take longer to return to exercise.
Continue pelvic-floor exercises to strengthen pelvic-floor muscles and prevent bladder-control problems. Start slowly, and delay more vigarious exercise for at least six weeks.
Tell Dr Metawa if any of the following occur during or after exercise:
- Blood or fluid leaking from the vagina
- Shortness of breath
- Chest pain or rapid heartbeat
- Headache, feeling faint or dizziness
- Uterine contractions
- Abdominal or vaginal pain
- Decreased fetal movements
- Any other concerns you may have.
Any surgical or invasive procedure carries risks.
Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.