There have been a number of articles around the Internet lately about exercise during the childbearing year. They have come as a result of a recent Opinion by The American College of Obstetricians and Gynecologists Committee on Obstetric Practice on Physical Activity and Exercise During Pregnancy and the Postpartum Period. So what does the Opinion say and what should doulas know about the latest recommendations on exercise during pregnancy and the postpartum period? The DONA Doula Chronicles has you covered!
“…physical activity in pregnancy is safe and desirable, and pregnant women should be encouraged to continue or to initiate safe physical activities.” — ACOG Committee Opinion, Physical Activity and Exercise in Pregnancy and the Postpartum Period
What is considered physical activity or exercise?
At its base level, physical activity or exercise does not necessarily mean an hour long spin class. In the Opinion, ACOG defines physical activity more simply as any movement produced by the skeletal muscles. Exercise is outlined as repetitive body movements that are planned, structured and repeated to improve physical fitness. The Opinion goes on to say “physical fitness is an essential element of a healthy lifestyle…”
Benefits of Physical Activity
The health benefits of being physically active across the lifespan are well documented. The authors note that the benefits of exercise are indisputable and far outweigh the risks and that worldwide physical inactivity is the fourth-leading risk factor for early mortality. Their message is quite clear – we should be moving at all ages and stages of life.
Exercise increases aerobic capacity and improves or maintains physical fitness in pregnant and non-pregnant people. The Opinion mentions that observational studies have shown that exercise during pregnancy is correlated with lower rates of gestational diabetes, cesarean birth, vaginal operative birth (using forceps or vacuum extraction) and a shorter recovery after birth. For those with gestational diabetes, exercise can lower glucose levels and prevent preeclampsia. Exercise in pregnancy has also been shown to reduce overall weight gain. In the postpartum period, returning or initiating exercise supports a healthy lifestyle.
The Opinion notes that exercise in pregnancy is well tolerated by a healthy fetus. Vigorous exercise in the third trimester has been correlated with a slightly lower birth weight but was not associated with increased risk of fetal growth restriction.
General Exercise Recommendations for Pregnancy & the Postpartum Period
The following are the recommendations for healthy pregnant and postpartum people:
- 20 – 30 minute sessions on most days of the week totaling 150 minutes per week
- Aerobic exercise of moderate intensity, such as brisk walking
- For those who were previously not active, exercise should begin gradually and increased over time
- Activity should be adjusted as needed for medical reasons
- Those who are highly active or routinely engaged in vigorous exercise, such as running before pregnancy, can continue that level of exercise so long as they remain healthy and discuss with their care provider how and when their physical activity should be adjusted
- To prevent heat stress, particularly in the first trimester, ACOG recommends avoiding high heat and humidity, staying well hydrated and wearing loose fitting clothing
- Pelvic floor exercises can begin very soon after birth
- Nursing prior to exercise can reduce discomfort due to engorged breasts
- Care providers should prescribe an individualized exercise plan for individual patients based on overall health, medical conditions and lifestyle
Contraindications to Exercise in Pregnancy
ACOG lists a number of conditions that are considered contraindicated to aerobic exercise in pregnancy. The health conditions listed as absolute contraindications include ruptured membranes, incompetent cervix, persistent bleeding in the second or third trimester, placenta previa after 26 weeks, premature labor and preeclampsia. In addition to these pregnancy related health conditions, ACOG also lists heart disease that impacts blood pressure or blood flow (hemodynamic), restrictive lung disease and severe anemia as absolute contraindications to exercise in pregnancy.
Exercise in pregnancy is potentially inadvisable, ACOG says, under additional circumstances listed as relative contraindications. No specific guidelines are provided on how care providers should weigh the potential risks of exercise in pregnancy when these conditions are present. Many of these relative contraindications are related to overall health, such as extreme morbid obesity, extreme underweight, history of extreme sedentary lifestyle, being a heavy smoker and orthopedic limitations. Existing health conditions that are poorly controlled, such as type 1 diabetes, hypertension, seizure disorders and hyperthyroidism are also listed as relative contraindications. Pregnancy related health conditions that ACOG recommends care providers consider as potential risks related to exercise are intrauterine growth restriction and unevaluated maternal cardiac arrhythmia.
Safe and Unsafe Physical Activities During Pregnancy
This section of the Opinion recommends avoiding contact sports, such as hockey and boxing, and activities with a high fall risk, such as off-road cycling and horseback riding, scuba diving, sky diving, hot yoga and hot Pilates.
Activities considered safe to begin or continue in an uncomplicated pregnancy include walking, swimming, stationary bike riding and low impact aerobics.
Modified yoga and Pilates are also considered safe so long as positions which may decrease venous return are avoided.
Jogging or running, strength training and racquet sports can be continued if these activities were routine before pregnancy and in consultation with a care provider. The Opinion notes that racquet sports where the risk of falling is increased due to changes in balance brought on by pregnancy should be avoided as much as possible.
ACOG states that exercise during pregnancy should be discontinued and the care provider consulted if any of the following conditions arise:
- Vaginal bleeding
- Regular painful contractions
- Leakage of amniotic fluid
- Labored breathing before beginning the activity
- Chest pain
- Muscle weakness that affects balance
- Pain or swelling in the calf
The Committee Opinion on Physical Activity and Exercise in Pregnancy and the Postpartum Period also includes a scale for evaluating exertion in exercise as well as recommendations for special populations which address obesity and competitive athletes. The Opinion also notes ACOG’s position on bed rest stating, “bed rest is not effective for the prevention of preterm birth and should not be routinely recommended.”