Exercise During Pregnancy

Now that you're pregnant, you're probably wondering about exercise during pregnancy. I'm summarizing the Canadian guidelines for physical activity throughout pregnancy set by the SOGC.

By exercising during pregnancy, you're positively affecting your and your baby's health. If you don't have any contraindications to pregnancy (which are posted below), now is the time to start doing something. Especially if you were previously inactive and/or considered overweight or obese.

How much and what type?

Ideally you should aim for about 150 mins of moderate-intensity activity over the week (think: 30 minutes, 5 days a week).

If you've been previously inactive, you may want to begin gradually at a lower intensity, and increase the duration and intensity as your body gets used to it.

Aerobic and resistance training, with a pinch of yoga are great options. And in terms of improving health outcomes for you and your baby, you should aim to do all of them within the week.

Some activities do carry a higher risk and are considered contraindicated during pregnancy - like scuba diving, any activities with physical contact, danger of falling, and non-stationary cycling. Avoiding high-heat activities like hot yoga - as it may cause dehydration.

What the F is DRA?

DRA, known as diastasis rectus abdominus, may occur in some people. Essentially, your abdominal muscles may begin to separate. If you're noticing that this has happened, book a visit with your pelvic floor physiotherapist to see what you can do. This means that you may also want to avoid ab strengthening exercises for the time being.

One of my colleagues filmed a video about DRA a few years ago. Check it out if you'd like more info

What about the first trimester?

Studies show that exercise in the first trimester doesn't increase the odds of miscarriage or congenital anomalies. In fact, not exercising during the first trimester increased the odds of pregnancy complications like gestational diabetes, gestational hypertension, excessive gestational weight gain and depressive symptoms.

Let's keep it real though, most people are exhausted in their first trimester - so the idea of anything besides walking is absolutely not appealing. But, if your energy hasn't taken a nose dive, or if you've reached the point in your second trimester where you feel like you can start your routine again - let's get to it!

Should ALL pregnant people exercise?

Exercising during pregnancy can provide many health benefits, but there are women who shouldn't engage in strenuous exercise as its contraindicated. Keep in mind, this doesn't mean they're not allowed to move and continue their activities of daily living.

Absolute contraindications to exercise include:

• Ruptured membranes
• Premature labour
• Unexplained or persistent vaginal bleeding
• Placenta previa after 28 weeks
• Preeclampsia
• Incompetent cervix
• Intrauterine growth restriction
• High-order multiple pregnancy - like triplets
• Uncontrolled type 1 diabetes
• Uncontrolled hypertension
• Uncontrolled thyroid disease
• Other serious cardiovascular, respiratory or systemic disorder

Relative contraindications to exercise include:

• Recurrent pregnancy loss
• Gestational hypertension
• A history of spontaneous preterm birth
• Mild/moderate cardiovascular or respiratory disease
• Symptomatic anemia
• Malnutrition
• Eating disorder
• Twin pregnancy after week 28
• Other significant medical conditions

Obviously, if you fall into any of these categories you'll want to check in with your OB/Gyn or Midwife to see about your specific health situation - especially if you fall into the 'relative' category. You'll want to figure out the advantages and disadvantages of exercise with your care provider before you start to exercise.

Tell me about KEGELS

During pregnancy, you may start noticing some urinary incontinence - perhaps some leaking will occur when you're running, jumping, and laughing. Although this is common, it's not considered normal. Many books or other professionals will tell you to start doing kegels. Do NOT do this. Instead, visit a pelvic floor physiotherapist so they can assess your pelvic floor. The reason being is that your pelvic floor may be "tight" yet weak (hence the leaking), and doing kegels can cause your pelvic floor to become tighter, not stronger. However, sometimes kegels can be helpful - but it's super important to get a professional assessment before starting these.

Never heard of kegels before? Check out this video filmed by one of my colleagues!

Final Thoughts

Exercise during pregnancy is a great thing if you don't have any of the above absolute/relative contraindications - but always speak to your care provider if you have any questions.

If you've been a bit sedentary in the first trimester (that's okay, pregnancy is tiring!), start slow with low intensity and shorter durations and increase as you go.

If you happen to notice any abdominal separation or even leaking while jumping/running/laughing, be sure to book an appointment with a pelvic floor physiotherapist. I'm writing this post during the COVID-19 pandemic and a lot of health care practitioners have transitioned to virtual visits, so there's still an opportunity to see a pelvic floor physiotherapist or naturopathic doctor if you have the ability to do so.

References

Mottola, M., Davenport, M., Ruchat, S., Davies, G., Poitras, V., & Gray, C. et al. (2018). No. 367-2019 Canadian Guideline for Physical Activity throughout Pregnancy. Journal Of Obstetrics And Gynaecology Canada, 40(11), 1528-1537. doi: 10.1016/j.jogc.2018.07.001