Pregnancy: Make It Fit

For modern moms-to-be, preparing for the birth of a child involves physical training in addition to childbirth education classes and decorating the nursery. Comments by women who continued to exercise throughout their pregnancies support the theory that staying fit eases labor and delivery. According to Amy, a pilot for a major airline, exercise made a big difference. She says, "In contrast to my first pregnancy where I did almost no exercise, this time I gained less weight and remained more agile and active in every phase of my life." Betsy, an attorney and amateur tennis player, agrees. "After a complicated first labor and delivery by C-section, I think my success with a vaginal delivery the second time around was attributable to my improved condition."

Today, more and more obstetricians and midwives are urging their pregnant patients to walk, swim, dance, or do aerobics -- anything to maintain their current level of cardiovascular fitness and muscle strength and flexibility -- and the sooner they start the better. Remember, however, that pregnancy is not a time to train for competition or to exercise to achieve weight loss goals.

The Guidelines

In February 1994 the American College of Obstetricians and Gynecologists (ACOG) released a revised set of guidelines for exercise during and after pregnancy (see ACOG recommendation). These new guidelines are much less restrictive than the old ACOG guidelines released in 1985, and they are a good starting point if you have not exercised in the past, or if you need to know how to modify your pre-pregnancy exercise routine. These guidelines discuss your changing body and center of gravity, your reduced oxygen available for aerobic exercise, and your need for extra calories and fluids when exercising.

Of course, you can modify the guidelines to suit your fitness level and your caregiver's advice. Be sure to discuss your proposed exercise program with your caregiver before you begin. Also, during periods of physical activity, be on the lookout for the following warning signs to stop exercising and contact your caregiver: reduced fetal movements, back pain, chest pain, difficulty walking, dizziness, faintness, palpitations, pubic pain, shortness of breath, uterine contractions, and vaginal bleeding or fluid loss.

A key point to remember when exercising is to listen to your body. Because your resting heart rate increases approximately 20% during pregnancy, Rate of Perceived Exertion (RPE) is a more accurate reflection of your level of exertion during the exercise session than simply measuring heart rate.

To help gauge your exertion level, rate yourself on a scale from 6 to 20 (20 being most difficult), and select the number that reflects how you feel at the precise moment the response is given. Consider factors such as how hard you are breathing, how much you are perspiring, how comfortably you can talk, and your overall feeling of comfort or discomfort. The advisable intensity range during pregnancy is 12 to 14.

Drinking water before, during, and after exercise will help to regulate your core (rectal) temperature, reducing the risk of maternal heat injury. Overheating is of special concern during pregnancy because the fetus has no mechanism (such as perspiration or respiration) to dissipate excess heat, which can induce neural tube defects.

While low-impact and STEP aerobics continue to be popular choices for the pregnant exerciser, integrating strength training is also important. A recent study shows that dividing a 30-minute exercise session equally between aerobic activity and strength training leads to greater muscle gain and fat loss. For pregnant women, strength training is especially beneficial because by concentrating on those muscles used during pregnancy and childbirth -- the abdominals, the quadriceps, the gluteus, and the Kegel (pelvic floor) muscle -- and by strengthening those muscles used after childbirth (muscles in the upper body in addition to those named above), you will have a much more rapid recovery from the delivery.

Depending on your fitness level, using light hand weights (4-10 pounds) or tubing can add resistance and increase intensity. Be sure to stretch before and after the strength training segment of your workout to prevent muscle pulls and tears, and be careful to avoid ballistic (bouncing) movements that can over-stretch muscles and injure joints. Also, avoid any exercises while lying on your back after the first trimester because the increasing weight of the uterus can interfere with blood return by compressing the vena cava.

The Rewards

The psychological benefits of exercise shown to exist at all stages of life -- improved self- image, increased self-confidence, happier disposition -- are magnified during pregnancy and recovery from childbirth. After getting medical clearance to exercise, your options are wide open. Many caregivers, hospitals, childbirth educators, massage therapists, and health clubs offer, or will recommend, exercise programs designed for pregnant women.

Dr. Raul Artal, a leader in the area of pregnancy exercise research, recommends that ". . . such programs should be supervised by a certified exercise leader qualified also to conduct programs for pregnant women." (Contemporary OB/GYN, May 1995). If there are no pre-natal exercise programs in your area, you can workout at home using one of several pregnancy exercise videos currently available. Regular exercise (at least 3 times per week) will ease some of the unpleasant side effects of pregnancy, such as back pain and water retention. Physically active pregnant women appear to tolerate labor pain better (Exercise in Pregnancy, 2nd ed., Baltimore, 1990). They also seem to recover from childbirth quicker and easier. A recent study by MetroHealth Medical Center at Case Western Reserve School of Medicine showed that women who continued strenuous aerobic exercise during their pregnancy averaged smaller weight gains and less fat accumulation than women who did not.

Getting Started

Getting into good physical condition should be part of your pre-conception planning. The sooner you begin your exercise routine, the better. However, if, like many women, you find that pregnancy is the needed inspiration to get into shape, start slowly, perhaps by taking a brisk 20-30 minute walk at least 3 times per week. As your pregnancy progresses and you recover from the first trimester fatigue and nausea, you may find yourself craving more challenging physical activities. Just remember to pace yourself carefully, pay extra attention to your body's signals, and have fun!

American College of Obstetricians and Gynecologists Recommendation for Exercise in Pregnancy & Postpartum, Februrary 1994.

For women who do not have a high-risk pregnancy, the following recommendations apply:

1. During pregnancy, you can continue to exercise and derive health benefits even from mild- to-moderate exercise routines. Regular exercise (at least three times per week) is preferable.
2. Women should avoid exercising in a back-lying position after the first trimester. Prolonged periods of motionless standing should also be avoided.
3. Women should be aware of the decreased oxygen available for aerobic exercise during pregnancy. Pregnant women should stop exercising when fatigued and not exercise to exhaustion.
4. Changes in your body during pregnancy should be your guide to avoiding certain types of activities in which loss of balance is probable.
5. Pregnancy requires an additional 300 calories per day. Therefore, women who exercise during pregnancy should be particularly careful to ensure an adequate diet.
6. Pregnant women who exercise in the first trimester should drink plenty of water, wear loose-fitting clothing, and make sure that the area is well-ventilated.
7. Many of the changes of pregnancy persist 4-6 weeks postpartum. Therefore, pre- pregnancy exercise routines should be resumed gradually based on a woman's physical capability.

Contraindications to Exercise:

• Pregnancy-induced hypertension
• Preterm rupture of membranes
• Preterm labor during the prior or current pregnancy or both
• Incompetent cervix/cerclage (a treatment for incompetent cervix)
• Persistent second- or third-trimester bleeding
• Intrauterine growth retardation

In addition, women with certain other medical or obstetric conditions, including chronic hypertension or active thyroid, cardiac, vascular, or pulmonary disease, should be evaluated carefully in order to determine whether an exercise program is appropriate.

(Source: The American College of Obstetricians and Gynecologists)

For more information regarding the recommendation above, contact:
The American College of Obstetricians and Gynecologists (ACOG)

409 12th Street, S.W.
Washington, D.C. 20024-2188
(202) 638-5577