Current Guidelines for Prenatal Fitness

The interest and need for maternal fitness guidelines is increasing as more woman who are physically active become pregnant. Recent studies have shown that regular exercise at moderate to somewhat hard levels during pregnancy has positive benefits. These benefits include reduced level of fat deposition and retention, shorter and less complicated labors, and a quicker recovery postpartum. In addition, women who exercise during and after pregnancy tend to have greater energy levels, deal better with physiological and psychological stresses and develop fewer physical complaints.

It is important for healthcare and fitness providers to be able to provide appropriate fitness information to active pregnant women, as well as for women who decide to start exercising during or after pregnancy. This article offers information and guidelines that will assist healthcare and fitness providers in offering their patients safe and effective prenatal exercise information.

The American Congress of Obstetricians and Gynecologists has established guidelines for exercise during pregnancy, along with signs and symptoms that should alert a pregnant woman when to contact her healthcare provider. These guidelines are for women with non-complicated pregnancies and without any of the ACOG listed contraindications. You may obtain the current ACOG committee opinion on prenatal fitness here.

Women need to be aware of how pregnancy affects their body and understand how these changes will limit their ability to do some activities. The exercise program should fit each woman’s fitness, strength, and flexibility levels. It should be modified as needed, allowing her to comfortably and safely exercise throughout pregnancy.

If a woman has exercised before becoming pregnant, instruct her to keep in mind that she may not be able to continue the same activities at the same intensity as she did previously. If she has never exercised before, teach her methods for monitoring her level of exertion and signs that she may be overtraining.

For some women, taking part in a supervised exercise class can help supply reassurance that they are exercising at an appropriate level and also provides peer support. Some information to aid you in finding a qualified prenatal program:

• The instructor has a fitness / health related degree, as well as experience and training in pre-and postnatal fitness.
• A physician or midwife consent to exercise is required before joining the class.
• The instructor incorporates ACOG guidelines in the program and knows warning signs and symptoms for pregnancy.
• There is an established procedure for management of injuries or emergencies.
• The instructor is sensitive to the varying fitness levels of the participants. The class should be able to be modified to allow all participants to safely and comfortably exercise.
• The facility is appropriate for prenatal exercise: a supportive floor, mats, rest rooms, and cool temperature.
• There should be frequent exertion level checks and water breaks.
• The class includes a warm-up, aerobic, strength and flexibility exercises, and a cool-down period. The exercises address pregnancy needs, such as low back stretches and pelvic floor exercises.

Whether you choose to join a class or exercise on your own, you should use the following tips to ensure a safe and comfortable fitness program:

• Clothes should be loose fitting and allow for ventilation. Bras should offer support and have wide straps to prevent shoulder discomfort. It is a good idea to buy shoes 1/2 to 1 size larger, to allow room if feet swell.
• A women needs to add 300 calories to her daily food intake to meet the needs of pregnancy. If she is physically active, she may need to increase that amount. The number of extra calories needed depends on the intensity and duration of exercise.
• The 300 extra calories ideally should come from nutrient rich foods such as vegetables, fruits, whole grains, low fat dairy products, and lean meats. An active pregnant woman should drink 8-12 cups of water each day.
• Exercise in heat and humidity can be dangerous. It is safest to exercise in an air-conditioned facility during the summer months. If a woman chooses to exercise outdoors during warm weather, instruct her to avoid the high heat times between 11:00 AM and 4:00 PM, don’t exercise during high heat index days and reduce intensity and duration to prevent overheating. She should wear sunscreen and a broad brimmed hat to protect her skin.
• A pregnant woman needs to monitor herself during exercise for signs of overheating such as dizziness, faintness, or nausea. She should drink plenty of water before, during and after exercise to replace the fluids lost.
• Hot tubs and saunas can cause core temperature to rise to unsafe levels and should be avoided.
• A well-rounded fitness program consists of a warm-up, aerobic, strength, and flexibility components and a cool-down.

Aerobic Exercise

Aerobic exercise strengthens the cardiovascular system and helps improve endurance and muscle tone. During pregnancy, exercise at a moderate to somewhat hard level of exertion can enable a woman to continue her daily activities throughout pregnancy with less fatigue and discomfort. In order to derive optimal benefit from aerobic exercise, the frequency should be at least three to five days a week. Exercise modes can vary depending on what feels comfortable, is enjoyable, and poses little risk to a woman and her fetus. Activities such as walking, swimming, cycling, jogging and low impact aerobic dance are easily modified and good choices. The duration of each exercise bout can vary from 20 to 60 minutes or more depending upon a woman’s fitness level, intensity and goals.

A simple tool for measuring a pregnant woman’s exercise level is the Rating of Perceived Exertion (RPE) scale. She should feel that her exercise level is moderate to somewhat hard, which corresponds to 12-14 on the 20 point RPE scale, and 3-4 on the 10 point RPE scale. If she feel out of breath or is unable to talk, she’s working at too high a level and should decrease intensity, or stop and rest.

The following tips will help make a pregnant woman’s fitness program safe and effective:

• Begin the aerobic portion with a warm-up. Slow walking, biking or any gentle exercise, done for 5-6 minutes will help prepare her body for exercise.
• As a woman’s pregnancy progresses, the type of exercise that feels comfortable may change. She should modify her fitness program to fit her needs.
• Some women find that non-weight bearing activities, like stationary biking or swimming, cause less discomfort.
• Avoid sports such as scuba diving, platform diving, water skiing or any activity than could cause trauma to the abdomen. Contact sports and activities that require balance and fast movements may not be appropriate. A woman should contact her health care provider before attempting any questionable activity.
• Wind down the aerobic portion with a cool-down. She can slowly reduce her level on exercise equipment, or if walking or jogging or swimming, slowly decrease intensity.

Strength Training

Muscular strength is critical for maintaining proper posture, providing spine and pelvic organ support, and preventing neck, shoulder, and back discomfort. After delivery, a strong back and arms help protect a woman’s body from injury resulting from lifting and carrying and her baby.

Strength training requires proper form and frequent monitoring to avoid injury. Apply these basic points when developing a weight training program:

• Warm-up before doing any strength exercises.
• Start out and progress slowly. One set of 12-14 repetitions, 2-3 times a week is sufficient for maintaining strength. It is important to have a rest day between strength workouts to allow you body to recover.
• Use any type of weight from soup cans to light weights or resistance bands. Use a weight or resistance allows a woman to do 12 repetitions without feeling unsteady or shaky.
• Exhale when lifting the weight, inhale as it is lowered.
• Perform the exercises without straining, using a slow, steady motion.
• Avoid doing any exercises while lying on your back after the first trimester.
• Discontinue exercise if severe pain or discomfort develop during or after strength training and consult with healthcare provider.

Flexibility Exercises

The changes in a pregnant woman’s posture, weight, and center of gravity can cause her muscles to feel tight and sore. Flexibility exercises help stretch muscles that are overworked and tight from exercise and body changes. To effectively stretch muscles and avoid injury, keep the following points in mind:

• Avoid supine exercise after the first trimester as the weight of the baby can constrict maternal abdominal blood flow. Use a wedge or pillows to position her into a semi-reclined position.
• Increased levels of hormones cause ligaments to loosen, possibly decreasing joint stability. Use slow, gentle movements.
• Stretches should be slowly moved through range of motion to and held at the point where the muscle feels tight.
• Never bounce or force a stretch.
• Don’t continue a stretch that feels uncomfortable or painful.
• Flexibility exercises can be done everyday, and frequent back stretches may help prevent low back pain.

Pelvic Floor

The muscles of the pelvic floor are important for support and function of the abdominal organs. If they become weak, conditions such as incontinence and prolapsing of bladder, uterus or bowel can develop. Pelvic floor (also termed “Kegel”) exercises can help prevent muscle weakness. Proper training techniques ensure that women are contracting the correct muscles and effectively strengthening the pelvic floor.

The pelvic floor muscles form a figure eight around the perineal body by surrounding the urethra, vagina, and anus. The movement of the pelvic floor muscles can be felt by placing fingertips on the perineal body and feeling for a downward push when coughing. They are also the muscles that contract to stop the flow of urine, although do not do your pelvic floor contracts while urinating, doing so may contribute to urinary tract infection.

Pelvic floor exercises:

• Slow contraction and slow release, squeezing the pelvic floor muscles progressively tighter to a count of three and relaxing to a count of three. Work up to a set of 25-50 or more contractions a day.
• Contract and hold. Squeeze your pelvic floor muscles tight and hold for 10 seconds. If you find it difficult to hold for 10 seconds, start with 5 seconds and build up over time as you become stronger. Work up to a set of 25-50 contractions or more a day.
• The abdomen, buttocks, and thighs should not be tensed when doing these exercises. Lie, sit, or stand with your legs slightly apart so you can isolate the correct area.
• No one will be able to tell that you are doing these exercises, so you can do them anywhere. It is helpful to establish certain times of the day (before you get out of bed each morning) or activities (driving to work, brushing your teeth) that are your “cue” to do your exercises. You should contract your pelvic floor muscles each time you lift, laugh, sneeze, or cough to provide support and prevent further weakening.

Research has increasingly shown that maintaining fitness during pregnancy can improve physical and emotional well-being. An appropriate exercise program during and after pregnancy has shown to provide many benefits, without increasing the risk of injury to mother or fetus. Maternal healthcare and fitness provider can play an important role by offering current, evidence based prenatal fitness information to their patients and clients.