Considerations for exercise during pregnancy

Considerations for exercise during pregnancy

Pregnancy is a time of great change within a person’s body, however in a healthy, uncomplicated pregnancy, exercise can continue to be safe and is generally recommended during most pregnancies.

Guidelines* on exercise during pregnancy recommend regular aerobic and strengthening exercises, assuming that there are no contraindications to exercise.

It is recommended that pregnant people are cleared for exercise by their medical practitioner. Some important considerations when exercising during pregnancy are detailed below.

Avoid overheating

Your growing baby does not have the same ability to dissipate heat as you do.

To avoid overheating:

• Avoid exercising in very hot and humid conditions
• Give yourself breaks during your exercise sessions to rest and cool off
• Stay well hydrated. Ensure you bring a water bottle and drink plenty of water before, during and after an exercise session even if you do not feel thirsty
• Don’t use sweating as an indicator of how hot you may be getting, as your core temperature may rise disproportionately to the amount of perspiration
• Wear light-weight, loose fitting clothes
• Avoid saunas and steam baths

Type of exercise

• Most pregnant people should aim for a moderately intense level of exercise, meaning that you don’t feel as though you are out of breath. A good guide is that you should be able to comfortably carry on a conversation whilst exercising – referred to as the ‘talk test’. Those with higher fitness levels or elite athletes should discuss exercise intensity levels with their medical provider
• Exercise at your own pace and avoid holding your breath
• Avoid contact sports and those activities which may involve a risk of falls
• Avoid scuba diving and exercising at high altitudes
• Avoid rapid changes of position and stopping suddenly. Keep the feet moving to help the circulation and prevent leg cramps and faintness
• Minimising the amount of exercise performed whilst lying on the back as the pregnancy progresses past the first trimester is recommended*, due to the possibility of the enlarged uterus obstructing venous return. This may cause a reduction in the blood flow to the placenta and baby
• Stretch gently. Pregnancy hormones contribute to increased joint mobility, so gentle stretching is advised
• Wear a good supportive maternity bra

Abdominal exercises

During pregnancy, as the baby grows and the abdominal muscles are lengthened, a common result is a widening of the gap in between the two rectus abdominal muscles, which run vertically from the bottom of the ribs to the pubic bone.

This is known as a rectus abdominis diastasis, or simply, diastasis, which is very common and is considered a normal adaptation to pregnancy.

The extent of this widening will be variable, as will the location along the midline, although generally the greatest amount of separation is above the navel.

You may notice a bulge in the abdomen during movements such as getting up out of bed, lifting, or with sudden fast actions such as a cough or sneeze.

This is often referred to as ‘doming,’ and is a midline bulge along the length of the separation.
Assessment for a diastasis will allow for advice on exercise during and after pregnancy.

Pelvic floor muscles

The pelvic floor muscles are a group of muscles located at the base of the pelvis which have a role in:

• Supporting the abdominal and pelvic organs
• Control of the bladder and bowel functions
• Control and support of the lumbo-pelvic region in association with the deeper abdominal and back muscles and diaphragm, often referred to as the ‘core’ muscle complex
• Sexual function

Correct pelvic floor muscle activation involves a squeeze and lift around the front and back passages, such as what would be done in stopping the flow of urine or controlling wind.

Also important is the ability for the muscles to be able to relax post-contraction.

Pelvic floor muscle training is important during pregnancy, however a training program should be individualised as some people may require strengthening, whereas others may need to focus on learning how to relax the muscles.

Signs that the pelvic floor muscles might not be working optimally are:

• Leakage of urine with a cough, sneeze, laugh, changes in direction or position or with high impact exercises involving bouncing or jumping movements. This is termed stress urinary incontinence
• Feelings of urgency when needing to urinate, with or without leakage of urine or having to go to the toilet to urinate very frequently
• Difficulties completely emptying the bladder or bowel
• Difficulties holding onto a bowel movement
• Feelings of a bulge or lump in the perineum or vagina, or heaviness or dragging in this area which may indicate a pelvic organ prolapse
• Internal pelvic pain or painful sexual intercourse

Stop exercising and seek medical advice if you experience any of the following*:

• Vaginal bleeding or leakage of amniotic fluid
• A decrease in the movements of your baby
• Uterine contractions or pain in the lower back, pelvic area or abdomen (potentially indicating pre-term labour)
• Chest pain, dizziness, faintness or palpitations
• Blurred vision, disorientation, or severe or continuous headaches
• New or persistent nausea or vomiting
• Excessive fatigue or muscle weakness
• Calf pain, swelling or redness
• Shortness of breath before exertion, or excessive shortness of breath, which does not resolve on rest
• Sudden swelling of hands, ankles or face

Summary

Most people can continue to exercise safely and with benefits throughout their pregnancy.

Appropriate exercises are those which:

• Do not cause:
  • Pain
  • Sensations of heaviness or downward pressure onto the pelvic floor muscles
  • Leakage from the bladder or bowel
• Have been advised following assessment for the presence of a diastasis
• Are moderately challenging, without limiting the ability to talk

* The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (2023) Exercise During Pregnancy