Pregnancy is a very exciting, but often scary time. Guidelines are continuously being updated for what you should (and shouldn’t) eat, and what you should be doing throughout your day. Exercise is a major point that people are unsure about, especially with their first pregnancy. Between advice from doctors, parents and friends, as well as what you read online – it can be very confusing to figure out what you should be doing.
Regarding exercise, new guidelines were released in 2019 from CSEP (Canadian Society of Exercise Physiology) and SOGC (Society of Obstetricians and Gynaecologists of Canada). It is the Canadian Guideline for Physical Activity throughout Pregnancy and can be found in it’s entirety at the link. The groups found that less than 20% of pregnant women were getting the recommended amount of exercise. They also discuss that activity throughout pregnancy is not simply a recommendation, but rather “a specific prescription to reduce the complications of pregnancy, and to optimize the health of the mother and her baby.”
As with any recommendations, they are for the population as a whole. There are always exceptions, and you should always speak to your healthcare provider if you have any questions or are looking for clarification. With that being said, lets take a look at the recommendations.
- All women without contraindication should be physically active throughout pregnancy.
3 groups at higher risk of pregnancy complication were studied- previously inactive, those diagnosed with gestational diabetes, and those categorized as overweight/obese prior to pregnancy. In all these groups, the benefits of exercise to both mom and fetus outweigh any potential risks related to exercise.
It was previously thought that women who were not active prior to becoming pregnant should wait until the end of the 1st trimester to begin exercising – this is no longer the case. The potential risks of exercise are far outweighed by the benefits. Mom’s should still listen to their bodies, and keep exercise to comfortable length and intensity.
Where this changes is if contraindications are present. Absolute contraindications to exercise (you should not do it) include (but are not limited to) ruptured membranes, premature labour, preeclampsia, and incompetent cervix. Relative contraindications (speak to your obstetric care provider before engaging) include recurrent pregnancy loss, gestational hypertension, a history of spontaneous preterm labour and malnutrition. Please visit the second page of this link to see the complete list of contraindications. Even if you do not have any conditions on these lists but are unsure about starting to exercise, please speak to your healthcare provider. - Pregnant women should accumulate at least 150 minutes of moderate intensity physical activity each week to achieve clinically meaningful health benefits and reductions in pregnancy complications.
When we think of physical activity, our mind often goes to working out at the gym. This does not have to be the case! A brisk walk, exercising outdoors or at home are all great options. Especially if you are just starting out, work your way up to doing 150 minutes per week. Exercise is not an all-or none activity – do what you can! If you have a busy week or are feeling more pregnancy fatigue than usual, do what you can.
What is moderate intensity? It is defined as intense enough to noticeably increase your heart rate, but you should still be able to have a conversation without gasping for air. This level is an estimated heart rate of 120-145 depending on your age. You can also think about it as exercise that you would consider “somewhat hard”. Using this scale of “somewhat hard” may be a good way to think about your exercising if you are new to it, as this will change as your fitness does. - Physical activity should be accumulated over a minimum of 3 days per week; however, activity every day is encouraged.
Once again – start gradually if you have not exercised before, and do what you can. Some people find it easier to split exercise up into smaller amounts every day, while other prefer to do longer sessions 3-4 days per week. Although exercise every day is ideal, it is best to do what you can each week. The studies done found that women who are able to do at least 150 minutes per week at least 3 days a week had meaningful reductions in gestational diabetes, pre-eclampsia and gestational hypertension. - Pregnant women should incorporate a variety of aerobic and resistance training activities to achieve greater benefits. Adding yoga and/or gentle stretching may also be beneficial.
If you had an exercise routine that you enjoyed before pregnancy, you can continue many of the same exercises. You do want to be sure to avoid contact sports, or those with a risk of falling. Your chiropractor or other healthcare practitioner can help you to modify any exercises that are becoming uncomfortable, or provide alternatives.
- Pelvic floor muscle training may be performed on a daily basis to reduce the risk of urinary incontinence. Instruction in proper technique is recommended to obtain optimal benefits.
Prenatal pelvic floor muscle training has been found to reduce pre- and post-natal pelvic incontinence. The key is to ensure that kegals or other pelvic floor exercises are being performed properly. There are a number of cues that can be used to ensure that the correct muscles are being activated, and this can be discussed with your healthcare practitioner. - Pregnant women who experience light-headedness, nausea or feel unwell when they exercise flat on their back should modify their exercise position to avoid the supine position.
Many pregnant women are told to avoid laying on their back at all during later pregancy, but this is not always necessary. Although it is possible that laying on your back or right side later in pregnancy could cause superiorvenacava compression, it has been found 2-3 minutes in this position is deemed safe. That being said- if you ever begin to feel lightheaded, nauseous or unwell that change position immediately. This is another case of listening to your body if something does not feel quite right. You could always try doing exercises on an incine rather than on your back, use an exercise ball or perform a seated/standing alternative exercise.
These guidelines are now in place in Canada because exercise as indicated above is associated with maternal health benefits, fewer newborn complications and reduced fetal stress during labour.
Please reach out if you are looking for any more detailed information, or have any questions about these guidelines.
Resources
CSEP 2019 Canadian Guideline for Physical Activity throughout Pregnancy (https://csepguidelines.ca/wp-content/uploads/2018/10/4208_CSEP_Pregnancy_Guidelines_En_P2A.pdf)
Mottola, M.F., Davenport, M.H., Ruchat, S.M., Davies, G.A., Poitras, V.J., Gray, C.E., Garcia, A.J., Barrowman, N., Adamo, K.B., Duggan, M. and Barakat, R., 2018. 2019 Canadian guideline for physical activity throughout pregnancy. British Journal of Sports Medicine, 52(21), pp.1339-1346.
SOGC New Canadian Guideline Prescribes Exercise for Healthier Pregnant Women, Healthier Babies (https://www.sogc.org/en/content/featured-news/new-canadian-guideline-prescribes-exercise-for-healthier-pregnant-women-healthier-babies.aspx)
Dr. Brenna Byer D.C. 