Exercise During Pregnancy


Women's Sports Medicine Center,
Hospital for Special Surgery

From the moment you find out youíre pregnant until the birth of your baby, exciting and overwhelming changes characterize your life and body. Many women worry about their ability to maintain an active lifestyle during pregnancy or hope to prevent excessive weight gain. Other women consider beginning an exercise program as part of an effort to make better lifestyle choices and deliver a healthy baby.

What do we know about the safety of exercise during pregnancy?

Every woman and every pregnancy is completely different. Thatís why itís critical to work with your obstetrician to decide on your activity plan. Certain medical conditions put you at risk for injuring either yourself or your baby. Listen to your doctor. Pregnancy is NOT the time to charge into a vigorous regimen of exercise, especially if youíve been a couch potato! However, there is good evidence to suggest that a healthy woman can begin or maintain a program of regular moderate exercise during her pregnancy. If youíre an athlete, athletic performance doesnít seem to be affected during the first 2-3 months of pregnancy. You may be able to continue training well into your pregnancy (depending on your sport). Work with your doctor to modify your exercise intensity and training schedule.

There are several studies which show that fit and active women can exercise vigorously during pregnancy and deliver healthy babies. Women who exercise regularly report feeling better during their pregnancy than sedentary women and may gain less fat weight.

Guidelines for Exercise

Cardiovascular activities that are low-impact or non-weight bearing (swimming, walking, cycling) have the best potential to be carried on throughout your entire pregnancy. Water aerobics or swimming not only minimize joint stress but can reduce fluid retention. Other forms of regular aerobic exercise might include aerobics classes (particularly low impact), stairstepping, jogging, hiking, elliptical trainers and cross-country skiing.

How hard? Standard target heart rate formulae are probably somewhat flawed due to cardiovascular and blood flow changes during pregnancy. There is some evidence that vigorous intensity exercise (above 150 bpm) causes bursts of rapid heart beats in the fetus which may be an indicator of stress. Itís probably best to exercise at a moderate level based on your own feelings of exertion. However human studies have not shown bad effects on mother or baby when exercising at vigorous intensities or using traditional heart rate ranges. Standard recommended intensities are 60-75% maximum heart rate for the unfit woman and 70-85% for the regularly exercising woman. Subjective feelings of exertion have been shown to be a more reliable indicator of work intensity during pregnancy than heart rate. Listen to your body! Pregnant women often naturally lower exercise intensity during late pregnancy. Smart move, ladies!

How often? Avoid the "weekend warrior" syndrome. Ideally, a pregnant woman should perform cardiovascular exercise at least 3-4 days per week. If you exercise more frequently, consider a variety of activities (to reduce overuse injuries) and drink plenty of fluids.

How long? Short aerobic exercise intervals (15-20 minutes) may help prevent heat stress to you or your baby. However there is no evidence to suggest that a more typical 30-60 minute workout is harmful.

Strength Training: Strong muscles will prepare you for the lifting required when your new baby arrives, along with the associated paraphernalia youíll be lugging around (car seat, stroller, diaper bag). Depending upon your intended delivery position youíll need good strength in your "squatting" muscles. Low back pain, a common complaint of pregnant women, can be helped by specific strengthening and flexibility exercises. A physical therapist who understands your bodyís changes during pregnancy is in the best position to suggest specific exercises.

Correct posture, breathing and lifting technique are very important. Avoid straining or holding your breath during challenging lifts. The use of exercise machines rather than free weights is probably smarter in latter pregnancy when normal balance is disrupted. Since not much information is available about heavy lifting during pregnancy, itís best to avoid heavy loads and use a standard conditioning approach: 8-12 reps, 1-3 sets, to momentary muscular fatigue, 2-3 times/week.

The American College of Obstetrics and Gynecology recommends that women avoid exercise while lying on their backs after the first trimester because this position can decrease blood flow to the baby. For example, pelvic tilt exercises can be performed in the side-lying, sitting, standing or "all fours" positions. Prolonged, motionless standing should also avoided.

Do you lose urine when sneezing, laughing, coughing, jumping or exercising? Pelvic floor exercises are critical to prevent stress incontinence (involuntary loss of urine) during pregnancy and in preparation for postpartum recovery. A physical therapist or childbirth educator can provide expert instruction.

Balance/Coordination: If you play tennis, squash, ski, dance or participate in other activities requiring agility or balance, remember that hormone changes after 28-30 weeks will loosen your joints and make you more susceptible to injury. Increased body size, altered center of gravity and changing posture will also begin to slow your movements, affect your balance, change your body mechanics and make you work harder. Use common sense! Consider cross-training or adopt some alternative, safer exercise activities during the latter stages of your pregnancy.

Sports activities that challenge your ability to get oxygen such as mountain climbing or scuba diving should be avoided. Snorkeling is fine during pregnancy, but deep sea diving may cause decompression problems in the fetus and should not be done. A healthy, non-acclimatized pregnant woman should not exceed an altitude of 8,000 ft during the first 4-5 days of short-term altitude exposure. Exercise activities such as climbing or cross-country skiing should be done at even lower altitudes.

After 20 weeks, sports that carry the risk of falls or abdominal trauma may also be a problem. For example, contact sports like soccer and basketball, gymnastics, skiing, hang gliding, horseback riding and vigorous racquet sports may cause premature labor or injuries. This is the time to rely on other forms of exercise.

General Tips

  • If you experience pain, bleeding or your baby stops moving, stop exercise and immediately check with your obstetrician.

  • During the first trimester, excessive fatigue and low energy levels may increase your risk for injury. Make sure you get adequate sleep and that your food intake meets your bodyís needs for increased calories, vitamins and minerals.

  • A gradual coo-ldown after vigorous endurance activity helps maintain adequate blood flow to your baby. Take 5-10 minutes at the end of your exercise session to perform light cardiovascular activity.

  • In order to meet the energy and nutrient needs of you and your baby during pregnancy you must eat an additional 300 calories and 10 grams of protein per day. Pregnancy is not the time to think about losing weight. Normal-weight women should gain between 25-35 lbs during pregnancy. Weight gain should be 2-4 lbs by the first trimester, and about 1lb per week thereafter.

  • Make SURE you are getting enough fluids, necessary for the increased blood volume and amniotic fluid your body is making! Donít wait to feel thirsty. Increase fluid intake to 2-3 quarts per day. Drink plenty of extra fluids before, during and after an exercise session. Avoid drinking beverages containing caffeine and alcohol which dehydrate and can be dangerous to the babyís development.

  • While routine supplementation with prenatal vitamin and mineral supplements has been common in the past, the National Academy of Sciences now recommends only iron supplements (30 mg) for normal pregnancy. However active women and athletes need to consider the issue of supplementation with their physician and/or nutritionist. Other key nutrients which may require supplementation are calcium and folate. Make sure youíre taking in 1000 mgs of calcium and 400 micrograms (mcgs) of folate per day. Folate supplementation is recommended to prevent neural tube birth defects for all women of childbearing years as well as during pregnancy.

  • Supportive bras and undergarments to support your breasts and tummy during exercise are now available. If you canít find these under-things at a local department store, athletic store or "pregnant mom shop", try Title 9 Sports catalog at (800)609-0092.

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