Research Recap: Exercise and Pregnancy…
…in recreational and elite athletes: 2016/2017 evidence summary from the IOC expert group meeting, Lausanne. Part 5. Recommendations for health professionals and active women (Bo et. al. 2018)
So I am trying this thing where I read 1 research article/review each week. In order to remember it better, I am hoping to also spend a bit of time writing a recap of what I have read in the article. Similar to if I was taking notes, but I am sharing the notes with all of you and including a few of my insights :)
I hope you enjoy and if you don’t let me know how I can do it differently!
This article lists absolute and relative contraindications for exercise during pregnancy, and common concerns during pregnancy and in the early postpartum stages in regards to exercise and returning to exercise.
Common Concerns that were Answered in this Research Review
What is the concern with having an increased body temp in regards to exercise?
Moderate exercise will not increase your core body temp above 38C and causes no concern.
Can I exercise while laying on my back?
Yes, however, if you begin to experience symptoms such as dizziness, it is suggested that you stop or modify the activity. Modifications may include: tilting the torso to 45 degrees, doing the exercises side-lying, sitting, or standing, or even elevating your torso so you are not completely flat.
What is too much?
A general guideline in exercise is to follow your perception of exertion or fatigue.
Can I strength train?
Absolutely! The article suggests that “strength training of the pelvic floor muscles during pregnancy can prevent and treat urinary incontinence during pregnancy and after birth.” The reference isolated pelvic floor contractions, but in my opinion, this can also be achieved through any exercise and strength training as we automatically activate our pelvic floor when exercising. It is recommended to be cautious when lifting while laying on your back (as above), and avoid holding your breath.
Are there sports that should be avoided?
Yes. it is recommended to avoid sports that have a risk of falling or that could cause direct trauma to the abdomen or the fetus. So if you can fall, collide with an object or another athlete, or get hit by a ball, then the sport should be avoided. That does not mean you can not participate at all, it just means you need to modify to find a safer alternative. Another sport to note is Scuba diving. The fetus is not protected from decompression problems, thus it should be avoided.
How does exercise affect birth outcomes?
The research appears to be scarce on this topic, but it is noted that light to moderate-intensity physical activity does not increase the risk of miscarriage. Excessive standing and heavy lifting at work has been shown to increase preterm birth. This is something I would like to look into more because it appears to be a vague and inconsistent finding. Another review for another time!
When can I return to exercise postpartum?
You could return to exercise immediately however, this may not look like the exercise you are thinking of, or that you were doing during pregnancy. You want to start gradually and work your way back to where you want to be. If you had a non-complicated birth you may get back to exercise more quickly than someone who had a larger tear or cesarean birth. The review recommends starting gradually with low impact activities and focusing on strength training with a “pelvic floor muscle first focus”. If you are looking for some guidance in this area take a look at Movement With Moms. It is an online, at your own pace, self-guided detailed program created with busy moms in mind.
Does breastfeeding impact exercise?
Exercise during the period of breastfeeding is safe. Moms may find it more comfortable to exercise after a nursing session and to look into finding a bra that fits them properly.
When should a mom seek care?
If you are noting a buldge in the vagina it is recommended to discuss this with your gynaecologist/pelvic floor physiotherapist. If you are experiencing urinary or fecal incontinence it is recommended to discuss this with a pelvic health therapist. If you are experiencing back pain after the 6-week postpartum mark it is recommended to seek care from a pelvic health therapist.
I personally work with the pregnant and postpartum population who have concerns about pelvic health, are pregnant and have other musculoskeletal health concerns, or who are looking for some guidance in returning to exercise. To learn more about me click here.
What about Diastasis Rectus Abdominus?
This is such a hot topic these days on social media. This review article suggests there is no evidence showing specific exercises that are helpful in closing the gap. My thoughts? What if returning to exercise itself IS what we need to be doing to assist with closing ‘the gap’? Click here to read more about DRA.
Absolute Contraindications for Aerobic Exercise
Absolute contraindications: Could cause a life-threatening situation.
Aerobic exercise: an exercise that gets your heart rate up.
Haemodynamically significant heart disease.
Intrauterine growth restriction in current pregnancy.
Poorly controlled hypertension.
Restrictive lung disease.
Cervical insufficiency/cerclage.
Multiple gestation at risk of premature labour.
Persistent second or third trimester bleeding.
Placenta previa after 26 weeks gestation.
Premature labour during the current pregnancy.
Ruptured membranes.
Pre-eclampsia/pregnancy-induced hypertension.
Severe anaemia.
Relative Contraindications for Aerobic Exercise
Relative Contraindication: Proceed with caution.
History of fetal growth restriction, miscarriage, premature birth or labour.
Cervical enlargement.
Unevaluated maternal cardiac arrhythmia.
Chronic bronchitis or other respiratory disorders.
Poorly controlled type I diabetes.
Extreme underweight.
Orthopaedic limitations.
Poorly controlled seizure disorder.
Warning Signs to Stop Exercise
Vaginal bleeding.
Regular painful contractions.
Amniotic fluid leakage.
Dyspnoea prior to exertion.
Dizziness/syncope.
Headache.
Chest pain.
Muscle weakness.
Calf pain or swelling.
A recommended guideline for screening prior to exercise during pregnancy is the ParMed-X for Pregnancy
For more information on physical activity during pregnancy or in the postpartum period check out the ACOG guidelines!
Thank you for reading through my notes.
If you have any questions or would like to discuss, please do not hesitate to reach out!
