Advice & Guidance for Exercise in the Childbearing Years

For the majority of women, it is safe to exercise and actively encouraged during pregnancy. There are some conditions where exercise may not be encouraged or consent from your primary care-giver (the midwife and /or GP or the consultant Obstetrician ) must be given please see the sections below -Are there any body changes I should look out for when exercising and When should I not exercise?

In pregnancy, the aim should be to maintain or moderately improve your level of fitness. After your baby is born the aim is to regain the former level of fitness, or to improve on it.

Moderate exercise intensity is also known as the Talk Test – you should be able to carry on a conversation.

For up-to date government advice on physical exercise in pregnancy and after childbirth See https://www.gov.uk/government/publications/physical-activity-guidelines-infographics

Lying flat on your back (supine lying) after 19 weeks of pregnancy or prone lying once your bump is showing. This is due to the extra pressure it places on the joints and ligaments in your spine, as well as the changes in blood flow that occur as pregnancy progresses. 

Lying on your back should be for a short time only and alternative positions considered particularly if you have been told of any complications in your pregnancy.

If during exercise you experience any dizziness or begin to feel unwell you should change to lying on your left side or into a sitting position or stop until you feel better. 

It is advised that you stop exercise immediately if you suffer with any of the following:

• Tummy pain
• pain in the calf muscle
• bleeding from the vagina
• difficulty in walking
• persistent and severe headache
•  

You should also contact your ADAU/Antenatal assessment unit immediately for further advice.

Whilst exercising, be aware of the following and seek telephone advice from your midwife if you are concerned:

• Breathing – you may feel short of breath more quickly than usual- as your body needs more oxygen when pregnant. If uncomfortable stop exercising and rest until your breathing returns to normal.
• Heart rate – this is naturally faster in pregnancy so a heart rate monitor isn’t always accurate. If uncomfortable – stop exercising and rest until your heart rate returns to normal.
• Dizziness - Your womb and placenta need extra blood which can make your blood pressure fall, this may make you feel dizzy especially with position changes. Try to do these slowly and maintain one position until the dizziness wears off.
• Joints and muscles – you will gradually gain weight during pregnancy causing a natural change in your balance and centre of gravity. This can change the workload placed on ligaments and muscles. These structures are required to support the joints. Hormones released in pregnancy can also make the ligaments more elastic and the joints less supported. You may develop some general low back, hip or pelvic pain due to these changes.
  Ensuring that you maintain good posture and muscle strength can help.
  It is also important to ask for support and guidance on to how to reduce pain and impact on activities of daily living.
  A specialist women’s health physiotherapist will assess your posture, joint mobility and pain and is often able to give treatment and management to reduce the symptoms you are having.

The benefits can include:

• an  increased release of  endorphins (your body’s ‘feel-good’ chemicals)
• helping to  improve your sleeping pattern
•  improvement of  your balance and posture
• maintaining a healthy body and mind
• helping to control your weight
• helping in the prevention of pregnancy induced diabetes (Gestational Diabetes Mellitus or GDM),
• helping  your body prepare for labour and delivery
• increased fitness levels and quicker recovery after childbirth

There are a few conditions which complicate pregnancy and you are likely to be under the care of a Consultant/Obstetrician for these. Your consultant will be able to tell you if exercise is safe and give any appropriate limitations. However, if you have any of the following, exercise is not advisable - unless you have been told otherwise:

• Vaginal bleeding
• reduced baby (Foetal) movements
• any heart/lung/kidney/thyroid disease
• history of recurrent miscarriage or premature labour or ‘small for dates’ baby
• poorly controlled Type1 Diabetes Mellitus (DM)

You are advised to speak to your Obstetrician (or primary care giver) prior to starting exercise, in the following situations. If you:

• have been told that you have a placenta lying low in the uterus (placenta praevia) after 26weeks of pregnancy or early placenta praevia
• have unstable blood pressure (high or low)
• lack of iron in your blood (anaemia)
• have Type1 Diabetes Mellitus
• are extremely overweight or underweight
• are a heavy smoker
• have pelvic and/or low back pain

Yes, but start slowly and listen to your body

No, keep going, but modify your routine if it included any high risk/contact sports and listen to your body. Take advice from your trainer or seek help from the appropriate professional (doctor or specialist physiotherapist) if you are unsure.

It is advised to avoid contact sports ( e.g. football, rugby and  hockey) and also high risk activities particularly those where there is an increased risk of falling (e.g. horse-riding, downhill skiing or snowboarding) and some racquet sports such as squash.

Activities such as scuba diving and those involving altitudes over 6000feet/1850m (such as skydiving) are also considered dangerous in pregnancy.

Walking and gentle swimming (being careful with breast-stroke) can be very beneficial.

Pilates or yoga for pregnancy or aquanatal exercise taught by a registered professional can be very helpful. Choosing a registered professional is important as they will have far greater knowledge and understanding should you have any other symptoms (such as low back pain or pelvic girdle pain) during your pregnancy.

If your low back or pelvic pain doesn’t ease and affects your daily life ask to be referred to a specialist women’s health physiotherapis

Find a Physiotherapist

It is important to stay hydrated during pregnancy and especially during exercise.

If you have any of the following symptoms, you may be dehydrated:

• feeling thirsty
• passing dark-coloured urine
• not weeing very often (less than three times a day)
• a dry mouth and eyes
• feeling light-headed or dizzy
• a headache

Return to exercise after delivery is recommended but it should be gradual and should not involve high impact exercise too quickly. It is advised to wait until at least 6weeks after your delivery to ensure healing and vaginal discharge (lochia) have stopped.

Remember that the hormonal changes that begun in pregnancy can still affect your ligaments and joints for 6months or more postnatally. Ensure that you have comfortable supportive clothes and bra when exercising and are well hydrated, especially if you are breastfeeding.

If you have any concerns regarding urinary or faecal leakage (incontinence), a division or gap  in your tummy muscle (diastasis recti) or ongoing low back or pelvic pain. It is advised that you seek help and support from your GP or local women’s health specialist physiotherapist prior to starting exercise.

For guidance as to when to return to running refer to:

Groom, Tom; Donnelly, Grainne and Brockwell, Emma (2019).

https://www.researchgate.net/publication/335928424_Returning_to_running_postnatal_-_guidelines_for_medical_health_and_fitness_professionals_managing_this_population

Pelvic floor exercises should be done throughout your pregnancy and post-natally. It is best to start pelvic floor exercises before conception of your baby, and to continue not only for the childbearing year, but should be done throughout a woman's life.  The exercises will help to prevent urinary leakage and other problems associated with weak pelvic floor muscles – check out booklet -- Pelvic Floor Muscle Exercises (for women)

If you have any problems with urinary incontinence or you have been told you have a gynaecological prolapse during or after your current or previous pregnancy, ask to be referred to a specialist women’s health physio. Advice will be given on which exercises maybe beneficial in reducing or improving your symptoms; as well as forms of exercise that are best avoided.

There is limited evidence to offer guidance for this. POGP recommend that low level weights or body weight only are used. Avoid combining use of weights with deep squats, kettle bell swings and extreme movement to avoid extra stress placed through the pelvic and lumbar spine joints.

There is no specific advice on recommendations for time to exercise. However it is advisable to monitor your fatigue levels and respond accordingly. Muscle and joint injury is more prevalent when fatigue levels are higher.

Useful and informative, evidence based POGP booklets are available:

• Pregnancy-related Pelvic girdle pain (for mothers-to-be and new mothers)
• Fit for Birth
• Fit for Pregnancy
• Fit for the future
• Aquanatal Guidelines
• Prolapse
• Pelvic floor exercises for Women
• Pilates

Other:

• https://www.nhs.uk/conditions/pregnancy-and-baby/pregnancy-exercise
• https://www.tommys.org/pregnancy-information/im-pregnant/exercise-pregnancy/what-kind-exercises-can-i-do-during-pregnancy
• https://www.nhs.uk/conditions/pregnancy-and-baby/keeping-fit-and-healthy/
• https://www.acog.org/Patients/FAQs/Exercise-After-Pregnancy?IsMobileSet=false
• https://www.nhs.uk/live-well/exercise/couch-to-5k-week-by-week/
• https://bjsm.bmj.com/content/50/10/571