Have you decided to exercise during pregnancy but need clarification as to what type and how much exercise you should be doing? Here I provide some guidelines regarding the frequency, intensity, duration and type of physical exercise that is recommended for pregnancy.
If you have decided to continue or commence an exercise programme during your pregnancy then congratulations and well done! So long as you do not have any medical conditions or contraindications that would prevent you from exercising safely then you should be able to enjoy an active pregnancy and reap the benefits that prenatal exercise can bring to both you and your baby.
These days an active pregnancy involving safe and appropriate prenatal exercise is widely encouraged by official governing bodies such as ACOG, RCOG and the ASCM. The many benefits are widely documented and supported by both scientific evidence and anecdotal reports. It can, however be confusing to determine what constitutes safe and appropriate exercise and what a prenatal exercise programme should look like.
Types of exercise to avoid
Certain activities or types of exercise are considered to be unsafe or risky as they could put the baby or mother at risk of abdominal or musculoskeletal injury due to impact or falls e.g. racket, contact sports. Some can also elevate the mothers internal body temperature to dangerous levels e.g. ‘hot’ classes, others can restrict circulation and reduce the blood supply to the baby e.g. lying on the back. These activities/sports should be avoided and include:
Horse riding
Gymnastics
Hot Yoga
Aerial yoga
Rock climbing
Skiing
Water skiing
Scuba diving
Ball sports: tennis, netball, football, hockey, basketball etc.
Full contact martial arts or boxing
Any exercise where you will lie on your back for prolonged periods of time
Recommended Types of exercise/activity
Certain activities are considered to be low risk and hence safer to continue or initiate during pregnancy. These include
Walking
Swimming
Aqua aerobics
Stationary cycling
Low impact aerobics/exercise to music e.g. dance, Zumba
Strength training (body weight or low-moderate external weight)
Prenatal fitness classes e.g. circuit training, low intensity interval training
Prenatal yoga
Prenatal Pilates
Regressive rather than progressive programming
Most exercise programmes are progressive, meaning that they increase in intensity as time and ability progresses so that a person can get fitter, stronger, more flexible etc. However, during pregnancy the opposite approach should be taken in most cases. Programming for the pregnant woman should be slowly and gently progressive to maintain moderate fitness and then regressive. The reason for this is that as your pregnancy progresses your body will already be under increasing physical and physiological demands to support your growing baby and uterus so you do not want to over-tax your anatomy, physiology or biological resources. Otherwise both you and your baby may be depleted or at risk of injury. Some of the ways in which your body adapts are listed below.
Your body mass will increase meaning that you will be moving more weight and intrinsic resistance every time you move, so you will be working harder to shift your own weight.
Your increased abdominal mass, stretched ligaments and pressure on the pelvic floor mean that you are more likely to find high impact exercises uncomfortable and inappropriate especially as your baby develops and your pregnancy progresses. In fact, if you have not previously been engaging in high impact exercise such as running then it is probably best to avoid starting it until you have fully recovered and rehabilitated your body postnatally.
Your balance will be compromised as your centre of gravity shifts forward due to your growing baby and uterus. This will make you more prone to imbalance and falls.
Your joints will become laxer as levels of the hormone relaxin increases. This means that your joints will be less stable and more prone to injury.
You are likely to develop musculoskeletal imbalances and discomforts due to postural changes e.g. lower back pain & pelvic girdle pain which can make certain exercises uncomfortable or inappropriate.
You are more likely to experience breathlessness due to reduced space in your thoracic cavity, which means that you will find it harder to catch your breath.
All of these changes warrant a regressive approach to prenatal exercise programming wherein you slowly regress the intensity of your workouts by reducing the duration and difficulty of exercises. It is important to remember that pregnancy is not the time to think about making huge gains in fitness but rather increasing levels of fitness, if previously sedentary, and maintaining fitness for those who are already active and regularly exercising. Despite the regression you will still be able to obtain a good workout and reap the benefits and will be safer whilst doing so.
Recommended Amount of exercise
You may already be participating in a regular exercise programme, in which case it is generally accepted that you can continue and regress your programme as required.
If you are starting an exercise programme and were previously inactive or sedentary then the general guidelines are to aim to exercise for 20-30 minutes on most days of the week and for no longer than 45 mins and not at high intensity.
Cardiovascular exercise: 3-5 days per week at a moderate intensity wherein a comfortable conversation can be carried out during the exercise, without causing laboured breathing. On a rate of perceived exertion (RPE) from 1-10 (1 being minimum intensity and 10 being maximum intensity) pregnant women should aim to be training at approx. 3-6 RPE. This is a qualitative, relative method of assessing how intense a woman is working out hence it is very useful as it is adaptable throughout pregnancy- an RPE for a particular exercise at one stage of pregnancy may differ to an RPE at a later stage of pregnancy. As long as a woman never feels as though she is pushing herself past a RPE of 6 she will be exercising within safer zones.
Resistance training: 2-3 days per week 12-15 reps, for 2-4 sets targeting all of the major muscle groups. Exercising at an RPE of 3-6.
Pelvic Floor exercises: integrated pelvic floor training should be carried out during each workout. Isolated pelvic floor exercises can be carried out daily if desired.
Core stability: integrated core training should be included during resistance training sessions.
Myofascial release and maintenance stretches should be carried out during each workout to release stuck tissues, maintain flexibility and facilitate recovery from exercise.
How to split your exercise routine
There are numerous ways to train- finding what works best for you is the key to maintaining and enjoying your prenatal exercise plan. It will serve you well to also be flexible and listen to your body so that you can adapt your plan as and when you feel the need to.
Decide how many days you want to exercise, how much time you have for each workout and whether you want to combine or separate your cardiovascular and strength training, here are some examples that follow the recommendations for cardiovascular and strength training:
5 days per week: 5 cardiovascular + 3 strength sessions
5 days per week: 3 cardiovascular + 2 strength sessions
4 days per week: 4 cardiovascular + 2 strength sessions
3 days per week: 3 cardiovascular + 3 strength sessions
3, 4 or 5 days per week: 3,4 or 5 circuit training or interval training sessions combining both cardiovascular and strength training exercises.
What body parts should be trained
You should be looking to train your entire body over the course of each week making sure that you train opposing muscle groups to achieve balance. It will also serve you well to take some time to focus on correct posture and lateral breathing technique.
Posture correction (head to toe)
Lateral Breathing
Chest & upper back
Core: Abdominals & lower back
Shoulders
Arms: Triceps, biceps & forearms
Glutes & hip flexors
Hamstrings & quadriceps
Calves
Pelvic floor
Feet
It is always beneficial to incorporate integrated, functional fitness exercises that are compound. This means that they will train your core, pelvic floor, multiple muscle groups and balance as well as provide functional strength for use in everyday life. Ensure that you squat, lunge, push, pull, rotate, balance, bend & extend your body and move in all planes of motion: forwards, backwards, sideways, up and down.
Where to train? Home, gym or PT
So long as you understand the contraindications to exercise, warning signs and symptoms and how to exercise with considerations and adaptations for pregnancy, then in theory you can exercise safely alone at home or in a gym, structured class or with a personal trainer. However, it is recommended that you train with instructors who are pre and postnatally certified and/or use home exercise workouts that are specifically designed for the prenatal woman. In an ideal world you would join an exercise class or personal training programme that is designed specifically just for prenatal women and that offers bespoke elements to take your personal needs and situation into consideration so that you are screened, exercise safely and effectively for your personal circumstances.
If you are fortunate enough to have a prenatal exercise class nearby that you can attend, then you may also have the added benefit of the class providing the following prenatal training/coaching:
Pelvic floor preparation & exercises (both isolated & integrated)
Labour & Birth preparation exercises
Birth preparation discussions/articles
Prenatal nutrition advice
Postnatal recovery advice
Prenatal resources (books, discounts)
Mindfulness & relaxation
Peer support
Whatever safe prenatal exercise/activity you decide to do and however much you manage to schedule into your week, make yourself aware of the recommendations, contraindications, risks and warning signs/symptoms so that you know what to be aware of. Listen to your body and be sure to disclose any conditions or changes to your circumstances to your trainer/instructor. Then seek out the best exercise experience and instructors that you can and enjoy the benefits that exercise can bring to both you and your baby.