Winnipeg Free Press - PRINT EDITION

Exercise essential part of modern prenatal care

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Exercising during pregnancy is gaining in popularity. Past medical advice for pregnancy fitness has been overly cautious and women are less hesitant to engage in their favourite exercise activities during pregnancy. With adequate carbohydrate and fluid intake, women are able to exercise right up to the date of delivery. Women who take part in regular aerobic exercise before pregnancy can make a smooth transition into pregnancy exercise.

Who cannot exercise

There are very few women who will be told by their physician that they cannot do regular aerobic exercise in pregnancy. If exercise is not recommended, it is usually due to one of these medical conditions:

-- Multiple gestation (twins or more) at risk for pre-term labour.

-- Preeclampsia/pregnancy-induced hypertension (high blood pressure).

-- Significant heart disease.

-- Persistent second or third-trimester bleeding.

-- Incompetent cervix (cervix does not stay closed).

-- Premature labour during current pregnancy.

-- Placenta previa (low lying placenta over cervix) after 26 weeks gestation.

-- Restrictive lung disease.

-- Ruptured membranes.

Daily is best

If no exercise risks are present, 30 minutes or more of moderate aerobic exercise is recommended on most, if not all, days of the week. It is important to recognize that this amount refers to aerobic activity. Many women engage in yoga or aquacize during pregnancy. These activities, at a beginner level, do not qualify as moderate, aerobic exercise. Examples of moderate exercise include: walking, elliptical trainer and swimming laps. Not only does aerobic exercise give you more energy in pregnancy, but it helps to control weight gain. Some women gain too much weight in pregnancy that is very difficult to lose afterwards. The extra weight also places a woman at risk for coronary heart disease and other diseases after pregnancy. Extra weight in pregnancy can also place a woman at risk for gestational diabetes.

Watch those sit-ups

You can certainly add other activities to your exercise regime in addition to aerobic exercise. Strengthening exercises, yoga, pilates, aquacize and ball exercises are popular favourites. After the first trimester, you should not do exercises while lying on your back such as sit-ups. Instead, abdominal strengthening can be done using an exercise ball or doing planks.

Activity choices

Most recreational activities are safe. The exceptions are those activities where there is a risk of falling or abdominal trauma. Examples of activities to be avoided include: scuba diving, water skiing, gymnastics, downhill skiing and horseback riding. It is safe for women who are experienced in minimal contact sports to do these sports in the first trimester. Examples would include hockey, soccer and basketball. However, since the fetus is not protected in the pelvis in the second and third trimesters, contact and minimal contact sports should not be played after the first trimester. Physical activity at altitudes above 1,828 metres is also not recommended.

There is no evidence that jogging during pregnancy is dangerous to the mother or the baby. Joggers usually stop running by the third trimester due to discomfort, not because of any harm to the mother's or baby's health. With the exception of risky activities noted above, women can continue the same pre-pregnancy aerobic activities during their pregnancy. Furthermore, if you were not physically active before pregnancy, it is perfectly safe for you to start an aerobic exercise program during pregnancy. Also, weight training can continue into the second and third trimesters but fewer repetitions and lighter weights are recommended.

Talk to your physician

Before you embark on an exercise program, you should discuss it with your physician in order to make sure your activities are appropriate for your pregnancy. If you experience any discomfort with exercise such as dizziness, headache, bleeding, water breaking, pain in legs or chest, cramps or breathing problems, stop exercising and seek medical attention.

Dr. Maureen Kennedy MD, CCFP, FCFP, Dip. Sport Med., is a sport and exercise medicine physician at the Sport MB-Sport Medicine Centre and the Reh-Fit Centre in Winnipeg.

Republished from the Winnipeg Free Press print edition December 4, 2012 C3

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