Pregnancy is often a woman’s first lesson in flexibility as she
approaches motherhood. Despite the best-laid plans, factors like morning
sickness and fatigue can make it difficult—if not impossible—to follow
an ideal prenatal fitness program. In fact, it is not uncommon for women
to have to adjust their programs on the fly, depending on how they feel
during each stage of pregnancy.
Of course, every woman is different. While some have to dramatically
modify their fitness programs, others continue their normal workouts,
including high-intensity activities like running marathons and
participating in boot-camp classes. In fact, researchers have discovered
that some women can safely continue almost any activity they were
participating in before pregnancy throughout most of their pregnancies.
While this may be true, all women should pay close attention to how they
feel and be prepared to modify their programs accordingly.
Prenatal Precautions
The American Congress of Obstetricians and Gynecologists
(AGOC) published their first recommendations on exercise in 1985. Since
then, these have been updated in 1994, and again in 2002. You can read
the complete current ACOG Guidelines here to learn how to identify absolute and relative contraindications to exercise during pregnancy.
Reasons to discontinue exercise and seek medical advice include:
- Vaginal bleeding
- Sudden swelling of the ankles, hands or face
- Dizziness or faintness
- Persistent, severe headaches and/or visual disturbances
- Chest pain, excessive fatigue or palpitations
- Unexplained abdominal pain
- Calf pain or swelling
- Persistent contractions that may be indicative of preterm labor
- Insufficient weight gain [less than 2.2 pounds (1 kg) per month during the last two trimesters]
- Amniotic fluid leakage
Source: American College of Sports Medicine. (2000). ACSM’s Guidelines for Exercise Testing and Prescription, 6th ed. Philadelphia: Lippincott, Williams & Wilkins.
Additional precautions include:
Hyperthermia
Increases in fetal temperatures from high fevers have been related to
birth defects, which initially led doctors to be concerned about
elevated body temperatures during exercise. Current research has shown
that this is not a major concern, as adaptations that happen during
pregnancy and exercise help women regulate their core body temperature
more efficiently. Even so, it is still very important to:
- Stay well hydrated
- Avoid exercising in extremely hot and humid temperatures
Not Consuming Enough Carbohydrates
Pregnancy is not the time to think about weight loss. Even when the
doctors warn about excessive weight gain, restrictive dieting is not
recommended. Pregnant mothers should consume an additional 300 kcal/day
and even more if they are exercising regularly. Focus on eating smaller,
healthier meals, and eating a healthy pre-exercise snack of protein and
carbohydrates.
Supine Hypotensive Syndrome
While lying in the supine position, the additional weight of the
uterus during the second and third trimesters can add pressure to the
inferior vena cava, thus potentially causing a decrease in venous return
to the heart. This can lead to lightheadedness and dizziness. Some
research questions the warnings that this position will lead to a
decrease in fetal blood supply, but until there is further research,
supine exercises—if performed at all—should be done with caution, in
very short bouts and with awareness of the feelings of the expecting
mother.
Maternal Conditions and Exercises That Can Help
Pregnancy comes with hundreds of aches, pains and unpleasant
symptoms. Some people experience almost all of these, while others are
fortunate enough that they experience very few. Here are three common
aches and pains felt usually during the second and third trimesters and
how to use exercise to alleviate them.
Round Ligament Pain
The round ligament, located in the front of the womb, is stretched as
baby and uterus grow, which can lead to a sharp jabbing pain in the
lower belly or groin area.
Cat Cow
The Cat Cow Pose is a great yoga move to help
alleviate round ligament pain. Assume a quadruped (all fours) position
with hands pointed forward. Inhale and round the back high, letting the
head fall while curling the pelvis under, relieving tension on the
ligament. Exhale, pulling the belly toward the mat, and extending the
back body wide to stretch the ligament. Repeat 10 times.
Diastasis Recti
The linea alba is the tendinous tissue that merges the rectus
abdominal muscles with the fascia. Both the rectus abdominis and the
linea alba are designed to contract in a vertical fashion, and are not
always able to withstand the strong horizontal pressure put on them with
an expanding belly. This can lead to a thinning of the linea alba and a
protrusion in the middle of the belly.
Seated abdominal compressions
This is a great way to train the transverse abdominals, while also teaching the individual how to engage these muscles.
Have one partner hold a string or band around the stomach of the
exerciser. Encourage them to exhale, drawing the navel in and
contracting the lower part of the abdominals. As this new tightness is
achieved, the partner holding the string will slightly tighten it while
the exerciser continues to breathe under this contraction. If the
exerciser is having trouble doing the compression correctly, have them
make a “ha ha” or coughing sound to encourage the appropriate
contraction. Repeat two to three times.
TRX resisted heel taps
These are another great option. Begin lying on the ground facing the
anchor point. Place both hands in the foot cradles and press down. Keep
the core braced and knees bent at 90 degrees. Slowly lower one heel
toward the ground until just before the low back rises up. Return to the
starting position keeping pressure down in the hands. Aim for two
30-second sets of this exercise. (Note: Because this move is performed
in the supine position, avoid doing this exercise any longer than 30
seconds and have the exerciser roll to her left side between sets.)
Low-back Pain and Posture Issues
Exercise can ease low back pain for the expecting mother, but if not
done properly, it can also aggravate it. Muscles that tend to shorten
include the chest, low back, shoulders, hamstrings and calves. Muscles
that tend to weaken include the upper back, glutes, abdominals, pelvic
floor and quadriceps. Begin by focusing on mobilizing tight muscles, and
then work on strengthening weak muscles. Here are some sample
exercises:
Seated or Standing Spinal Flexion
Due to the forced anterior pelvic tilt caused by increased weight in the belly, the lower back and hamstrings often tighten up.
To perform this exercise from a seated position, sit at the front of a
chair with the feet flat on the ground. Separate the knees and bend at
the waist.
To perform this exercise from a standing position, bend the knees and
position the legs a comfortable distance apart. Lower the hands to the
floor or a step. Slowly begin to lift the tailbone toward the ceiling
while straightening the legs. Stop once a stretch is felt.
Standing Scapular Retraction With a Foam Roller
Increased lumbar lordosis also leads to a kyphotic posture in the
thoracic spine. This posture can be somewhat alleviated by strengthening
the muscles in the upper back.
Place a 3-foot foam roller up against a wall and stand facing away
from it. Bend the knees slightly and place the tailbone onto the roller.
Continue aligning the back on the roller so that an imprint is felt on
the spine. Gently (not forcefully) hug the foam roller with the scapula
and hold for one minute.
Pelvic Tilts (Supine or Standing)
Pelvic tilts are another great exercise for alleviating low-back pain. This move also strengthens the abdominals while stretching the tight lower-back muscles.
Begin lying supine on the ground or standing against a wall with
knees slightly bent. Gently tighten the glutes and belly muscles and
shift the pelvis posteriorly. This should flatten the curve in the lower
back and create an imprint on the mat or wall. Hold for six seconds and
repeat. This exercise can also be performed from a seated or quadruped
position, or while siting on a stability ball. (Note: If performing this
exercise in the supine position, avoid holding it for longer than 30
seconds. Have the exerciser roll to her left side between sets.)
Side-lying Clam Shell
With the increased anterior pelvic tilt, the glutes and hips are
weakened due to an over-tightening of the hip flexors. Strengthening the
gluteus medius and minimus helps stabilize the sacroiliac joint, which
can become loosened and unstable during pregnancy. This is a great
exercise to do in between supine exercises as it only takes a quick roll
to the side.
Begin in a side-lying position with the pelvis perpendicular to the
floor. Knees should be bent between 45 and 90 degrees. Brace the core
and keep the feet together. Contract the glutes and lift the top knee
off of the bottom knee. Stop before the pelvis moves or the hips roll
back. Hold for five to 10 seconds and repeat.
Assisted Lunges
Again, strengthening the glutes is important to help stabilize the
hips and improve posture during pregnancy. Assisted lunges are also
great for improving both balance and leg strength. As pregnancy
progresses, a woman typically gains more weight and her joints become
more lax, which can make lunges more difficult. Lunges can be unloaded
using a suspension trainer or by placing a BOSU ball under the back
knee. While returning to a stand with each lunge, ensure the glutes are
engaged by thinking of scissoring the legs together, helping to preserve
proper posture and glute engagement.