Exercise in Pregnancy: Frequently Asked Questions

WHEN_Peta_Titter_Womens_PREGNANT

Can I run during pregnancy?

Whilst running during pregnancy is not considered harmful to the developing baby, there is currently no research to indicate whether running is safe for the pregnant woman or not.   

Running is considered a high-impact exercise. In pregnancy, your joints and soft tissues are at increased risk of injury due to the effect of certain hormones. Your resting heart rate and body temperature are also increased, and as such it will take a lower intensity of exercise to raise them even higher. In addition, your oxygen requirements in pregnancy are increased and you will probably find you become short of breath just walking up stairs.

If you choose to run when pregnant you will need to be extra mindful of all of these changes and the force and strain you are putting on your joints, and other soft tissues, including your pelvic floor.

The point at which running no longer feels comfortable or safe will be different for everyone, but may happen much earlier than expected, so try to stay tuned in to the signals your body tells you.

Can I do deep squats?

In most cases it’s extremely safe to squat to 90 degrees, which is around the same level as sitting on a standard sized chair.  Squatting deeper than this places a large amount of pressure on the joints of your pelvis, including your sacroiliac joints and your pubic symphysis. Your pelvic floor is also altered in this position. By squatting deeper than 90 degrees, you put yourself at risk of developing pelvic pain in pregnancy and possibly compromising your pelvic floor and risking continence issues. We recommend keeping your squats to no lower than 90degrees - it remains an effective exercise, with similar outcomes, but without risking injury.

Can I do single leg work?

We do not recommend standing on one leg whilst exercising during pregnancy and some forms of loaded side lying exercises. This is because there is a large amount of pressure directly going through one side ofthe joints of your pelvis. This puts a greater strain on your sacroiliac joint and your pubic synthesis, (click here for drawing). The structural support for your pelvis does not have the strength there is a risk of developing pelvic pain and pelvic instability.

Is stretching still safe?

Stretching can help with the tightness and discomfort that commonly occurs in pregnancy due to the change in posture and weight distribution. In general, your upper and lower back will feel tighter as well as your buttock (gluteal) muscles. Often your chest muscles also feel tighter as you adjust to your changing body shape and size.

Stretching should be performed in a slow and controlled manner. Remember that your ligaments and tendons are softening under the influence of pregnancy hormones, and you will be at increased risk of over-stretching which would make you vulnerable to soft tissue damage, as well as pelvic pain and pelvic instability. 

Should I do abdominal exercises in pregnancy?

Abdominal muscles play an important role in posture and supporting your spine. As soon as your uterus moves out of your pelvic basin (this happens as your baby grows) it increases the pressure pushing out against your abdominal muscle wall. It is common in pregnancy for women to experience the condition known as diastasis retus abdominus – also know as abdominal separation – which is a painless splitting of the abdominal muscle at the midline. It has been reported that up to 97% of pregnant women will have some degree of diastasis by the end of their pregnancy. It is important to be mindful that this is likely to occur at some point, and avoid exercises that might make the muscles separate very early, or make the separation worse. Continuing with traditional abdominal exercises such as sit-ups, crunches or planks, especially if they have not been appropriately modified, may make the separation worse and are generally ineffective during pregnancy. They may also put increased pressure on your pelvic floor muscles, risking pelvic floor issues including incontinence. Also be mindful of back extension exercises that will stretch your abdominal muscles as they may aggravate a diastasis.

WHEN_Peta_Titter_Women's_health_ diastasis_recti.jpg



Appropriate core stability exercises are recommended during pregnancy to strengthen the muscles of the abdomen. For example:

  • Concentrate on drawing your belly button towards your spine.

  • Breathe out while pulling in your belly.

  • Hold the position for up to 10 counts.

  • Relax everything (your abdomen and pelvic floor) completely as you breathe in.

  • Repeat 10 times, as many times a day as you are able.

  • You can perform this exercise sitting, standing or on your hands and knees.

Find a fitness professional who has a working knowledge of the pregnancy guidelines and experience working safely with pregnant woman. 

Should I do weight training when pregnant?

Yes! The World Health Organisation recommends:

  • Muscle strengthening exercises involving 2 or more muscle groups

  • Strength exercises to be performed on 2 or more non consecutive days a week

  • Getting clearance from your health professional while pregnant

However, there is limited research into this area during pregnancy. The current recommendations are to focus on using light weights, body weight and elastic resistance bands. The recommendation for lighter weights is to reduce the risk of injury. The movements should be slow and steady and be performed in a controlled manner. Ensure a good breathing technique, and the general rule of thumb is to breathe out with exertion.

When performing weight/strength training remember that your ligaments and tendons soften due to your pregnancy hormones. This allows them to stretch in preparation for birthing your baby, but it also means the structural support you had before pregnancy has altered. You may also be carrying more weight than you have before, and this will also increase the force and pressure through your joints, ligaments and muscles. You can reduce some of the increased pressure by performing your weights in a seated, semi reclined or side lying position.

References

  1. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Exercise in Pregnancy (position statement). Last updated July 2016. https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Exercise-during-pregnancy-(C-Obs-62)-New-July-2016.pdf?ext=.pdf

  2. Lewis, E. 2014. Exercise in pregnancy. AFP. 43(8), 541-542

  3. Sports Medicine Australia. Exercise in Pregnancy and the Postpartum Period (position statement). Last updated 19/07/16. https://sma.org.au/sma-site-content/uploads/2017/08/SMA-Position-Statement-Exercise-Pregnancy.pdf

  4. Aladabe, D, Ribeiro, DC., Milosavljevic, S & Dawn Bussey M. 2012. Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review. Eur Spine J, 21, 1769-76.

  5. Borg-Stein JP, Fogelman, DJ & Ackerman, KE. 2011. Exercise, sports participation, and musculoskeletal disorders of pregnancy and postpartum. Semin Neurol, 31, 413-22.

  6. Evenson, KR, Mottola, MF, Owe, KM, Rousham, EK & Brown, WJ. 2014b. Summary of international guidelines for physical activity after pregnancy. Obstet Gynecol Surv, 69, 407-14.

  7. Melzer, K, Schutz, Y, Boulvain M & Kayser, B. 2010. Physical activity and pregnancy: cardiovascular adaptations, recommendations and pregnancy outcomes. Sports Med, 40, 493-507.

  8. Morkved, S. & Bo, K. 2014. Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. British Journal of Sports Medicine, 48, 1-13.

  9. Nascimento, SL, Surita, FG & Cecatti, JG. 2012. Physical exercise during pregnancy: a systematic review. Curr Opin Obstet Gynecol, 24, 387-94.

  10. Zavorsky, GS & Logno, LD. 2011. Exercise guidelines in pregnancy: new perspectives. Sports Med, 41, 345-60.

  11. World Health Organisation. Global recommendations on physical activity for health. 2011. https://www.who.int/dietphysicalactivity/physical-activity-recommendations-18-64years.pdf

Authors:

Peta Titter & Dr. Rhea Psereckis

Marco van der Heide