Training Considerations During Pregnancy: Part 2 Exercise Programming Considerations Benefits of Exercise During Pregnancy
During pregnancy women free from medical complication can freely be advised to participate in some moderate forms of physical activity at least twice a week. If their attending physician deems the client low risk, then exercise does not raise any immediate concerns nor pose any threat to the pregnancy.
Just as exercise programming for non-pregnant women aims to develop cardio-respiratory and muscular fitness, this should also be the focus for low-risk pregnant women. The trainer requires an additional focus on maintaining the mother’s functional ability and offsetting the negative effects of the pregnancy.
It has been shown that women who exercise before and during pregnancy experience less weight gain, deliver smaller healthier babies, have greater control during labour and recover to full functionality quicker post birth.
Despite the many and varied risks associated with exercise during pregnancy, there are at least as many and benefits. In most cases, the benefits will far out weigh the risks.
Benefits include:
Increased Fitness
Increased fitness may help with feelings of fatigue whilst at the same time increasing joint stability due to increased muscular endurance capabilities. Increased fitness will also help the mother cope with labour better.
Decreased Risk of Excessive Weight Gain
This may decrease negative self-image feelings and decrease the risk of developing gestational diabetes.
Prevention and Relief of High Blood Pressure
This may decrease the potential for the development of pre-eclampsia later in the pregnancy.
Prevention of Gestational Diabetes, and Associated Physiological Complications
Maintaining blood glucose profiles reduces the risk of renal dysfunction, hypertension and developing type 2 diabetes later in life.
Prevention of Stretch Marks
These may have an effect on the mother’s positive self-image.
Prevention of Varicose Veins
Getting the blood pumping increases circulation thus decreasing the rate of localised muscle fatigue as well as the risk of peripheral muscular cramping and limiting negative body image feelings.
Promoting Faster Delivery
This decreases the stress placed on both mother and child during labour and as a result decreasing the potential for complications during labour.
Faster Recovery of Functional Abilities After Childbirth
This allows the mother a greater ability to care for both herself and the baby.
Improved Psychosocial Wellbeing
Improved mood and increasing positive body image.
Prevention of Leg Cramps
Leg cramps are associated with decreased circulation to the peripheral muscles.
Improved Posture
Improved posture through exercise may decrease the occurrence of muscular skeletal imbalances which increase uneven force distribution within the joint. This helps to reduce joint pain during the pregnancy and associated continued complications after childbirth.
Contraindications to Exercise During Pregnancy
Contraindications to exercise during pregnancy are extremely important.
They can be divided into absolute and relative contraindications for assessment.
Absolute Contraindications include:
Ruptured membranes
Prior premature labour
Heart disease including circulation problems and heart valve dysfunction
Restrictive lung disease
Clots in arms or legs (venous thrombosis or pulmonary embolism)
Premature labour during current pregnancy
Pregnancy induced hypertension
Incompetent cervix
History of miscarriages
Continued bleeding in second or third trimester
Placenta praevia (where the placenta is fixed to the lower segment of the uterus and thus can obstruct the cervix and cause haemorrhage prior to or during labour)
Relative contraindications including:
Chronic bronchitis
Anaemia
Hypertension
Heavy smoking
Morbid obesity
Underweight i.e. where BMI< 12
Poorly controlled Type 1 Diabetes
Extremely sedentary lifestyle
Cardiac arrhythmia
Seizure disorder
Thyroid disorder
History of bleeding during pregnancy
Warning Signs
The trainer should be aware that there are a number of warning signs that the exercise program is creating potential issues for the pregnant mother.
Pain in the Mother’s Back Without Associated Shooting Pain or Numbness
This may be an indication of poor joint alignment. This can cause pressure on the articular structures of the vertabral column and increase the risk of degeneration. Applying forces through the back can accelerate this risk.
Pain in the Mother’s Back with Associated Radiating Shooting Pain and Numbness
Numbness or shooting pain down the legs or into the arms may be an indication of nerve entrapment and needs immediate assessment by a doctor or physiotherapist.
Pain in Pubic Region
Pain in the pubic region be an indication of a problem with the pubis symphysis due to laxity caused by relaxin. This may lead to a sheering effect on the joints and may develop into chronic osteitis pubis. This can persist post pregnancy.
Shortness of Breath
This may indicate maternal hyperventilation, restriction of the mother’s diaphragm, or decreased neural sensitivity. These may lead to poor activation of the intercostal muscles which can lead to decreased oxygen availability for both mother and child.
Palpitations
Palpitations may indicate desensitisation of autonomic neural control of the heart.
Faintness
Faintness may be the result of decreased glycogen sensitivity or decreases in oxygen availability.
Vaginal Bleeding
May be an indication of placenta praevia.
Vaginal Fluid Loss
Vaginal fluid loss may be an indication of pre-term membrane rupture or placental complications.
Difficulty in Walking
This may be an indication of complications with the hip joint including the sacral-iliac joint. It may also indicate pubis symphysis separation.
Uterine Contractions
Uterine contractions may indicate the start of labour.
Absence of Foetal Movement
This may indicate foetal distress.
Tachycardia (High Heart Rate)
Tachycardia may indicate the presence of hypertension or early signs of pre-eclampsia.