We know that pregnancy isn’t a condition and we CAN lift a box, really I promise, we can!  It’s actually good for us, really!  We know how important exercise is to our overall health, but what is ok while we are growing a little one?  Heather Johnson at Nurtured Moms, a doula service in the Gresham and Greater Portland Oregon area, has done some research for you.  Here is what she has to say…….

I’m a runner, and I remember being SO worried about losing my running fitness when I became pregnant with my daughter. One of the first things I asked my OB was whether or not I could keep running. Fortunately, she thought it was a great idea, and even encouraged me to continue my regular workout schedule. I kept running until I was about 26 weeks and my belly became too cumbersome; at that point, I climbed on the elliptical trainer and continued working out until the day my daughter was born. The fitness paid off big time: the difference between how I felt at the end of my second pregnancy — worked out every day — and my first — gave up the workouts and gained 70 lbs. — was astounding. I had plenty of energy, felt great, and the swelling and back-aches were minimized. Not only that, but I was back to my pre-pregnancy weight by the time I came home from the hospital (before you start hating, remember this weight includes the weight I never lost from my first pregnancy).

Evidence for Exercise Throughout Pregnancy

Obviously the carefully compiled anecdata of one pregnant woman does
not constitute scientific evidence, but there is, in fact, actual evidence that seems to point to exercise being a great thing for people in general, and pregnant women in particular. One study of 131 women, published in the American Journal of Obstetrics and Gynecology, found that women who continued a regular running or aerobics program had shorter labors and less frequent fetal stress than those who discontinued their exercise program in the first trimester. While their labors tended to begin earlier (277 +/- 6 days gestation vs 282 +/- 6 days), the exercise group had similar rates of pre-term delivery and also had a lower incidence of surgical delivery than the non-exercise group.  Unfortunately, most of the studies on pregnancy and exercise are small. The one Cochrane Review of the subject concluded that, while there is evidence that pregnant women who engage in vigorous exercise at least two to three times per week improve or maintain their physical fitness and that — contrary to what was once thought — prenatal exercise does not cause pre-term labor, larger studies are needed to be more definitive on the subject.

In spite of the dearth of evidence, the American College of Obstetrics and Gynacology (ACOG) has decided there is enough to recommend that ‘‘[i]n the absence of either medical or obstetric complications, 30 minutes or more of moderate exercise a day on most, if not all, days of the week is recommended for pregnant women.’’  But what makes for a good and safe workout?

The FITT Principle of Training
One of the best ways for anyone, not just pregnant women, to exercise safely is to follow theFITT principle of training, which stands for frequency, intensity, type and time. Pregnant women can use the following guidelines, adapted from a study published in Current Sports Medicine Reports:

Frequency
Your body needs time to recover between any kind of exercise, both cardiovascular or resistance-based. For a sedentary woman, 3-4 sessions of cardiovascular exercise a week is probably an appropriate frequency, where a woman who has been exercising regularly, 4-5 times may feel better. An elite athlete would probably be fine training 5-6 times a week, but even she would need to make sure her body has time to rest. When it comes to resistance exercise, or lifting weights, it all depends on what you’re doing. If you’re doing a full body workout each time, you will need to leave a day of rest between sessions. I like to break up my resistance workouts and do one body part on each day. This means I can lift five days a week and still give my muscles the rest they need between workouts.

Intensity
Intensity is a measure of the amount of effort you are exerting when you exercise. You can measure this in a couple of different ways; you could rock a heart rate monitor, or you could use something like the Borg Rate of Percieved Exertion Scale, which is easier for those who are not technically minded (and also free!).  For sedentary women, working out with a rate of perceived exertion (RPE) of moderate to moderately hard would be appropriate. For women who are used to exercising, an acceptable range of RPE would be moderately hard to hard. For an elite athlete, a hard RPE or heart rate of 70%-80% of maximum would probably be fine.

Type
Type refers to the kind of exercise you choose in order to achieve the results you want — in this case, health and fitness. In order to improve your fitness, you need to choose exercises which are continuous in nature and use your large muscle groups, like running, cycling, circuit training, walking, etc. Novice exercisers should choose something low impact, like walking, biking, or swimming. Women who are already into fitness and elite athletes should also choose low impact exercises when trying something new, but can probably safely continue any exercise their body is already used to, such as running or dancing. In general, as long as your body is feeling good while you’re doing it, an exercise is probably ok.

Time
Time is pretty self-explanatory — it refers to the length of time spent on any given workout. Beginning exercisers should start with no more than 30 minutes, but can increase that time slowly if they feel comfortable. Regular exercises will probably do well with 30-60 minutes of continuous exercise, while elite athletes can tolerate 60-90 minutes.

When Exercise is Not Safe in Pregnancy
While they promote exercise for most pregnant women, ACOG does leave some women out. In their opinion on exercise during pregnancy, there are some absolute contraindications to exercise and also some relative contraindications.

Absolute contraindications are:

• Significant heart disease
• Restrictive lung disease
• Incompetent cervix or cervical cerclage
• Multiple gestation with risk for preterm labor
• Persistent second or third trimester bleeding
• Placenta previa after 26 weeks of gestation
• Premature labor during the current pregnancy
• Rupture of membranes
• Pregnancy-induced hypertension

Relative contraindications are:

• History of sedentary lifestyle
• Intrauterine growth retardation
• Poorly controlled hypertension
• Poorly controlled seizure disorder
• Poorly controlled insulin-dependant diabetes
• Severe anemia
• Chronic bronchitis
• Maternal cardiac arrhythmia
• Poorly controlled thyroid disease
• Extremely overweight (morbid obesity)
• Extremely underweight (BMI 12 or lower)
• Orthopedic limitations
• Heavy smoker

Another important caveat they give — if you should encounter any of the following problems while exercising, stop immediately and contact your care provider:

• Vaginal bleeding
• Difficulty breathing before you start working out
• Dizziness
• Headache
• Chest pain
• Muscle weakness
• Calf pain or swelling
• Pre-term labor
• Decreased fetal movement
• Amniotic fluid leakage

In the absence of these conditions, exercise can be safe and enjoyable during pregnancy. There is an ever-increasing body of evidence in support of exercise during pregnancy, and for most women, it is clear that the benefits far outweigh any theoretic risks. The risks that may exist are small when proper guidelines and precautions are followed. And here is where I make my disclaimer: I am not a medical professional. Make sure you are seeing your health-care provider regularly and discuss any fitness regimen with her. As a your body changes throughout the pregnancy, you may need to to adjust your workouts to ensure continued safety. Happy Exercising!

Sources:
ACOG. Committee on Obstetric Practice. Exercise during pregnancy and the postpartum period. ACOG Committee Opinion 267. Obstetrics & Gynecology 99:171–173, 2002.

Kramer, M.S. Aerobic exercise for women during pregnancy (Cochrane Review). In: The Cochrane Library, Issue 4. Oxford: Update Software, 2002.

Paisley T.S., E.A. Joy, and R.J. Price. Exercise during pregnancy: A practical approach. Current Sports Medicine Reports 2:325–330, 2003.