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Physical Activity & Pregnancy

Physical Activity & Pregnancy

Physical Activity & Pregnancy

The Facts, the Figures & the False Conceptions

If you are pregnant or planning a pregnancy and you are unsure about the current guidelines for physical activity and what is safe, this is a must read! An excellent team of experts have appraised over 27,000 manuscripts and abstracts (Davies G & Artal R., 2019) in order to bring us the most up to date information and guidelines on physical activity during pregnancy.

THE FACTS:

Physical activity during pregnancy:

  • DOES NOT increase the risks of structural or functional birth defects which stem from in the womb (Davenport MH, et al., 2019)
  • Has a significant effect on reducing the severity of low back pain, pelvic girdle pain and lumbopelvic pain. (Davenport MH, et al., 2019)
  • Decreases the chances of using instruments during delivery (Davenport MH, et al., 2019)
  • Reduces the chances of depression during pregnancy as well as the severity of symptoms. Unfortunately, this does not apply to the post-natal period. (Davenport MH, et al., 2018)
  • Reduces the risk of excessive weight gain during pregnancy as well as weight retention postpartum. (Ruchat S, et al., 2018)
  • Results in a small increase in the mother’s body temperature which is safe for the baby. (Davenport MH, et al, 2019)
  • Effectively reduces the risk of developing gestational diabetes mellitus, gestational hypertension and pre-eclampsia. (Davenport MH, et al., 2018)
  • Reduces the odds of having abnormally large babies (Davenport MH, et al., 2018)

Additionally…

  • There is no association between physical activity during pregnancy and increased risk of miscarriage or perinatal mortality (stillbirth or deaths in the first week of life) (Davenport MH, et al., 2019)
  • There is not enough evidence to inform us if lying on our back to exercise is safe or if it should be avoided altogether during pregnancy (Mottola MF, et al., 2019)
  • There was no association found between exercise during pregnancy and complications with the newborn baby or harmful childhood outcomes (Davenport MH, et al., 2018)

THE FIGURES & RECOMMENDATIONS

(Mottola MF, et al., 2018)

  • An accumulation of 150 minutes of moderate intensity exercise each week is recommended in order to achieve the health benefits and reduce risks of pregnancy complications
  • Exercise over a minimum of 3 days per week, however daily exercise is encouraged
  • Variety is key in order to achieve greater benefits
  • Pelvic floor muscle training can be performed daily in order to reduce risk of urinary incontinence
  • Exercising flat on the back should be modified if the pregnant women is experiencing light headedness, nausea or feeling unwell
  • TAKE HOME MESSAGE: All women WITHOUT contraindications should be participating in physical activity during pregnancy

THE FALSE CONCEPTIONS

  • Exercise will harm the baby. The evidence has shown that there are no increased risks of miscarriage or a small baby when undertaking physical activity during pregnancy
  • Heart rate should be below 140 beats per minute. This is an outdated guideline from the 80s and there was no evidence to even support this guideline, it was based on expert opinion.
  • Exercise needs to be at a gym or with group fitness. Lots of studies that were looked at were walking programmes. Additionally, moderate intensity physical activity can include gardening, mowing the lawns and some household chores.

Other considerations for physical activity & pregnancy

There are other considerations specific to the mother during pregnancy and physical activity. These include, but are not limited to, the pelvic floor and risk of overload/prolapse as well as pelvic pain. If you are planning a pregnancy/already pregnant and have a history of pelvic pain or pelvic floor concerns, it is important to see your physiotherapist before commencing physical activity. Here at Physiotec, your women’s health physiotherapist can assess your pelvic floor muscles to ensure you are using them correctly, assess and address other areas of concern such as low back pain or pelvic pain and advise you on the safest exercises during pregnancy as well as into the post-natal period. You might also like to join one of our Pilates classes to stay strong or build strength and control before, during or after your pregnancy.

Download more information on Physical Activity during Pregnancy here

Why should I exercise during and after Pregnancy

Why should I exercise during and after Pregnancy

For Mums and Mums to be…

Have you ever experienced some pain in the pelvis  or in the hips during or after pregnacy?

Poor pelvic control or instability is a condition more common in women and is most likely to occur during or post –pregnancy.  During pregnancy, a hormone called relaxin is released in the body to allow the ligaments to stretch to accommodate the fast growing baby. With another human being growing rapidly, the pelvis does undergo an increase in loading, which some women cope with a little better than others – this can be due to genetic factors such as natural pelvic and ligamentous structure, or the background muscle conditioning you had prior to the pregnancy.

DON’T WORRY THOUGH…. remember that “instability” does not mean your pelvis is physically out of place but rather your muscles around the pelvis are not providing adequate’ force closure’ or mechanical compression or support around the pelvis while the ligaments are lax.

Who is more at risk of developing Pelvic pain due to pelvic instability?

Research has shown that  women who are involved in strenous work, or have a previous history of low back pain and a history of lumbo-pelvic (lower back and pelvis) pain during previous pregnancies are at risk. Although, direct trauma to the pelvis such as a fall can also result in pelvic instability.

How can Physiotherapy Help?

Use of Physical Aids

Physiotherapy can help by identifying the cause of the pain around the pelvis, whether it is originating from the lumbar spine or from pelvic instability. Off loading the pelvis may be important in reducing the symptoms such as using crutches or walking sticks. Tape or pelvic/abdominal belts  can also provide some compression around the pelvis, assisting with stability in the shorter term.

Postural and Movement Education

Being aware of movements or postures that may overload the pelvis, and optimising muscles support around the lumbar spine and pelvis are the most  important factors in managing this condition. Some specific advice on what movements or positions you may need to avoid or adjust can make a big difference in avoiding pain aggravation.

Specific and Appropriate Strengthening Exercises

Improving activation of the deep supporting muscles around the pelvis is also extremely important for providing dynamic control, so

despite laxity in the ligaments, your muscles can assist in compensating for the reduced support that ligaments can give during your pregnancy. Using real time ultrasound to train deep abdominals and pelvic floor muscles, and some of the deep hip/pelvic muscles are beneficial to someone who has pelvic instability. This is followed by a progressive strengthening program matched to the needs of the individual. Your physiotherapist can recommend appropriate Pilates and Pilates-based exercises as well as monitor your progress throughout your pregnancy and even after your pregnancy.

Transversus Abdominis Ultrasound At Rest
Ultrasound retraining of the abdominal wall – Transversus abdominis

If you are suffering from pelvic pain due to instability, see a Women’s Health Physiotherapist and get some good advice on pain management, training in deep muscle activation and an appropriate exercise program.

Image Courtesy of keerati of freedigitalphotos.net

References:

Vleeming et al. (1992). An integrated therapy for peripartum pelvic instability. A study of the Biomechanical effects of Pelvic Belts. American Journal  of Obstetrics. 166 (4): 1243-1247

Wu et al. (2004). Pregnancy-Related Pelvic Girdle Pain (PPP)I: Terminology, Clinical Presentation and Prevalence. European Spine Journal. 13:575-589