Exercise during pregnancy.

EXERCISE DURING PREGNANCY

Exercise has become a way of life for millions of women. Today, women of all ages, including those in their childbearing years, are engaging in physical fitness activities. Until recently, women were rarely encouraged to engage in exercise programs. They were told that if they exercised too strenuously they might harm their reproductive organs, overdevelop their muscles, and become social outcasts. Today, with the tremendous amount of knowledge available on exercise, we know that women can develop extremely high levels of fitness - regular exercise is just as beneficial for them as it is for men.

If exercise is beneficial for women in general, how about pregnant women? Many of the women involved in physical fitness programs will someday become pregnant. At some point during the initial stages of their pregnancy, they must make a decision whether they will continue to exercise. Women and health-care professionals have been faced with questions such as: What are the effects of exercise on the mother and the fetus? What types of exercise are safe? How much exercise is enough? Is exercise necessary or desirable for a healthy pregnancy? While some of these questions have yet to be answered, we do have sufficient information to make recommendations for women who wish to exercise during pregnancy.

Many obstetricians are recommending exercise to healthy pregnant women as part of their childbirth preparation. Prenatal and postnatal exercise classes are becoming commonplace in health clubs. Even though experts have yet to determine whether exercise during pregnancy has a beneficial effect on the fetus, we do know that exercise will help women feel better both physically and mentally. Women who exercise regularly should feel more confident before and during labor, for their high endurance level will help them cope with the physical demands of labor and delivery.

Stephanie Eittriem has been involved in athletics her entire life. Her interest in athletics encouraged her to become an aerobic dance exercise instructor. Presently the aerobics director at Johnson Ranch Racquet Club in Roseville, California, Stephanie teaches between five and seven classes each week. She is certified by the International Dance Exercise Association, and has a degree in physical education from Oregon State University. When Stephanie found out she was pregnant, she never once considered giving up exercise. Once she got approval from her physician, she continued teaching classes, first eight a week, then five, and then three a week. The day before her delivery, she was teaching her regular aerobics class at the club!

Stephanie found teaching aerobics during her pregnancy to be a rewarding experience. She was able to pay more attention to her students by moving around the room and offering support and encouragement, since she was not able to perform the same exercises as her students. She found her students responded well to her during her pregnancy, and were just as motivated by her, or even more so, than when she was not pregnant. Stephanie has found it not uncommon to have several pregnant women in a class daily. More and more women are taking better care of themselves before, during, and after their pregnancy, and exercise has become an important part of contemporary prenatal and postnatal care.

Before Stephanie will allow a pregnant student into her class, she first requires they get a written medical clearance from their physician. Second, the student must read the American College of Obstetricians and Gynecologists (ACOG) guidelines and recommendations for exercising during pregnancy. And third, they must meet with her prior to their first class so that Stephanie can demonstrate exercise modifications (see picture). Stephanie encourages her pregnant students to eat before they come to class, and to walk through the class the first couple of times to learn the movements and keep the exercise intensity low at the start.

Stephanie's advice to exercising moms is to "pay attention and listen to your body. Your body will be changing, and activities that were once easy to perform may be more difficult during pregnancy." Stephanie feels that "as long as mom is getting enough rest and proper nutrition, exercise can be engaged in right up to delivery." Stephanie finds that women who exercise through their pregnancy are able to return back to their regular exercise program faster. They also find it easier to get back to their original weight sooner. Stephanie points out, "Labor requires a great deal of energy, and moms should be well rested prior to the big day."

Before starting an exercise program, pregnant or not, consult with your physician. If any unusual symptoms appear, all strenuous activities should be stopped and the physician consulted. As with any exercise program, an individualized approach should be used. During pregnancy it becomes necessary to design a program around the special needs of pregnancy. Some women may be able to exercise vigorously right up to the time of delivery, while others may be able to tolerate only mild exercise sessions for short periods of time. After the birth, your physician will let you know when it is safe to resume exercise. Exercise after delivery could begin as early as two days after an uncomplicated vaginal delivery, or much later if major surgery was performed. Most physicians allow women to start vigorous exercise six weeks after delivery, following a postpartum physical.

Other precautions for exercise during pregnancy include modifying exercise routines in the supine position. Obstructed blood flow back to the heart may occur when a pregnant woman exercises on the floor. The ACOG has determined this position on the floor to be contraindicated after the fourth month of pregnancy. Care should also be used when moving from a lying or sitting position to a standing position, in order to prevent dizziness. Pregnant women must take care not to become overheated during exercise. Exercise causes an increase in body temperature, which can be harmful to the fetus if the core body temperature exceeds 100 F. Pregnant women should be conservative in their exercise and not exercise in hot, humid environments, since the pregnant exerciser may have more difficulty regulating body temperature.

During pregnancy many women feel they are more flexible than ever before. This increased flexibility is due to joint laxity. With the release of the hormone relaxin, joints become looser, and there can be an increased risk for potential injury during physical activity. Care should be given not to overstretch, or to move in a range of motion that is different from what was normally performed. Last, pregnant women should eat before exercising, in order to help prevent low blood sugar. It is also important to drink plenty of water before, during, and after exercise.

Women with the following conditions should undertake exercise only under the supervision of their doctor: (1) high blood pressure; (2) anemia; (3) thyroid disease; (4) diabetes; (5) irregular heart rhythms; (6) a breech presentation in the last three months; (7) excessive obesity; (8) bleeding during pregnancy; and (9) a history of short labor. The ACOG considers the following conditions to be contraindications to vigorous exercise in pregnancy: history of three or more miscarriages, ruptured membranes, premature labor, incompetent cervix, excessive bleeding, diagnosed heart disease, and multiple gestation.

The most important goal of exercise during pregnancy and the postpartum period should be to maintain the highest level of fitness consistent with maximum safety. Sedentary women who become pregnant should start their exercise program at a very low intensity level, and not expect to get in superior physical condition during or right after their pregnancy. Healthy women who wish to exercise during pregnancy might consider walking, swimming, stationary cycling, and mild aerobics.

Scientific literature is lacking on the amount of exercise necessary to improve and maintain cardiovascular fitness during pregnancy. A safe guideline to use would be two to three aerobic sessions per week for 20 to 30 minutes. Each exercise session should contain a gradual warm-up and cool-down period. Maternal heart rate should not go over 140 beats per minute during exercise, and the mother should be careful to monitor her exertion and fatigue level before, during, and after exercise. Women who participate in an exercise program during pregnancy can expect to improve their cardiovascular fitness, muscular strength, and flexibility. In addition, they will enhance their self-concept, and be better prepared for the birthing process.

Scott Roberts, M.S., is an administrator of health promotion programs. He lives in Rocklin, California.