1 APRIL 2022 ausdoc . com . au
Therapy Update
Exercise during pregnancy
With the support of newly published guidelines , encourage women to engage in regular physical activity during pregnancy and beyond .
First published online on 24 February 2022
Women ’ s health
Dr Melanie Hayman is a senior lecturer in allied health ( health science ) at the school of health , medical and applied sciences , CQUniversity , Rockhampton , Queensland . Her research focus is exercise and physical activity in pregnancy .
Professor Wendy Brown is a behavioural epidemiologist and academic at the school of human movement and nutrition sciences , University of Queensland . Her research interests focus on the behavioural epidemiology of physical activity and the prevention and management of chronic illness at a population level .
IN 2020 , the Department of Health released new guidelines for physical activity / exercise during pregnancy and the post-partum period ( see online resources ). The guidelines are based on an umbrella review of published reviews on physical activity in pregnancy and 27 health outcomes , as well as recently published guidelines from other countries . They were developed by an interdisciplinary team of researchers with backgrounds in epidemiology , exercise physiology , medicine , sports science and psychology , in consultation with leading international researchers , representatives from a wide range of health professions and policymakers .
The guidelines are designed to encourage women to begin or continue with physical activity / exercise during pregnancy and post-partum . They also aim to provide evidence-based guidance and information for health professionals about how to support this and identify risks and contraindications .
Given that most women will see health professionals regularly during and following pregnancy , this is an excellent opportunity to encourage physical activity — not only to improve the chances of a healthy pregnancy but also to establish or maintain good habits to ensure wellbeing beyond the post-partum period .
The quality of evidence for exercise in pregnancy
Numerous systematic reviews confirming
health benefits with physical activity for both pregnant women and the developing fetus were found in the evidence review . However , the quality of the evidence was only rated as ‘ high ’ for prevention of excess gestational weight gain and prevention of urinary incontinence . Although this meant that most of the reviewed evidence was rated moderate or low quality , no adverse outcomes were found in any of the studies reviewed .
As a guide for doctors and those who provide health advice and care for women during pregnancy , the following outline is an interpretation of these new guidelines and answers commonly asked questions about physical activity and exercise during pregnancy .
Types of activity
The Australian Physical Activity and Sedentary Behaviour Guidelines for Adults are shown in box 1 .
What are moderate-intensity and vigorous activities ? These are aerobic activities — for example , brisk walking ; cycling , on a stationary bike later in pregnancy ; swimming ;
Box 1 . Australian Physical Activity and Sedentary Behaviour Guidelines for Adults
• Doing any physical activity is better than doing none . If you currently do no physical activity , start by doing some and gradually build up to the recommended amount .
• Be active on most , preferably all , days , every week .
• Accumulate 150-300 minutes ( 2.5-5 hours ) of moderate-intensity physical activity or 75- 150 minutes ( 1.25-2.5 hours ) of vigorous physical activity or an equivalent combination of both moderate and vigorous activities each week .
• Do muscle-strengthening activities at least two days a week .
• Minimise the amount of time spent in prolonged sitting .
• Break up long periods of sitting as often as possible .
dancing ; exercise classes — that will maintain or improve cardiorespiratory fitness and endurance and help to avoid excess gestational weight gain . For pregnant women , it is recommended to assess intensity using ratings of perceived exertion . On a scale of one ( not moving ) to 10 ( maximal effort ), activities in the range of 3-7 are considered safe and are recommended to achieve health benefits in pregnant women .
Is vigorous activity safe ? Is it safe for athletes and sportswomen to continue with high-intensity or prolonged physical activity / exercise training during pregnancy ? The only systematic review of the effects of vigorous intensity physical activity / exercise during pregnancy concluded that it is safe but further research is required in the earlier stages of pregnancy .
It is recommended that athletes who do high-intensity training consult with suitably informed expert health professionals and review training loads throughout pregnancy on an individual basis .
Since many activities become more uncomfortable in the later stages of pregnancy , it is likely that physical activity / exercise will decrease in intensity and duration as pregnancy progresses .
What about muscle-strengthening activities ? The recommendation is to perform muscle-strengthening activities , including functional and postural exercises , at least two days a week . These exercises help to reduce musculoskeletal discomfort — for example , low back and pelvic girdle pain — as pregnancy progresses .
There is little research on the types of resistance training that are now commonly included in gym-based programs , but use of light weights or resistance bands appears to be safe . We recommend avoiding heavy lifting and intense repetitive isometric exercises .
Is sitting time important ? Again , there is limited research on the effects of sedentary behaviour during pregnancy , but it is likely that venous pooling — which occurs during long periods of both sitting and standing — may be exacerbated during pregnancy .
We know that daily sitting for more than eight hours is associated with increased risks of several non-communicable diseases but that there are metabolic and circulatory benefits when prolonged periods of sitting are interrupted by short periods of light activity .
Since many women continue to work late into pregnancy , it is worth discussing strategies to minimise prolonged sitting and break up long periods of sitting as often as possible . For women who have to sit for long periods at work ( or in transit ), about 45 minutes a day of moderate-intensity physical activity , such as brisk walking , will offset the increased health risks of sitting .
Activity modification
Modifications to some activities , especially those requiring high levels of balance and agility , may be required as pregnancy progresses . Although it is feasible that venous return may be reduced during exercise performed in the supine position , research has not confirmed this . It is recommended to modify exercises that are typically performed supine to a side-lying position .
What about yoga and stretching exercises ? Yoga and / or gentle stretching may be beneficial during pregnancy , but flexibility exercises should be individualised to reduce the risk of joint injury .
Should any specific activities be avoided ? Activities that involve risk of serious injury from falling , contact , collision or blunt trauma ; significant changes in pressure , such as sky diving and scuba diving ; or very heavy lifting should be avoided .
What about heat and altitude ? Consensus suggests that physical activity / exercise levels should be modified in very hot weather , especially when humidity is high . It is preferable , but not always possible , to exercise in a cool environment . In the heat , advise women to wear loose
NEED TO KNOW
Physical activity / exercise during pregnancy and the post-partum period is safe , has health benefits for the woman and fetus , and reduces the risks of some pregnancy-related complications ( evidence based statement ).
Encourage all women without contraindications to meet the Australian Physical Activity and Sedentary Behaviour Guidelines before , during and after pregnancy ( evidence-based recommendation ).
Modifications to physical activity / exercise may be required to accommodate physical changes as the pregnancy progresses . If there are any concerns ( including warning signs and contraindications ), women should seek advice from a qualified health processional ( consensus-based recommendation ).
Advise all pregnant women to do pelvic-floor exercises during and after pregnancy ( evidence-based recommendation ). Support women to take an active role in shared decision-making about their physical activity / exercise during and after pregnancy ( consensus-based recommendation ).
Be familiar with contraindications , signs and symptoms that suggest physical activity / exercise should be modified or avoided ( consensus-based recommendation ).
Advise women who were inactive prior to pregnancy to start slowly and to increase amounts of physical activity / exercise gradually . Those who were active prior to pregnancy can continue with their usual activities for as long as they feel comfortable .
clothing made from ‘ breathable ’ fabric and stay well hydrated .
Women should be counselled to avoid physical activity / exercise at high altitude ( above 2000m ) unless they are acclimatised and trained to do this prior to pregnancy or they seek advice or supervision from an appropriately qualified health professional before undertaking such activity .
Pelvic-floor exercises
Why is there a specific guideline on pelvic-floor muscle exercises ? The evidence on pelvic-floor muscle strengthening and prevention of urinary incontinence is strong . Supervised pelvic-floor exercise has greater effects for treatment of urinary incontinence . Encourage all women to learn the correct technique and to practise pelvic-floor exercises before and during pregnancy , recommencing as soon as possible after the birth .
The role of the health professional in exercise in pregnancy
This guideline encourages women and their health professionals to discuss physical activity / exercise regularly during antenatal and postnatal visits .
Women who are healthy and already active do not need to seek medical clearance to start or continue with physical activity / exercise , but those who are considering exercise and training at levels above those recommended in the physical activity