Gymnastics

Exercising during pregnancy seems a dangerous activity to many women as well as obstetricians, because of fears of a bad pregnancy outcome due to physical stress. More specifically, the traditional medical advice to women who were exercising was to lower their usual exercise levels and, to women who were not, the advice was to avoid starting a tiring exercise regime. This advice was based on fears that exercise results in higher body temperature during embryogenesis, increasing genetic abnormality risks, and also that moving the oxygenated blood and energy elements to the mother’s muscular tissue, away from the developing fetus, leads to development disruptions.

Other concerns were about the danger of the mother’s myo-skeletal injury due to body position and centre of gravity changes, or of fetal or placental injuries or stress due to abrupt movements.

Recent studies focusing on aerobic and power-enhancing exercises during pregnancy show that:

  • 1) No first month miscarriage increase is reported.
  • 2) No increase in advanced pregnancy implications is reported.
  • 3) No fetal growth restriction was reported.
  • 4) No unwanted consequences on newborn babies were observed

Therefore, the early advices are now regarded as highly conservative. The Society of Obstetricians and Gynaecologists of Canada published the following recommendations for exercise during pregnancy:

  • 1. All women without contraindications should be encouraged to participate in aerobic and strength-conditioning exercises as part of a healthy lifestyle during their pregnancy.
  • 2. Reasonable goals of aerobic conditioning in pregnancy should be to maintain a good fitness level throughout pregnancy without trying to reach peak fitness or train for an athletic competition.
  • 3. Women should choose activities that will minimize the risk of loss of balance and fetal trauma.
  • 4. Women should be advised that adverse pregnancy or neonatal outcomes are not increased for exercising women.
  • 5. Initiation of pelvic floor exercises in the immediate postpartum period may reduce the risk of future urinary incontinence.
  • 6. Women should be advised that moderate exercise during lactation does not affect the quantity or composition of breast milk or impact infant growth.

Women and their care providers should consider the risks of not participating in exercise activities during pregnancy, such as:

  • – loss of muscular and cardiovascular fitness
  • – excessive maternal weight gain
  • – higher risk of gestational diabetes or pregnancy-induced hypertension
  • – development of varicose veins and deep vein thrombosis
  • – a higher incidence of physical complaints such as dyspnoea or low back pain, and poor psychological adjustment to the physical changes of pregnancy.

In the clinic we offer a DVD with exercises for pregnant women, made by a Greek female gymnastics instructor.

The DVD was edited and produced by Eleni Tzachrista, obstetrician – gynaecologist.

It lasts 1 hour 30 minutes and includes an overview of passive abdominal muscles exercises, as well as of Kegel exercise.

WHICH WOMEN SHOULD EXERCISE?

All women without contraindications should be encouraged to participate in aerobic and strength-conditioning exercises as part of a healthy lifestyle during their pregnancy.

CONTRAINDICATIONS

ABSOLUTE CONTRAINDICATIONS

  • Ruptured membranes
  • Preterm labour
  • Hypertensive disorders of pregnancy
  • Incompetent cervix
  • Growth restricted fetus
  • High order multiple gestation (≥triplets)
  • Placenta previa after 28th week
  • Persistent 2nd or 3rd trimester bleeding
  • Uncontrolled type 1 diabetes, thyroid disease or other serious cardiovascular, respiratory or systemic disorder

RELATIVE CONTRAINDICATIONS

  • Previous spontaneous abortion
  • Previous preterm birth
  • Mild/moderate cardiovascular disorder
  • Mild/moderate respiratory disorder
  • Anemia (Hb less than 100 g/L)
  • Malnutrition or eating disorder
  • Twin pregnancy after 28th week

WHEN AND HOW TO START AN EXERCISE PROGRAM?

Many women find that the best time to initiate an exercise program is in the second trimester, when the nausea, vomiting, and profound fatigue of the first trimester have passed and before the physical limitations of the third trimester begin. Concerns about the teratogenic effect of high core body temperatures in the early first trimester have not been demonstrated in studies of exercising.

  • – Women who have been exercising prior to pregnancy may continue their exercise regimens throughout pregnancy using the guidelines outlined below.
  • – When starting an aerobic exercise program, previously sedentary women should begin with 15 minutes of continuous exercise three times a week, increasing gradually to30-minute sessions four times a week.
  • – Episodic maximal exercise by pregnant women in a research setting appears to be safe for mother and fetus.
  • – Reasonable goals of aerobic conditioning in pregnancy would be to maintain a good fitness level throughout pregnancy without trying to reach peak fitness or train for an athletic competition.
  • – Elite athletes who continue to train during pregnancy require supervision by an obstetric care provider with knowledge of the impact of strenuous exercise on maternal and fetal outcomes.
  • – Women with special needs may require a referral to a physiotherapist, exercise physiologist, or sports medicine specialist to develop an appropriate exercise program.

J Obstet Gynaecol Can 2003; 25 (6): 516-22