Author: Paul Dardagan, Masters in Physiotherapy, Postgraduate in Human Movement and Sports Physiotherapy, Bachelor in Coaching Science.
In previous years pregnancy was thought to be the end of a woman’s sporting career. As described by Sports Medicine Australia, “Pregnancy is a natural condition rather than an illness and unless you have complications, it should be possible to enjoy your sport or activity at some level throughout most of your pregnancy”.
At bounceREHAB we are repeatedly asked what is safe and what to expect throughout pregnancy. Linda Moxham a prestigious personal trainer for over 10 years with an extensive background in sports, exercise and personal training recently became pregnant. Along with bounceREHAB’s physiotherapy supervision and Linda’s extensive background in exercise and wellbeing, we developed a program that allowed Linda to safely exercise throughout her pregnancy up to the last few days before childbirth.
In line with current research we will begin to highlight key features with exercising during pregnancy. Thank you to Sports Medicine Australia for identifying these key issues.
HOW WILL PREGNANCY AFFECT MY BODY AND PHYSICAL ABILITIES?
Increase in body weight (average 10-15kg). Weight distribution changes are common and will affect the bodies centre of mass when moving forward, which increases the curvature of the spine. This alters balance and co-ordination therefore special consideration needs to be made when participating in sports requiring high levels of balance, such as skateboarding and ice skating.
Loosing of all Ligaments. The release of the hormone relaxin will loosen all the joints in the body in preparation for birth. This can increase the risk of ligamentous injury with physical activity. This particularly can affect the sacroiliac joint and pubis symphysis. Prevention techniques can be used to manage these risks such as specific evidenced based exercise prescription delivered by a physiotherapist within a clinical pilates framework.
Increase in resting heart rate. Due to an increase in resting heart rate and a decrease in maximal heart rate heart rate during pregnancy, it is not recommended to use target heart rate to determine intensity of exercise. In healthy pregnant women intensity of exercise can be monitored by the mothers’ rating of perceived exertion (see Borg RPE Scale below).
Decrease in blood pressure. During the second trimester the development of blood vessels to supply the growing placenta will cause blood pressure to fall. From around the fourth month rapid changes of position from lying to standing and vice-versa should be avoided. Stopping suddenly should also be avoided to help prevent dizzy spells as cardiovascular adjustments may take longer than usual. Aerobic leg exercises performed while lying on the back should be avoided as the weight of the foetus can slow down the return of blood to the heart.
Increase in blood volume and haemoglobin and VO2 max. As pregnancy progresses, the body’s ability to transport oxygen improves. This happens to help supply oxygen to the foetus and in doing so, the oxygen carrying capability to other parts of the body also improves, which can improve athletic performance after birth. During pregnancy the advantage of this adaptation is offset by the previous mentioned body changes such as change in weight, blood pressure, ligament laxity and the need to supply oxygen to the developing foetus. It is true that these adjustments can be advantageous after birth for some weeks to aid in returning to exercise, sports and competition. However, for most women these advantages go unnoticed as breast feeding, sleep deprivation, and managing a new baby takes over.
Pelvic Floor. Damage to the pelvic floor muscles occurs during vaginal delivery. Pelvic floor exercises should commence as soon as possible after birth. Real time ultrasound is the gold standard for implementing safe and specific core muscle training. This is done by our physiotherapists in a clinical setting.
Rectus Abdominus Diastasis (RAD). Stretching of the abdominal wall occurs while the uterus expands as the foetus grows. This can lead to abdominal separation known as RAD, leading to abdominal pain, discomfort, and reduced postural support. The abdominal muscles have an important role in the body in movement, breathing, protection of internal organs, and support of posture. When their structure is disrupted due to RAD, the reduced ability to support posture can lead to an increased risk of injury. Physiotherapists can assess the degree of RAD, provide appropriate compression support garments, and prescribe an appropriate core strengthening program to get the mother back to her normal physical activity safely.
ARE THERE ANY DANGERS TO EXERCISING WHILE PREGNANT ?
There are some theoretical concerns which include:
Overheating in an uncontrolled environment.
Positioning the body upside down.
Reducing oxygen and nutrient delivery to the foetus and possible risk of premature labour.
Reduced birth weight – it is recommended in the third trimester that training is limited to 3 sessions or less per week.
Contact sports are considered at a case by case basis for individual athletes and their abilities – however there is no research to support any concerns.
Benefits for the mother:
Maintain fitness levels
Reduced onset of gestational diabetes
How much exercise is safe ?
Generally healthy women who have uncomplicated pregnancies can continue previous exercise programs in consultation with their doctor and physiotherapist. It is currently recommended by Sports Medicine Australia that no more than 3 sessions of vigorous exercise should be performed per week.
Moderate exercise (as determined by the perceived exertion scale) is considered to be safe throughout pregnancy.
When to stop ?
Exercise should be stopped if any abnormal symptoms occur such as pain, contractions, vaginal bleeding, dizziness, or unusual shortness of breath. It is not advised with heart disease, severe hypertension, risk of premature labour, growth retardation or pre-eclampsia.
When to resume exercise after the baby is born ?
After vaginal delivery gentle exercises including pelvic floor, abdominal exercise and walking can begin when comfortable. Normal exercise should be delayed for 6 weeks to allow for resolution of the effects of delivery specifically to the pelvic floor muscles and pelvic joints.
After caesarean section it is recommended to wait 6 weeks prior to recommencing exercise to allow time for soft tissue healing. However it is recommended to see your physiotherapist to commence safe, gentle pelvic floor and abdominal activation exercises during that 6 week period.
Things to think about…
Exercise has not been shown to adversely affect lactation.
Supportive clothing is recommended for breasts and lower abdomen. Compression has been shown to reduce discomfort and improve return to exercise.
For best pelvic floor and core retraining real time ultra sound is used by a physiotherapist. This is non-invasive and allows full clothing to be worn.
At bounceREHAB we use the latest in technology with support of the best evidence to construct a safe exercise program.
Our Physiotherapists have post graduate qualifications which include masters and strength and conditioning specialist qualifications which would cater for all elite athletes or everyday mums wanting some medical supervision.
A special mention to Linda Moxham must be made for her diligence, hard work and pursuit of knowledge, which have allowed her to have an Athletic pregnancy.
SMA statement on benefits and risks of exercise during pregnancy (see www.sma.org.au)