Mahmoud Ibrahim, Certified Personal Trainer with a Bachelor's Degree in Athletic Training and Sports Science.
Not so long ago, pregnancy was regarded by fitness professionals almost as a disease. Pregnant women were asked to rest, lie down, elevate their feet, and, maybe during the last trimester of pregnancy, they could walk a little. Nowadays, this outlook on pregnancy has changed quite drastically. Pregnancy is finally being recognized as a modified state of health rather than an illness. Research is unravelling the benefits of exercise during pregnancy, and more and more data is being registered on the positive effect of exercise on pregnant women’s cardiovascular fitness, weight gains, mobility during pregnancy, discomfort, etc.
In this article, I am going to try and give you enough information so that you can understand the physiological, hormonal, endocrinal, anatomical, and psychological changes the pregnant women are going through. Always remember that this information and whatever other knowledge you have on the subject are not substitutes for medical advice. This information is only aiming to help you do safe and effective exercises as a pregnant woman and to show you what types of exercise modifications you might need.
In a normal pregnancy, a pregnant woman is a healthy adult. Her body will respond to exercise in the same way her non-pregnant counterparts would. However, a pregnant woman’s body is undergoing certain changes to accommodate its new state.
Physical Changes During Pregnancy
During pregnancy, a woman’s body would start increasing its level of production of some hormones. Relaxin, Elastin, estrogen, and progesterone levels are higher during pregnancy. These hormones soften the connective tissue surrounding the joints. Such increases are mainly aiming to allow the pelvis to expand to accommodate childbirth. Unfortunately, all the weight-bearing joints of the body are affected, especially the knees, ankles, and hips. A pregnant woman’s psychological state is also greatly affected by those hormonal changes, which make her more prone to mood swings, depression, and lowered self-esteem.
Cardiovascular and Circulatory Changes
During pregnancy, blood volume may increase as much as 30 to 50%. As a response to that, the body increases its production of progesterone, which causes vasodilation, to maintain normal arterial pressure. Also, cardiac output and stroke volume increase. The resting heart-rate may elevate by up to 15 beats per minute above normal. Regarding oxygen consumption during exercise, researches are conflicting. Some suggest that pregnant women do not tolerate high levels of aerobic activity, while others feel that improved blood volume and cardiac output during pregnancy improves the body’s ability to take up and utilize oxygen.
- Lordosis: As the uterus increases in size and weight during pregnancy, it pulls the pelvis into a forward tilt, causing stress on the lumbosacral ligament and lower back muscles. The abdominal muscles stretch and weaken while the lower back muscles shorten, resulting in a lordotic posture. Assuming a lordotic posture becomes a natural tendency in pregnant women.
- Kyphosis: During pregnancy, the woman’s breasts enlarge, and their weight tends to pull forward on the shoulders resulting in a rounded upper back (Kyphosis). The pectoralis muscles shorten while the upper back muscles (trapezius and rhomboids) stretch and weaken.
- Carpal Tunnel Syndrome: A pregnant woman may experience a swelling in the wrists, which could result in the compression of the median nerve.
- Round Ligament Syndrome: The uterus is suspended in the abdominal cavity by ligaments. The two-round ligaments run diagonally down the pelvis from the hip bones. After a fetal growth spurt, women may notice a dull, pulling sensation in these ligaments for two to three days. Sudden turns or sharp movements may illicit a spasm in these ligaments. Bending slightly forward, taking deep breaths, and massaging the area gently will usually help ease this discomfort. Movements that involve turns, or lateral movements that don’t keep the hips facing forward, may irritate the round ligaments. The round ligaments may also bother most of the women in all four positions when the leg is fully extended behind for hip extension.
- Diastasis Recti: The Linea Alba (white line) is the fibrous-like seam that connects the two recti in the centre of the abdomen. As the uterus expands during pregnancy, the forces may cause the Linea Alba to separate like a zipper. This is known as Diastasis Recti.
- Slide show: Pregnancy exercises - Mayo Clinic
Pregnancy exercises can help you improve your core strength and prepare your muscles for labor.
General Exercise Guidelines During Pregnancy
Similar to other populations, physical activities in women who are pregnant and those in postpartum period confer numerous benefits and should be encouraged to avoid excessive weight gain, reduce the risk of gestational diabetes, lower the incidence of low back pain, and prevent excessive decreases in cardiorespiratory and muscular fitness.
The general recommendations for exercising during pregnancy:
- The warm-up should be longer and more gradual (8 to 12 minutes).
- Stretches should not be taken to their full range since the ligaments and tendons are too flexible during that period.
- Pay special attention during stretches of the hip adductors since forceful stretching of the inner thighs may place undue stress on. The pubic bone, potentially causing separation at that joint.
- Deep knee flexion, such as deep lunges and squats should be avoided.
- Since the mother experiences a constant shift of her center of gravity, balance, forceful movements or extreme jarring should be avoided to reduce the risk of orthopedic injury.
- During the third trimester, pelvic instability and round ligament discomfort may require modification of side-lying hip abduction and adduction exercises. Elevating the leg no higher than the shoulder will avoid unnecessary torque in the muscles surrounding the sciatic nerve for hip abductions. Resting the upper leg on pillows or a step will ease discomfort for hip adduction exercises.
- Pregnant women who are not accustomed to regular exercise should start with 15 to 20 minutes of cardiovascular workout. The more experienced exercisers may continue exercising for a longer duration while keeping in mind that exercising vigorously for longer than 45 minutes carries a higher risk of hypoglycemia and dehydration.
- Training zone should be between 55 and 70 % for beginners and may go up to 75 % for more advanced exercisers. Heart Rate checks should be performed at 5 to 10-minute intervals throughout the vigorous segment of the class.
- The supine position should be avoided starting from the 4th month of pregnancy. In this position, the weight of the uterus may compress the inferior vena cava, thus reducing the venous return from the legs to the heart, therefore potentially decrease cardiac output.
- Hot tubs, saunas, steam rooms, Jacuzzis and exercising in a hot climate should be avoided to minimize the possibility of hyperthermia (overheating).
- Pregnant women should be encouraged to drink before, during and after exercise.
- They should also eat a snack rich in complex carbohydrates and protein at least one to two hours before exercising.
- To help prevent Lordosis, pregnant women should concentrate on strengthening their abdominals, buttocks, and quadriceps and stretching the lower back, hamstrings, and hip flexors.
- Upper body strengthening should give particular emphasis to the muscles of the upper back (Trapezius and Rhomboids) in order to avoid permanent Kyphosis. Strengthening the other muscles of the upper body is also recommended to prepare women for their new chores after delivery (carrying the baby and the baby’s things around, etc.). Special care should be given to stretching the pectoralis major.
- Rubber bands should be avoided in upper body strengthening in order to reduce the risk for the Carpal Tunnel Syndrome.
- The muscle most used in childbirth is the Transverse Abdominis. To strengthen this muscle, instruct clients to pull their abs inwards and upwards and hold them in with forced exhalation. This can be done sitting, semi-reclining or in an all-fours position (most effective, however, uncomfortable for some women, especially in the third trimester).
- Pregnant women who begin exercising during the last trimester should stick to maintenance exercises, such as pelvic tilts and abdominal contractions inward with exhalation.
- Pregnancy is not the time for significant strength gains. Abdominal strengthening should be conservative and relative to the incoming strength level of the participant.
The Kegel Exercise
This exercise is excellent for strengthening the pelvic floor muscles during pregnancy. It is performed as follows:
- Tighten the muscles used to stop the flow of urine, hold for a count of ten seconds (without holding your breath), and release. Repeat at least five times.
- Rapidly contract and release those muscles. (Great preparation for childbirth).
- Gradually tighten the muscles slowly to the count of three, pulling up and holding at each level, and then relax slowly to the count of three stopping again at each level. This is known as the “Elevator” exercise.
- Getting closer to the delivery time, when doing the Elevator exercise, allow the muscles to relax totally or “bulge” slightly after relaxing. This very relaxed state is useful during pushing to ease the baby down the birth canal and through the pelvic floor muscles with less resistance.
During pregnancy, exercises should be somewhat difficult but not challenging and definitely not uncomfortable nor painful.
Pregnant exercisers should wear shoes that are slightly larger than usual since their feet tend to swell.
Remember that pregnancy is the only time in a woman’s adult life where she can add new fat cells in her body. So, even though this is not a time to be dieting, healthy, balanced meals should be consumed in order to avoid unnecessary weight gains.
Exercise After Pregnancy
After delivery, a woman’s body does not automatically go back to normal. This process takes some time. However, but she can regain her shape and fitness in many useful ways.
- After natural childbirth, a woman should not start exercising before 40 days have elapsed and not before 3 months in a Caesarean section. In both cases, she needs medical clearance before resuming exercise.
- A woman who suffered from Diastasis Recti during pregnancy needs to continue doing splinted abs until her recti are completely reconciled.
- After the labors of pregnancy and childbirth, a returning exerciser should be handled almost like a beginner. Her balance is not completely back to normal and her ligaments and tendons are still quite soft and malleable. So be careful with lunges, plies, squats and one-legged exercises.
- Before doing any abdominal exercises, a woman should restore her pelvic floor muscles by doing Kegel exercises 4 to 5 times per day, every day for about a month.
- During the post-partum phase, abdominal muscles are still too loose to offer any support to the back. Therefore, back exercises are crucial during this period to avoid back pains and any permanent misalignments.
- Shoulder external rotations and scapular retractions exercises are also very useful for sustained the weight of the enlarged breasts for lactation. This will also help them avoid a permanent kyphotic look.
- During lactation, women’s breasts are very sensitive so the prone position might be quite uncomfortable for them. Also, until the pelvic floor muscles are restored, the All-Four position should be avoided. Standing, supine and side-lying positions are your best choices for this period.
How to Identify and Fix Diastasis Recti
Pregnant women should be checked for Diastasis Recti at 20 weeks of pregnancy and weekly thereafter. Also, if a woman who recently gave birth joins your class, it is recommended that you perform a diastasis recti check on her before she does any abdominal and/or oblique exercises.
To check for Diastasis Recti, do the following:
- Lie supine with knees bent.
- Gently but firmly place your index and forefinger perpendicular to the Linea Alba, approximately 1 to 2 inches below the navel.
- Hold an abdominal crunch. As you do so, check how many fingers you can insert into the gap.
1. Separation of half an inch (one finger) is considered normal. You can exercise normally.
2. If separation is two fingers:
- Eliminate any oblique work (trunk rotations).
- Do not splint her abs by crossing the hands over the abdominal area.
- You can now perform slow, small ROM crunches. Maintain ROM in the zone where a bulge in the middle of the abdomen does not occur.
3. If separation is more than two fingers wide:
- Eliminate all abdominal crunches.
- Perform Transversus Abdominis contractions with expiration while keeping abs splinted.
- Perform pelvic tilts in various position with abs splinted.
As a parting thought, please remember that, even though pregnant women are not sick, they are undergoing a modified state of health. The main concern here is her safety and the safety of her baby. Exercise should help make her life better and not, in any way, make it more painful or stressful. Pain, even mild pain, indicates an underlying problem or a problem about to occur. This should be a sign to immediately stop whatever she is doing. Also, remember that pregnancy is not a time to start building muscles or significantly improving her fitness level. Exercises should be moderate, she should drink plenty of fluids, she should not over-exert herself, and should not expose her body to any strenuous exercises that it is not accustomed to.
This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.
© 2016 Mahmoud Ibrahim
Hana on February 20, 2019: