Prenatal Exercise

Maintaining a regular exercise routine throughout your pregnancy can help you stay healthy and feel your best. Regular exercise during pregnancy can improve your posture and decrease some common discomforts such as backaches and fatigue. There is also evidence that physical activity may prevent gestational diabetes (diabetes that develops during pregnancy), relieve stress, and build more stamina needed for labor and delivery.

In general, aerobic, resistance, and flexibility exercises are safe during pregnancy. However, each pregnancy, and each woman, is different. So, exercise programs are individualized to assure safety. Always ask your doctor for advice before beginning any exercise program when you are pregnant.

Exercise and Heart Rate

If you were physically active before your pregnancy, you should be able to continue your activity in moderation. Don't try to exercise at your former level; instead, do what's most comfortable for you now. Low impact aerobics are encouraged versus high impact. Pregnant women used to be told not to raise their heart rate higher than 140 beats per minute during exercise. However, that recommendation was based on limited evidence, and the American College of Gynecology no longer makes a recommendation regarding heart rate during exercise. What is known from research is that exercising at approximately 70% of maximal heart rate causes no change in fetal heart rate.

Previously Sedentary

The rule of thumb used to be that it was not a good time to start exercising if you were pregnant and had been previously sedentary. That stance has changed. The American College of Gynecology now states, "If you are active, pregnancy need not cause you to alter your fitness routine," and "If you have not been active, now is a good time to start." Of course, this doesn't mean throw caution to the wind and be reckless, but it does send the strong message that exercise during pregnancy is okay for most women.

Who Should Not Exercise During Pregnancy?

If you have a medical problem, such as asthma, heart disease, or diabetes, exercise may not be advisable. Exercise may also be harmful if you have a pregnancy-related condition such as:

• Bleeding or spotting
• Low placenta
• Threatened or recurrent miscarriage
• Previous premature births or history of early labor
• Weak cervix

Talk with your health care provider before beginning an exercise program. Your health care provider can also give you personal exercise guidelines, based on your medical history.

Wet Your Whistle

It's crucial for pregnant women to stay well-hydrated when exercising, whether indoors or out. Experts recommend sipping on cool water before, during, and after your workouts. Don't skimp on liquids because you're worried that you'll have to go to the bathroom. If need be, stay within a block or two of home when walking or running, or go pre-emptively before leaving the gym locker room. It's important to stay hydrated for exercise. Drink 8 ounces of water 20-30 minutes prior to exercise and 8 ounces every 20 minutes during exercise.

What Should a Pregnancy Exercise Program Consist Of?

Although each exercise program is individualized, some general guidelines for healthy pregnant women without complications can be made. Always begin by warming up for five minutes and stretching for five minutes. Include at least fifteen minutes of cardiovascular activity. Measure your heart rate at times of peak activity. Follow aerobic activity with five to ten minutes of gradually slower exercise that ends with gentle stretching.

What Exercises Are Safe During Pregnancy?

Most exercises are safe to perform during pregnancy, as long as you exercise with caution and do not overdo it. The safest and most productive activities are swimming, brisk walking, indoor stationary cycling, step or elliptical machines, and low-impact aerobics (taught by a certified aerobics instructor). These activities carry little risk of injury, benefit your entire body, and can be continued until birth.

Tennis and racquetball are generally safe activities, but changes in balance during pregnancy may affect rapid movements. Other activities such as jogging can be done in moderation, especially if you were doing them before your pregnancy. You may want to choose exercises or activities that do not require great balance or coordination, especially later in pregnancy.

Stretching Exercises

Stretching exercise make the muscles limber and warm which can be especially helpful when you're pregnant. Here are some simple stretches you can perform before or after exercise.

Stretching Exercises: Neck Rotation

Relax your neck and shoulders. Drop your head forward. Slowly rotate your head to your right shoulder, back to the middle, and over the left shoulder. Complete four, slow rotations in each direction.

Stretching Exercises: Shoulder Rotation

Bring your shoulders forward and then rotate them up toward your ears and then back down. Do four rotations in each direction.

Stretching Exercises: Swim

Place your arms at your sides. Bring your right arm up and extend your body forward and twist to the side, as if swimming the crawl stroke. Follow with left arm. Do the sequence ten times.

Stretching Exercises: Thigh Shift

Stand with one foot about two feet in front of the other, toes pointed in the same direction. Lean forward, supporting your weight on the forward thigh. Change sides and repeat. Do four on each side.

Stretching Exercises: Leg Shake

Sit with your legs and feet extended. Move the legs up and down in a gentle shaking motion.

Stretching Exercises: Ankle Rotation

Sit with your legs extended and keep your toes relaxed. Rotate your feet, making large circles. Use your whole foot and ankle. Rotate four times on the right and four times on the left.

Kegel Exercises

Kegel exercises help strengthen the muscles that support the bladder, uterus, and bowels. By strengthening these muscles during your pregnancy, you can develop the ability to relax and control the muscles in preparation for labor and birth.

To do Kegels, imagine you are trying to stop the flow of urine or trying not to pass gas. When you do this, you are contracting the muscles of the pelvic floor and are practicing Kegel exercises. While doing Kegel exercises, try not to move your leg, buttock, or abdominal muscles. In fact, no one should be able to tell that you are doing Kegel exercises.

It is recommended to do five sets of Kegel exercises a day. Each time you contract the muscles of the pelvic floor, hold for a slow count of five and then relax. Repeat this ten times for one set of Kegels.

Tailor Exercises

Tailor exercises strengthen the pelvic, hip, and thigh muscles and can help relieve low back pain.

Tailor sit: Sit on the floor with your knees bent and ankles crossed. Lean slightly forward, and keep your back straight but relaxed. Use this position whenever possible throughout the day.

Tailor press: Sit on the floor with your knees bent and the bottoms of your feet together. Grasp your ankles and pull your feet gently toward your body. Place your hands under your knees. Inhale. While pressing your knees down against your hands, press your hands up against your knees (counter-pressure). Hold for a count of five.

Yoga Exercises

Some people think that yoga and pregnancy go hand in hand, so novices buy a DVD or sign up for class. This isn't always a good idea. “Only go to a prenatal yoga class,” says Erin O'Brien, a prenatal and postnatal exercise specialist. “They will be very specific about what you can and can't do." If you decide to attend a regular yoga class, tell the instructor beforehand that you're pregnant so she can modify poses for you, O'Brien says. Some fitness centers offer “hot yoga,” taught in a room that's pumped with heat. These classes are OK for your non-pregnant gym buddies, but not for you.

What Exercises Should Be Avoided During Pregnancy?

There are certain exercises and activities that can be harmful if performed during pregnancy. They include:

• Holding your breath during any activity.
• Activities where falling is likely (such as skiing and horseback riding).
• Contact sports such as softball, football, basketball, and volleyball.
• Any exercise that may cause even mild abdominal trauma such as activities that include jarring motions or rapid changes in direction.
• Activities that require extensive jumping, hopping, skipping, bouncing, or running.
• Deep knee bends, full sit-ups, double leg raises, and straight-leg toe touches.
• Bouncing while stretching.
• Waist-twisting movements while standing.
• Heavy exercise spurts followed by long periods of no activity.
• Exercise in hot, humid weather.

What Pregnancy Changes May Affect Exercise?

Physical changes during pregnancy create extra demands on your body. Keeping in mind the changes listed below, remember that you need to listen to your body and adjust your activities or exercise routine as necessary.

• Your developing baby and other internal changes require more oxygen and energy.
• Hormones produced during pregnancy cause the ligaments that support your joints to stretch, increasing the risk of injury.
• The extra weight and the uneven distribution of your weight shift your center of gravity. The extra weight also puts stress on joints and muscles in the lower back and pelvic area and makes it easier for you to lose your balance.

A Balancing Act

Center of gravity shifts as pregnancy progresses and creates balance problems. Therefore, activities that increase the risk of falling, like vigorous racket sports, skating, and gymnastics, should be avoided. It's easy to understand why you may feel clumsier than usual: “Pregnant women have an altered center of gravity, because the large abdomen shifts the weight forward,” says Scott G. Williams, MD, FACOG, an ob-gyn in St. Louis. “Some patients fall just going up and down the stairs in their houses. Stick with exercises you're familiar with, so you don't trip while learning a new step aerobics move. Low-impact exercises are ideal, including walking.

Warning for Pregnant Women

Stop exercising and consult your health care provider if you:

• Feel chest pain.
• Have abdominal pain, pelvic pain, or persistent contractions.
• Have a headache.
• Notice an absence or decrease in fetal movement.
• Feel faint, dizzy, nauseous, or light-headed.
• Feel cold or clammy.
• Have vaginal bleeding.
• Have a sudden gush of fluid from the vagina or a trickle of fluid that leaks steadily.
• Notice an irregular or rapid heartbeat.
• Have sudden swelling in your ankles, hands, face, or calf pain.
• Are short of breath.
• Have difficulty walking.
• Have muscle weakness.

How Soon Can I Exercise After Delivery?

It is best to ask your health care provider how soon you can begin your exercise routine after delivering your baby. Although you may be eager to get in shape quickly, return to your pre-pregnancy fitness routines gradually. Follow your health care provider's exercise recommendations.

Most women can safely perform a low-impact activity one to two weeks after a vaginal birth (or three to four weeks after a cesarean birth). Do about half of your normal floor exercises and don't try to overdo it.

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