What about Pregnancy?

It's important that we treat pregnancy as an altered physiological state, not a condition, and therefore make a few allowances concerning an exercise routine. It is very important to continue regular activity throughout pregnancy. It is also important to know a few fundamental changes to the body brought about by this pregnant state.

1. The pregnancy condition produces an increase in body temperature; therefore the body is already running at a higher temperature before beginning exercise. It's important to avoid overheating by not doing more than 20 minutes of fast exercise at a time.
   
2. The resting heart rate of a pregnant woman naturally increases while there is a decrease in maximal heart rate. Since the heart is going through temporary changes it is important not to put extra stress on the heart, and therefore best to avoid high intensity exercise (no more than 140 heart beats per minute). In addition to these changes, comes the increase in overall blood volume and the development of more blood vessels to create enough blood for the growing foetus. This can both increase and decrease the mother’s blood pressure depending on the stage of pregnancy. From about the fourth month of pregnancy, the woman should avoid rapid changes of position from standing to lying and visa versa to avoid any dizzy spells. Avoid stopping or starting exercise suddenly because cardiovascular adjustments take longer and may cause dizziness or even fainting. Long periods of motionless should also be avoided..
   
3. The pregnant woman produces a hormone called relaxin which makes muscles more flexible. This is obviously released for the birth muscles to be able to stretch enough for the birth canal to be capable to give birth. In the gestational period however, this hormone allows all the body muscles to become more easily stretched. Therefore it is important that pregnant women stretch gently in the 2nd and 3rd trimester as the muscles are more susceptible to over flexing and pulling.
   
4. The amount of blood glucose can decrease much more rapidly in a pregnant state. Therefore it is more important to have a sugar 'fix' (eg. Cordial, jelly beans) at hand when you are exercising.
   
5. Some anatomical changes to be aware of is that obviously some women get a noticeable increase in breast size. For this reason it is important to wear good supportive bras when exercising. The increase in belly size is going to change the centre of gravity, therefore it is important to be aware that subtle balance could catch the pregnant women unaware.
   
6. In the 3rd trimester of pregnancy, the growing uterus begins to compress on the vena cava located deeply through the lower back/buttock area. The result of the uterus pressing on this major vein is a decline in venous blood returning to the heart. This effect is greatest in the supine position which is why it is recommended that some floor exercises be done in a recumbent position rather than supine.
   

Are there any risks to the foetus caused by exercise?

It is important to avoid overheating during pregnancy. Hot humid weather and exercising in poor ventilated rooms should be avoided. Special attention should be given to wearing cool clothing and drinking plenty of fluid, especially in warmer weather. It has been shown that women who exercise intensely more than three times a week in their third trimester, give birth to significantly small birth weight babies. Therefore lighter intensity exercise, three times a week or less is recommended.

Are there any risks to the mother caused by exercise?

As mentioned, the pregnant woman goes through many body changes, particularly in the second half of the pregnancy, which can increase injury susceptibility. These include postural changes, a shift in the centre of gravity, weight gain and hormonal changes. These changes can alter balance and co-ordination making activities requiring these skills more difficult and therefore more injury prone.

The release of the hormone Relaxin makes all joints more mobile especially the pelvic joints causing potential problems of instability and injury to the sacroiliac and pubic symphysis joints.

Exercise Precautions

Pregnancy is not the time to start a more intense exercise program but rather continue or modify an established regime. If in pregnancy any of the following symptoms are experienced, exercise should cease immediately and the physician contacted:

• High heart rate
• Dizziness
• Headache
• Uterine Contractions
• Vaginal bleeding
• Amniotic fluid leakage
• Nausea
• Insufficient weight gain
• Shortness of breath
• Faintness
• Back or pelvis pain
• Decreased foetal movements
• Sudden swelling of ankles, hands and face

Exercise during pregnancy is not advised in the following conditions:

• Heart disease (ischaemic or valvular)
• Severe hypertension (high blood pressure)
• Risk of premature labour
  (incompetent cervix, multiple pregnancy, ruptured membranes)
• Growth retardation
• Pre-eclampsia

Any illness or complication needs to be fully assessed by a physician before starting or continuing with an exercise routine.

Activities during pregnancy that should be avoided

• Scuba diving
• Water skiing
• Martial arts
• Gymnastics
• Trampolining
• Weight lifting

In conclusion, many benefits have been associated with exercise during pregnancy. A well designed programme may aid in minimizing problems such as swollen extremities, leg cramps, lower back pain, fatigue and excessive weight gain which are all commonly associated with pregnancy. Walking and swimming are two activities that are considered safe throughout pregnancy. It is important to be monitored by a qualified instructor and make sure you keep your Doctor informed of your activity during pregnancy. In general, effort always reaps rewards.