Finally, we’ve progressed into the 21st Century and realised pregnancy is not a debilitating circumstance, but rather a natural and normal condition where functional physical activity should be encouraged.
Gone are the days of wrapping pregnant women in cotton wool, confining them to a total state of rest and warning them to avoid all forms of strenuous activity through fear of complications! Nowadays, women are beginning to embrace the concept of physical activity during pregnancy as a way of reducing the associated effects and promoting the health benefits.
If we rewind the clock to pre 1985, we find very little information about guidelines for physical activity during pregnancy. In fact, most recommendations were largely based on the opinions of health care providers, rather than any scientific research or study evidence. These recommendations followed a very cautious, restricted and limiting approach to participation in physical activity during pregnancy and in most cases actually advised against it. Can you believe it?
In 1985, things changed (thank God for the 80’s!). The American College of Obstetrics and Gynecology (ACOG) released its first formal publication containing guidelines for exercise during pregnancy. Whilst these guidelines still followed a relatively conservative approach to physical activity, they were a great way of reassuring women that physical activity during pregnancy was beneficial if done safely. Additionally, it gave fitness professionals a universal guideline to follow, allowing them to advise pregnant clients with confidence.
For the next decade, pregnant women were advised (among other guidelines) they could:
Continue to exercise during pregnancy if they were active prior to pregnancy, but not to initiate a physical activity program for the first time during pregnancy
To maintain a heart rate of less than 140 bpm throughout the exercise session and to limit exercise bouts to a duration of approximately 15 minutes exercise 3 times a week
But the more women began to embrace physical activity during pregnancy, the more frustrated fitness professionals and expectant mothers became. Women perceived no adverse effects of exercise during pregnancy and actually experienced more positive effects than their non-exercising counterparts. Yet they were still limited to the boundaries of an overconservative, generic target heart rate and a limited training duration. The guidelines failed to take into account the individual’s pre pregnancy exercise history and fitness levels.
Based on emerging research and a more liberal viewpoint from healthcare and fitness professionals, in 1994 ACOG released an updated version of their original guidelines. The revised guidelines acknowledged there was no data to suggest that women should limit exercise intensity and target heart rates. Furthermore, restrictions on exercise duration were removed and women were encouraged to continue to exercise and derive the associated health benefits from a regular exercise routine.
As more and more evidence developed to support the benefits of physical activity during pregnancy, (and a lack of evidence to suggest it increased complications) the more relaxed the exercise guidelines became. Health care professionals finally conceded that previous guidelines had been over conservative. ACOG released a more contemporary committee opinion in 2002 which has also since been reaffirmed in 2009.
Offering a very different outlook from the original guidelines published in 1985, these recent guidelines suggest that: In the absence of other medical complications, 30 minutes or more of moderate exercise a day on most, if not all, days of the week is recommended for all pregnant women. Previously inactive women (and those with medical complications) should be evaluated before recommendations for physical activity during pregnancy are made, but are encouraged to exercise if safe to do so.
This is also the general consensus from most other institutions offering contemporary guidelines for exercise during pregnancy. The Society of Obstetricians and Gynecologists of Canada (SOGC) and the Canadian Society for Exercise Physiology (CSEP) believe women should consider that the risks of not participating in physical activity may actually be greater than the minor risks associated with participating in physical activity.
So now the question is; as the guidelines become more relaxed and less defined, how can we as fitness professionals be confident we are providing safe and effective exercises for our pregnant clients?
Here are some practical guidelines that may assist:
- Always consult a medical professional prior to prescribing physical activity for any pregnant client, especially if the client is experiencing associated conditions.
- Know (and look for) the warning signs to discontinue exercise
- Avoid exercising in altitudes above 6000 feet
- Avoid ballistic movements, rapid changes in direction and extreme end ranges of motion
- Avoid the Valsalva maneuvere Supine positions result in restricted venous return, causing decreased cardiac output and hypertension.
- Avoid supine positions as much as possible, especially after the first trimester.
- Avoid prolonged periods of standing, especially in the third trimester.
- Avoid exercises that may increase blood pressure such as isometric positions, positions where the head is lower than the heart (eg declines) and overhead resistance exercises.
- Warm-up and cool-down thoroughly for at least 10 minutes.
- Exercise on soft surfaces, such as grass, carpet, rubberised flooring.
- Maintain a moderate intensity.
- Encourage regular, proper breathing during exercise.
- Change positions carefully and slowly.
- Monitor body temperature and keep up fluid intake.
- Exercise in a comfortable, temperature controlled climate.
- Consume adequate calories and avoid excessive exercise durations to reduce the risk of hypoglycaemia.
- Select both cardiovascular and resistance exercises that enhance normal everyday functional patterns, core strength and posture.
- Do not aim to improve fitness levels, but rather maintain them. (Use the increasing physical demands of pregnancy to progress the program, rather than traditional methods of program progression)
- Provide access to facilities to allow for regular toilet breaks.
And one final piece of advice;
Don’t be afraid to work with pregnant clients! The human body is very resilient. If you follow all the recommended guidelines, then her experience will most likely be a positive one. You might even find that your toughest challenge is not actually related to exercise, but more about helping her to keep those unusual late night cravings under control!
Written by Lauren Kennedy, AFA Education Manager. Lauren has been a Personal Trainer for over 12-years and worked in fitness education for 8-years. Lauren’s strengths lie in the areas of corrective functional exercise, core conditioning and pre/post natal activity. Her thorough approach, energetic passion and positive attitude translates into every personal training session, something Lauren now relays to AFA Personal Training students as she educates them to become tomorrow’s fitness industry leaders.
ACOG committee opinion: exercise during pregnancy and the postpartum period. Number 267, January 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 2002;77:79-81. (Reaffirmed 2009) Exercise during pregnancy and the postpartum period. ACOG Technical Bulletin Number 189 — February 1994. Int J Gynaecol Obstet. 1994;45:65-70.
Joint SOGC/CSEP Clinical Practice Guideline: Exercise in pregnancy and the postpartum period. Journal of Obstetrics and Gynaecology Canada, No. 129 – June 2003.