Exercise Pregnancy
Exercise Pregnancy
Exercise Pregnancy
12
Exercise in Pregnancy
Irene Alton
An increasing number of adolescent females are partic- or medical complications can safely exercise with few
ipating in recreational and competitive sports, strength restrictions during pregnancy.1, 3
training and other fitness activities. During pregnancy
• Adolescents who are trained athletes prior to preg-
they may want to remain physically active and con-
nancy can continue to exercise throughout pregnancy
tinue some of these activities. Other adolescents who
with modifications made as needed.4
were previously sedentary may want to begin an exer-
cise program as part of a healthy lifestyle. • Adolescents who were not exercising regularly prior
to becoming pregnant can safely begin an exercise
program during pregnancy.1
SAFETY OF EXERCISE
DURING PREGNANCY
POTENTIAL BENEFITS OF EXERCISE
• Observational and interventional studies support the DURING PREGNANCY
tolerance and safety of moderate exercise in healthy
pregnant individuals.1 Physical exercise enhances muscular strength, endur-
ance, flexibility and cardiovascular health. Additional
• The fetus is protected from potentially harmful effects
benefits of exercise during pregnancy,1, 4-6 which may be
of maternal exercise (e.g., hyperthermia, decreased
especially important to the adolescent, are listed in
uterine blood flow and oxygen delivery, decreased
Table 1.
carbohydrate availability and uterine contractions) by
maternal physiologic adaptations to pregnancy.1, 2
119
120 NUTRITION AND THE PREGNANT ADOLESCENT
Less isolation from nonpregnant peers • Regular exercise (at least three times per week) is
Increased placental weight, blood flow and infant preferable to intermittent activity or a sudden increase
birthweight in exercise level, which can result in muscle strain.3
Maintenance or improvement of fitness level • Exercise sessions should begin with a warm-up and
Less likelihood of excessive weight gain end with a cool-down and relaxation period (e.g., 10-
15 minutes of slow walking or stationary cycling on
Fewer stretch marks low resistance followed by gentle stretching). This
Improved posture will reduce the risk of ligament and back strain,
Faster postpartum recovery ensure a safe cardiovascular response, normalize
metabolic rate and respiration and prevent pooling
of blood in exercising muscles.7 After exercise, the
adolescent should rise gradually from the floor to
• Beginning early in pregnancy, relaxin softens and prevent dizziness.
stretches connective tissue, resulting in laxity and
• Exercises that require lying on the back should be
instability of ligaments and joints and increased risk
avoided after the first trimester.3
of sprains and strains.7
• Exercise intensity should be light enough to allow
• The enlarging uterus and breasts and growing fetus
conversation and prevent shortness of breath,
shift the center of gravity, resulting in balance prob-
fatigue, pain, and exhaustion.3, 8 Since resting heart
lems, increased lumbar lordosis (sway back), and
rate increases and maximum heart rate decreases in
greater strain on the lower back and hips.7
pregnancy, monitoring target heart rate to determine
• Weight gain may place additional stress on joints exercise intensity is of limited usefulness.1
and make movement more difficult.1
• Fatigue and discomfort may be less likely if exercise
• In later pregnancy, edema may limit range of motion intensity is decreased in later pregnancy (e.g., exer-
and cause nerve compression.1 cising more slowly with fewer repetitions, or engag-
ing in less strenuous activities such as doubles tennis
• Pressure exerted on the vena cava by the enlarging
instead of singles, walking instead of running).
uterus may result in decreased cardiac output and
reduced blood flow to the uterus when exercising on • Exercise sessions should be short enough to prevent
the back after the first trimester.8 Symptoms may hypoglycemia, fatigue and discomfort (e.g., 20-30 min-
include dizziness and shortness of breath. utes of moderate aerobic activity, 3-5 times per week).1
EXERCISE IN PREGNANCY 121
• Running may require shorter distances, slower • Water skiing could result in forceful entry of water
speeds, flatter terrain and more frequent rest periods. into the uterus, which could result in miscarriage.9
• Strength training should be limited to 2-3 times per • Scuba-diving may be associated with decompression
week using light weights (2-5 kg) and fewer repeti- disease, gas embolism, and in the first trimester, risk
tions. Heavy free weights or heavy resistance on of fetal malformation.10
weight machines could increase the risk of spinal disc
injury 7 and intra-abdominal pressure. Straining and
breath-holding should be avoided.7 EXERCISE ENVIRONMENT
• Exercise activities that do not require a high degree of
• Particularly during the first trimester, overheating
balance and coordination, quick movements, or
(which may have teratogenic effects on the fetus)
involve the risk of falling or fetal trauma are consid-
should be avoided. Exercise should not be done while
ered safe during pregnancy. (See Table 2).
febrile or in hot, humid weather. Saunas or hot tubs
may also increase the risk of hyperthermia and should
TABL E 2 be avoided.7 Exercising in light clothing during a
Examples of Activities cooler time of day outdoors, or with a fan indoors will
Considered Safe During Pregnancy help prevent dehydration and hyperthermia in hot
weather.3, 8
Adolescents with chronic hypertension or active thy- • Musculoskeletal and cardiovascular changes associ-
roid, cardiac, vascular or pulmonary disease should ated with pregnancy gradually reverse during the
be evaluated individually to determine if exercise is postpartum period and continue to affect the safety
advisable.3 and comfort of exercise.7
REFERENCES
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Review and recommendations. Sports Med 1997;23(1):33-47.
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Harcar-Sevcik R. The one-year morphometric and neurodevelop-
mental outcome of the offspring of women who continued to exer-
cise regularly throughout pregnancy. Am J Obstet Gynecol
1998;178(3):594-599.
3. Exercise during pregnancy and the postpartum period.
ACOG Technical Bulletin Number 189—February 1994. Int J
Gynaecol Obstet 1994;45(1):65-70.
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outcomes among active and sedentary primiparous women. J
Obstet Gynecol Neonatal Nurs 1996;25(1):49-54.
5. Koniak-Griffin D. Aerobic exercise, psychological well-
being, and physical discomforts during adolescent pregnancy. Res
Nurs Health 1994;17(4):253-263.
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fetal development and birth. Am J Obstet Gynecol 1998;178(2):
280-286.
7. Artal R, Buckenmeyer PJ. Exercise during pregnancy and
postpartum. Contemporary OB/GYN 1995;May:62-90.
8. Wang TW, Apgar BS. Exercise during pregnancy. Am Fam
Physician 1998;57(8):1846-1852, 1857.
9. ACOG Technical Bulletin. Exercise during pregnancy and
the postnatal period. No. 87. American College of Obstetricians
and Gynecologists, 1985.
10. Camporesi EM. Diving and pregnancy. Semin Perinatol
1996;20(4):292-302.