Regimented exercise is universally regarded as having a positive effect on health and wellness. It is associated with a decreased incidence of disease, improved functional capacity and better mental health. As much as 60% of pregnant women, who have the most to gain from staying active, remain sedentary throughout their term. The Institute of Medicine identified pregnancy as a critical risk for inactivity and obesity, therefore one can understand why the health-related implications of maternal fitness are so important. 

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BENEFITS

Improved Weight Management: The majority of US women experience their greatest weight gain during the childbearing years of 25-34, mostly attributed to weight gain during pregnancy. It has been observed that pregnant women who maintained physical activity levels gained 20% less weight while pregnant compared to those who were inactive. This is significant for health during pregnancy but also because postpartum weight retention is inversely proportional to a woman’s degree of prenatal physical activity. 

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Reduced Incidence of Gestational Diabetes: GDM is the most common medical complication associated with childbirth, affecting up to 10% of all pregnancies. Women with GDM are prone to developing Diabetes postpartum and to further complicate things, children born to mothers with GDM are at increased risk of obesity, impaired glucose tolerance and Type II Diabetes. Women who exercise during pregnancy can reduce their odds of acquiring GDM by over 50%. 

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Decreased Incidence of Preeclampsia: This is a pregnancy-related disorder that leads to maternal hypertension. It is the second leading cause of maternal death in the US. Regimented prenatal exercise has been shown to prevent and oppose the progression of the disease. 

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Enhanced Body Image: These changes lead to a reduced sense of body image as early as preterm into early pregnancy. It has been shown that women who exercise during pregnancy (as little as 90 minutes a week at moderate intensity) have a significantly better body image and this extends into the later stages of pregnancy. 

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Better Psychological Well-Being: Pregnancy is associated with alterations in mood which can often lead to depressive episodes, particularly during the third trimester. Hormonal shifts, body changes and impaired physical function contribute to this experience. Maternal physical activity and the incidence and severity of depression are inversely correlated throughout pregnancy and into postpartum. These findings are consistent with the general population that exercise can be as effective as medication in treating mild to moderate forms of depression.

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Reduced Lower Back Pain: This is one of the most common pregnancy-related disorders with over 70% of women reporting lumbosacral pain at some point during their term. This has significant interference during activities of daily living and disturbing regular sleep patterns. Lower back pain is brought on by changes in body shape and composition as well as changes in the center of gravity. There is also a hormone called Relaxin that causes ligament laxity. With increased mobility there is reduced joint stability which leads to less capability of withstanding the heightened physiological demands of daily living. 

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Improved Fetal Development: Women that have exercised throughout pregnancy have given birth to children who are longer and had lower fetal fat mass and more lean body mass compared to age-matched controls. 

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Easier Labor: Women who exercise regularly have been shown to have a decreased risk of premature labor and reduced incidence of cesarean delivery as well as shorter hospitalization. It has been shown that those who exercise experience a shorter duration of active labor and a lower incidence of abdominal and vaginal operative delivery. 

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Safety of Maternal Exercise: The health of the mother and fetus is of paramount importance. Women should always obtain the physician’s consent prior to initiating physical exercise. It is recommended that, in the absence of medical conditions, 30 minutes or more of moderate exercise on most, if not all, days of the week is both safe and encouraged for pregnant women.

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EXERCISE DURING PREGNANCY

1st Trimester: This is the most important period for fetal growth including the development of limbs and internal organs. Major physiological changes take place but without significant changes in maternal anthropology. Generally there is no need to adapt exercise prescription at this stage. However, the secretion of the Relaxin hormone increases significantly which causes joints to become less stable. It becomes incredibly important for pregnant women to maintain correct technique during exercise. 

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There are often other complications such as nausea, vomiting and excessive fatigue. This needs to be taken into consideration when doing exercise and the intensity needs to be adjusted accordingly. 

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2nd & 3rd Trimester: There is a significant increase in weight and this is centered about the midsection which alters posture and the center of gravity. Many exercises are no longer viable and this does make breathing more challenging as there is pressure on the diaphragm. 

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There are exercise-related restrictions warranted at the start of the second trimester and the most important being that the supine position (laying flat on your back) should be avoided as it obstructs venous return from the uterus as the vena cava is compressed. This decreases cardiac output and can result in orthostatic hypotension - an abnormal increase in blood pressure upon standing up. 

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Any exercises that require forward flexion at the hips and / or the waist should be avoided as the uneven weight distribution tends to make these movements uncomfortable and increase strain at the lumbar spine. In addition, overhead movements should be avoided as this puts strain on the lower back and can aggravate lumbar stress.

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