When & What? Advice from a Pelvic Health Physiotherapist
A common question I get as a Pelvic Health Physiotherapist is: “What kind of exercises are safe to do during pregnancy?”. The short answer is that most forms of exercise are safe and advocated. Maintaining fitness, preventing health issues such as gestational diabetes and preparing the body for an optimal birth and recovery are a few of the reasons why regular exercise is important. Of the different types of exercises, “core exercise” is often a hot topic for pregnant women. Although your deep core muscles do assist in breathing and pushing efforts during birth, your uterus does most of the work so you don’t need abs of steel to to have a smooth birth (another blog to come on this topic). Engaging in different types of exercise will keep you well in pregnancy and beyond.
Safety: When shouldn’t I exercise during pregnancy?
In rare circumstances there may be reasons to more drastically modify standard exercise recommendations or avoid exercise all together. If there is an underlying condition involving the uterus, placenta or your overall state of health, your primary care provider will typically indicate when this is the case. Refer to this link for more information.
What kind of exercise should I be doing?
General exercise guidelines still apply during pregnancy – cardio for lung and heart health 30 minutes, 5 times a week; muscle strengthening 3 times a week; and stretching daily. There is also a lot of new research outlining the importance of daily mindfulness to counteract the chemical stress response that most of us have in our busy lives. Try a 15 minute guided body scan (lots on YouTube), meditation, prayer or gratitude journaling.
Some women find during the first trimester symptoms of morning sickness limit them from doing strenuous activity. Be patient with yourself and give your body some time. Starting with a gentle walk for 15 mins 2x/day just to get the blood pumping and muscles moving is still beneficial. The same principles apply if you are new to exercise – start slow and gentle and progress as you are able.
What about Kegels?
A “kegel” is a sustained and repeated pelvic floor activation named after the OBGYN who started advocating for them in the 1940s (Dr. Arnold Kegel). Yes, we want our pelvic floor muscles to be strong but we also need them to be flexible; they need to be able to relax, and to be coordinated with our muscles. As a Pelvic Health Physiotherapist, I can help you set up an inner core program incorporating pelvic floor muscle training that will support you through your pregnancy, during exercise, throughout labour and into your recovery post partum.
What about Yoga?
Prenatal yoga can help with flexibility and relaxation during pregnancy and also has the added benefit of meeting other Moms-to-be for you to connect with during pregnancy and into motherhood. Yoga is a great compliment to your strength and cardio program. Note that hot yoga is not recommended during pregnancy as the increases in core temperature can impact fetal development.
High Impact Exercise: What about Running? Crossfit? HIIT? Power Lifting?
In the media there tends to be an all-or-nothing approach to pregnancy – either all you do is yoga or you continue to power lift until the day you birth your baby. If you were performing high intensity or high impact exercises before pregnancy it is typically safe to continue these, but the intensity will taper down during pregnancy. Here are some things to remember:
You must acknowledge that your body will change during pregnancy and it is wise to honour these changes. There are a number of physical adjustments that affect your posture, breathing and your muscles' ability to generate power as the length of muscles change and the relationship of structures adjusts. Good form when executing high-impact exercise is always very important and simply put is more difficult to do when pregnant. Unfortunately, most trainers do not have the adequate knowledge to guide women through these high impact exercises in a safe and appropriate manner. Sit ups, curl ups, toes to bar, V sits, boat pose, Russia twists and double leg lowers are examples of traditional core exercises that increase abdominal pressure and overrecruit our external core which can contribute to rectus diastasis or “Mummy Tummy”. To prevent pelvic floor issues and abdominal wall issues, you are best to touch base with a Pelvic Health Physiotherapist who can appropriately guide you through the exercise program you desire.
Don’t forget that pregnancy is a time for maintaining your strength and endurance then tapering the intensity as your needs change. The goal is not to develop fitness at this time through max lifts or personal bests, so an adjustment in your approach to exercise and fitness is important. During pregnancy you should be able to talk throughout your workout, recover quickly and modify your movements easily.
I hear I am supposed to listen to my body – what am I listening for!?
- Pain – of any kind, especially in the back or pelvis.
- A feeling pressure or heaviness in the pelvis
- Loss of control of urine – leaking with lifting, running, coughing, sneezing, laughing
- A “tenting” or “coning” through the front of the abdomen with any movement
- A tendency to to hold your breath to perform a movement
- Development of hemorrhoids or varicose veins
These events signal there is a muscle and pressure imbalance through the body that needs to be addressed. Again, as a Pelvic Health Physiotherapist I can help you connect with these imbalances and educate you as to how to manage them going forward.
Take Home Message: Exercise is Medicine in Pregnancy and Beyond!
Exercise during pregnancy is safe for most women and should be fun, engaging and rewarding – physically and emotionally! You can start at a low intensity and build your way up, or continue with the work you were already doing and make modifications along the way. At the WOMB we have workshops, fitness classes and our Pelvic Health Physiotherapy team ready to support you through your pregnancy and into motherhood.
Jenny Telfer Crum is a Registered Pelvic Health Physiotherapist at The WOMB. She has a special interest in helping women exercise safely during pregnancy, prepare for labour and return to their exercise intensity of choice after birth while honouring their body along the way.