As an Osteopathic Manual Practitioner (thesis writer), I value the active participation of each patient in their overall health and well-being. To reap the full benefits of manual therapy and maintain its effects, exercise as homework is essential. My appreciation for movement and the incorporation of it in my clinical practice, comes from my active upbringing. Prior to my schooling in Osteopathy, I trained extensively as a ballet, jazz and modern dancer, played competitive ice hockey (fun fact) and obtained a Bachelor of Science in Kinesiology at McMaster University. When I am not at Body Co. treating, I am teaching functional movement, to strengthen and condition the body. When I began teaching dance and yoga in 2011, I did not anticipate that eight years later I would primarily be instructing people during pregnancy or immediate postpartum. I can recall the uncertainty I experienced the first time I had a pregnant student attend one of my yoga classes. I felt a heightened sense of responsibility and I was hesitant about any risk associated with certain exercises or yoga postures. Even with the abundance of exercise based training I obtained, there was a general lack of knowledge surrounding exercise during pregnancy.
Although it is not often addressed, there remains a stigma which suggests that pregnancy is a fragile condition and it is projected that one should take extra cautionary care when exercising. When I speak with friends or clients who just discovered they are pregnant, this perception holds true. They often express some degree of concern regarding the safety of exercise during pregnancy and are hesitant to continue exercising. This is in large part, due to the fact that the recommendations, up to this fall have been very unclear. This September, the Canadian guidelines for physical activity during pregnancy were finally updated. Prior to this recent publication, the last time the guidelines were published was in 2003, over fifteen years ago!
Davenport, Ruchat, Mottola, Davies, Poitras, Gray, & Barakat (2018) conducted an extensive review of the research published to date, and generated evidence-based recommendations regarding exercise throughout pregnancy. These guidelines were approved by the Society of Obstetricians and Gynaecologist of Canada (SOGC) and approved by the Canadian Society of Exercise Physiology (CSEP). The purpose of this blog is to dissect the most current recommendations for exercise during pregnancy. With the hopes of making physical activity more approachable and appealing during pregnancy.
The specific recommendations are as follows:
- In the absence of contraindications, all women are strongly suggested to participate in prenatal physical activity.
Based on the recent review of literature, physical activity during pregnancy is not at all associated with miscarriage, stillbirth, preterm/prelabour rupture of membranes, neonatal hypoglycaemia, low birth weight, birth defects, induction of labour or birth complications. So, much of the anxiety surrounding exertion during pregnancy is unwarranted. In fact, adhering to the newest physical activity guidelines has been associated with fewer newborn complications, decreased risk of gestational hypertension and diabetes, fewer emergency caesarean sections, instrumental delivery, urinary incontinence, depression, and lumbopelvic pain.
- During pregnancy, women should accumulate at least 150 minutes of moderate to intense physical activity a week
There is little to zero research that demonstrates the effects of vigorous exercise on maternal-fetal health during pregnancy. However, moderate activity is recommended throughout pregnancy. Intensity of exercise is calculated by working at a percentage of your maximal heart rate per minute. Your maximal heart rate is calculated by subtracting your age from 220 (ie. 220 – 30 = 190 beats/min). Exercising at 40-59% of your maximal heart rate, would be considered moderately intense physical activity. Another way to determine your level of exertion is the “talk test”, meaning if you cannot talk while exercising you should reduce your intensity of exercise.
- Physical activity should be completed at minimum 3 days a week, but physical activity each day is ideal
Being more physically active, increasing frequency, duration or volume per week has demonstrated to have great maternal and fetal health benefits. There is a clear dose-response relationship between intensity of exercise and reducing ones odds of hypertension and depressive symptoms during pregnancy.
- Both aerobic and resistance training should be incorporated for maximal benefit
Brisk walking, stationary hiking, swimming, jogging are okay to maintain during pregnancy. It is suggested to avoid sports or activities that increase ones risk of contact or falling, like horseback riding, ice hockey, downhill skiing and gymnastics.
- Pelvic Floor Muscle Training (PFMT) or Kegel exercises may be done on a daily basis to reduce the risk of urinary incontinence.
Of course, it is best to see a Pelvic Floor Physiotherapist to learn the proper execution of the exercise first!
Based on the literature, all women are strongly encouraged to be physically active throughout pregnancy, granted there are no severe contraindications to exercise, such as: ruptured membranes, pre-eclampsia, pre-mature labour, uncontrolled type 1 diabetes, intrauterine growth restriction and other pre-existing medical conditions.
Some Additional Considerations:
If you were relatively active prior to your pregnancy, there is no evidence to suggest that you must adapt or “slow down”. Rather it is recommended to maintain the same level of activity.
If you are new to regular exercise, it is recommended to meet the guidelines gradually. Increasing the frequency, volume and duration progressively each week. The standard recommendation is 10% a week!
Lightly discussed in the guidelines is Diastasis-Rectus Abdominus (DRA), which is the separation of the abdominal muscles that results from the stretching and expansion of the abdominal wall. The separation of the six-pack muscle occurs in about 70% of pregnant women during their third trimester. You can read more about DRA in my last blog.
Exercise during any stage of life has many physical and mental benefits, pregnancy is no exception! It is best to understand what level of activity is appropriate during pregnancy, but, to think exercise during pregnancy is unsafe, is a misconception. Women, should not be concerned about maintaining a physically active lifestyle or starting to become physically active during their pregnancy. Overall, regular exercise during pregnancy has demonstrated to have preventative and therapeutic maternal-fetal effects. It was my intention to outline the facts about exercise during pregnancy, in the hopes of making it more approachable. I hope that this information has allowed you to feel more confident about being physically active during your own pregnancy, or to share some knowledge with a friend!
Florence was first introduced to alternative therapeutic modalities in her teens, as a dancer and competitive athlete. After high school, Florence furthered her dance training and obtained her Honors Bachelor of Science in Kinesiology from McMaster University. Teaming up with the artistic director of the McMaster University contemporary dance company, she developed introductory dance classes for children and teens across Hamilton. Inspired to further her teaching skill-set, she obtained her yoga teacher certification in Hatha yoga. Florence teaches across the city and combines her knowledge of human kinetics, dance, strength and conditioning, and yoga. Teaching movement to pre and postnatal women, and coaching as a birth doula, she gained a unique perspective into the supportive systems available to new and expecting mothers. Florence has an affinity for the holistic approach to women’s care. She is passionate about the assimilation of progressive knowledge to educate and empower women at any stage of life including: pre-conception, pregnancy and recovery after birth. Most recently, Florence completed her five years of study at the Canadian College of Osteopathy in Toronto. As a manual therapist, she believes in having her patients actively participate in their healing. She currently is working to complete her thesis which will examine how osteopathic treatment effects diastasis-recti abdominus in postnatal women.