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Exercise during and after pregnancy

Prenatal physical activity should be considered a front-line therapy for reducing the risk of pregnancy complications and enhancing maternal physical and mental health.” Canadian guidelines for exercise in pregnancy 2019

The latest guidelines on exercise in pregnancy tell us that not only is it okay to exercise during pregnancy, there are many benefits. This includes women who have previously been inactive, overweight or have gestational diabetes as long as exercise is commenced at a suitable level and progressed slowly.

There are some situations when women should avoid exercise or should do so with caution/advice from their obstetric care provider. This includes problems such as persistent bleeding, placenta previa and uncontrolled diabetes, blood pressure or thyroid conditions.

There are also some safety precautions to observe such as:

  • Avoid physical activity in excessive heat, especially with high humidity
  • Maintain adequate nutrition and hydration—drink water before, during and after physical activity
  • Avoid activities which involve physical contact or danger of falling.

And cease exercise if there is:

  • Persistent excessive shortness of breath, dizziness or faintness that does not resolve on rest
  • Severe chest pain
  • Vaginal bleeding or persistent loss of fluid from the vagina indicating rupture of the membranes

A complete list of contraindications and precautions can be found here.

Exercise for specific areas during pregnancy

  • Abdominals – you may have heard and be concerned about “abdominal separation” or diastasis rectus abdominus. This refers to the stretching and widening of the connective tissue between the 2 bellies of the rectus abdominus muscle to accommodate the growing baby and occurs in nearly all women during pregnancy. There is some evidence that exercise (general or specific abdominal exercises) may reduce the extent of separation after delivery. Your physiotherapist can advise on the appropriate exercises for you. If you observe “doming” with particular exercises you should cease that exercise and ask your physiotherapist for alternatives.
  • Pelvic floor regular pelvic floor exercises during pregnancy are associated with a 50% reduction in pre-natal and 35% reduction in postnatal urine leakage. The guidelines recommend instruction in proper technique by a health professional trained in this area such as one of our Women’s Health Physiotherapists.
  • Pelvic girdle pain – pain in the low back and pelvic girdle (pubic symphysis and sacro-iliac joints) affects up to 80% of pregnant women. The pain is best managed by an individualised, multi-modal approach (education, manual therapy, pelvic belts or taping, exercises to improve control). Occasionally pain is associated with “overactive” pelvic floor muscles. Your women’s health physiotherapist can advise on the best specific and general exercises for your particular problem.
  • Pre-natal exercise classes at Total Physiotherapy address all of the above and are offered when we have sufficient demand - currently offered on a Monday evening at 6:00pm.

The “fourth trimester” or the postnatal recovery period

The physical recovery for women after childbirth varies greatly. This means  there is no timetable for returning to exercise – it should be based on your body’s capabilities.

For this reason we highly recommend a postnatal assessment with one of the Women’s Health physiotherapists to guide return to exercise. We assess the key areas that can be vulnerable when returning to exercise postpartum and advise on specific and general exercise to optimize recovery.

  • Abdominals - For many women the separation between the rectus abdominus muscles reduces on its own within 8 weeks. Some women will need to perform specific exercises or perhaps use some support to assist with this.
  • Pelvic floor - Approximately 33% of women will report some urinary incontinence (leakage of urine) in the first 3 months postpartum. Some women will report difficulty controlling wind or stool, or a heaviness or bulging in the vaginal area (prolapse). While these are common symptoms, they are not something to put up with – our Women’s Health physiotherapists can assess, provide advice and prescribe a specific, individualized program for you. For some women, the symptoms will not be unmasked until they return to higher impact exercise. Early assessment (from 6 weeks) can help you get on the right track before you increase your physical activity.
  • Pelvic girdle pain - experienced during pregnancy resolves for most women after delivery, however up to 10% will experience pain in the 3 months after delivery. For some it will not be provoked until they return to exercise such as running. Again we can advise on specific exercises to assist recovery as well as appropriate general exercise based on a thorough assessment.
  • Postnatal exercise classes are conducted at Total Physiotherapy - and are currently offered on Tuesday mornings (where you can bring your baby if you wish) at 10:00am and 11:00am.

To learn more about our Women's Health Team or to book an appointment with a Women's Health physiotherapist please click here.

References:

  • Beales et al., 2014,
  • Benjamin et al., 2014,
  • Davenport et al., 2018,
  • Mottola et al., 2018,
  • Salvatore et al., 2017.

 

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