By Dr Meenakshi Sauhta
Physical activity at all stages of life maintains and improves cardiorespiratory fitness, reduces the risk of obesity and associated comorbidities, and results in greater longevity. Physical activity in pregnancy has minimal risks and has been shown to benefit most women, with some modification to exercise routines depending upon foetal requirements. Exercises should neither be commenced nor halted suddenly as cardiovascular adjustments take more time during pregnancy. Sudden changes in activity levels can cause dizziness and even fainting. Long periods of motionlessness should also be avoided.
Women with uncomplicated pregnancies are encouraged to engage in aerobic and strength-conditioning exercises before, during and after pregnancy. Despite having a handful of benefits at its core, recommendations do not exist in India for physical activity during pregnancy. Regular physical activities during pregnancy have a positive impact on pregnancy outcomes and foeto-maternal health. Pregnancy offers the chance to increase physical activity and sustain this healthy behaviour beyond childbirth as well.
Exercise during pregnancy is not advised for those with the following conditions:
- Heart disease
- Severe hypertension (high blood pressure)
- Risk of premature labour (incompetent cervix, multiple pregnancy, ruptured membranes)
Any illness or complication needs to be fully assessed by a physician before a pregnant woman can start or continue with an exercise routine.
Healthy behaviours that have been established during childhood tend to last across a lifetime. Therefore, physical activity interventions during pregnancy certainly provide a powerful opportunity for population change. Women in general are advised to avoid any kind of physical activity that might put on a strain on both the mother and child.
During the course of those nine months of pregnancy, the body of a woman goes through significant changes like the expansion of the uterus from the pelvic organ to an abdominal growth, an anterior shift of the centre of gravity, displacement of the diaphragm and increase in the blood volume by up to 45 per cent. The heart rate increases by 20 per cent as well, while hyperventilation leads to primary respiratory alkalosis, raising the total requirement of oxygen by a woman. Within 45 minutes of exercise, a decrease is seen in plasma glucose levels.
Warnings signs to discontinue exercises during pregnancy:
- Vaginal bleeding
- Regular painful contractions
- Chest pain
- Calf pain or swelling
Regular physical activity during pregnancy improves or maintains fitness, helps with weight management, reduces the risk of gestational diabetes in obese women, and enhances psychological well-being. An exercise programme that leads to an eventual goal of moderate-intensity exercise for at least 20–30 minutes per day on most or all days of the week should be developed with the patient and adjusted as medically indicated.
During pregnancy, the goals of physical activity are mainly to maintain a sense of maternal well-being, to avoid foetal harm and establish a pattern of regular activity that would ultimately be helpful in preventing the onset of chronic disease that can be associated with a sedentary lifestyle. Women can participate in a wide range of recreational activities and maintain an active lifestyle during the period of pregnancy.
Modifications might be important for those women who regularly participated in strenuous recreational or competitive physical activities before their pregnancies. Additionally, women who have been active before pregnancy might modify their exercise programmes somewhat; for example, weight gain or joint laxity might prompt them to walk instead of jog or they might have to exercise indoors instead of outdoors because of improved environmental control.
Activities that should be avoided during pregnancy:
- Scuba diving
- Water skiing
- Martial arts
Now, because of all the physiological changes that are bond to occur during pregnancy, activity recommendations for pregnant women are subject to modifications. Regular physical activity throughout pregnancy generally outweighs the risks.
Women who exercise daily in the prenatal period have a lower incidence of babies with low birth weight. Starting with the first trimester, regular activity might help in easing nausea and lessening fatigue. Regular physical activity positively influences the body image and mood—both during pregnancy and in the postpartum period.
Regular physical activity during pregnancy benefits preeclampsia, hypertension, and gestational diabetes. During the second trimester period, supine exercises are not recommended, because they can cause the uterus to compress the inferior vena cava and might result in decreased cardiac output. Because of the shift in the expecting mother’s centre of gravity, exercises that need balance are to be avoided later in pregnancy.
Despite the fact that pregnancy is associated with profound anatomic and physiological changes, exercise has minimal risks and has been shown to benefit most women.
(The writer is Director of Obstetrics and Gynecology, Cloudnine Hospitals, Gurgaon.)