The Benefits of Exercise during Pregnancy: How to Advise Your Chiropractic Patient, Part II
By Debra W. Levinson(Editor's note: Part I of this article appeared in the May 31, 1997 issue.)
Specific Recommendations for Exercise during PregnancyJogging
It is generally recommended that women not start jogging during pregnancy.If jogging is initiated during pregnancy, it should be started at a low intensity and frequency, with monitoring for any adverse symptoms.
Walking Walking is a supportive alternative to jogging, cycling and other intense exercises because it does not involve any ballistic movements, but also helps to condition the cardiovascular system.
Cycling can be started during pregnancy because it is not a weightbearing activity. A stationary bicycle is generally safer than a standard bicycle because of the changes in balance that can occur during pregnancy.
The ACOG guidelines recommend that exercise in the supine position, as well as jerky, bouncing movements and deep flexion and extension, be avoided after four months gestation. Low impact aerobics may be easier for the pregnant woman to tolerate, especially in the third trimester.
Swimming is considered by many to be the perfect aerobic exercise because it can be safely initiated during pregnancy. Swimming in excessively cold or hot water probably should be avoided.
Immersion, or hydrotherapy, is one of the oldest forms of healing therapy. Its benefits have been touted since antiquity. Immersion, because of its diuretic and natriuretic effects, has even been proposed as therapy for patients with some forms of renal disease and patients with cirrhosis. The diuresis of immersion may have positive effects on the pregnant woman who is bothered by fluid retention. Water aerobics during pregnancy is a non- weightbearing exercise that occurs in a "thermal-friendly" medium.
Weightlifting Lifting weights for maintenance of strength can be cautiously continued throughout pregnancy provided proper breathing is performed and the Valsalva maneuver is avoided.
Water skiing should be avoided, because high speed falls have been reported to cause forceful entry of water into the uterus and subsequent miscarriage.
Experienced divers who are pregnant may continue making very conservative dives, not to exceed one atmosphere of pressure (10m/33 ft.). They should also limit the duration of the dive to 30 minutes or less. Deeper or longer dives and diving by inexperienced divers should be avoided. The compressed air environment can cause decompression sickness in the mother, as well as maternal acid base and nitrogen imbalances and an intravascular air embolism in the fetus.
Experienced downhill and cross-country skiers who are pregnant may continue to ski cautiously during pregnancy. Falling can be dangerous, and these sports should not be pursued by inexperienced pregnant skiers.
Ice skating is more dangerous than snow skiing because falls on hard ice can cause more serious trauma. Skating should definitely not be engaged in by inexperienced skaters and should be pursued only with extreme caution by those with experience.
Yoga has been popular with pregnant women for two main reasons. First, yoga offers the relaxation effect that many women seek while pregnant. Second, the pregnant woman is able to maintain muscle tone and flexibility throughout gestation. Yoga should be accompanied by some form of aerobic exercise.
The skill of relaxation and good breathing has been known to help prepare a pregnant woman to cope with the challenge and discomforts associated with childbirth. Practicing relaxation and good breathing also has a positive effect on the fetus. Babies, before and after birth, thrive best in a calm and temperate environment.
It is important to strengthen the muscle of the back during pregnancy. It can help to reduce lower back pain and increase flexibility. The benefits of good posture allow the back and neck to lengthen upward, so that the head is well balanced. The spine is then lengthened, allowing plenty of space to accommodate the baby.
As a chiropractor, it is important to stress to the pregnant patient that good posture and maintaining a strong spine free from vertebral subluxation complexes is vital to the health of the mother and fetus.
The physiological changes of pregnancy remain until 6-12 weeks after birth. Hormones will not return to normal levels in nursing mothers until they stop breast feeding. Many of the guidelines for exercise during pregnancy still apply to the postpartum period.
All exercise modes for physical fitness, including aerobic activities, can be resumed after pregnancy. Few women are able to resume activity within a week after delivery. Most women begin to exercise again around the sixth week; each woman should consult with her doctor to determine the best time to resume exercise.
Most women resume their exercise program by walking. After 6-8 weeks of walking, they gradually switch to the mode of exercise they prefer. For example, those women who resume dance exercise early in the postpartum period may report the sensation of their uterus dropping, and the sensation should disappear once the muscles regain their former tone.
Abdominal exercises are still important to firm up the muscles of the stomach. Continuing lower back exercises will help control low back pain, and additional instruction in lifting and carrying should help prevent lower back problems and fatigue. Abdominal and lower back exercise used in non-pregnant patients can be safely incorporated into the postpartum exercise program.
Exercise frequency, duration, and intensity will depend on the fitness goals of the new mother. To maintain fitness, a postpartum exerciser will probably have to work out two to three times per week for 20 to 30 minutes. To improve fitness, she may have to increase the frequency to three to four times per week and the duration to 30 minutes. If she also wants to lose excess fat gained during pregnancy, her exercise program should emphasize long duration, low intensity exercises four to five times per week. Because exercise intensity during pregnancy was low, any increase in intensity should be made gradually and as comfort indicates.
Debra W. Levinson, DC