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Exerise During Pregnancy - What the Experts Say

Exercise during pregnancy has multiple benefits for both the pregnant woman and the baby. Those benefits include:

  • Increased circulation
  • Avoidance of excessive weight gain
  • Decreased fatigue
  • Decreased risk of blood clots, varicose veins, leg cramping and swelling
  • Decreased nausea
  • Less lower back pain
  • Reduced risk of gestational diabetes
  • Reduced risk of preeclampsia
  • Shortened labor
  • Increased comfort in the third trimester
  • Diminished depression
  • Improved posture
  • Strengthens muscles

Butler, Joan Marie, RNC, CNM, Fit & Pregnant: The Pregnant Woman’s Guide to Exercise, at 33 (2nd ed. 2006); Stone MD, Joanne & Eddleman, MD, Keith, consulting eds, The Pregnancy Bible: Your Complete Guide to Pregnancy and Early Parenthood, at 114 (2nd ed. 2008)

The American College of Sports Medicine (ACSM) issued a recommendation in 2000 that stated that “[p]articipation in regular weight-bearing exercise has been shown to improve maternal fitness, restrict weight gain without compromising fetal growth, and hasten postpartum recovery. In addition, the psychological benefits of exercise are undeniable and should be nurtured by all who care for pregnant women.” Butler, at 35

The American College of Obstetricians and Gynecologists (ACOG) also endorsed exercise during pregnancy, but its recommendations have gone through several iterations. In 1985, the ACOG published a bulletin entitled “Exercise During Pregnancy and the Postnatal Period”. In that bulletin, the ACOG advised that a pregnant woman should keep her heart rate at 140 beats per minute and not engage in strenuous exercise for more than 15 minutes. Id. For many women, myself included, this would mean that they wouldn’t even break a sweat and would not feel that they were receiving any benefit.

In 1994, the ACOG moved away from the target heart rate of 140 beats per minute, and instead recommended that woman used “perceived exertion” as a guide. “Perceived exertion” is fully described below. Id.

And, in 2002, the ACOG’s new guidelines stated that “recreational and competitive athletes with uncomplicated pregnancies can stay active during pregnancy while modifying their usual exercise routines as medically indicated.” Id.; see also ACOG FAQ 0119 (2011)

The pregnant woman should always check with her health care provider before starting any exercise program and keep the doctor continually informed as to what type of exercise she is doing. See Stone & Eddleman, at 114.

As previously cited (Butler at 41), the ACOG originally recommended that a pregnant woman’s heart rate not exceed 140 beats per minute. And, as I mentioned stated (Butler at 41-42), my obstetrician gave me that recommendation. However, mostly due to the fact that women were feeling that they were not able to really exercise if they had to maintain a heart rate under 140 beats per minute, that standard is generally not used anymore. See at 41. One of the reasons that a pregnant woman might not feel like she is really exercising if she sticks to a heart rate below 140 beats per minute is that during pregnancy, the resting heart rate increases. Id. See also Clapp III M.D., James F. and Cram, M.S., Catherine, Exercising Through Pregnancy, at 193 (2nd ed. 2012)

Therefore, a better measure of exercise intensity is the Borg Rating of Perceived Exertion (RPE) which was developed by Gunnar Borg, a Swedish physiologist. The scale ranges from 6 to 20. It is advisable to stay between 12 and 14 during pregnancy which level is considered “somewhat hard”, and a person should be able to pass the “talking test” and carry on a conversation. Id. at 41-42.

               The Borg RPE Scale is as follows:

6   No exertion at all
7   Extremely light
8
9   Very light
10
11  Fairly light
12
13  Somewhat hard
14
15  Hard (heavy)
16
17  Very hard
18
19  Extremely hard
20  Maximal Exertion

A pregnant woman might feel more breathless than a non-pregnant woman because the uterus displaces the diaphragm upwards, allowing for a smaller volume of air to fill the lungs. The brain also signals the need to breathe faster since the carbon dioxide level will be higher because the pregnant woman is also eliminating carbon dioxide for the fetus (or fetuses). However, the body will adapt to a moderate level of exercise after a short while, especially if she is physically fit before she is pregnant. Id. at 36.

Another concern voiced by my obstetrician was that during exercise, the blood would be diverted from the uterus to the working muscles, and therefore, the fetuses might be adversely affected. It is common thought now, however, that, while this is a concern during strenuous exercise, during moderate exercise the blood volume, increase in cardiac input and relaxation of the blood vessels compensate and maintain an adequate blood flow to the uterus. Id. at 40.

As far as the duration and frequency of the exercise, a lot depends on the pre-pregnancy fitness level and how the woman feels during the exercise. However, it is generally thought that at least 30 minutes on a given day is needed for it to be beneficial. The 30 minutes, however, does not have to be done all at once. In addition, the pregnant woman should exercise at least 3 times a week. See Clapp and Cram, at 194, 196.

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