Exercise and pregnancy in women: A conflicting opinions of its benefits among reproductive females

Introduction

According to American College of Obstetrics and Gynaecologists (2012), during pregnancy women should perform 30 minutes or more of moderate-intensity exercise on most, if not all, days of the week, stressing that active healthy women are at low risk for adverse foetal or maternal events if they participate in routine physical activity during pregnancy.

However, Gatson and Cramp (2011) observed that once pregnant women generally tend to decrease their activity levels due to lack of motivation, perceived lack of time due to family and work demands; desire to postpone weight loss until after delivery and pain with movement. Thus, the means to motivate women to exercise during pregnancy needs to be explored. Kwolek, Berry-Caban and Thomas (2011) reported that, in a cohort of pregnant women who exercised, it was the knowledge of the benefits to the foetus that motivated them to exercise. To motivate healthy pregnant women to exercise, health care providers should provide education regarding the appropriate type and amount of exercise that should be undertaken during pregnancy and the benefits to the pregnant woman, the foetus, and the newborn infant.

Prather, Spitznagle and Hunt (2012) stated that there is considerable evidence that exercise during healthy pregnancy has positive effects on the mother and foetus. Furthermore, there is some evidence that suggests positive effects on the child.  All women without contraindications should be encouraged to participate in aerobic and strength-conditioning exercises as part of a healthy lifestyle during their pregnancy. Reasonable goals of aerobic conditioning in pregnancy should be to maintain a good fitness level throughout pregnancy without trying to reach peak fitness as this leads to improved physical and mental wellbeing and the maintenance of a healthy weight during pregnancy in returning to pre-baby weight more quickly and also reduces the risk of developing gestational diabetes which is more common in mothers who are overweight.

Conceptual framework

Exercise during pregnancy is defined as any bodily movement produced by the contraction of skeletal muscles during pregnancy.  During pregnancy, exercise maintains and improves cardiorespiratory fitness, reduces the risk of obesity and associated comorbidities, and ensuring foetal health. Women who begin their pregnancy with a healthy lifestyle (e.g. exercise, good nutrition, non-smoking) should be encouraged to maintain those healthy habits. Those who do not have healthy lifestyles should be encouraged to view the preconception period and pregnancy as opportunities to embrace healthier routines (American College of Sports Medicine [ACSM], 2014).

Artal (2015)described exercise during pregnancy as physical activity consisting of planned, structured, and repetitive bodily movements done to improve one or more components of physical fitness. It is regards as an essential element of a healthy lifestyle, and urged obstetrician–gynaecologists and other obstetric care providers should encourage their patients to continue or to commence exercise as an important component of optimal health.

In 2008, the U.S. Department of Health and Human Services issued physical activity guidelines. For healthy pregnant and postpartum women, the guidelines recommend at least 150 minutes per week of moderate-intensity aerobic activity (i.e., equivalent to brisk walking). This activity should be spread throughout the week and adjusted as medically indicated. The guidelines advise that pregnant women who habitually engage in vigorous-intensity aerobic activity (i.e., the equivalent of running or jogging) or who are highly active “can continue physical activity during pregnancy and the postpartum period, provided that they remain healthy and discuss with their health care provider how and when activity should be adjusted over time” (Department of Health and Human Services, 2008).

Physical inactivity is the fourth-leading risk factor for early mortality worldwide. In pregnancy, physical inactivity and excessive weight gain have been recognized as independent risk factors for maternal obesity and related pregnancy complications, including gestational diabetes mellitus (GDM) (Artal, 2015).

Recommended exercises during pregnancy

Szymanski and Satin (2012) advised that before engaging in any exercise, pregnant women should consult their health care provider. However, some of the exercises recommended for pregnant women include:

• Swimming
• Walking
• Running
• Bicycling
• Dance

1. Swimming: Many health care providers and fitness professionals say swimming is the safest exercise for pregnant women. Swimming keeps the body of pregnant toned without adding weight and stress to the joints. Swimming raises the heart rate and allows the pregnant woman to enjoy a safe cardiovascular exercise that is not likely to cause overheating. Another benefit of swimming during pregnancy comes from the safety of not falling(Szymanski & Satin, 2012).
2. Walking: Walking is very beneficial because it is safe for the body of pregnant women. It is easier on their knees than running and can be easily worked into manageable schedule. However it is advisable to set realistic goals and wear good shoes to decrease the risk of falling or pressure on the feet (Szymanski & Satin, 2012).
3. Running: Before starting to embark on running and jogging, it is advisable to speak to a health care provider before. It is able advisable to be well hydrated, avoid over-heating, and putting on a comfortable pairs of shoes (Szymanski & Satin, 2012).
4. Bicycling: The best thing about biking is that the bike supports the weight of the pregnant woman, so there is less stress on the body. It is advisable to use a stationary bike because there is a low risk of falling(Szymanski & Satin, 2012).
5. Dance: Dancing can be done in the home or at the gym that offers special classes for pregnant women. Pregnant women are advised to avoid a lot of spinning, leaping, and jumping.

Exercises to avoid during pregnancy

There are plenty of exercises that are great for pregnant women. In fact, most physical activity is perfectly safe during pregnancy. However there are a few exercises that pregnant women should avoid which according to Clarke and Gross (2014) include:

• Sports that carry a higher risk of falling or abdominal injury, like gymnastics, downhill skiing, snowboarding, ice-skating, vigorous racquet sports, horseback riding, cycling, contact sports (such as ice hockey, soccer, or basketball), diving, bungee jumping and rollerblading.
• Exercises that involve lying on the back are off limits after the first trimester, since the position could cause the weight of the enlarging uterus to compress major blood vessels and restrict circulation to the mother and the baby.
• Advanced abdominal moves like full sit-ups or double leg lifts, which can cause the abdominal muscle to separate from the midline and even tear.
• Backbends or other contortions, as well as movements that involve deep flexion or extension of joints (like deep knee bends), which can increase risk of injury.
• Excessive or bouncy stretching, since the ligaments are already loosen
• Scuba diving, which can cut off oxygen to the baby.
• Holding of breathe is never recommended during pregnancy — both the mother and the baby need a constant flow of oxygen.
• Motionless standing after the first trimester can restrict blood flow, it is necessary to avoid these movements in yoga (extended hand to big toe)
• Hot yoga or exercise in super-hot weather can raise body temperature too much, which causes blood to be shunted away from your uterus to your skin as the body attempts to cool off.
• Exercises involving balance, since it can be more difficult (and riskier) as pregnancy progresses. Having a chair or a wall close by can be helpful.
• Toe pointing during pregnancy can lead to cramping in the calves.
• Jumping and jerky motions may be uncomfortable with the extra weight of baby — although aerobics are perfect safe so as long as the pregnant woman is comfortable.

Benefits of exercise during pregnancy

Meher and Duley (2015) highlighted the benefits of exercise during pregnancy by stating that exercise benefits pregnant women and the unborn child.

1. Benefits of exercise during pregnancy for the mother

According to Meher and Duley (2010), exercising during pregnancy has been found to:

• Reduce risk of pregnancy complications: Women who participate in exercise are less likely to develop gestational diabetes and less likely to have unplanned caesarean sections than those who do not exercise.
• Lower odds of delivery complications: Women who take part in exercise gained less weight during pregnancy and were less likely to have macrosomic babies (or babies weighing more than about nine pounds at birth). Having a heavier baby, in turn, can lead to complications for both mother and baby during delivery.
• Speed post-delivery recovery: The more a pregnant woman increase her pregnancy exercise, the faster she will recover physically after childbirth, the more fit they will be after delivery. Women who exercise during pregnancy recovered faster after labour (even after controlling for delivery method), resuming household chores faster than those who do not exercise.
• Reduces depression: Women are more susceptible than ever to depression during pregnancy, with an estimated one in two of all women has increased tendency to experience depression during pregnancy But research has found that exercise during pregnancy reduces depression, releasing endorphins that help improve mood while diminishing stress and anxiety.
• Lower blood pressure: Blood pressure occasionally does go up during pregnancy, but too much and it can be a warning sign of preeclampsia. Staying active by simply walking regularly has been found to keep blood pressure from rising.
• Ease back and pelvic pain: The growing baby bump puts extra pressure on the lower half of the pregnant woman, resulting in lower back pain and an achy pelvis. Exercising, however, may result in less lower-back and pelvic pain during late pregnancy.
• Improve sleep: While many pregnant women report having a harder time falling asleep, those who exercise consistently (as long as it is not near bedtime, which can be too energizing) say the quality of their sleep is better and that they wake up feeling more rested.

2. Benefits of pregnancy exercise for the unborn child

Meher and Duley (2015) highlighted the potential benefits of exercising during pregnancy for the unborn child to include:

• Reduced odds of diabetes: Children born to exercising women had better insulin sensitivity and reduce the chances of diabetes.
• Boost to brain health: Offspring of women who engage in exercise during pregnancy are less prone to neurodegeration (the changes in the brain that can lead to Alzheimer’s disease).
• Lower body mass index (BMI): Women who exercise during pregnancy usually give birth to babies who are less prone to obesity and diabetes.

Attitude of women towards exercise during pregnancy

Despite the well-established benefits of exercise during pregnancy, many pregnant women remain inactive. This may be related, in part, to women’s beliefs about exercise in pregnancy, which are likely influenced by cultural background. In traditional culture, pregnancy is considered a vulnerable period that requires rest and recuperation, with many antenatal taboos some of which may contrast with international guidelines on exercise in pregnancy (Lee, 2009).

Two relevant taboos intended to avoid spontaneous miscarriage include “not walking too fast” and “not walking too often”, which have been reported to be adhered to by the majority of pregnant women. Women often expressed concern about the safety of exercise, with the most common reason given for not exercising during pregnancy being a fear of miscarriage (Zhang, 2014).

In contrast, the main barriers to exercise in most women has been reported to include feeling too busy, too tired, too unwell, and because exercise was too uncomfortable. All of these factors were rated as a greater impediment than exercise being ‘unsafe’ (Duncombe, 2009).

Measures to promote exercise during pregnancy

Clark and Gross (2014) suggested measures to promote the participation of women in physical activities during pregnancy to include:

• Health education: Pregnant women should be given adequate health education on the importance of exercise during pregnancy to their health and that of the unborn child.
• Physical exercise should be part of antenatal services: Health care givers in charge of antenatal care should structure their programme to ensure that pregnant women participate in physical activities during their routine antenatal clinic days to ensure active participation.
• Provision of facilities: The government and non-government organisation in charge of reproductive health should make facilities for physical activities available to pregnant women at an affordable price to help them have access to the facilities they need in carrying out exercise.
• Affordable coaching services: Majority of pregnant women have lack information the type of exercise that is safe for them during pregnancy. So the government and all other related agencies should ensure that coaching services are provided to pregnant women at an affordable price.

References

American College of Obstetrics and Gynaecologists (2012).Exercise during pregnancy and the post-partum period. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet., 77,79-81

American College of Sports Medicine (2014).ACSM’s guidelines for exercise testing and prescription. (9^thed.). Philadelphia (PA): Wolters Kluwer/Lippincott Williams & Wilkins.

Artal, R. (2015).The role of exercise in reducing the risks of gestational diabetes mellitus in obese women. Best Pract Res Clin Obstet Gynaecol., 29, 123–32.

Department of Health and Human Services (2008).2008 physical activity guidelines for Americans. Washington, DC: DHHS..

Duncombe, D. (2009). Factors related to exercise over the course of pregnancy including women’s beliefs about the safety of exercise during pregnancy. Midwifery, 25,430–438

Gaston, A. & Cramp, A. (2011).Exercise during pregnancy: a review of patterns and determinants. J Sci Med Sport.,14(4),299–305.

Clarke, P.E. & Gross, H. (2014).Women’s behaviour, beliefs and information sources about physical exercise in pregnancy. Midwifery, 20, 133–141.

Kwolek, L. A., Berry-Caban, C.S. & Thomas, S.F. (2011). Pregnant soldiers’ participation in physical training: A descriptive study. Mil Med., 176, 926-931.

Lee, J. H. (2009). The effects of physical activity and physical activity plus diet interventions on body weight in overweight or obese women who are pregnant or in postpartum: a systematic review and meta-analysis of randomized controlled trials. Prev Med., 56,351–64.

Meher, S. &Duley, L. (2015).Exercise or other physical activity for preventing pre-eclampsia and its complications. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD005942

Prather, H., Spitznagle, T.M. & Hunt, D. (2012).Benefits of exercise during pregnancy.PM & R, 4(11), 845-50.

Szymanski, L. M. & Satin, A. J. (2012). Exercise during pregnancy: fetal responses to current public health guidelines. Obstet Gynecol., 119,603–10.

Zhang, Y. (2014). Physical activity level of urban pregnant women in Tianjin, China: a cross-sectional study. PLoS ONE, 9(10),e109624.