Nine things to know about fitness training during pregnancy

Advice to “mind yourself” during pregnancy no longer means cutting out exercise and putting your feet up for nine months. On the contrary, the benefits of physical activity for both mother and baby have become apparent in ever-evolving scientific research.

Yet, newly pregnant women can still be on the receiving end of conflicting information. As one dedicated gym-goer recalls: “There was well-intentioned advice from family friends along the lines of ‘wrap yourself up in cotton wool and don’t exert yourself’.” It can be a confusing and fearful time about what’s safe and what’s not but stopping is not the answer.

At least 150 minutes a week of physical activity at a moderate intensity is a broad recommendation throughout pregnancy, but those used to doing more can keep up their routines. Slowing down and shorter distances will come naturally, whether through exhaustion in the first trimester or the added load from the second half of pregnancy onwards.

Here are nine things to know about fitness training in pregnancy.

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1) An obstetrician’s advice

“There are persisting misconceptions about possible harmful effects of exercise in pregnancy,” says consultant obstetrician Prof Fergal Malone, chairman of the department of obstetrics and gynaecology at the Royal College of Surgeons in Ireland school of medicine. The belief that it could interfere with early pregnancy success or cause miscarriage is untrue.

[ Helping women overcome stigmas surrounding pregnancy ]

“Unless there are specific general health contraindications already in place for a particular patient, almost all pregnant women can continue with their previous exercise habits, including gym workouts and exercise classes such as yoga or Pilates,” he says. “Obviously, as the pregnancy progresses and the size of the woman’s abdomen increases, common sense would suggest that some abdominal exercises, such as crunches or sit-ups, will become quite impractical. But other than that, there are few specific restrictions.”

Overall, the best practical advice is to listen to your body, he says. “Pain and excessive fatigue are obvious signs that perhaps it’s time to take a break or reduce intensity.”

2) Preconception health

Offering this advice for pregnancy might have shades of the old joke, “If I were you, I wouldn’t start from here”, but, if it’s not too late, ensuring you are physically fit and in an exercise routine before becoming pregnant is the best strategy.

“Preconception health is fundamental for pregnancy health and lifelong health of mother and baby – but often forgotten,” says nutritionist and former midwife Kathy Whyte, who founded Nurture Mum to promote education around the first 1,000 days of life. In Ireland today, one in two women attending their first antenatal appointment will either be overweight or living with obesity, and she believes health professionals have to start talking about this.

“If we just ignore it, we are normalising it. There is a big untold story about the impact of being overweight during pregnancy. Some people can go on to have a perfectly normal pregnancy and normal weight baby but the chances are they will have some issues.”

[ Fitness and pregnancy: What’s changed over the past five years? ]

Body mass index (BMI) is a crude measure, she says, but is still a valid reference point. Even if women can’t get down to a BMI of 25, 26, 27 before pregnancy, to incrementally lose even 10 per cent of their body weight would be a huge benefit, she says.

Taking up a moderate exercise routine and becoming active in preparation for fertility treatment has been shown to be beneficial to outcomes, says fertility nurse specialist Mary McAuliffe, who is head of clinical services at the Waterstone Clinic, which operates in Dublin, Cork, Kildare, Limerick and Waterford. “But it doesn’t have to be through a class or gym membership. You can increase your activity and fitness through small and practical changes such as walking any short distances you might usually drive; using your lunch break for a short walk, even around a car park; taking the stairs instead of the lift; using a step counter or an activity app such as Couch to 5K.”

3) Avoid high-impact activity

Don’t bump the bump is a general rule of thumb but that precious cargo can withstand vigorous movement.

“Exercises that have a high risk of falling or being associated with abdominal trauma [full-contact sport] should be avoided,” says Prof Malone. So horse riders and rugby players, for instance, are encouraged to hang up their boots temporarily.

4) Make adaptations in the gym

Most regular gym-goers will want to continue their workout programmes, for both their physical and mental health. Finding a suitably knowledgeable personal trainer or small group classes adapted for pregnancy will ensure you can follow programmes that take your changing body into account.

Raise any doubts you have with your doctor and/or a physiotherapist. In the second half of pregnancy, exercises that are performed when lying completely flat might be more likely to be associated with faints, says Malone and therefore should be adjusted with a slight left-sided tilt.

5) Target pelvic floor muscles

If you are not in the habit of flexing your pelvic floor muscles, now is the time to start. Pregnancy and delivery weaken pelvic floor muscles so it is important to strengthen them, to try to avert issues with urinary incontinence.

Rotunda Hospital’s website provides helpful and reliable video advice about these matters. Aoife Clarke, one of the physiotherapy team there, recommends doing pelvic floor exercises three times daily and outlines how to do them. In this newspaper, Aoibhín McGreal, founder and clinical director of Vie Physio, a specialist pelvic and women’s health physiotherapy clinic in Co Kildare, shared her tips for pregnancy and the postnatal period.

6) Eat well

Thinking for two rather than eating for two is what Kathy Whyte recommends for nutrition in pregnancy (not to mention before and immediately afterwards, too). Babies in the womb are “scavengers”, she says and have first dibs at incoming nutrition. This will leave the mother rather than the baby depleted first if the pregnancy diet is lacking in quality and quantity.

[ Eat for two, don’t dye your hair, stay away from cats, and other myths about pregnancy ]

A well-balanced daily diet incorporating at least five fruits and vegetables and the “really important” 25g-30g of fibre is a standard recommendation. Typically, advice is always food first and supplements second, she says, “but pregnancy is unusual in that we absolutely recommend folic acid. That message has got diluted and we understand only 50 per cent of mums take folic acid for the 12 weeks before conception.” The advice has also changed to continue taking it throughout pregnancy. A vitamin D supplement is also recommended and vegetarians and vegans would probably benefit from a fish oil. There are vegan-friendly sources of fish oil, Whyte says.

7) Returning to fitness

After a vaginal birth, most women can resume normal physical activities, including exercise, at their own preferred pace, says Prof Malone.

“There is no evidence that rapid resumption of exercise compromises pelvic floor function. Similarly, after Caesarean birth, there is evidence that early return to pre-pregnancy activities and exercise could even reduce postoperative complications. For uncomplicated surgeries, most women can resume exercise/training four to six weeks after surgery.”

8) If you are undergoing IVF

Around the time of egg retrieval, McAuliffe advises to avoid any intensive exercise, even if you are used to it. “It is important to protect your body during these few weeks and not be vigorous with exercise. Activities like walking, yoga and swimming will help you stretch your muscles without straining.”

After the embryo transfer, patients often say that the two-week wait is the hardest part of treatment.

“If you do feel like exercising during this time, our advice would be to keep it light and gentle, particularly for the first few days after embryo transfer, with some walking and easy yoga stretches. Keeping busy and continuing regular life is really important at this time,” McAuliffe says. “Be gentle and kind to yourself and listen to what your body needs.”

9) If you don’t exercise

The Health Service Executive says that not being active may lead to:

• Loss of muscular and cardiovascular fitness
• Excessive weight gain
• Increased risk of gestational diabetes or preeclampsia (high blood pressure in pregnancy)
• Varicose veins
• Physical problems such as back pain

Personal trainer Heather Rowland completed a specialist course in pregnancy and postnatal fitness coaching to work with expectant mothers, but now first-hand experience is adding to her understanding.

“Going through it myself puts me in a much better position,” she says, 18 weeks into her first pregnancy. She used to advise clients it wasn’t the time to be trying for personal bests and now realises she wouldn’t have a hope of achieving one even if she tried.

Having been used to training four or five days a week, along with her work at FFS gyms in Dublin, Rowland, who is 31, was exhausted during her first trimester. “I was struggling to get up and in bed at 7pm,” she says. This was a novel experience for somebody whose childhood passion for as many sports as possible led to a University College Dublin degree in sports and exercise management, international honours in tag rugby, and stints in sports agencies and the FAI before her current focus on being a gym trainer.

Early in her pregnancy, she reduced her own workouts to twice a week. “I was getting through my sessions and enjoying them but definitely not lifting the weights I used to lift or doing the high intensity I used to do. But it did make me feel better afterwards and that is something I have heard, especially from people with nausea. Something I was personally surprised about.”

You have to be realistic about lower energy levels, she says. “You just have to accept that and remind yourself what’s going on and why you’re tired.”

In the early weeks, before she had announced her pregnancy, Rowland was conscious that she was following some of the adaptations of exercises they recommend for pregnant clients and wondering if any colleagues would notice. For example, from the first trimester, it is advisable not do a full burpee where you are hitting your stomach off the floor.

Now, in the second trimester, she is training more, with the tiredness having lifted a bit after the 12-week mark. “But I still have days when I am just wiped out and I might not train,” Rowland says. At this stage, she is following the recommendations about modifications of pull-ups, push-ups and avoiding lying on her back with heavy weights.

“There will come a point where something like a bench press isn’t suitable – you’re lying on your back, an extra weight pushing down on you; you have extra pressure and tension in your stomach and you just don’t need to add to that.” Preferences and abilities for gym training programmes during pregnancy are very individual. As the bump gets bigger, some people don’t like hinging over or lunging, she says. Yet, she has had some women on or beyond their due date still doing jump squats.

When Katie Chubb, who is 34, was planning her second child, she knew it was going to be a high-risk pregnancy. She had developed sudden and severe preeclampsia when expecting her first while living in the United States. Emilia was delivered by emergency C-section at 28 weeks with numerous issues with her lungs and had to spend 12 weeks in neonatal intensive care.

Back in Ireland, Chubb consulted an obstetrician about a preconception plan. With regards to exercise, he said continuing what she was used to doing once she became pregnant should be fine but he would review it.

“Once I got pregnant, I asked him again. At the time I was doing Hitt [high-intensity interval training] workouts in a group setting but they weren’t tailored for pregnancy.” The exercises and trainers changed every day, so she was a bit concerned about how needing modifications might work, especially in the early days “when I didn’t want to tell every single person I was pregnant”. Neither did she want to be trailing behind everybody else.

I was more active during my second pregnancy and I physically felt much better and much stronger much quicker this time around

Her doctor told her he wasn’t comfortable with her doing that level of intensity and questioned if the trainers knew how to modify the exercises safely. But he also said he didn’t want her to stop exercising as being fit and healthy would help.

“With my issue in my pregnancy with Emilia having been blood pressure, we needed to find that balance between getting exercise and not overdoing it, so as not to push my blood pressure too much,” says Chubb. So she swapped gyms to avail of the designated pregnancy and postnatal training groups at an FFS gym in Leeson Street, where she continued to train twice a week up to 33 weeks.

“Then my blood pressure started to creep so I had to stop doing stuff,” she says. Jack was delivered safely by elective Caesarean last January at 38 weeks. After getting the all-clear at her six-week check up, Chubb went back for her first gym session at seven weeks, the day before we talk. Being able to bring Jack with her meant needing childcare wasn’t a barrier.

“It was great, really nice to be back,” says Chubb, who believes continuing exercise through her pregnancy this time made her recovery better. “This recovery, weirdly, I found easier than the first time, even though he was obviously a bigger baby and it was a longer pregnancy. I think I was more active during my second pregnancy and I physically felt much better and much stronger much quicker this time around.”

Sinéad Doherty, who is 38, the mother of two small children, has trained regularly for the past 10 years. She was in the routine of doing three gym sessions and two 10K runs a week before becoming pregnant with her first child just over four years ago.

“I was nervous that I was going to have to quit physical activity which is a big part of my identity and keeps me happy and balanced, both physically and psychologically,” she says. However, staff at FFS gyms, which is opening its fourth location in Dundrum Town Centre on April 3rd, recommended alternatives for various stages and reduced the intensity of her programme over time.

“But they worked closely with me as no two people are the same, no two bodies are the same, and they know the level I like to work at. We found a happy medium in my first pregnancy and when we got to my second pregnancy, we were all more comfortable with what I could and couldn’t do,” says Doherty.

I wish we could change the narrative to where pregnant women are encouraged to exercise. The benefits are now known

She says her obstetrician was happy for her to continue what she was doing and at the same level of intensity. “He was saying what will naturally happen is as you get bigger, it will become more challenging and there will be increased pressure and you will see a fall-off in your distance and speed. And that is what happened.”

Doherty had light bleeding during her first pregnancy and while others were quick to suggest it might be due to her exercise regime, her doctor believed the two were unrelated. “Of course there were days when I would take it down a notch,” she says, but she believed maintaining her fitness would put her in a better place for labour and recovery afterwards.

Having given birth to two children, now aged 3½ and 10 months, she reckons she is fitter than she was before her pregnancies.

“I wish we could change the narrative to where pregnant women are encouraged to exercise,” she adds. “The benefits are now known.”