June 2021

Pregnancy Part 1: Is Walking Adequate Fitness During Pregnancy?

By Tracie Smith-Beyak

There is no question that walking is generally a good form of exercise. However, it is not always appropriate during all phases of pregnancy, nor does it adequately prepare a woman for delivery or the fourth ‘Tornado’ Trimester. Long gone are the days of no lifting and putting your feet up during pregnancy. Pregnancy is the time to ‘train’ for a postnatal marathon that will last several years in a sleep-deprived state.  Prenatal fitness and stamina training are essential! An optimal conditioning program should be at least 2.5 hours of exercise/week and include resistance training, weight-bearing activity, core stability training, flexibility, and pelvic floor strengthening. Biomechanical and cardiovascular modifications need to be made as the trimesters progress and regular assessment should be done. As with all things during pregnancy, do not start an exercise regimen without first consulting your physician.

Over a 5-year period, a Canadian expert panel reviewed over 73,000 publications, 27,000 abstracts, completed an extensive systematic review and then released the 2019 Guidelines for physical activity during pregnancy1 (US-based recommendations are similar; see “Physical Activity Guidelines for Americans”, below).  These guidelines provide ‘evidence-based recommendations regarding physical activity throughout pregnancy in the promotion of maternal, fetal, and neonatal health.’ There were 6 main messages2 within the guidelines:

All women without contraindication should be physically active throughout pregnancy.

Pregnant women should accumulate at least 150 minutes of moderate-intensity physical activity each week to achieve clinically meaningful health benefits and reductions in pregnancy complications.

Physical activity should be accumulated over a minimum of 3 days per week; however, being active every day is encouraged.

Pregnant women should incorporate a variety of aerobic and resistance training activities to achieve greater benefits. Adding yoga and/or gentle stretching may also be beneficial.

Pelvic floor muscle training may be performed on a daily basis to reduce the risk of urinary incontinence. Instruction in proper technique is recommended to obtain optimal benefits.

Pregnant women who experience light-headedness, nausea, or feel unwell when they exercise on their back should modify their exercise position to avoid the supine position.

Relaxin levels increase during pregnancy creating laxity across ALL joints. The weight-bearing foot, ankle, knee, hip, and pelvis are most vulnerable during the second, third, and fourth trimesters and women quite often go up half a shoe size permanently.

During the pregnancy journey significant musculoskeletal adaptations take place requiring modifications to fundamental movements such as a squat, a lunge, pushing, pulling, and lifting. Weight-bearing joints in particular are at risk for injury. ‘The hormone relaxin has a known impact on both vascular tone and connective tissue (among other areas), whereas, estrogen and progesterone activity have an impact on renal water retention and serum electrolytes concentrations. These physiologic changes have clinical ramifications that practitioners should be aware of when caring for the parturient.’3 Relaxin levels increase during pregnancy creating laxity across ALL joints. The weight-bearing foot, ankle, knee, hip, and pelvis are most vulnerable during the second, third, and fourth trimesters and women quite often go up half a shoe size permanently.

Writing in a 2013 study published in the American Journal of Physical Medicine & Rehabilitation, Segal et al observed that ‘Pregnancy appears to be associated with a permanent loss of arch height and the first pregnancy may be the most significant. These changes in the feet could contribute to the increased risk for musculoskeletal disorders in women. Further research should assess the efficacy of rehabilitative interventions for prevention of pregnancy-related arch drop., 4 Joint laxity, center of mass shift, gait change, poor posture and lack of strength/resistance training can lead to weak joint stabilizers and diminished balance rendering the patient at increased risk of injury.5

Physical Activity Guidelines for Americans

Pregnant or postpartum women should do at least 150 minutes (for example, 30 minutes a day, five days a week) of moderate-intensity aerobic physical activity per week, such as brisk walking, during and after their pregnancy. It is best to spread this activity throughout the week.

Women who already do vigorous-intensity aerobic physical activity, such as running, can continue doing so during and after their pregnancy.

Any Amount of Time is Fine

We know 150 minutes each week sounds like a lot of time, but you don’t have to do it all at once. Not only is it best to spread your physical activity out during the week, but you can break it up into smaller chunks of time during the day. As long as your aerobic physical activity is a moderate or vigorous effort, any amount of time counts toward meeting the aerobic guideline.

Are there risks involved with physical activity and pregnancy?

According to scientific evidence, the risks of moderate-intensity aerobic activity, such as brisk walking, are very low for healthy pregnant women. Physical activity does not increase your chances of low birth weight, early delivery, or early pregnancy loss.

What are some things to keep in mind when I do physical activity during and after my pregnancy?

Unless you have a medical reason to avoid physical activity during or after your pregnancy, you can begin or continue moderate-intensity aerobic physical activity.

Source: U.S. Centers for Disease Control and Prevention. Healthy Pregnant or Postpartum Women. Physical Activity Basics. Available at https://bit.ly/3qZ795D. Accessed May 20, 2021.

So, what does a clinician need to focus on with a pregnant patient/client?  What type of training is appropriate?

The Essentials

  • Take a decent history [injuries, medical conditions, meds, lifestyle, habitual environments, support, equipment, fitness level/experience, etc.].
  • Have pregnant patients and their primary caregiver complete a PARQ Med X  Pregnancy Screening Form6 or the ACSM Information On… Pregnancy Physical Activity7 and be aware of any contraindications.
  • Each trimester do a basic movement assessment [squat, lunge, push, pull, lift and balance] and note gait and posture changes and mechanical errors.
  • Create a program to minimize injury, strengthen main movers and target stabilizers for posture, occupation, and general functionality. Occupational and functional movement will be gleaned from the history, but don’t forget to plan for life after the baby arrives. Carrying baby/baby gear, nursing, laundry, cooking, and household chores all require training for a sleep-deprived mother and should be integrated in program design.
  • Listen, observe, and reassess movement regularly.

The appropriate type of training is dictated by stage of pregnancy and each patient’s particular movement patterns. For example, for patients who regularly jog or do aerobics, there may be no change during the first trimester, but the second trimester may trigger a move to lower impact water jogging or water aerobics; programming long walks for a woman in third trimester with altered gait, arch collapse, low back pain, and tension headaches may further aggravate her discomfort.  Hypothetically speaking …Her joints may not properly articulate, her arches may further collapse under the continuous impact, the impact may also compress the lordotic curve of her lumbar spine, and hyperextension of the cervical spine combined with long period of standing could cause muscle fatigue and neck pain or headache.8 In short, non-impact activities such as water walking or metabolic strength training may be better suggestions in the third trimester for cardiovascular conditioning.

Stay tuned for Pregnancy Part 2: Targeting Prenatal Programming and a Sample Workout.

Tracie Smith-Beyak is an award-winning entrepreneur, master trainer, a member of the 2019-2020 Canfitpro National Fitness Advisory Panel and has worked in sports and recreation and the business industry for over 35 years. Specializing in athletics, rehabilitation, biomechanics, and prenatal fitness, she makes regular appearances in the fitness, medical, and business sectors. She has worked internationally in government, post-secondary institutions, and the private sector. Tracie leads by example and thrives on mentoring her teams with respect, authenticity, empathy and vision.

REFERENCES
  1. Mottola MF, Davenport MH, Ruchat SM, et al. No. 367-2019 Canadian Guideline for Physical Activity throughout Pregnancy. J Obstet Gynaecol Can. 2018 Nov;40(11):1528-1537. Erratum in: J Obstet Gynaecol Can. 2019 Jul;41(7):1067.
  2. Canadian Society for Exercise Physiology. 2019 Canadian Guideline for Physical Activity throughout Pregnancy. Available at csepguidelines.ca/wp-content/uploads/2018/10/4208_CSEP_Pregnancy_Guidelines_En_P2A.pdf. Accessed June 9, 2021.
  3. Kepley JM, Bates K, Mohiuddin SS. Physiology, Maternal Changes: Introduction. StatPearls Publishing LLC. Sept. 11, 2020. Available at https://www.ncbi.nlm.nih.gov/books/NBK539766/. Accessed June 9, 2021.
  4. Segal NA, Boyer ER, Teran-Yengle P, Glass N, Hillstrom HJ, Yack HJ. Pregnancy leads to lasting changes in foot structure. Am J Phys Med Rehabil. 2013;92(3):232-241.
  5. Danna-Dos-SantosA, Magalhães AT, Silva BA, et al. Upright balance control strategies during pregnancy. Gait Posture. 2018;66:7-12.
  6. Canadian Society for Exercise Physiology. PARmed-X for pregnancy: Physical Activity Readiness Medical Examination. Copyright 2015. Available at https://vancouver.ca/files/cov/par-q-plus-form-for-pregnancy-before-exercising.pdf. Accessed June 9, 2021.
  7. American College of Sports Medicine. ACSM Information On…Pregnancy Physical Activity. https://www.acsm.org/docs/default-source/files-for-resource-library/pregnancy-physical-activity.pdf?sfvrsn=12a73853_4. Accessed June 14, 2021.
  8. Ribeiro AP, João SMA,Sacco ICN.  Static and dynamic biomechanical adaptations of the lower limbs and gait pattern changes during pregnancy.  Womens Health (Lond). 2013 Jan;9(1):99-108.

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