GENERAL QUESTIONS AND GUIDELINES

• Can you exercise while pregnant?
  If you have not exercised prior to pregnancy, you can begin a low intensity walking program, or prenatal exercise class that is taught by a qualified instructor. Gradually increases the time you exercise and listen to your body, if you are overly fatigued don’t exercise or cut back the length of time, intensity, or frequency you exercise.
  - The Fit to Deliver Team
  
  
• Who should not exercise during pregnancy?
  Any women who are experiencing a healthy normal pregnancy may exercise with the consent of their caregiver. All women who chose to exercise during pregnancy should discuss their decision with their caregiver prior to starting an exercise program. (There are a small percentage of the populations for whom exercise during pregnancy is contraindicated.)
  
  
• What Guidelines Exist for Exercise During Pregnancy?
  Guidelines for Exercising While Pregnant (Summary of American College of Obstetricians and Gynecologists (ACOG) 2002)
  
  
• The following is a summary of revised ACOG Guidelines. The guidelines were last updated in 2002.
  
  
  1. In the absence of contraindications (above) pregnant women are encouraged to engage in 30 minutes or more of moderate exercise on most, if not all, days of the week. A woman should always check with her caregiver before beginning an exercise program.
     
  2. After the first trimester, pregnant women should avoid supine positions during exercise. Motionless standing should also be avoided.
     
  3. Participation in a wide variety of recreational activities is safe. However, any activity with a high risk for falling or abdominal trauma should be avoided. Examples are ice hockey, soccer, basketball and vigorous racquet sports.
     
  4. Scuba diving should only be performed under a physician’s direction.
     
  5. Exertion at altitudes up to 6000 feet appears to be safe. Engaging in physical activities at higher altitudes carries a risk of hypoxemia.
     
     
• What are the Benefits of Exercise During Pregnancy?
  
  
  • Benefits to the pregnant woman
    
    
    1. Reduction in risk of developing gestational diabetes (especially in women with at BMI index greater than 33, ACOG 2002)
       
    2. Reduction in risk of developing pregnancy induced hypertension
       
    3. Fewer obstetric interventions (vacuum extraction, forceps)
       
    4. Reduction in the ‘active stage’ of labor
       
    5. No significant difference in the rate of cesarean section
       
    6. Increase in maternal well being
       
    7. Quicker return to pre-pregnancy weight
       
    8. Decreased incidence of loss of bladder control during pregnancy and postpartum
       
    9. Reduction in bone density loss during the lactation state
       
    10. Reduction in common pregnancy complaints (hemorrhoids, leg cramps back pain etc)
        
        
  • Benefits to the Infants
    
    1. Infants have less body fat at birth
       
    2. Infants are less cranky, have a reduction in the incidence of infant colic
       
    3. Greater neurodevelopmental scores in oral language and motor areas (tested at age 5)
       
    4. Do the benefits of lower body fat extend into adulthood? (Reduction is ASHD, cholesterol)
       Summary of the Research performed by James F. Clapp, III, MD
       
  
  
• When should I stop exercising?
  Guidelines for stopping exercise (Summary of American College of Obstetricians and Gynecologists (ACOG) 2002). If you experience any of the following symptoms you should stop exercising and seek medical advice.
  
  
  • Vaginal bleeding
  • Dyspnea prior to exertion (Out of Breath, prior to exercise)
  • Dizziness
  • Headache
  • Chest pain
  • Muscle weakness
  • Calf pain or swelling (DVT must be ruled out)
  • Preterm labor
  • Decreased fetal movement
  • Amniotic fluid leakage
    
    
• What should or shouldn’t I do if I have a previous injury?
  Pregnancy can aggravate old injuries, so you should discuss any old injuries with your fitness professional/phsyiotherapist prior to beginning an exercise program. If you become symptomatic, speak with your physician/physiotherapist.
  - Carl Peterson, Physical Therapist
  
  
• Will exercise affect the growth of my baby?
  In a normal, healthy pregnancy, a supervised exercise program under the guidance of a qualified professional has no impact on fetal growth or development.
  - Karen Nordahl, MD
  
  
• Will exercise cause a miscarriage?
  No, although your caregiver may advise you not to exercise until after the first trimester if you have had two or more previous miscarriages.

  - Karen Nordahl, MD
  
  
• How much weight should I gain during my pregnancy?
  With some individual variation, you should gain between 25 and 35 pounds during your pregnancy. People who are underweight at the start of their pregnancy may gain more (they tend to "catch up"), and those who are overweight may gain less. It is important to remember that if a woman gains excess weight during her pregnancy (generally greater than 40 pounds), it puts her at a greater risk for gestational diabetes and high blood pressure. There are also some OBs who are finding that extremely overweight women are having longer labors and are at a higher risk for C-sections.
  
  

  - Karen Nordahl, MD

  
  
  

CARDIO & WEIGHT WORKOUTS DURING PREGNANCY

• I can only get to the gym a few days a week (usually two to three). Is it okay to do long workouts on those days, combining cardio and weights?
  Consistency is the key to exercise during pregnancy, so you should continue to go to the gym two to three times per week but work to maintain this level of activity through out your entire pregnancy. It's fine to do cardio and weights back-to-back as long as you are not overly fatigued at the end of the workout. If you are exhausted, your workout is too hard. Be sure to monitor your intensity using the Borg Scale of Perceived Exertion or the Talk Test – see next question.
  - Renee M. Jeffreys, MS
  
  
• How Hard Should I exercise During Pregnancy? Do I monitor HR?
  Intensity level is very important during pregnancy. Remember this is not the time to improve cardiovascular fitness but to maintain it. Because of the changes that take place during pregnancy it is better to use perceived exertion vs heart rate as a measure of intensity. The Borg Scale of Perceived Exertion follows; you should exercise in the 3 to 5 range. Another method of perceived exertion, is the talk test, you should be able to carry on a conversation while you exercise, if you cannot you should decrease your intensity.
  - Renee M. Jeffreys, MS
  

Borg Scale of Perceived Exertion

• Can I do sit-ups?
  Strong abdominal muscles and lower back muscles are key to minimizing pregnancy related discomfort and dysfunction. Current guidelines suggest avoiding exercise on your back after the 4th month. The question of whether or not it is safe to do sit-ups is currently being researched and we do not have a definitive answer, however we believe that it is a mute point. We advocate “Core” training instead of sit-ups during pregnancy, and for a complete list of exercises please refer to our book.
  - Renee M. Jeffreys, MS/ Carl Petersen, Physiotherapist
  
  
• Can you workout on your back?
  Current guidelines suggest avoiding exercise on your back after the 4th month. An incline bench can be easily substituted for exercises usually performed on a flat bench. If you experience any symptoms, i.e. are dizzy or light headed, roll to your left side and eliminate all exercises on your back or on an incline. Your qualified fitness professional can help you modify your workouts so that all exercises can be done in a in a standing or sitting position. (I think this is what you would want to put on the website)
  
  If you want to go further to what we stress in the certification course. – The rationale behind the guidelines is that exercise on your back might cause a restriction in blood flow to the baby. If you do not have any symptoms, i.e. you are not light headed while exercising on your back, then you may remain there for 30 seconds, then roll to your left side for recovery.
  
  
  - Renee M. Jeffreys, MS/ Carl Petersen, Physiotherapist
  
  
• I'm 15 weeks pregnant and want to maintain my weight lifting routine. What exercises are safe to do? I'm wondering about squats, leg presses, hip abductor machines and ab exercises.
  Continue doing what exercises feel comfortable, but don't strain yourself by attempting new, unfamiliar lifts or by using too much resistance. Exercises that mimic your daily activities, like step-ups, split squats and mini lunges, are best.
  
  
  • Here are some tips to keep in mind:
    
    
    • Squats are okay, but you should decrease the range of motion-- never flex your knees more than 90 degrees. You can increase the squat workout by slowing down the tempo. Try lowering slowly to a count of three or four.
      
    • Leg presses are a good exercise in the first trimester, but after that you should not work out on your back for more than 30 seconds at a time. Leg presses give you a good workout and keep your lower abdominals tight to protect your back.
      
    • Hip abductor machines are great. Building strength in your hips will help you overcome postural changes during your pregnancy. Be sure to keep your lower abdominals tight to avoid hyper extending your back, and be cautious if you have sciatic symptoms, such as pain, numbness or tingling in your buttocks and down the back of your legs. (You should see your doctor if you have these symptoms.)
      
    • For your abs, cut out traditional sit-ups and focus on gaining control of your lower abdominals. Sitting on a physio-ball and doing kegel exercises will help strengthen them safely.
      
      
      - Carl Petersen, Physiotherapist

• Is Pilates Safe During Pregnancy?
  The benefits that have been associated with exercise and pregnancy are based on research done on cardio-vascular exercise (aerobic). There has been minimal research done on the independent benefits of Pilates. Because the base of Pilates is “Core” training, we believe that Pilates can be a beneficial adjunct to any exercise program. The pregnant woman she should make sure she is working with a Pilates instructor that is trained in prenatal exercise.
  
  

  - Renee M. Jeffreys, MS/ Carl Petersen, Physiotherapist
  
  
• Is Yoga Safe During Pregnancy?
  The benefits that have been associated with exercise and pregnancy are based on research done on cardio-vascular exercise (aerobic). There has been minimal research done on the independent benefits of yoga. We believe that yoga can be a beneficial adjunct to any exercise program. For the pregnant woman she should make sure she is working with a yoga instructor that is trained in prenatal exercise. Pregnant women should avoid exercise in extreme environmental conditions- i.e. hot yoga should be avoided- and avoid inverted positions or positions that require spending long periods of time on your back. As always, pregnant women should not stretch past their pre-pregnancy range of motion.
  
  
  - Renee M. Jeffreys, MS/ Carl Petersen, Physiotherapist
  
  
• Is Tae-Bo safe during pregnancy?
  Tae-Bo, like any other exercise that includes a cardio, flexibility and strength component, is a good adjunct to your training program while pregnant. Just be careful with fast, uncontrolled movements and jumping or high bouncing activities. Be aware that as your pregnancy progresses, your postural changes may require you to use a smaller range of motion when exercising. Avoid the fast kicks and high leg thrusts if you have any problems with your hip muscles or groin. Talk to your physical therapist for further modifications or precautions.
  
  
  - Carl Petersen, Physiotherapist
  

• Why should I work with a trainer during pregnancy, and how do I know they are qualified?
  Pregnancy is an extremely dynamic state with metabolic, and biomechanical changes taking place through out. Individuals who are “certified” either by the government, as in Canada, or by a national agency, as in the US, meets a minimum level of competency. In the United States, you should look for someone who has a degree in the field in addition to being certified as a personal trainer or group fitness instructor. Reputable personal training or group fitness certifications include: ACSM (American College of Sports Medicine), ACE (American Council on Fitness), and NASM (National Association of Sports Medicine) Certified, with ACSM being the Gold Standard. Fitness professionals should also have a certification or continuing education in pre/post natal fitness.
  

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