Exercise is a major modifiable risk factor that has one of the greatest effects on our health and longevity. Aerobic exercise and strength training both play roles in overall fitness. There is no upper limit to the duration of daily aerobic exercise that positively affects cardiovascular fitness. Men who can do a minimum of 40 push-up exhibit a significantly decreased risk of heart attack. Resistance training has been found to decrease risk of developing osteoporosis, it is the method of choice to prevent bone loss in astronauts. Aerobic and resistance training decreases dementia risk and progression in old age, and reduces depression and anxiety. Sedentary lifestyle is associated with obesity, metabolic syndrome, type 2 diabetes, chronic inflammation, cardiovascular disease and many cancers.
During pregnancy, however, the benefits of exercise have not always been emphasized. In addition to the benefits noted for non-pregnant adults, exercise in pregnancy decreases risk of excessive weight gain (and subsequent postpartum weight retention) and may reduce the risk of gestational hypertension, gestational diabetes, preeclampsia, large-for-gestational age newborn, pelvic pain, and associated urinary incontinence.
There are pre-existing conditions that require reduced or limited exercise in pregnancy and if you have reason to believe your pregnancy may be of above average risk, you should definitely consult your doctor, but in general women with uncomplicated pregnancies and no pre-existing reason to preclude participation are encouraged to perform both strengthening and aerobic exercises. The same minimum standard of thirty minutes of aerobic exercise most days of the week is recommended in pregnancy as in the pre-conception and post-partum period (also recommended to men!). The anatomy and physiology of the body changes in pregnancy, so modifications to your normal routine may need to occur.
Reasons to stop exercising and contact a healthcare provider may include amniotic fluid leakage, abdominal pain, fainting or dizziness/lightheadedness, difficulty breathing prior to exercise, vaginal bleeding, headache, calf pain or swelling, chest pain, and fatigue or muscle weakness. Exercise should be discontinued if regular painful contractions are occurring (especially if preterm) until evaluation by a healthcare provider. Pregnancy increases risk for thromboembolic events due to it being a hypercoagulative state. Being sedentary further increases this risk. Bedrest is not routinely recommended for pregnant women with intact membranes. however women with known increased risk for miscarriage or preterm labor may be asked to reduce their physical activity by their healthcare provider.
Movement during active labor is likely beneficial, though may be limited due to use of epidural anesthesia. Being upright during labor may shorten duration and may reduce risk for cesarean. Being more cardiovascularly fit, with fewer health problems before and during pregnancy generally foreshadows a smoother labor and delivery. This should be no surprise. Yoga, stretch and incorporation of Kegel exercises can be beneficial before and after delivery in reducing long term effects of pregnancy and vaginal delivery on the pelvic floor (prolapse and incontinence). Women who undergo cesarean are less likely to have postoperative postpartum complications if they started with normal prepartum weight and didn’t gain excessively or develop metabolic or cardiovascular disorders. Morbid obesity alone makes a cesarean more high risk.
“Even when all is known, the care of a man is not yet complete, because eating alone will not keep a man well; he must also take exercise. For food and exercise, while possessing opposite qualities, yet work together to produce health.” – Hippocrates
Brück Clift, MD 