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How to exercise safely during pregnancy

When it comes to exercise during pregnancy, there are a lot of myths and misconceptions around what is safe and what isn’t. So we spoke to Dr Etti Barsky to get the facts.

Dr Barsky says the most common myths about exercising during pregnancy include:
• Pregnant woman should take it easy during pregnancy.
• You can only exercise gently by going for walks.
• You cannot raise your heart rate above 140 beats per minute.
• You cannot use weights.
• You can’t do abdominal exercises if you are pregnant.

“If you have never exercised before, the main thing is to find a trainer who has experience training pregnant women and appreciates the body changes. You would want to initially start off training twice a week at a moderate intensity for 30 minutes to an hour. As you get fitter you will be able to increase the frequency and intensity of your training,” Dr Barsky explains.

In terms of types of exercises, most forms of recreational exercise are fine, but make sure your programme includes cardiovascular and strength training, as well as flexibility and balance.

Why pregnant women need to exercise
According to Dr Barsky, the following are the most important reasons why it’s important to exercise when you are pregnant:
• Exercising in pregnancy helps improve your fitness and endurance for labour.
• Placentas of exercising women have been found to be of better quality than their non-exercising counterparts. This shows an improved delivery of nutrients to the growing foetus.
• Women who exercise during their pregnancies heal faster after delivery regardless of their mode of delivery.
• Exercising in pregnancy helps control the amount of weight gained during the pregnancy
• By exercising in your pregnancy, you return to your pre-pregnant shape faster.

The heart rate confusion
One of the first things pregnant women who begin exercise hear is that they shouldn’t get their heart rate too high. However, as pregnancy affects your resting heart rate and thus your heart rate during exercise, it’s not always the best indicator of effort. It is also why the rather old-fashioned method of keeping your heart rate below 140 beats a minute during exercise has been shown to be ineffective.

Dr Barsky explains that heart rate refers to the amount of times your beats in a minute. Traditionally, this is an easy way for someone to measure the intensity of their training. The harder you train, the faster your heart beats. Everyone has a maximum of how high they can push their heart rate, based on their age. There are a few formulas you would then use to determine your heart rate range – this would be your target heart rate during your training session.

“But in pregnancy, heart rate is no longer an accurate indicator of exercise intensity. This is mainly due to the physiological adaptations that happen in your body during this time. During pregnancy your resting heart rate goes up, there is only so much reserve left for your heart to pump faster and your heart’s maximal rate gets reset to a lower rate.

“Also, many other factors then affect your heart rate too – such as your age, level of fitness and how well hydrated you are at the particular time that you choose to exercise.”

Barksy says she prefers using the method of RPE (Rate of Perceived Exertion).

“The RPE uses a scale (most commonly Borg’s) where you would score yourself out of 20, where 20 is the hardest you could possibly train. In pregnancy you would want to score yourself between 12 and 14. Research has correlated this to a moderate intensity of training.

“This is the reason why the heart rate limitation of 140bpm was removed from international Obstetric and Gyneacological guidelines for exercising in pregnancy,” she adds.

Exercise in the first trimester
There are no official guidelines per trimester. Barsky says the main concern during the first trimester is over-heating. In order to avoid this you would need to do the following:
• Drink cool water during your training session
• Wear cool comfortable clothing
• Exercise in a well ventilated environment
• Don’t exercise in extreme heat
• Don’t exercise if you are running a temperature.

Exercise in the second and third trimester
By the time you reach your second trimester you should be over any of the common gripes of the first 12 weeks such as morning sickness and you will be feeling great. This is often referred to as the “honeymoon trimester” and exercise for the next few weeks will be a pleasure as you will have lots of energy.

By the third trimester
If you have been exercising regularly, you should still be able to continue, although Barsky says your primary concern here will be to avoid going into premature labour.

“This is why advise against starting [exercising] if you are 30 weeks pregnant. Similarly, if you have not trained regularly up to this point, the third trimester is not the time to start. The reason being that it is in this stage of pregnancy the uterine muscles start figuring out how to work together - otherwise known as Braxton-Hicks contractions. The uterus becomes sensitive to stimulation and will contract as a result.

“If you experience contractions during an exercise session that do not subside with decreasing intensity – this is your warning sign to stop. If the contractions still don’t subside or become more intense and frequent you will need to see your gynaecologist or midwife as a matter of urgency as you could be in labour,” she says.

When not to train
Since you will be exercising for two, you need to pay extra attention to any signals your body may send you during exercise that you might be over-doing it. Barsky says that there are a number of medical and obstetrical contra-indications as to when you should not train, so check with your gynae that it is safe to train before you start a programme.

However, if you experience any of the following, you need to immediately stop exercising:
• Excessive shortness of breath
• Chest pain or palpitations
• Severe dizziness
• Abdominal pain, particularly in back or pubic area
• Sever pelvic girdle pain
• Reduced fetal movement
• Headache
• Calf pain or swelling.
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