The Active Glow: Exercising Safely During Pregnancy: Part 1

"The fitter you go into pregnancy and labour, the fitter you are postnatally, which means you will cope better with all of the stresses, and strains, and pressures of having a newborn"

In this episode, Dr Rangi is joined by pelvic floor physiotherapist and researcher Professor Helena Frawley, to discuss exercise in pregnancy, labour, postpartum and beyond.

This topic will be split into 2 episodes, in this episode Rangi and Helena discuss:

• The safety of exercise in pregnancy,
• How to approach exercise,
• Which activities are best to continue or modify,
• The benefits of exercise in pregnancy

In our next episode, Rangi and Helena will  focus on exercise after birth and how to safely return to exercise, what’s normal when it comes to pain, how to manage it, and when to seek help.

Transcript

SPEAKER_00 0:01

Welcome to Prepare, the Mimesy Pro Inhabitable podcast dedicated to helping parents prepare for the journey of pregnancy, childbirth, and early parenthood. Mimesy Pro Inhabitable would like to begin by acknowledging the wonder why we were wrong people, the traditional custodians of the land on which we gather today, and also the traditional custodians of the lands in which you're listening from today. We'd like to pay our respects to the elders past, present and emerging, and we extend that respect to Aboriginal and Torres Strait Islander peoples listening today.

SPEAKER_02 0:32

Hi everyone and welcome back to Prepare. I'm Dr. Rangy DeSilva, an obstetrician and gynecologist and researcher here at Mercy Perrinatal. Today I'm so excited to be joined by the wonderful Professor Helena Frawley, who's going to chat to me about exercise in pregnancy, labour, postpartum, and beyond, which is a really important topic. Helena's a true expert in this as she's worked as a clinical physiotherapist for many years prior to becoming a senior academic here at the University of Melbourne in Women's Health Physiotherapy. She now teaches women's health physio and is involved in some major research projects in this very area. So she'll not only be talking to us today from a clinical point of view but from a really evidence-based point of view. This is a really important topic for everyone going through pregnancy, and there's a lot to get through, so we'll break it up into two parts. Today's part we will explore the safety of exercise in pregnancy and how to approach it, and how to modify it if needed, as well as the benefits. In our next episode, we'll focus on exercise after birth and how to safely return to exercise, on what's normal when it comes to pain, how to manage it, and when to seek help. So I might ask Helena to give us a brief introduction and then we'll go from there. Thanks, Alina, and welcome to Prepare.

SPEAKER_01 1:44

Thank you, Rangi, and it's a pleasure to be part of this topic. It's a great topic, so thank you for inviting me to have a chat with you about this today. Yes, I certainly do bring a clinical background in this field as I've been a clinical physiotherapist for a long time, and in fact, an accredited fitness instructor for exercise in pregnancy in postpartum. So that's something that I did a long time ago in my career, but loved that part of my work. It was great actually doing the exercise with pregnant and postnatal women. And since then, my career has taken me into education and research, and we've done some research on exercise in pregnancy for women with gestational diabetes and the impact of having other challenges during your pregnancy in postpartum and the impact they have on your ability to exercise. So it's a great topic, it's a really important topic. Happy to talk about that today with you.

SPEAKER_02 2:37

Thank you so much, Alina. It sounds like you're the perfect person to answer some of these questions. So many of the patients that I see in clinic and and even people in the community who are pregnant or becoming pregnant or who have had a baby, the one question that they always consider is should I be exercising in pregnancy? And is it safe to exercise in pregnancy? And I know there's lots of things to consider in that question. But what are your thoughts on that?

SPEAKER_01 3:07

Absolutely, it's the number one important consideration to make everybody feel really confident that they understand it is safe. There are a few situations where we need to apply caution and we can talk about those. But for the majority of women, physical activity or exercise during pregnancy and the postpartum period is absolutely safe, and it has enormous health benefits for the pregnant person and the unborn child. So we really want to encourage pregnant people to take up that opportunity because they can actually make such a difference to their own health and even reduce some of the pregnancy-related complications that they may be at risk of developing. So it's a very important message that we can support. Yes, absolutely, it's safe to exercise. If you're in one of those special groups that might have a risk, then definitely under the guidance of a qualified health professional. But for the majority of women, it's safe to go ahead. That's really true. Unfortunately, not enough pregnant women are active. Yes. So that's the biggest challenge we face. We know it's safe, we've got very good evidence, we know it's really good for pregnancy, postpartum, and the baby. The challenge is how do we get that message across and how do we encourage more pregnant people to take up exercise if they've not previously been active, or how to continue rather than just drop everything because they're in that very special phase of being pregnant.

SPEAKER_02 4:32

So, what are your thoughts? Because I think that is a real challenge with lots of people who are considering pregnancy. They may not have incorporated regular exercise into their schedule. Being pregnant can also be quite challenging and a tiring time, physically exhausting, and lots of changes happening in your body. So taking up exercise if you haven't previously been regularly exercising can seem intimidating, challenging, time consuming, and we know that there are benefits, but how would you say is the best way to try and approach this, particularly if you're worried that you might be doing harm if you haven't previously exercised?

SPEAKER_01 5:14

Yes. Always something is better than nothing. So start slowly and gently with a little bit of exercise and build up. So we definitely want to avoid somebody who's not previously been active, picking up something new that perhaps has some stress and strain associated with it. For example, a contact sport or a fast-paced sport that has twists and turns and high impact landing and jumps. So those kinds of activities would not be a good idea to pick up for the first time once you're pregnant. If you had previously been doing those kinds of activities, it may be completely safe to continue throughout the pregnancy with some modifications as your pregnancy progresses, and we can look at those. But for the majority of people who've A not been active at all or haven't been engaged in those kind of high impact or high-risk contact sports, you would really want to start with something quite gentle and easy and cost-effective, like walking. And then you could increase your pace so that you're getting to the level where you're exerting yourself or exercising at a moderate intensity. And this is quite an important concept for exercise, and it's often very self-regulated. So nobody's going to be watching you or monitoring you as you're walking. So you need to regulate your own level of activity. So for moderate activity, it's the ability to talk while you're exercising, but you might be puffing a bit. So it's it's somewhat hard, somewhat challenging, but you can still have a conversation. So that's a good guide for what is a moderate level of intensity. Beyond moderate, we would talk about vigorous activity, and that's where you really cannot have a conversation while you're exercising as well. That's not a good idea to start at that level if you've not been exercising before. So you would definitely start at a gentle, progress up to a moderate level for somebody who's not in the habit of exercising. So what I'm hearing is try not to put too much pressure on yourself. Exactly. Go gently and always remember, listen to your body, and something is better than nothing. So don't be too hard on yourself if you feel, oh, I didn't meet the guidelines, which are try to do 30 to 60 minutes of activity every day during pregnancy at a moderate intensity or more vigorous intensity if you're used to that several days a week. So don't be too critical of yourself if you don't manage to make that every day. As long as you're doing something and you're enjoying it and you're building up, that's the most important thing. So, yes, we have the situation where we want to encourage people to do as much as they can to meet the guidelines, not be too critical on themselves if they don't manage that every day. You've got many months to improve your fitness and health. So go go slowly and gently and build up.

SPEAKER_02 8:11

Yeah, that's great advice. And do you think that that recommendation changes depending on the trimester you're in? Is or is it roughly consistent throughout pregnancy?

SPEAKER_01 8:20

It's roughly consistent. The changes would be if you were used to doing quite vigorous level of activity, that could be fast running or some of those contact sports or the uh rapid twisting and turning. You will find as you become heavier that that's actually not very comfortable. Some of them actually do carry a risk too if you're playing a contact sport such as football or rugby. Even netball can be quite challenging and quite physically demanding and accidental bumps. Even though it's technically non-contact. Correct. Yes, having um been a past netballer, it does feel like it's quite a challenging sport. So you'll feel yourself that that doesn't feel comfortable, and there is then a slight risk that if you did have a contact to your pregnant belly, that um that could harm the baby. So they're the kind of considerations to reduce that level of intensity as you become more pregnant, and then just scale it down to if you were running, you might then do fast walking or stationary cycling. Yeah. So the stationary cycling is a good replacement for road bike riding, where you might have been a cyclist out on the road when you were not pregnant, and that might be fine in the early pregnancy. But you'll find as you get bigger and heavier, your balance may not be so good, and that's a safety consideration on the road. So very easy to swap back to a stationary exercise bike. You can still exercise at a moderate intensity, even vigorous on some days. If walking is feeling a bit of a challenge, you could actually swap to a pool. So if you're walking in the pool, standing up walking in water at the depth of your chest, you'll feel an enormous sense of buoyancy and relief of the strain and the weight going down through your spine and pelvis. That can be a wonderfully comfortable and enjoyable way to exercise right through to the end of your pregnancy. Swimming's also excellent. Yeah. So for if you've been a swimmer, that's a great thing to continue with. It is very hard to injure yourself in the pool. So it's a very safe environment. Oh, good.

SPEAKER_02 10:29

And I imagine quite comfortable on the joints.

SPEAKER_01 10:31

It's wonderfully comfortable. I taught aqua aerobics during pregnancy and postpartum for many years, and the the look of relief on the pregnant person's face when she got in the water, just that relief of weight was fabulous. That's so great. And you can exercise as at a fairly moderate, vigorous intensity.

SPEAKER_02 10:48

Yeah, you can still build up that increased heart rate and muscle strength, which is great.

SPEAKER_01 11:22

Yes, there are a couple of obstetric or pregnancy-related conditions where you would be advised to seek guidance and clearance first from your doctor, whether that's your obstetrician or your GP or the midwife who's caring for you, or your women's health physiotherapist, somebody who understands the effect of pregnancy, the particular pregnancy risk or complication that you have, and is able to give you advice on how to modify the type of exercise you want to do. So that comes back to another really important point. What's the best type of exercise? It's the exercise you want to do and that you enjoy doing. So it shouldn't be a chore. Correct. It should be enjoyable and it it actually does make you feel better and it is good for you. But you do need to be aware of some of those conditions where you need to have advice from a qualified health professional. And that could be what we call an incompetent cervix. So whether there's any risk of your cervix opening early, ruptured membranes or risk of going into preterm labour, persistent bleeding during your second or third trimester, a problem with where the placenta is lying inside, preeclampsia or high blood pressure, that needs special consideration. Whether there's any evidence that your baby is not growing as expected for the dates of your pregnancy, if you have multiple bubs on board, so triplets or higher, if you have diabetes that's poorly controlled, or any other serious heart, lung, or problem with any other part of your body that does need consideration. So under any of those conditions, you should seek expert advice. But for the most part, you'll be able to find something that you can do.

SPEAKER_02 13:07

Absolutely. So with that advice.

SPEAKER_01 13:22

Great.

SPEAKER_02 13:22

I think that's really important to note because so many people are afraid of exercising in pregnancy for fear that they might do damage. So there's lots of safe ways and enjoyable ways to exercise in pregnancy, and it's recommended.

SPEAKER_01 13:35

Absolutely. So I think that's the main message we we need to share as widely as possible. It's safe, it's good for you, it's good for the baby, and there are some conditions that require modification and monitoring, but that's the minority. And even those, it's still good for you and it's safe. But yes, I think you're right, Rangi, we do need to overcome some of the myths that are out there about pregnancy because it is very special, and it's very important that we give good advice so that women can enjoy their pregnancy and enjoy the benefits it will give them, not just during the pregnancy, but during labour, birth, and recovery postnatally, because we tend to have the focus on the pregnancy, but recovering postnatally, the fitter you go into pregnancy and labour, the fitter you are postnatally, which means you will cope better with all of the stresses and strains and pressures of having a newborn. So that's a really important to remember.

SPEAKER_02 14:29

Yeah, I I did want to ask a bit more about that actually. How we know that there's definitely benefits to the pregnancy and the baby and how you will feel physically, emotionally, mentally to exercising in pregnancy. But what are some of the specific benefits of in labour with having regular exercise in pregnancy?

SPEAKER_01 14:49

Women who have a better level of fitness and strength tend to find the labouring part of labour easier to cope with. So they have a better reserve and capacity to cope with the physical stress and strain. Because it is quite a vent, yes. That's right, and particularly and specifically related to pelvic floor muscle training. If you've done pelvic floor muscle training during the pregnancy, and we can perhaps just detour slightly here that the type of exercise we recommend during pregnancy, it's not just one type. We actually need a little bit of three things. We need some aerobic or cardiovascular exercise, which is good for your heart and lungs, and we need muscle strengthening exercise, which will help build up the strength in your whole body. And there's a third type of exercise that's really important, and that's the pelvic floor muscle. So pelvic floor muscle exercises are also important to add to those other two main exercise types. And that comes into play during labour, so that women who've done pelvic floor muscle training during the labour tend not to have as difficult a labour. And that's one of the myths that has been around for a long time that if you do pelvic floor muscle training during pregnancy, that might make labour and delivery more difficult. That's absolutely not the case. In fact, it's the opposite. So we can certainly give women a lot of encouragement to do all three kinds of exercise and know that it's not going to have any negative effect on their labour and birth.

SPEAKER_02 16:21

That's really reassuring and important to know, I think, because particularly the pelvic floor, and and that is an episode that we're going to focus specifically on because it's such a difficult thing to grasp and um consider for many women. But particularly knowing that pelvic floor exercises can be beneficial for labour and postpartum, not detrimental, is really, really important.

SPEAKER_01 16:46

Absolutely. The evidence has shown that having done pelvic floor muscle training, it does not prolong second stage and it does not increase the risk of any uh birth-assisted procedures.

SPEAKER_02 16:58

Yeah, which means it doesn't increase the time that you might be pushing better out or the risk that we might need help with a forceps or a vacuum because your pelvic floor is supposedly too tight or too strong.

SPEAKER_01 17:10

That's to accommodate that myth has been debunked for sure. And with any exercise you do, it's easier to learn how to do it when you're not in pain and exhausted, or potentially if there's been any trauma to the pelvic floor because of a difficult birth. Yes. So if you've not previously done pelvic floor muscle exercises and you need to start after your baby's born, it's actually quite difficult to learn how to contract a muscle that's trying to recover and repair itself. Whereas if that muscle is used to exercising, you have a muscle memory and it will recover more quickly, it will have better blood supply and oxygen. So all of those things will help your recovery.

SPEAKER_02 17:51

Perfect. Thanks so much, Alina. I think that's a great place to pause and pick up things in our next episode. This has been such a valuable discussion, and there's clearly so much to cover. We could easily turn this into a whole series. To recap, we've talked about how exercising pregnancy is generally safe and recommended, unless you've been specifically advised otherwise by your healthcare professional. And we've talked about the many benefits it can offer for your pregnancy, labour, and recovery. I think the key takeaway is to stay active in ways that feel comfortable for you. Don't hesitate to modify your activities if needed, whether it's opting for water-based exercise or switching to something lower impact like a stationary bike. We've also touched on some important questions. Is it safe to exercise in pregnancy? How should you approach it? What types of activities are helpful? What should be avoided and adapted? And what actually are the real benefits, not just during pregnancy, but beyond. Next time we'll move into the postpartum period, looking at returning to exercise after birth and continuing the discussion around the all-important pelvic floor and how to approach pain during and after pregnancy, including when to seek her. So many great insights in this episode, and I can't wait for you to join us for part two, Helena. Thank you so much, and bye for now.

SPEAKER_00 19:08

Every pregnancy is unique. The information provided in today's podcast is for educational and general purposes only. It is not intended to be substitute for professional medical advice. It is important that you always seek the guidance of qualified health professionals with any questions you may have regarding your health, pregnancy, or any medical conditions.