Five facts about … exercise during the child-bearing year
To coincide with Women’s Health Week 7–11 September, Brooke Dobo and Tory Toogood contribute five evidence- based practice points about the benefits of exercise during and after pregnancy.
1. Exercise during pregnancy has many benefits to mother and baby
It is recommended that pregnant women perform at least 150 minutes of moderate- intensity exercise per week, as there are many known benefits to mother and baby.
Benefits include controlling gestational weight gain (Santaella et al 2020, Nascimento et al 2012), limiting weight gain in pregnant women who are overweight or obese (Sui et al 2012), reducing the risk of preeclampsia/gestational hypertension (Santaella et al 2020), reducing the risk of gestational diabetes and associated macrosomia (Bianchi et al 2020, Han et al 2012), and improving mood and sleep (Robledo-Colonia et al 2012, Hollenbach et al 2013), to name a few.
It is safe for healthy women who habitually engaged in exercise before pregnancy to continue during pregnancy, provided they remain healthy and discuss with their healthcare provider how and when activity should be adjusted over time (Birsner & Gyamfi-Bannerman 2020).
For women who were previously sedentary, pregnancy is a great time to commence gentle exercise and gradually progress over time. This can be guided by a physiotherapist.
It is important that healthcare providers (including physiotherapists working with pregnant women) educate this population on the importance of antenatal exercise.
Antenatal exercise classes are an excellent way for mothers-to-be to connect with other new mums, for social support, motivation and a positive impact on general wellbeing.
Pregnancy is the perfect time to establish and maintain lifelong healthy habits, including regular exercise.
2. Exercise prevents and reduces pelvic girdle and lower back pain during pregnancy
Over 50 per cent of women experience lower back pain (LBP) during their pregnancy, with one-third suffering from severe pain at some point (Katonis et al 2011).
Furthermore, some studies report up to 90 per cent of pregnant women suffering from pelvic girdle pain (PGP) and/or LBP.
It is well established that regular exercise not only treats antenatal LBP and PGP and associated disabilities, but it can also help prevent the onset of pain (Augustina et al 2020).
Individualised exercises prescribed by a physiotherapist can help to treat pregnancy-related LBP/PGP (van Benten et al 2014).
This includes abdominal strengthening exercises, pelvic floor muscle training, as well as targeted stretches and general low- impact exercises such as gentle walking, stationary cycling or swimming.
3. Pelvic floor exercises during and after pregnancy greatly reduce the risk of pelvic floor dysfunction
There is a grade A recommendation based on level 1 evidence that pelvic floor muscle training during and after pregnancy prevents (and reduces symptoms of) pelvic floor dysfunction, including stress urinary incontinence (Wesnes & Lose 2013).
Despite the well-known benefits of pelvic floor muscle training during and after pregnancy, there are barriers to women not performing exercises, with many women suffering from symptoms of pelvic floor dysfunction.
It is well established that up to one-third of women who have ever had a baby leak urine, yet there are currently no guidelines for exercise during pregnancy that include pelvic floor muscle training, which is unfortunate considering the evidence for the prevention and treatment of urinary incontinence.
A supervised pelvic floor muscle training protocol following strength-training principles, emphasising maximum contractions, is recommended during and after pregnancy to prevent urinary incontinence (Mørkved & Bø 2014).
It is also important that women have an awareness of functional pelvic floor muscle activation, including during exercise as well as during the day with activities that involve increased pressure on the pelvic floor.
It is important to educate our patients on the importance of exercise and its benefits of not only preventing but also reducing pain, as pain itself during pregnancy is a potential barrier to physical activity.
4. Individualised assessment and rehabilitation is best after delivering a baby
Pregnancy and childbirth cause significant stretch to the pelvic floor muscles, as well as the pelvic ligaments and fascia, such that most women have a weak and injured pelvic floor after delivery.
Like any muscle injury, this requires time and individualised rehabilitation to recover optimal function of the abdominal and pelvic muscles.
Recovery of the pelvic floor muscles and associated connective tissue and nerves is usually maximised by 4–6 months postnatally.
As mentioned, there is level 1 evidence that postnatal women can benefit from individualised assessment and guided pelvic floor rehabilitation to prevent and manage conditions such as pelvic organ prolapse and urinary incontinence, and to improve sexual function.
Every mother, regardless of mode of delivery, should have access to an individualised pelvic health assessment at 6–12 weeks postnatally to comprehensively assess her abdominal wall and pelvic floor function as indicated.
5. It is recommended to wait at least three months after childbirth before considering a return to running
Recognising that there were no clear guidelines existing for health and fitness professionals to guide women in returning to running after having a baby, a group of three physiotherapists in the UK collated the evidence and have now presented their findings around the world.
Running is a high-impact activity that places significant loads on the pelvic floor, especially when compared to low-impact forms of exercise.
Therefore, a low-impact exercise regimen for the first three months incorporating basic cardio (walking, cycling, and swimming) and low-load pelvic floor and abdominal exercises, followed by a graduated return to more load over the next three months, should be planned following usual return-to-sport rehabilitation guidelines.
Women with signs of pelvic floor dysfunction—such as incontinence, urinary or faecal urgency, pelvic heaviness or bulging, sexual or lumbopelvic pain or decreased abdominal strength—should prioritise a comprehensive pelvic health assessment before running.
Load and impact screening, video analysis, and strength testing should all be performed.
A ‘Couch to 5k’ type of program is a useful framework following the first three months. It is better to err on the side of caution for these women in the first six months.
Brooke Dobo, APAM, is vice-chair of the Queensland chapter of the Women’s, Men’s and Pelvic Health group, and works as a women’s, men’s and pelvic health physiotherapist at The Wesley Hospital, Brisbane. Brooke has a special interest in antenatal/ postnatal exercise, prostatectomy rehabilitation and sexual pain.
Tory Toogood, APAM, MACP, is an APA Women’s, Men’s and Pelvic Health Physiotherapist and a registrar of the Australian College of Physiotherapists who works exclusively in private practice in Adelaide at both Vital Core Physiotherapy and in medical specialist rooms in gynaecology and colorectal surgery. Tory is also a marathon runner.
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