Limiting physical activities

Evidence 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874745/ 

Nichelle Satterfield, Edward R. Newton, and Linda E. May 

Women with a history of preterm delivery who are receiving regular prenatal care and indicated progesterone therapy should be encouraged to continue working with minimal restrictions and participate in 30 minutes of moderate intensity exercise most days of the week. This recommendation would not apply to women with a short cervix (less than 25 mm) who undergo cerclage placement, as exercise is contraindicated in that population. For patients who are hospitalized for preterm labour, regardless of whether they have a history of preterm birth, aerobic exercise is not recommended, and work activity may need to be restricted depending on the patient’s occupation. Many obstetricians may recommend women in that situation stop working but should be cautioned against prescribing bed rest. Given the modest occupational risks on preterm labour, it is reasonable for women with a history of preterm birth to reduce their amount of time standing and heavy lifting at work. 

Education 

Some health conditions in pregnancy such as hypertension or lung disease restrict safe exercise during pregnancy. It is important therefore that pregnant women discuss their activity levels with a health professional and make adjustments as advised. 

Exercise during Pregnancy  

Specific activities to avoid during pregnancy include contact sports, high-altitude exertion, including downhill skiing and scuba diving. Also, exercise in the supine position (lying on back) should be avoided after the first trimester or 16 weeks gestation. Modifying the position of the exercise to instead be performed on your side, sitting, or standing is a safe alternative. Types of exercise to do during pregnancy include aerobic conditioning and strength training of all the major muscle groups and your pelvic floor. 

Aerobic exercise which are safe during pregnancy can include: 

• walking 

• jogging 

• swimming 

• cycling (on a stationary bike) 

• low-impact aerobic exercise classes. 

• exercise in water (aqua aerobics) 

• yoga or Pilates – tell your instructor that you are pregnant before the class 

• pregnancy exercise classes. 

Women who are active during pregnancy can continue with their regular exercise or sport, as long as associated risks and any recommended changes are considered (such as avoiding the specific activities above and not making rapid changes in direction). 

Cautions for Pregnancy exercise  

While most forms of exercise are safe, there are some exercises that involve positions and movements that may be uncomfortable or harmful for pregnant women. Be guided by your doctor or physiotherapist, but general cautions include: 

• Avoid raising your body temperature too high – for example, don’t soak in hot spas or exercise to the point of heavy sweating. Reduce your level of exercise on hot or humid days. 

• Don’t exercise to the point of exhaustion. 

• If weight training, choose low weights and medium to high repetitions – avoid lifting heavy weights altogether. 

• Avoid exercise if you are ill or feverish. 

• If you don’t feel like exercising on a particular day, don’t! It is important to listen to your body to avoid unnecessarily depleting your energy reserves. 

• Don’t increase the intensity of your sporting program while you are pregnant, and always work at less than 75 per cent of your maximum heart rate. 

In addition, if you develop an illness or a complication of pregnancy, talk with your doctor or midwife before continuing or restarting your exercise program. 

Exercises to avoid while pregnant  

During pregnancy, avoid sports and activities with increased risk of falling. If you’re not sure whether a particular activity is safe during pregnancy, check with your healthcare professional. Activities to avoid include: 

• Contact sports or activities that carry a risk of falling (such as trampolining, rollerblading, downhill skiing, horse riding and basketball) 

• Competition sports – depending on the stage of your pregnancy, the level of competition and your level of fitness (consult your doctor, physiotherapist or healthcare professional) 

• After about the fourth month of pregnancy, exercises that involve lying on your back – the weight of the baby can slow the return of blood to the heart. Try to modify these exercises by lying on your side. 

• In the later stages of pregnancy, activities that involve jumping, frequent changes of direction and excessive stretching (such as gymnastics). 

When to stop exercising while pregnant  

Stop exercising while pregnant if you experience: 

• abdominal pain 

• any ‘gush’ of fluid from the vagina 

• calf pain or swelling 

• chest pain 

• decreased foetal movement 

• dizziness or presyncope (light-headedness, muscular weakness and blurred vision) 

• shortness of breath before exertion 

• excessive fatigue 

• headache 

• pelvic pain 

• excessive shortness of breath 

• painful uterine contractions 

• vaginal bleeding. 

Ultimately, listen to your body. Be aware of these signs and symptoms, stop physical activity immediately and consult your doctor. 

Warning signs to stop physical activity/exercise 

International physical activity guidelines and expert opinions suggest that pregnant women who experience any of the following symptoms during physical activity/exercise should stop, and seek advice from their health professional before continuing with a physical activity/exercise program: 

• Chest pain 

• Persistent excessive shortness of breath – that does not resolve with rest 

• Severe headache 

• Persistent dizziness / feeling faint – that does not resolve with rest 

• Regular painful uterine contractions 

• Vaginal bleeding 

• Persistent loss of fluid from the vagina – indicating possible ruptured membranes

Things you should never do (Absolute Contraindications) 

International physical activity guidelines and expert opinions concur that pregnant women who have any of the following are advised not to exercise until individually tailored advice has been sought: 

• Incompetent cervix 

• Ruptured membranes, preterm labour 

• Persistent second or third trimester bleeding 

• Placenta previa 

• Pre-eclampsia 

• Evidence of intrauterine growth restriction 

• Multiple gestation (triplets or higher number) 

• Poorly controlled Type 1 diabetes, hypertension or thyroid disease 

• Other serious cardiovascular, respiratory or systemic disorder 

Things you should be careful about (Relative Contraindications) 

International physical activity guidelines and expert opinions also concur that a pregnant woman with a history of, or who develop, the following conditions during pregnancy should discuss starting or continuing physical activity/exercise with their health professional: 

• History of spontaneous miscarriage, preterm labour or fetal growth restriction 

• Mild/moderate cardiovascular or chronic respiratory disease 

• Pregnancy induced hypertension 

• Poorly controlled seizure disorder 

• Type 1 diabetes 

• Symptomatic anaemia 

• Malnutrition, significantly underweight or eating disorder 

• Twin pregnancy after the 28th week 

• Other significant medical conditions 

Useful Links 

The Australasian Faculty of Occupational and Environmental Medicine Guide to Pregnancy and Work  

https://www.racp.edu.au/docs/default-source/advocacy-library/guide-to-pregnancy-and-work-afoem.pdf?sfvrsn=85c3031a_14 

Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). 

https://ranzcog.edu.au/wp-content/uploads/2022/05/Exercise-during-pregnancy.pdf 

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