If you do not exercise routinely and you are starting an aerobic exercise programme, you should be advised to begin with no more than 15 minutes continuous exercise three times per week. Increase gradually to a maximum of 30 minute sessions four times a week to daily.

If you exercised regularly before pregnancy, you should be able to engage in the same higher intensity exercise programmes, such as running and aerobics. It will have no adverse effects for you or the baby.

As your pregnancy progresses, you should be aiming to gradually reduce your overall activity. Your healthcare professional can give you guidance on when and how to reduce your exercise.

• You should avoid exercises which involve lying flat on your back, particularly after 16 weeks.
• You should avoid contact sports where there is a risk of being hit in the abdomen, such as kickboxing, judo or squash.
• You should take particular care when doing exercises where there is a possibility of falling or losing your balance, such as horse riding, downhill skiing, ice hockey, gymnastics and cycling. Because your joints are less stable, your centre of gravity is altered (the bump tends to overbalance you), and your reactions are slower. It might be best to avoid these exercises unless you do these activities regularly and you generally take extra care. The consequences of a fall can be more severe in pregnancy.
• You should avoid scuba diving for your entire pregnancy because the baby has no protection against decompression sickness and gas embolism under water.
• You should avoid exercising over 2500 metres until you have acclimatised.

To ensure that you do not over-exert yourself, you should always have a warm-up and a cool-down period.

There are also various techniques to help you to stay fit without exercising too intensely. These are:

The ‘talk test’

During recreational exercise, you should be able to hold a conversation. If you become breathless as you talk, then you are probably exercising too strenuously.

Self-assessment scale

Another way to ensure that you are not over–exerting yourself is to use the ‘Borg Scale of Perceived Exertion’. This scale allows you to assess for yourself how strenuously you are exercising. One advantage of this technique is that it enables you to increase or decrease the intensity of your exercise as your pregnancy progresses.

Borg Scale of Perceived Exertion: As can be seen, ‘very, very, light exercise’ is at one end of the scale (7 points) and ‘very, very, hard exercise’ is at the other end (19 points). During pregnancy you should be aiming to stay fit, which is around the middle of this scale, described as ‘Somewhat hard’ (12–14 points).



Monitoring your heart rate

When doing aerobic exercises, you should have a target zone for your heart rate. The target zone will depend upon your age and your exercise routine (as below). If you had a sedentary lifestyle prior to pregnancy, you will probably be advised of a maximum heart rate of sixty to seventy percent above your normal rate. If you are aiming to maintain fitness during pregnancy, then the upper limit of sixty to ninety percent of maximum heart rate will be advised. You should check your heart rate

regularly while exercising to ensure that you do not exceed your target zone. To check this, you need to be able to take your pulse. This is because your pulse rate tells you how many times your heart beats. Your healthcare professional should show you how to take your pulse accurately. Information can be found at http://www.strokeheart.org/CYPA/check.html

MODIFIED HEART RATE TARGET ZONES FOR AEROBIC EXERCISE IN PREGNANCY

Maternal age	Heart rate target zone (beats/minute)
Less than 20 years	140-155
20-29 years	135-150
30-39 years	130-145
Over 40 years	125-140

 

If you have any unusual symptoms, you should not continue to exercise. If your symptoms began during aerobic exercise, it is important that you do not bring your exercises to an end abruptly as this can make you feel very faint. Instead, you should either walk around slowly for a short while, or continue transferring your weight from one foot to the other by lifting one heel and then the other.

You should contact your healthcare professional immediately afterwards.

Unusual symptoms may include any of the following:

• dizziness or feeling faint
• headache
• shortness of breath before exertion
• difficulty getting your breath whilst exercising
• pain or palpitations in your chest
• pain in your abdomen, back or pubic area
• pain in your pelvic girdle
• weakness in your muscles
• pain or swelling in your leg/legs
• painful uterine contractions or preterm labour
• fewer movements from baby
• leakage of your ‘waters’ (amniotic fluid)

Your programme should be designed to keep you fit, rather than improve your physical fitness or prepare you for a competition. For some women, this will mean adjusting to a less intense routine. For other women, it might mean introducing exercise to their lifestyle.

The development of an exercise programme should take into account your fitness level including the kind of exercise you do, how much and how often you exercise and what you want to achieve.

Based on how fit you are, your exercise routine will be classified as sedentary, recreational or competitive athlete. A health professional with a specialist training in teaching exercise during and

after pregnancy will weigh up the potential benefits and harms of a range of exercises. Depending upon your current exercise routine, a programme should be recommended for you during pregnancy. This will include:

• appropriate types of exercise
• the length of each exercise session
• the number of exercise sessions each week
• how intensely you should exercise.

If you have had an uncomplicated pregnancy and delivery, then you should be able to do mild recreational exercise such as walking and stretching immediately after birth. You should be advised to do pelvic floor exercises after the birth, as this reduces the risk of urinary and faecal incontinence.

Women who do exercise during pregnancy, tend to continue to exercise after birth. The benefits of exercising at this time are that you:

• feel better
• feel less anxious and depressed
• have more energy
• lose weight
• feel fitter (improved cardiovascular fitness).

You should return to the exercise routine you maintained before pregnancy only when you feel ready to do so. You should not try any high impact activity (where both feet leave the ground at the same time such as jumping or jogging) too soon.

During pregnancy abdominal muscles are stretched and pulled to the side. You should follow advice of your Chartered Physiotherapist in Women’s Health about when and how to exercise in the first few days and weeks after birth.

If you had complications during pregnancy, then you should discuss what exercise is safe to do after birth with a healthcare professional.