A guide to playing safe when there’'s more than one of you on the field.
Not that long ago, a pregnant woman riding a bicycle might have caused an uproar among doctors, mothers, even exercise professionals. We have come a long way. These days, more and more women are staying active during pregnancy—and with the experts' blessing. Today it's a whole new ball game. More women are staying active during pregnancy—and for good cause. The latest research shows that sports and exercise not only are safe for most pregnant women but also can have tremendous benefits. Regular workouts may reduce your aches and pains, boost your energy and self-esteem, give you more confidence (and perhaps strength) during labor and hasten your recovery after you give birth.
"I have yet to be able to define an upper limit on exercise for pregnant women," says James F. Clapp III, M.D., a professor of reproductive biology at Case Western Reserve University in Cleveland, who has conducted research on exercise and pregnancy for the past 15 years. "We've had pregnant women run a marathon, complete a triathlon and do a 25k cross-country ski race."
If you aren't already a marathoner or triathlete, however, you'll want to be more cautious about your prenatal exercise regimen. To begin with, check with your doctor and read the guidelines of the American College of Obstetricians and Gynecologists. Keep your ambitions reasonable. Now is not the time to add intensity to your workout, but you'll probably be safe maintaining your present training schedule—until you can't.
During exercise, use the talk test to monitor your exertion, says Bonnie Rote, R.N., director of women's exercise programs at Pascack Valley Hospital in Westwood, New Jersey: "If you can't speak a full sentence without becoming breathless, you're pushing yourself too hard."
Research indicates that exercise during pregnancy is safe and effective not just for women who were fit before getting pregnant, but also for those who had been sedentary. A 1994 University of Miami study showed that women who didn't begin doing aerobics and strength training until their second trimester still significantly improved their cardiovascular fitness. At first they could train only an average of 5 minutes on a treadmill before reaching the rather high heart rate of 150 beats per minute, but after 15 weeks, despite having gained weight and fat with pregnancy, it took 12 minutes of exercise to reach that heart rate. The nonexercising women in the control group showed a slight decrease in cardiovascular endurance over the 15 weeks.
Factoring the risks
When Clapp began his research, he thought his subjects might get into trouble with hyperthermia (overheating), congenital abnormalities and miscarriages. Instead, he found, "Regular exercise actually improves the maternal adaptations to pregnancy in a way that protects the pregnancy." For example:
Pregnant women who exercise become more effective at getting rid of excess body heat—a logical concern, since overheating in early pregnancy (the time when most vital organs are formed) might cause birth defects. Clapp's pregnant exercisers began sweating at a lower temperature (thus dissipating heat buildup) than those who didn't work out.
Exercise doesn't seem to deprive the fetus of glucose (blood sugar), says Michelle Mottola, Ph.D., associate professor of anatomy and kinesiology at the University of Western Ontario in Canada. (Some have feared that lowered glucose could lower birth weight.) Her studies with rats indicated that training somehow had a protective effect on the maternal system.
There's no evidence that the cartilage-loosening hormone relaxin increases the risk of joint injury for pregnant women. Relaxin may take effect only in the pelvis, where it's needed to help the baby's head pass through. (Mottola believes pregnant women may still be at increased risk for joint injury, however, "because you now have more body weight on your joints.")
Pregnant women who exercise may actually suffer fewer injuries than other exercising women since they tend to take extra precautions, Clapp speculates. "They pay more attention to the surface they run on; when they play tennis they don't reach as hard for the corner shot, and they don't ski as hard down a hill."
Proceed with caution Regardless of those low injury rates, Clapp and other experts recommend that active pregnant women exercise extra caution—particularly to avoid abdominal trauma.
"Avoid anything where there's a risk of falling or of quick, sharp changes of direction," Mottola says. "Pregnancy is not a good time for competitive sports, but if you do compete, you need to decrease your intensity level and perhaps find easier opponents. You're not as agile; you're not going to get there as fast." Remember, too, that your enlarging uterus and breasts will cause your center of gravity to shift, and you may not have the same balance and coordination. You'll need to modify some of your favorite sports activities while pregnant—see page 71 for tips.
Also, be sure to drink plenty of fluids throughout the day. Dehydration can lead to an increase in body temperature and heart rate, which can cause preterm labor in later months. "The uterus gets irritable [under these conditions] and has contractions," says Mona Shangold, M.D., director of the Center for Sports Gynecology and Women's Health in Philadelphia.
The pros of exercise
Exercise can be beneficial during pregnancy. Clapp asserts that women who train throughout pregnancy have labors that are one-third shorter than women who don't, and a lower rate of medical interventions, such as cesarean sections, forceps deliveries, episiotomies or even epidurals.
Clapp further believes that exercise conditions the uterus for labor by enabling the cervix to become more elastic, and thus speed labor. At present, however, that's simply speculation; measuring it would require invasive methods.
Not all experts agree that exercise speeds labor along. "My feeling is there's no way in hell you're going to make labor any easier," says Mottola, who rode a stationary bike four times a week during pregnancy, yet had to endure an excruciating 19-hour labor. "No matter how fit you are, you're still going to have the pain, and have it for the same length of time. What exercise will do is give you more stamina and perhaps help you recover from labor sooner." Length of labor aside, experts say exercise at least seems to give women more confidence going into it. "They have a better attitude dealing with the pain," says Pat Kulpa, M.D., a sports gynecologist in Tacoma and Gig Harbor, Washington. "The reason they call it labor is because it's hard work, and these women are used to hard workouts. Going in with a positive attitude really makes a difference."
Rote agrees: "The ones who are exercising are more confident that they have the physical stamina. You need the most endurance at the end of labor. The more conditioned you are, the less fatigue you'll have when it comes time to push."
Energy and esteem
Women who exercise seem to have more energy and endurance during not only labor but also throughout their pregnancies. "If you really want to make the pregnancy less exhausting, especially at the end, I think a program that significantly improves your endurance will be beneficial," says Arlette Perry, Ph.D., an associate professor of exercise physiology at the University of Miami who supervised the exercise study involving formerly sedentary pregnant women. "In the eighth and ninth months, the exercising women felt so strong. They could go up one or two flights of steps without huffing and puffing. We didn't hear those types of comments from the control group." Exercise also helps pregnant women maintain a positive body image. In the Miami study, the pregnant women who exercised rated their attitudes toward their hips, facial complexion, physical stamina, muscular strength, energy level, body build and health significantly higher than did the sedentary control group. The exercisers also felt the same as ever about their sex lives, while the control group reported significantly more negative feelings about sexual activities.
The results of this study aren't surprising. Experts often say that women who exercise during pregnancy feel better about their bodies than those who don't. "The main benefit seems to be psychological," says Judy Mahle Lutter, president and co-founder of the St. Paul, Minnesota–based Melpomene Institute for Women's Health Research, which studies the link between exercise and health. "Exercise provides some sense of control for women when their bodies are blossoming."
Getting it back faster Women who exercise during pregnancy also feel more in control afterward. "It's clear-cut—the women who exercise three or four times a week before, during and after pregnancy recover much more rapidly and get their lives back in order much more quickly—about 50 percent faster—than women who don't," says Clapp. When he asks women to come for tests five days after delivery, he adds, "The control-group women have trouble getting their lives organized enough to get themselves to the lab for the study, but the exercising women don't seem to have [that problem]." In other words, when you make time to exercise, you find a way to make time for other things as well.
Bonnie Rote also has observed that women who exercise throughout pregnancy recover faster physically after delivery than those who don't. "Active women are up and around much more quickly, and have much less muscle soreness," she says. "I've seen ballet dancers 24 hours after a C-section, and you would never know they just had major abdominal surgery."
Dancing Swan Lake the day after you give birth is probably too much to expect. Still, if you exercise during pregnancy, you'll have plenty of reasons to be glad you did—including a healthy baby.
Suzanne Schlosberg is the co-author of Weight Training for Dummies (IDG Worldwide Books Inc.)