Updated: Feb 27, 2018
With all the misinformation and conflicting guidance out there it is difficult to know whether it is ok to workout during and after pregnancy.
In short, the answer is: Yes, you should!
Physical exercise poses numerous benefits for the pregnant women. Unfortunately, the interpretation of research over the past decade or so on maternal exercise is seemingly confusing as most studies fail to discern between different types of physical activity. As a result it was not 100% clear to what extent these benefits are realised from resistance training compared with other modalities.
Fortunately, emerging research is helping to dispel the myths that exist amongst pregnant women and medical professionals alike.
It is my aim to piece together a series of blog posts to help you understand the benefits of maternal strength training, separate myths from the truth, and explain the basic considerations with programme design.
Outlined within part 1 of this series are the benefits of exercise and resistance training during pregnancy.
Resistance training can help prevent excessive fat gain:
Women seem to experience their greatest gain in body-fat during the childbearing age (25-34). This is largely attributed to the weight gained whilst pregnant. Seemingly from lack of physical exercise. Research by Clapp (2000) suggested that much of this gain in body fat can be prevented by adhering to a regular and consistent programme of prenatal exercise. Barakat, Lucia and Ruiz (2009) showed how resistance training during the maternal period helped women limit the weight gained throughout the course of their pregnancy. More specifically, Clapp and Little (1995) found that pregnant women who maintained physical activity levels during pregnancy gained 20% less body fat compared with those who did not.
In two studies, one by Rooney and Schauberger (1990) and the other by Polley, et al. (2002), it was found that women who gained more than the recommended amount of weight during pregnancy were significantly heavier later in life. It is very important to limit excessive weight gain, both for health during and after pregnancy. Clapp (2000) explains how the less physical activity a woman is before giving birth, the more likely she is to retain the weight gained in the long term. This is especially problematic as failing to do so has been found to increase the risk of breast cancer (Kinnunen, et al., 2007).
So, regular and consistent resistance training throughout pregnancy can help prevent excessive fat gain and help keep you healthier later in life.
Reduced risk of Gestational Diabetes:
Women who are not physically active during pregnancy are at a greater risk of acquiring Gestational Diabetes (GDM). This is a condition where women who do not have diabetes develop very high blood glucose levels during pregnancy. It generally results in few symptoms, but increases the risk of pre-eclampsia, depression and the need for a caesarean section. It also increases the risk of the baby having jaundice and low blood sugar at birth.
GDM is the one of the most common medical complication associated with childbirth, affecting up to 10% of all pregnancies. Women with GDM are prone to developing diabetes post birth. Making matters worse, children born to women with GDM are at an increase risk of obesity, impaired glucose tolerance, and type 2 diabetes (Pettitt, et al., 1993).
Physically active women who exercise during pregnancy show substantially lower rates of GDM (Dye, et al., 1997; Dempsey, et al., 2004; Oken, et al., 2006). In fact, those who exercise during pregnancy reduce their odds of acquiring GDM by 59%, and the more the woman exercising the more these odds improve.
Brankston et al (2004) has shown that resistance training, specifically, may help to reduce the need for insulin therapy in women with GDM.
Reduced risk of pre-eclampsia:
Pre-eclampsia is a pregnancy related disorder that involves maternal hypertension (high blood pressure), proteinuria (presence of abnormal levels of protein in urine which may cause damage to the kidneys) and edema (swelling or the accumulation of fluid under the skin).
Pre-eclampsia can bring on seizures and or cerebral haemorrhage and is the second leading cause of maternal death in western populations. Research suggests that regular prenatal exercise may prevent or limit the progression of the disease (Weissgerber, et al., 2004). Again, more studies have shown that the more the woman exercises, the less risk she has on acquiring pre-eclampsia (Marcoux, et al., 1989). Sorensen et al (2003) demonstrated how light prenatal exercise reduced the risk by 24% whereas vigorous and regular exercise reduced the risk by as much as 54%.
It is said that exercise has this protective effect because of the stimulation of placental growth, vascularity, reduction of oxidative stress and exercise induced reversal of maternal endothelial dysfunction (Weissgerber, et al., 2004).
Improved Body Image:
The changes that occur during pregnancy often lead to a reduced sense of body image (Moore, 1978; Strang and Sullivan 1985). Many women report feeling overweight and unattractive, therefore resulting in a sharp decline in their perception of body image.
Marquez-Sterling et al (2000) found that women who exercised during pregnancy had a significantly better body image than those who did not. This extended into later stages of pregnancy also.
Moreover, Boscaglia et al (2003) reported that women who exercised at least 90 minutes in duration at a moderate intensity were significantly more satisfied with their bodies throughout the term.
Improved Psychological Well-Being:
Pregnancy is associated with alterations in mood, often leading to depression. Haas et al (2005) reported that the prevalence of depressive symptoms rises from 11.7% before pregnancy, to 25.2% during the third trimester. Hormonal shifts, body changes, and impaired physical function play a role in reducing a woman's feelings of well-being.
Research shows the reduction in incidences and the severity of depression following maternal exercise (Wallace, et al., 1986; Poudevigne and O’Connor, 2006).
Koniak-Griffin (1994) demonstrated how 6 weeks of exercise had profound effects on reducing anxiety.
Research has shown exercise to be as effective as medication in treating mild to moderate forms of depression (Wise, et al., 2006)!
Even a single bout or a one-off session has been shown to improve scores of mood in pregnant women during their second and third trimeters (Polman, et al., 2007).
Reduced Lower Back Pain:
Lower back pain (LBP) is one of the most common pregnancy-related disorders, with 76% of women reporting pain at some point (Kristiansson, et al., 1996). LBP during pregnancy can have wide-ranging effects, including interfering with day to day tasks and disturbing normal sleep. In some cases, the pain can become so unbearable that it forces a woman to take a leave of absence from work, often rendering them to bed rest.
LBP can be partially down to an increased lumbar lordotic curvature and altered center of gravity brought on by changes in body shape, which places increased stress on the muscles of the lumbar region. This can be made worse by spinal ligament laxity due to an increased secretion of the hormone relaxin.
Exercise has been shown to help counteract lumbar stress and reduce symptoms associated with LBP (Suputtitada, et al., 2002).
Exercises that target the core musculature or postural muscles of the trunk, appear to be particularly effective in improving maternal back health. Garshasbi and Faghih Zadeh (Garshasbi, et al., 2005) found that pregnant women who participated in an exercise program specifically designed to strengthen the core reported a significant reduction in LBP.
Improved Fetal Development:
In the recent past, women were advised to avoid exercise during pregnancy to prevent any adverse outcome and ensure a healthy delivery. Not only has this myth been debunked but studies suggest that prenatal exercise actually can have positive impact on the fetus.
Clapp et al. (2000) observed that children born to women who performed weight-bearing exercise 3–5 times per week throughout pregnancy were taller and had more lean body mass. Other studies show a reduction in fetal fat mass while maintaining lean muscle tissue (Clapp and Capeless, 1990). Barakat et al. (2009) found that prepregnancy maternal body weight was associated with increased bodyweight of the newborn in nonexercisers but not in those who performed resistance exercise. Moreover, resistance training reduced the risk of the baby being born with macrosomia (significantly larger than average) in those with GDM.
Positive effects of exercise on the fetus appear to extend into the postnatal period. The offspring of women who perform vigorous exercise throughout the pregnancy have been found to show signs of heightened attentiveness and discipline! By the age of 5, these children are neuro-developmentally more advanced compared with children of mothers who did not exercise (Clapp, 2003). These results were attributed to the ability of regular exercise to increase blood volume, cardiac output, and placental function, which in turn increases nutrient delivery to the placenta, thereby improving foetal nourishment.
Women who are physically active during pregnancy have been shown to have a decreased risk of premature labor (Klebanoff, et al., 1990) and a reduced incidence of cesarean delivery and shorter hospitalization (Hall and Kaufmann, 1987). Barakat et al. (2009) demonstrated how there were no negative effects noted in those who lifted weights.
Clapp (1990) found that frequent exercisers experienced a shorter duration of active labor and a lower incidence of operative delivery. In addition, there was a reduced incidence of acute foetal stress in the exercise group as.
Taken as a whole, these findings indicate that the use of a regimented program of maternal exercise has no negative effects on delivery and generally results in an easier pregnancy with fewer complications.
Reduce pelvic floor dysfunctions:
After pregnancy, up to 50% of women experience pelvic floor dysfunctions such as incontinence and pelvic organ prolapse. These will leave women feeling vulnerable and unable to train post pregnancy. Unfortunately, whilst the GP may clear a woman to exercise after a check-up post-birth, there is very little information given to help treat such symptoms.
Resistance training during pregnancy may help reduce the symptoms of pelvic floor dysfunction and also increase the rate of recovery post birth.
Exercise during pregnancy can help:
Limit excessive gains in body fat both during and after pregnancy.
Reduce the risk of gestational diabetes
Reduce the likelihood of the baby having jaundice, becoming obese and acquiring diabetes.
Reduce the risk of pre-eclampsia.
Improve body image and self-confidence.
Prevent the likelihood of depression and anxiety.
Reduce lower back pain and improve posture.
Improve metal development
Improve the physical and neural development of the child in early life.
Improve foetal nourishment
Produce an easier labour
Reduce likelihood for the need of a caesarean section and time in hospital.
Reduce symptoms of pelvic floor dysfunction.
If that isn't enough to persuade you to continue to train, I don't know what is!
In part 2 of the series, I aim to debunk some of the existing myths around resistance training during pregnancy.
Click here to read part 2
Barakat, R., Lucia, A. and Ruiz, J. R., 2009. Resistance exercise training during pregnancy and newborn's birth size: a randomised controlled trial. International Journal of Obesity, 33, pp. 1048-1057.
Boscaglia, N., Skouteris, H. and Wertheim, E. H., 2003. Changes in body image satisfaction during pregnancy: A comparison of high exercising and low exercising women. Aust N Z J Obstet Gynaecol 43, pp. 41–45.
Brankston, G. N., Mitchell, B. F., Ryan, E. A. and Okun, N. B., 2004. Resistance exercise decreases the need for insulin in overweight women with gestational diabetes mellitus. Am J Obstet Gynecol, 190, pp. 188–193.
Clapp, J. F., 2000. Exercise during pregnancy - a clinical update. Clin Sports Med, 19, pp. 273-286.
Clapp, J. F. and Little , K. D., 1995. Effect of recreational exercise on pregnancy weight gain and subcutaneous fat deposition. Med Sci Sports Exercise, 27, pp. 170-177.
Clapp, J. F. and Capeless, E. L., 1990. Neonatal morphometrics after endurance exercise during pregnancy. Am J Obstet Gynecol 163(Pt 1), pp. 1805–1811.
Clapp, J. F., 2003. The effects of maternal exercise on fetal oxygenation and feto-placental growth. Eur J Obstet Gynecol Reprod Biol 110(Suppl 1): S80–S85.
Clapp. J. F., Kim, H., Burciu, B. and Lopez, B., 2000. Beginning regular exercise in early pregnancy: Effect on feto-placental growth. Am J Obstet Gynecol, 183, pp. 1484–1488.
Dempsey, J. C., Butler, C. L., Sorensen, T. K., Lee, I-M., Thompson, M. L., Miller, R. S., Frederick, I. O. and Williams, M. A., 2004. A case-control study of maternal recreational physical activity and risk of gestational diabetes mellitus. Diabetes Res Clin Pract 66, pp. 203–215.
Dye, T. D., Knox, K. L., Artal, R., Aubry, R. H. and Wojtowycz, M. A., 1997. Physical activity, obesity, and diabetes in pregnancy. Am J Epidemiol, 146, pp. 961–965.
Haas, J. S., Jackson, R. A., Fuentes-Afflick, E., Stewart, A. L., Dean, M. L., Brawarsky, P. and Escobar, G. J., 2005. Changes in the health status of women during and after pregnancy. J Gen Intern Med, 20, pp. 45–51.
Hall, D. C. and Kaufmann, D. A., 1987. Effects of aerobic and strength conditioning on pregnancy outcomes. Am J Obstet Gynecol, 157, pp. 1199–1203.
Garshasbi, A. and Faghih Zadeh, S., 2005. The effect of exercise on the intensity of low back pain in pregnant women. Int J Gynaecol Obstet, 88, pp. 271–275.
Kinnunen, T. I., Pasanen, M., Aittasalo, M., Fogelholm, M., Hilakivi-Clarke, L., Weiderpass, E. and Luoto, R., 2007. Preventing excessive weight gain during pregnancy - a controlled trial in primary health care. European Journal of Clinical Nutrition, 61, pp. 884-891.
Klebanoff, M. A., Shiono, P. H. and Carey, J. C., 1990. The effect of physical activity during pregnancy on preterm delivery and birth weight. Am J Obstet Gynecol 163(Pt 1): 1450–1456.
Koniak-Griffin, D. 1994. Aerobic exercise, psychological well-being, and physical discomforts during adolescent pregnancy. Res Nurs Health, 17, pp. 253– 263.
Kristiansson, P., Svardsudd, K. and von Schoultz, B., 1996. Back pain during pregnancy: A prospective study. Spine (Phila Pa 1976), 21, pp. 702–709.
Marquez-Sterling, S., Perry, A. C., Kaplan, T. A., Halberstein, R. A. and Signorile, J. F., 2000. Physical and psychological changes with vigorous exercise in sedentary primigravidae. Med Sci Sports Exerc, 32, pp. 58–62.
Marcoux, S., Brisson, J. and Fabia, J., 1989. The effect of leisure time physical activity on the risk of pre-eclampsia and gestational hypertension. J Epidemiol Community Health 43, pp. 147–152.
Moore, D. S., 1978. The body image in pregnancy. J Nurse Midwifery, 22, pp. 17–27.
Oken, E., Ning, Y., Rifas-Shiman, S. L., Radesky, J. S., Rich-Edwards, J. W. and Gillman, M. W., 2006. Associations of physical activity and inactivity before and during pregnancy with glucose tolerance. Obstet Gynecol, 108, pp. 1200–1207.
Pettitt, D. J., Nelson, R. G., Saad, M. F., Bennett, P.H. and Knowler, W. C., 1993. Diabetes and obesity in the offspring of Pima Indian women with diabetes during pregnancy. Diabetes Care 16, pp. 310–314.
Polley, B. A., Wing, R. R. and Sims, C. J., 2002. Randomised controlled trial to prevent excessive weight gain in pregnant women. International Journal of Obesity Related Metabolic Disorders, 26, pp. 1494-1502.
Polman, R., Kaiseler, M. and Borkoles, E., 2007 Effect of a single bout of exercise on the mood of pregnant women. J Sports Med Phys Fitness, 47, pp. 103–111.
Poudevigne, M. S. and O’Connor, P. J., 2006. A review of physical activity patterns in pregnant women and their relationship to psychological health. Sports Med, 36, pp. 19– 38.
Rooney, B. and Schauberger, C. W., 1990. Excess pregnancy weight gain and long term obesity: one decade later. Obset Gynecol, 100, pp. 245-252.
Sorensen, T. K., Williams, M. A., Lee, I. M., Dashow, E. E., Thompson, M. L. and Luthy, D. A., 2003. Recreational physical activity during pregnancy and risk of preeclampsia. Hypertension 41, pp. 1273–1280.
Strang, V. R. and Sullivan, P. L., 1985. Body image attitudes during pregnancy and the postpartum period. J Obstet Gynecol Neonatal Nurs, 14, pp. 332–337.
Suputtitada, A., Wacharapreechanont, T. and Chaisayan, P., 2002. Effect of the ‘‘sitting pelvic tilt exercise’’ during the third trimester in primigravidas on back pain. J Med Assoc Thai 85(Suppl 1): S170– S179.
Wallace, A. M., Boyer, D. B., Dan, A. and Holm, K.,1986. Aerobic exercise, maternal self- esteem, and physical discomforts during pregnancy. J Nurse Midwifery, 31, pp. 255– 262.
Weissgerber, T. L., Wolfe, L. A., and Davies, G. A., 2004. The role of regular physical activity in preeclampsia prevention. Med Sci Sports Exerc, 36, pp. 2024–2031.
Wise, L. A., Adams-Campbell, L. L., Palmer, J. R. and Rosenberg, L., 2006. Leisure time physical activity in relation to depressive symptoms in the Black Women’s Health Study. Ann Behav Med, 32, pp. 68–76.