The first step before you plan to start or continue physical activity during pregnancy is to have a health checkup. Review general health and medical and obstetric risks associated with starting or continuing physical activity. To develop and safely implement physical activities for pregnant women, we need to know if they are feasible in terms of the pregnant woman’s fitness and health, intensity, and suggested exercises. In a normal, healthy pregnancy, no scientific studies have shown a negative effect of moderate-intensity aerobic exercise on fetal development or pregnancy. In fact, it appears that the benefits of exercise during pregnancy significantly outweigh the potential risks. We now know that healthy pregnant women can begin or continue a moderate aerobic exercise program without fear of adverse effects on themselves or their unborn child. In addition, recent systematic reviews show strong evidence of the effectiveness of physical activity on maternal cardiorespiratory fitness, overall reduction in the risk of gestational hypertension and hypertension, prevention and treatment of gestational diabetes, prevention of urinary incontinence, reduction in cesarean deliveries, and prevention of depression during pregnancy, as well as a positive impact on adult health.
Before starting fitness classes, pregnant women need to be assessed using a practical checklist in the form of a (preferably validated) questionnaire. Therefore, health professionals (not only physiotherapists) should encourage pregnant women to start or continue with exercise that suits their needs and the state of pregnancy. A practical questionnaire used worldwide is the recently updated Get Active Questionnaire for Pregnancy, a physical activity questionnaire designed to facilitate communication between the physical therapist, fitness instructor/worker, and the pregnant woman. This questionnaire provides pre-pregnancy health screening guidelines that include recommendations for physical activity, healthy lifestyle during pregnancy, and exercise safety. This questionnaire is available on the Canadian Society for Exercise Physiology (CSEP) website (https://csep.ca/2021/05/27/get-active-questionnaire-for-pregnancy/), in English and French, or in other languages.
If needed, this questionnaire can be used in conjunction with other screening tools, such as the latest version of the Physical Activity Questionnaire for All (PAR -Q+), available on the official website (http://eparmedx.com/). This questionnaire will help you decide if you need further advice before increasing your physical activity or undergoing a fitness assessment. It can be completed by your physician, physical therapist, and other health professionals or qualified athletes/sneakers. Another widely used tool is the ACSM Health Status and Health History Questionnaire, which you can use to assess the safety or possible contraindications to exercise. It should be noted that screening is especially important if pregnant women are overweight and have gestational diabetes or hypertension. These women should consult a physician before beginning an exercise program, which again must be tailored to their health status, symptoms, and fitness level. If there are no pregnancy complications and no contraindications to exercise, all women should participate in an exercise program regardless of their previous physical activity or fitness level, according to major international organizations such as the American College of Obstetricians and Gynecologists (ACOG), Society of Obstetricians and Gynecologists of Canada (SOGC), The American College of Sports Medicine (ACSM), Canadian Society for Exercise Physiology (CSEP), Royal College of Obstetricians and Gynecologists (RCOG), International Olympic Committee (IOC) and World Health Organization (WHO).
Nevertheless, many women and medical professionals do not know when is the best time to start exercising. Women who previously led a sedentary lifestyle can begin light activity at any time and gradually increase it. Women who were previously active can continue with pre-pregnancy exercises. Sometimes normal pregnancy symptoms such as lower back pain, fatigue or nausea can get in the way of continuing an active lifestyle. Women should then be encouraged to exercise when they feel comfortable. Other important issues related to an exercise plan and setting realistic goals and encouraging adherence to exercise include the following (3):
- What are the main motivations for exercising during pregnancy?
- What are women’s preferences?
- What might be the main barriers and factors that facilitate physical activity?
- What strategies should be used with regard to adherence to exercise?
Assessing pregnant women’s motivations and preferences and identifying barriers and facilitators to exercise is a very important step in the prescription process to avoid failure. Finally, it is important to make the pregnant woman understand that physical activity and exercise, if appropriate to her health and condition, will not have harmful effects on her or her baby. On the contrary, participation in, for example, a planned exercise program can increase her perception of health (there are several reliable sources of information where she can learn about the general and specific benefits of exercise during pregnancy). An interesting source of information is the infographic with new advice on “physical activity for pregnant women” published by the Chief Medical Officers of the United Kingdom, which aims to provide health professionals with the latest data on physical activity during pregnancy. In summary, engaging with the pregnant woman and developing an assessment process prior to physical activity is a key element in planning adapted/individualized physical activity (effective and safe). Professionals must keep in mind that some of the questions described above can be asked openly (or included in approved questionnaires) not only at the beginning of an exercise program, but whenever a woman’s health or fitness status has changed or adapted. In addition, psychological, physiological, musculoskeletal, and biomechanical adaptations should be considered at this stage of life (1) (2) (3).
Martyna Kasper-Jędrzejewska
References:
- Bredin SSD, Gledhill N, Jamnik VK, Warburton DER. PAR-Q+ and ePARmed-X+. Can Fam Physician. marzec 2013;59(3):273–7.
- Szumilewicz A. Who and How Should Prescribe and Conduct Exercise Programs for Pregnant Women? Recommendations Based on the European Educational Standards for Pregnancy and Postnatal Exercise Specialists. Dev Period Med. 30 czerwiec 2018;22(2):107–12.
- Santos-Rocha R. Exercise and Sporting Activity During Pregnancy: Evidence-Based Guidelines. Springer; 2018. 355 s.
