Pregnancy is commonly associated with a decline in women's physical activity, but the benefits of exercise during the antennal period are considerable. And while midwives are central to the promotion of health-related advice, encouraging an active pregnancy can be daunting.

So, what types of activity are safe, how much exercise is enough ¬– and what about the risks?

Women's health exercise physiologist Symone Esposito says exercise is not only safe in a healthy pregnancy, but it also reduces the risk of complications that occur in the antenatal period.

"Being regularly active during pregnancy can reduce the risk of complications like excessive pregnancy weight gain, pre-eclampsia, and gestational diabetes.

"Since gestational diabetes may still be diagnosed even in those considered healthy or low risk, regular exercise is a key strategy to manage healthy blood sugar levels."

A pregnant body goes through many physiological and physical changes, and being inactive reduces the adaptive effects of exercise on the cardiovascular and musculoskeletal system, adds Ms Esposito.

"This can leave many mums feeling disconnected from their bodies.

"Being active encourages them to focus on what is within their control and find self-management strategies for common challenges brought on by the rapid changes during pregnancy."

Benefits of an active pregnancy

The physical and emotional health benefits of exercise during pregnancy are numerous with active women enjoying:

• More energy
• Better sleep
• Fewer challenges with nausea, heartburn, constipation and swollen feet and ankles
• Less back pain, or pain that is more manageable
• Improved management of stress and anxiety
• More strategies for birth and an easier and more active labour
• A healthier rate of weight gain, and easier to return to pre-pregnancy fitness level and weight.

Type of exercise and safety considerations

There is no one 'best' type of exercise during pregnancy, but the following suggestions are popular for being low-impact or gentler:

• Walking
• Cycling (on a stationary bike)
• Low-impact aerobic exercises or water-based exercises and swimming
• Yoga or Pilates (with instructors who are qualified and can modify the exercises for pregnancy)
• Other pregnancy-specific exercise classes

Safety considerations:

• Avoid exercise in warm or humid environments (like spas or saunas), especially in the first trimester.
• Avoid isometric (static) exercise that encourages high effort and breath-holding
• Eat healthily and stay hydrated – especially around exercise
• Avoid supine exercise (lying flat on the back) after the fourth month of pregnancy
• Avoid activities which risk physical contact or risk of falling
• Avoid activities where oxygen is restricted, like scuba-diving, or high-altitude activities.
• Focus on general fitness - pregnancy is not the best time to set new records and start training for athletic competition

Overcoming obstacles to remain active

When it comes to exercise, the obstacles pregnant women face are no different to the rest of us, says Ms Esposito.

"Often, this will be common day-to-day challenges like time, resources, knowledge, fear of safety, or pregnancy challenges with tiredness or body aches and pains.

"Whether it is time, other children or the general complaints of pregnancy, many can find it hard to reach the recommended two and a half hours of exercise a week."

Tips on encouraging an active pregnancy

Midwives can encourage pregnant women by merely explaining that any small amount of exercise has benefits – and any is better than none, advises Ms Esposito. 

• Help them plan, and be specific: when, where, how long, how often, who will look after the other kids and so on.
• Self-talk ("I'll do it tomorrow", "I'm too tired", "Not enough time" ): just like physical habits, thoughts and self-talk needs practice. Encourage them to consider what exactly stops them, and rephrase it (for example, "I'm too tired" – can be rephrased as "maybe two minutes of fresh air will make me feel better")
• Always ask them to consider plan B, whether that is 10 minutes instead of 30 minutes, or just something that is weather-proof!
• A health professional one-on-one can be beneficial for many mums who have existing health concerns, are experiencing pain, or simply uncertain about the best exercise or techniques for their pregnancy phase.

When is exercise not advised?

Health professionals may warn women not to exercise in some situations, and a specialist usually provides this guidance.

The British Journal of Sports Medicine outlines the following absolute and relative contraindications for exercise during pregnancy.

Absolute contraindications – Placenta previa, persistent vaginal bleeding, pre-eclampsia after 28 weeks, incompetent cervix, ruptured membranes and higher-order multi-foetal pregnancy (triplets or more), uncontrolled Type 2 diabetes, serious cardiovascular, respiratory or systemic disorder.

Relative contraindications – Recurrent pregnancy loss, history of spontaneous preterm birth, gestational hypertension, symptomatic anaemia, malnutrition or eating disorder, twin pregnancy after 28th week, mild to moderate cardiovascular or respiratory disease, poorly controlled seizure disorder, morbid obesity and other serious medical conditions.


When to stop and seek support

As pregnancy progresses, the body goes through significant changes, says Ms Esposito, such as laxity of joints, a shift in the centre of gravity and increased resting heart rate.  So, women should remain vigilant of any symptoms that don't feel right.

FRANZCOG advises that women stop and seek support during exercise if they experience any of the following symptoms:

• Chest pain
• Unexplained shortness of breath
• Dizziness, feeling faint or headache
• Muscle weakness
• Calf pain, swelling or redness
• Sudden swelling of the ankles, hands or face
• Vaginal bleeding or amniotic fluid loss
• Decreased foetal movement
• Uterine contractions or pain in the lower back, pelvic area or abdomen (potentially indicating preterm labour)

All pregnant women without complications should be encouraged to exercise. After all, pregnancy and birth are physically demanding, so a reasonable fitness level will equip mothers-to-be for the challenges ahead – including early parenting!