The World Health Organisation (WHO) recommends pregnant women to incorporate a variety of aerobic and muscle-strengthening activities in their daily life. According to the health body, pregnant women without contraindication (medical conditions where exercise is not recommended) should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week.
“Observational studies have shown that there is a significant decrease in the incidence of gestational diabetes, caesarean birth and postpartum recovery time for women who exercise regularly during their pregnancies,” says Mumbai-based Dr Varsha Birla who specialises in women and child healthcare.
“Several meta-analysis and randomised controlled trials have shown that women with normal weight, uncomplicated singleton pregnancy without any obstetric contraindications and those who follow a fitness regime before pregnancy can continue with their regular physical activities during pregnancy as well. Women, who had a sedentary lifestyle before pregnancy, should follow a more gradual progression of exercise,” adds Dr Birla. Pelvis tilt (supine, all four/standing), pelvic floor, stomach strengthening, Kegel and adductor strengthening exercises are recommended, suggests Dr Birla.
Dr Smrithi D Nayak, consultant, obstetrician and gynaecologist, Aster RV Hospital, Bengaluru, tells Happiest Health that pregnant women should do at least four to five days of moderate-intensity aerobic physical activity per week, such as brisk walking. It is best to spread this activity throughout the week for 30 minutes a day.
And that is exactly what Delhi-based entrepreneur and image consultant Chandni Mahajan did. “I used to brisk walk daily in my first and second trimesters for 30 minutes to keep my weight in check. In fact, walking is one of the best and safest exercises. It is a total body workout without straining your muscles. But I used to stop walking whenever my back, feet or legs started to hurt,” says the 32-year-old.
The American College of Obstetricians and Gynecologists (ACOG) recommends exercises like walking, stationary cycling, aerobic exercises, dancing, resistance exercise (using weights, elastic bands), stretching exercise in pregnancy, hydrotherapy and water aerobics for expectant mothers. Several studies done by the ACOG have found that all these exercises are safe and beneficial for pregnant women.
Since Mahajan was carrying twins and was supposed to give birth by C-section, in the third trimester, she was told by her gynaecologist to take bed rest and avoid walking or travelling. “Twins do not complete 40 weeks or nine months in the mother’s womb. They are supposed to be delivered in 36-37 weeks. So, I took extra precaution to avoid preterm labour/birth,” recalls Mahajan.
Dr Archana Dinesh B, senior gynaecologist, Kamineni Hospital, Hyderabad, tells Happiest Health that doctors don’t recommend any exercise, especially in the first trimester. “However, women should carry on with their routine work, including cooking or commuting to the work.” She adds that the first trimester is about nausea, vomiting and bloating. “However, after their meals, they can do 10-15 minutes of brisk walking. We usually don’t recommend high-intensity exercises in the first and last trimester because there are chances of miscarriage and preterm labour. During the second trimester, women can do yoga and other forms of exercises like pelvic floor workouts.”
Mahajan, who also did breathing exercises throughout her pregnancy says that staying physically active helped her beat pregnancy blues and mood swings. “I did my exercises in moderation. I exercised if I was comfortable. I enjoyed my fitness during pregnancy. I did not exert or exhaust myself and stayed hydrated,” Mahajan adds.
Pregnancy and exercise
Dr Birla says that there are a few activities and exercises that should be completely avoided. Scuba diving is one such activity as there is a risk of the foetus developing compression sickness. Contact sports like kickboxing, judo or squash are not recommended for expectant moms. Skiing, skating, horse riding (as there is a danger of falling), tennis, basketball, other sudden stop and start activities and excessive abdominal exercise should be avoided.
As per the ACOG, there are some warning signs to discontinue exercise during pregnancy. Those signs are vaginal bleeding, abdominal pain, regular painful contractions, amniotic fluid leakage (a yellowish liquid that surrounds the foetus), dyspnea before exertion (breathlessness), dizziness, headache, chest pain, muscle weakness, loss of balance and calf pain or swelling.
Dr Nayak says that any woman with a complicated pregnancy should avoid exercise that might cause even mild abdominal trauma – including activities that include jarring motions or rapid changes in direction. “Activities that require extensive jumping, hopping, skipping or bouncing, deep knee bends, full sit-ups, double leg raises and straight-leg toe touches should be avoided.”
Garima Goyal, certified coach, nutritionist and founder of bodyrenderbygarima, Indore, tells Happiest Health that women after six to eight weeks of normal delivery and 20-25 weeks after C-section can start working out. For the first few months after childbirth, Goyal recommends light exercises like walking and yoga. Heavy exercises like weightlifting, cardio and jumping should be avoided as they put pressure on the lower body and abdomen. Depending on their physical condition and strength (with permission from a gynaecologist) they can start with light weight training (2 or 2.5 kgs) and can walk 3,000-4,000 steps in a day.
Explaining the benefits of exercising, Goyal says irrespective of the mode of delivery, the skin tends to become loose, and fat and water retention will persist in the body. “It is important to adopt proper diet and physical activity post-delivery. Otherwise, it leads to muscle loss and the skin tends to become saggy. Proper diet and physical activities help overcome postpartum depression. All these steps help to boost the confidence of new mothers,” she adds.
Dr Dinesh points out the importance of embracing workouts in a gradual manner. “Women can start with brisk walking and later move to cardio exercises and weightlifting,” she says. She adds that staying physically active and exercising in the fourth trimester (postpartum) help new mothers lose the fat accumulated during their pregnancy. Conditions like gestational diabetes and hyperthyroidism during pregnancy can be corrected with weight loss.
According to the BMJ Open Sport & Exercise Medicine, an open-access journal, postpartum aerobic exercises have also shown to reduce symptoms of postpartum depression. Evidence shows that physical activity reduces postpartum weight gain. Moreover, aerobic activities do not affect lactation.
Exercises during breastfeeding
Goyal recommends lactating women to walk 3,000-4,000 steps (2-2.5 km) a day. Gradually, they can increase it to 6,000-10,000 steps a day. “If they are planning to do some exercises, they should do it for 20-30 minutes a day in the beginning. Depending on their muscle strength, they can gradually increase it to 45 to 60 minutes a day. These exercises include stretching, cardio and strength training with the basic weight.”
According to the ACOG, lactating women should breastfeed their infant before starting their workout to avoid discomfort to breasts. They should also be hydrated before commencing their exercise. Regular aerobic exercise has been shown to improve maternal cardiovascular fitness without affecting milk production and infant growth.