Running during Pregnancy
image: @knowjack
My wife is currently in her third trimester of pregnancy and I am soon to be a father (a scary thought but also exciting). My wife and I see ourselves as active individuals who try to exercise on a daily basis with various types of movement, whether it be cardio or strength exercises, cycling, basketball, yoga, or plain old long walks by the river.
Why am I writing a blog about this you might ask? Well, recently we encountered someone who told my wife that it was unsafe to paddle board on the calm beaches of Georgian Bay. This made us laugh a bit and also spurred a thought on a previous topic of conversation had with other friends who are active alike.
My wife was never really big into distance running before I met her. For some years now however, she has been gradually working on incorporating it into her workout routines, thanks in large part to my persistent push towards joining me on a run. But now that she’s pregnant and getting closer and closer to the due date, she finds it harder to perform certain types of activities as a result of our little nugget pushing down on her bladder and wreaking all sorts of havoc on her body. To alleviate this discomfort, she’s backed off on running and has moved to lower impact exercises like cycling, pre-natal yoga, pre-natal strengthening classes/ program provided by her stellar pelvic health physiotherapist, and the daily walk.
When it comes to exercise during pregnancy and in particular running, there are lots of women who maintain their current levels of fitness and continue to run late into their pregnancy without any complications.
So who said that you have stop running when you’re pregnant?
I was unable to find any current research suggesting that pregnant women have to stop immediately. The best suggestions are to not start a running program if you were not running prior to becoming pregnant. It is also recommend to slowly reduce the intensity or speed as the pregnancy progresses. But for some reason, many of us feel as though it should not be continued, even postpartum (more on that another time). Some women may be told to hold off due to absolute contra-indications after assessment from their doctor.
The following are absolute contraindications to exercise:
Ruptured membranes.
Unexplained persistent vaginal bleeding.
Pre-eclampsia
Intrauterine growth restriction
Uncontrolled type I diabetes
Uncontrolled thyroid disease.
Premature labour.
Placenta praevia after 28 weeks’ gestation.
Incompetent cervix.
High-order multiple pregnancy (eg, triplets).
Uncontrolled hypertension.
Other serious cardiovascular, respiratory or systemic disorder.
The following are relative contraindications to exercise:
Recurrent pregnancy loss.
A history of spontaneous preterm birth.
Symptomatic anaemia.
Eating disorder.
Gestational hypertension.
Mild/moderate cardiovascular or respiratory disease.
Malnutrition.
Twin pregnancy after the 28th week.
It is important to always discuss with your doctor that it is appropriate to start/continue physical activity. It is also recommended to stop exercise immediately and seek medical attention if you experience any of the following during exercise:
Excessive shortness of breath
Chest pain
Presyncope
Painful uterine contractions
Leakage of amniotic fluid
Vaginal bleeding
To sum things up for you, here is some information on the research out there. Approximately 50% of runners sustain injuries each year. When comparing non-pregnant women to the pregnant population. The pregnant population is slightly more at risk of sustaining a musculoskeletal injury due to things like ligamentous laxity, therefore the 50% of injuries may grow. This risk is primarily related to physical changes, hormonal changes and the rapid weight gain experienced during pregnancy. These changes, when accompanied by potentially already weaker pelvic floor muscles, can increase the likelihood of complications from pelvic organ descent or urinary incontinence. These are all things to consider.
To put this simply, pregnant women who continue to run should not feel any musculoskeletal pain or experience any symptoms such as urinary or faecal leaking/ loss, perineal heaviness, pain in the genital area or lower abdomen, pain with intercourse, and reduced abdominal strength or separated abdominal muscles. If any are present, I would recommend consulting a pelvic health therapist as these issues can be treated and prevent long term consequences in doing so.
According to the 2019 Canadian Guideline for Physical Activity throughout Pregnancy, uncomplicated pregnancies should, for the benefit of the mother and the fetus, involve aerobic activity (without the risk of falling or trauma) for a period of 150 minutes and more per week. Training should be divided into three moderate-intensity sessions, at the minimum. One or two weight training sessions per week is also recommended. However, future mothers should listen to their body when training, especially in a humid and hot environment as it is harder for them to dissipate the heat in their body. They should thus avoid running long distances during heat waves. Ideally, pregnant women should opt for a sport which they practiced before pregnancy as the body is already accustomed to the type of impact and movements involved, thereby reducing the risk of injury. It is also suggested that some may need to eventually reduce the high impact activities later into the pregnancy according to how they feel. For those that are relatively inactive, the recommendation is to withhold starting any vigorous exercise that is new to your body prior to becoming pregnant.
Despite popular belief, participating a sport while pregnant does not increase the risk of spontaneous abortions, premature birth, low birth weight, or the need for a caesarean section. However, the 2016 International Consultation on Incontinence has shown that the practice of high-impact sports increases the risk of urinary incontinence during effort. Some experts may argue that running is not listed as a high-impact activity as it depends on the running biomechanics being optimal (examples include higher cadence, low vertical displacement, midfoot or forefoot strike, reduced noise on impact). Most importantly, the training volume needs to be balanced and adapted to one’s lifestyle. It is also recommended by some that elite athletes should not go beyond 90% of their maximum heart rate when training as it may affect both the expectant mother and the fetus.
I mentioned earlier, it is recommended by some that the intensity gradually be reduced over the course of the pregnancy. This can be done in a safe and effective way by listening to your body’s response to exercise. Every day may feel different. No recommendations have been made in the literature with regards to when to stop. There are many women that continue to run in the 8th and 9th months of their pregnancy. In fact, if there is no discomfort while running (no significant musculoskeletal pain or uro-gynecologic symptoms, as mentioned above), the activity may be maintained throughout pregnancy. It is recommended to gauge physical effort on a 1-10 scale. The majority of the workout should be about a 6-7 in terms of intensity.
As outlined above, if you are unsure about anything, always check with a registered health professional prior to commencing a new or existing routine to be on the safe side.
For those that want some extra reading on the topic, click on the link below and have a read. https://blogs.bmj.com/bjsm/2019/07/11/is-it-safe-to-exercise-during-pregnancy/
Live active and prosper.
Aras Ruslys
Registered Physiotherapist
References
Bjsm. (2019, July 16). Is it safe to exercise during pregnancy? Retrieved from https://blogs.bmj.com/bjsm/2019/07/11/is-it-safe-to-exercise-during-pregnancy/– Bo et al. Exercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from IOC Expert Group Meeting, Lausanne. Parts 1-2-3. BJSM 2016, 50: 571-589 + 1297-1305. BJSM 2017, 0: 1-10.
Committee Opinion of ACOG. Physical Activity and Exercise during Pregnancy and the Postpartum Period. 2015 (reissued in 2017), no 650.– Mottola et al. 2019 Canadian Guideline for Physical Activity throughout Pregnancy. BJSM 2018, 52: 1339-1346.– Report summarizing the conclusions: International Consultation on Incontinence 2016.
