Safe exercise for pregnancy

I am kicking the new year off with a new Q and A blog. Today an answer inspired by an interview with the Women’s Health Division of the Canadian Physiotherapy Association. They asked “What activities are safe for most pregnant women?”. Perhaps we need to rethink and redefine what is “safe”…read on!

Q: Are there specific types of physical activity that you believe are safe to be recommended to most pregnant women?

 A: If you want to talk about the lowest common denominator for safety, walking and swimming are awesome. Dancing with a spouse, or any low impact movement exercise that gets the heart rate up and they enjoy would be beneficial and have minimal risk. Strengthening would be great too, and there are lots of appropriate, basic strengthening exercises that can be accomplished by most ‘safely’. But if we had to take it to brass tacks, if everybody could at least walk that would be “safe” and it would help them maintain mobility, some cardiovascular health and some activity baseline to help them get through the pregnancy and optimize recovery.

However, in an effort to continue to push towards individualized programming based in critical thinking vs formulas….we need to understand that what is safe for each person will vary. For example, if your patient is a CrossFitter, walking and doing heel slides is just not going to cut it for them. We need to have appropriate conversations with them about risks, benefits, appropriate modifications as the pregnancy progresses, signs to look for that they aren’t tolerating the activity, and how to reach goals safely. But we need to understand that their brains and bodies get CrossFit. They know those movement patterns, they love them. We can use those movements and keep them connected with their body and their brain. We can tap into the neuromuscular capacity that is already there, versus making them do prenatal yoga or Pilates. These would be completely new patterns their brains and bodies need to learn. Which is actually safer for them?  

We have presumed that certain activities, like yoga for example, are safe for pregnancy. However, studies that have measured the intra-abdominal pressure and vaginal pressures created by functional and fitness activities, found a large range of pressures generated by study participants for each activity. Interestingly, a comparison of the range of pressures generated by downward dog and a crunch were quite similar (downward dog- 26-72 cmH2O, crunch 19-75 cmH2O). This means some folks were able to generate a lower level of IAP performing a crunch, than others generated while performing downward dog. Which activity is ‘safest’ then? Neither?! OR can we interpret the results with an understanding that HOW each participant performed the crunch or downward dog likely had more to do with how much pressure they generated vs which activity they were doing?  So we can redeem BOTH of these activities or ANY activity to be ‘safe’ if we are monitoring and modifying the strategy and the form they are using. And always monitoring for symptoms and leaks, modifying as indicated. 

In addition, if a woman is very active and we know that she is going to go back postpartum quicker than we think is “safe”, then perhaps maintaining them close to their baseline with their preferred activity will optimize their recovery.

We must also consider the emotional component of someones fitness choices. What I have witnessed over the last few years of working with patients who are doing higher intensity training, is that its not just their bodies, brains, but their HEARTS that  like love and respond well to those activities. If we take their favorite activity away from them in the name of safety, what emotional impact will that have? These are some tough conversations we need to have in our profession. We have to think of the whole person and the effect of exercise beyond just their musculoskeletal and pelvic health issues. We need to be careful that we don’t compromise benefits because we are trying so hard to be “safe”. I am not advocating supporting the invincibility mindset out there, instead I support a critical thinking, middle ground that we must work towards that is both safe (symptom and leak free), fun, engaging and effective (gets results). It can be done.

More Q and A coming later this month!

Happy New Year! Julie

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