When Ericka York found out she was expecting her first child earlier this year, she knew she wanted to stay active but didn’t feel safe sticking to her usual routine.
“I didn’t feel like I had enough knowledge to keep doing the workouts that I was doing,” said the Toronto resident who used to play soccer once a week and take about 10 fitness classes a month.
So she signed up for prenatal yoga and Belly Bootcamp classes a couple times a week and has discovered that few women in her classes are pregnant for the first time. Some of the second-time moms-to-be have told her they were too scared to enrol in fitness classes during their first pregnancy, but in hindsight wish they hadn’t felt that way.
In fact, a trio of doctors affiliated with Spanish and American universities say few pregnant women are getting enough exercise. In a jointly written opinion piece published in the Journal of the American Medical Association last month, they wrote that “misguided” notions that pregnant women need to eat more while doing less exercise are contributing to the world’s obesity problem.
Women who gain and keep excessive weight during pregnancy (Canadian guidelines identify healthy weight gains based on each women’s Body Mass Index before pregnancy) can pass it along to their newborn babies. Those who remain active experience fewer aches and pains and are less likely to a need a Cesarean or experience poor bladder control, the doctors write in the JAMA article.
The same article suggests not knowing how much and what kind of exercise pregnant women should be doing is in part to blame for why so few expecting mothers are not getting as much exercise as they should.
And while Canadian guidelines, jointly approved by the Society of Obstetricians and Gynecologists of Canada and the Canadian Society for Exercise Physiology, encourage women to exercise while pregnant, this push comes with a list of precautions: watch your heart rate, don’t get competitive, mind your balance and don’t lose your breath.
“Most recently we’ve been making the argument that being sedentary is actually much more risky to your pregnancy than being active,” said Gregory Davies, a professor and chair of maternal-fetal medicine at Queen’s University who has helped write the Canadian guidelines for exercise during pregnancy.
Davies said many decades ago when everyday life was substantially more physically demanding than it is now, the idea that women should take it easy during their pregnancies was probably more sound. “But fast forward to 2017 when people are living super sedentary lives, that advice is no longer valid. But it’s still in our culture that pregnant women need to slow down.”
Research on the topic has been slow. Early fears that working out while pregnant could hurt a growing fetus have led to today’s limited available data to push evidence-based exercise guidelines forward, Davies said.
Considering the high levels of obesity in the population, Davies said, many women should probably be more active than they already are to prepare for a healthy pregnancy.
“I’m a firm believer that almost all types of exercise are safe in pregnancy,” he said. “Just don’t overdo it. I don’t think the patient needs to be worried about having things being too much more prescriptive than that.”
Canadian guidelines specifically say that women should be told by obstetric care providers that “adverse pregnancy or neonatal outcomes are not increased for exercising women.”
Jennifer Blake, CEO of the Society of Obstetricians and Gynecologists of Canada, said the nationwide message on exercising while pregnant has been consistent for years: it’s good for you, do it. “But you also want to make sure you are not going to be in a situation where people are asking you to do things that may not be safe for you or for your pregnancy,” she says.
It’s important for both women and their fitness instructors to be well-informed.
In Canada, a checklist — the PARmed-X guidelines for pregnancy — is available online for pregnant women, their doctors and fitness trainers to help determine what type of exercise is safe for each expecting mother. This list recommends modifications for exercises and highlights physical warning signs for women to watch for including dizziness, chest pain and vaginal bleeding.
But beyond the uncertainty of what is and isn’t safe, lifestyle, scheduling and fear can all play a role in keeping pregnant women from working out.
Toronto’s Christine McKenna, 33, a full-time middle school teacher who is pregnant with her second child, said she’s never felt afraid to exercise while pregnant, but finding the time do it is tough. She continues to juggle work with a busy personal life through her pregnancy.
McKenna knows being in good shape will help her during labour and recovery. It is what motivates her to stay active. She goes to prenatal boot camp classes twice a week with York, even on days she doesn’t feel like it.
Michelle Mottola, director of Western University’s Exercise and Pregnancy Lab, suggested making small lifestyle adjustments: getting off the subway a few stops early, taking a more gratuitous wander through the grocery store, or if driving, avoiding those mom and baby spots close to the building and parking far away.
Pregnant women who have a step-counting device should aim for 10,000 steps per day, she suggested.
Mottola cautioned against commuting by bike in Toronto traffic when pregnant, especially in later weeks when balance can be an issue.
Fitting one of the rather rare prenatal fitness classes into a busy schedule can be challenging, but being pregnant doesn’t mean you can’t sign up for regular fitness classes, too.
When taking any kind of class, inform the instructor of the pregnancy before you start. Mottola suggested that women discuss the PARmed-X guidelines with their new instructors and consider modifying activities in accordance with them.
Canadian guidelines say women should watch out for activities that might put them at risk of losing balance or that are competitive while pregnant (ice hockey, gymnastics, horseback riding, scuba diving, and cycling are singled out as being risky).
Swimming, cross-country skiing, water aerobics or riding a stationary bike are considered to be safer options.
Yoga and Pilates are two of the most widely available types of “prenatal” classes, and it turns out the most controversial.
Michael Geary, chief of obstetrics at St. Michael’s Hospital, said that as a practising obstetrician he regularly notices the benefits yoga and Pilates have had on the women he treats — both physically and mentally. If he could wave a magic wand, government funding would appear and be used to pay for all pregnant women to take those types of classes.
However, several doctors interviewed by the Star said that women should not practice hot yoga or Pilates while pregnant, to avoid exposure to excessive heat.
The JAMA opinion article points out that even though yoga and Pilates are often recommended to pregnant women by doctors, clinical trials have yet to demonstrate that either is beneficial for moms-to-be.