The primary role of a female’s body in evolutionary terms is to carry a child. Female bodies have evolved differently to males to bring new life into the world. Women naturally have a higher body fat percentage that gives them the capacity to feed the child and wider hips for childbirth. The female body has adapted to carry out this amazing feat but there has been very little information and evidence available to these women on how to remain active and carry out exercise during pregnancy (something which can be beneficial for the act of childbirth) and how to get back to exercise after pregnancy.
In recent years, research has continued to grow around exercise and pregnancy and there is a greater understanding that physical activity and exercise during this time has a number of beneficial factors for both the mother and developing foetus. In fact it has been shown that being fit and active reduces the likelihood of complications during pregnancy and delivery, reduces some of the symptoms associated with pregnancy such as constipation, back pain, sleep disruption and bloating, alongside decreasing the likelihood of high blood pressure and diabetes as well as significantly improving mental health.
It is however important to note that everyone is different, so individual guidance should be sought from a medical professional before exercising in the period before and after childbirth. Also, due to the substantial hormonal changes that occur during pregnancy, exercise routines must be adjusted.
Listen to your body
The historic guidelines first advised to use heart rate as a guide to adjusting exercise intensity whilst pregnant, however, these have now been overlooked as during pregnancy there are natural changes in heart rate so this isn’t an accurate monitoring tool.
Now it is deemed that using a scale of perceived exertion (scale of 1-20, 20 being the hardest you have ever known!) and percentages of heart rate of aerobic capacity are better tools. Thus, if you were naturally fit, then exercising anywhere from 60-80% of your absolute maximum heart rate is fine1,2.
There are now a number of top-level athletes who have continued to exercise during pregnancy, albeit in an adjusted and lighter manner, such as heptathlete Jessica Ennis-Hill, footballer Alex Morgan, ultra-endurance runner Sophie Power and long-distance runner Jo Pavey.
All the above athletes have advocated listening to your own body and how it feels over the course of those nine months, as hormones continually change, and using that as the main tool guide throughout pregnancy as to how to gauge exercise and training accordingly.
However, as everyone is different, advice should always be sought from medical professionals, reflecting the individual nature of each mother.
Getting back to running postpartum
As with exercise in pregnancy, research and guidelines have been lacking about when and how to return to exercise postpartum. There are clearly lots of factors that can influence this, including the type of delivery and individual birth experience.
Postnatal women may be more susceptible to musculoskeletal pain, urinary and faecal incontinence, abdominal separation and pelvic organ prolapse as discussed on the Female Athlete Podcast ‘Pelvic Health’ episode with physiotherapists and women’s health specialists Emma Brockwell and Grainne Donnelly.
As discussed in this episode, there are many things women can do proactively to help themselves, and these are relevant at any stage of a woman’s life, not just during or after pregnancy. A key area that is underappreciated and under-discussed is the pelvic floor muscle. Often women only get introduced to this concept once pregnant, or for some, not until after pregnancy. But this is something we should be working on all the time – it has recently been shown that many sportswomen have experienced urinary incontinence, not just those who have been through childbirth. Strengthening the pelvic floor can reduce risk of this and in the episode we discuss the exercises women can do in detail and why pelvic health is so important to be aware of.
Giving birth can cause significant damage to the pelvic floor, which needs to be corrected before being able to undertake high-impact exercise, so it is advisable (as outlined in the guidelines below), to slowly and progressively build up to this type of exercise. As with everything, everyone is different, so it is advisable to work with a medical professional to help guide this return to exercise which factors in your individual circumstances.
Fortunately, for the pregnant women of today’s generation there are new up and coming specialists in this area who have develop detailed return to exercise (specifically running) guidelines after pregnancy written by Grainne Donnelly, Emma Brockwell and Tom Goom. The guidelines are available here.
The Female Athlete Podcast
Through this podcast, we’re using conversation and education as a tool to empower women and help them feel more confident about their bodies, especially when it comes to exercise.
In previous episodes we’ve spoken to a variety of guests including sports scientists, doctors, breast health experts, athletes suffering with menstrual dysfunctions such as endometriosis and premenstrual dysphoric disorder (PMDD), and we’ve interviewed real women about the impact of long-term oral contraceptive pill use on their bodies and personal experiences of female puberty, menopause and peri-menopause.
Wolfe LAWeissgerber TLClinical physiology of exercise in pregnancy: A literature reviewJ Obstet Gynaecol Can200325451453.8. Wolfe LA, Weissgerber TL. Clinical physiology of exercise in pregnancy: A literature review. J Obstet Gynaecol Can 2003;25:451–453. Medline, Google Scholar
Wolfe LAMottola MFPARmed-X for PregnancyOttawaCanadian Society for Exercise Physiology200214.9. Wolfe LA, Mottola MF. PARmed-X for Pregnancy. Ottawa: Canadian Society for Exercise Physiology, 2002:1–4. Google Scholar