‘Exercise during pregnancy is healthy and necessary’

Hedwig Neels specialises in pelvic floor and perinatal physiotherapy. She works as a principal research fellow at the Faculty of Medicine and Health Science at UAntwerp, and as a physiotherapist at UZA’s gynaecology department. She is also the driving force behind several initiatives around women’s health and empowerment, such as the online platform The Pelvic Floor, and she works with the ‘Woman and Heart’-team (Antwerp University Hospital/UAntwerp) on the website preeclampsia.eu. In this column, she explains how medical knowledge around exercising during pregnancy has evolved. 

Exercising is healthy for both mother and foetus 

‘Pregnant women used to be advised to avoid sports’, Neels says, ‘for fear that it posed a risk to the foetus, for example in terms of blood and oxygen supply. In the meantime, we have learnt that exercise increases blood flow to the foetus.’ And exercise also has a positive impact on mother and child in other areas. Exercise during pregnancy is recommended today to prevent a lot of complications: ‘It reduces the risk of obesity for the mother, which also makes her child less prone to obesity later on. There are other beneficial effects on the mental health of mother and baby, and brain development of the foetus.’ Finally, the advice for pain management has also been adjusted: ‘Pregnant women may experience lower back or pelvic pain. In the past, they were usually prescribed rest. Now we prefer to speak of “relative rest”: the woman should remain as active as possible, while not exceeding her pain threshold.’ 

Moving is not enough  

Neels stresses that just ‘moving’ is not enough: ‘Only when your heart rate rises, you start sweating more and talking becomes more difficult, are you exercising. The official guidelines now say that you should exercise about 150 minutes a week during pregnancy at a heart rate of 125-145 beats per minute.’  

However, not every sport is equally suitable. So be careful with contact and combat sports, or exercising in hot weather. ‘But it’s a misconception that this is a safety concern for the foetus’, Neels says. ‘The baby is very safe in the womb and is not likely to have issues. Being careful with certain sports is for the mother: she shouldn’t injure herself, because she should be able to stay active as long as possible.’ 

And what about women who do not like exercising or are not used to it? ‘The same advice applies to them as well. They are urged to start exercising more – in a gradual, safe way – during their pregnancy.’ 

A recent evolution 

The scientific knowledge around this topic began to change around the 2000s. The new advice recommending exercise during pregnancy has only become widespread since 2018, which is very recent. Neels frames this timing: ‘Research on women’s health is unfortunately a bit behind. Medical studies used to focus mainly on men, and then it was assumed that the results were the same for women. Now we know that women are quite different, for example when it comes to hormones. In addition, there weren’t many studies involving pregnant women for a long time because of safety concerns. And finally, of course, it takes time to observe long-term effects.’

Health promotion 

Even though we know today that exercising during pregnancy is good, we do not yet see this reflected in practice. ‘Very few pregnant women are sufficiently active’, Neels says. ‘Due to lack of proper information and sometimes motivation. Health care professionals can play a crucial role in this. They know the new guidelines, but sometimes still don’t encourage patients enough to take action. And it is definitely needed. Because exercising during pregnancy really lowers the risk of all kinds of conditions.’ Academic research can also help with health promotion: ‘A key research question is how to better convince pregnant women of the importance of exercise. If we find answers to that, we can promote health and prevention even better!’