Overprotecting pregnant women, urging them to control their activity and rest most of the time, has always been the custom. However, for approximately the last three decades, scientific literature has been demonstrating precisely the opposite. Maintaining an active life is as important during pregnancy as having a healthy diet or carrying out all routine medical check-ups, emphasizes Carmen Gutiérrez, gynecologist at the Pelvic Floor Unit of the 12 de Octubre Hospital in Madrid.
Despite the advice of specialists, less than 20% of women in the world meet the WHO recommendations of practicing 150 minutes of physical exercise per week. They are data from the Clinical Practice Guideline on Physical Activity during Pregnancypublished by the Polytechnic University of Madrid (UPM), and which explains the benefits of staying active during those nine months and how to do it safely for the mother and baby.
UPM researchers published, throughout 2023, several investigations that show the advantages that playing sports has for pregnant women. Some of the data provided by these articles is that future mothers who practice some type of physical activity reduce the risk of gaining excessive weight and suffering from diabetes during pregnancy by between 32% and 38%, respectively. It also reduces the possibility of having to resort to cesarean section by 13% and instrumental delivery by 16%. It is even associated with a reduction of about one hour in dilation prior to delivery.
Controlling the weight that the mother gains during pregnancy is one of the most important factors. Cristina Silva, doctor in Physical Activity and Sports Sciences and one of the authors of the work, explains that controlling this aspect prevents macrosomia (when the baby weighs more than four kilos), which is associated with obesity and higher incomes. in the neonatal ICU. Regarding mental health, it reduces anxiety, stress and pre- and postpartum depression. “Women who are physically active during pregnancy are more effective in the muscular, respiratory and mechanical tasks imposed by the birth process in each of its phases,” details Rubén Barakat, professor in Physical and Sports Education and one of the authors. of UPM research.
It is important to exercise the pelvic floor muscles. Although the scientific evidence on this is still scarce, it has been shown that working it for three or four days a week reduces postpartum urinary incontinence, according to Gutiérrez, from the 12 de Octubre Hospital in Madrid. Both she and Francisca Molina, vice president of the Spanish Society of Gynecology and Obstetrics (SEGO) and obstetrician at the San Cecilio Clinical Hospital in Granada, agree that women who remain active during pregnancy have a faster postpartum recovery than those who They lead a sedentary life.
If the recommended 150 minutes per week are divided into six days, that is 25 minutes of physical exercise per day, says Silva. “The important thing is to establish the habit from the beginning and make it regular,” he highlights and says that individualization is essential to achieve it. If the activities they practice interest them, they will maintain motivation more easily.
Adapt the activity to each case
The recommendations are not too specific, during those nine months almost any activity can be carried out, as long as it is adapted to the individual circumstances of each person. For example, a woman who practices cycling should replace it with a stationary bicycle during those months to avoid the risk of falls. Cristina Díaz del Campo, member of the Spanish Association of Physiotherapists in Women’s Health and Pelvic Health (AEF-SAMU), says that the most recommended and safe thing is to walk, practice Pilates or yoga for pregnant women (supervised by a physiotherapist) and swimming. Diving is not recommended, due to pressure changes, or sports where they can suffer blows (football, basketball, boxing, skiing…)
Women who train in the gym should adapt the postures of their exercises, but only if they have experience and know how to perform all the necessary techniques well, warns Silva, from the UPM. They should avoid prone positions and limit face-up time to two to three minutes per activity. In the latter case, they can adapt their posture and use a gymnastic ball so that they are not completely lying down and so that the practice is safer.
It is important that, in addition to being adapted, any physical activity that a pregnant woman does is guided. All experts agree that the ideal is for them to have a specialist (a personal trainer or a pelvic floor physiotherapist). However, individual attention is an option available to few people due to its economic cost and group classes are more accessible.
To work with pregnant women, exercise sessions must include several components: an aerobic part that is not strenuous, muscle strengthening (especially in the upper and lumbar areas for the care that the baby will require), balance and coordination to avoid falls as you go. changing the body, pelvic floor work, which is essential and, finally, relaxation and returning to calm, Silva details.
Pelvic floor and hip flexibility
In perinatal physiotherapy the three key points are: preparation of the pelvic floor, physical exercise and providing strategies to the pregnant woman and her companion to face childbirth, explains Díaz del Campo, from the AEF-SAMU. In addition to exercises to tone and get the future mother in shape, she details, aspects such as flexibility of the hips and pelvis are also worked on. These are individualized and supervised exercises in which internal and external rotation movements of the hips are performed, which help the baby fit better in the birth canal.
This physiotherapist warns that before starting to work the pelvic floor muscles it is necessary for a physiotherapist specialized in women’s health to make a prior assessment of their condition. Perinatal physiotherapy also recommends and teaches perineal massage so that women can do it at home. It is advisable to do it from week 32 of gestation and it can prevent tears or natural rupture of the perineal tissue, says Díaz del Campo.
“Toilets are a good speaker to make women aware of the importance of exercising during pregnancy,” says Silva. However, “her speech may be limited due to the lack of public offering,” laments Barakat. This situation leaves women with fewer resources relegated, most of the time, according to this specialist, who calls for greater investment in this area: “The existing scientific evidence must serve so that, from the institutional level, ambitious and extensive physical activity programs for pregnant women.
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