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INTRODUCTION
Pregnant women and their
unborn babies receive numerous health benefits from physical activity [1].
Though, in spite of the positive health benefits, few women meet physical
activity recommendations during pregnancy [2,3]. Moreover, research suggests
medical practitioners are key in encouraging women to be physically active and
to exercise during their pregnancies [4]. Unfortunately, previous research also
suggests medical practitioners may not be encouraging pregnant women in
accordance with recommended guidelines [5], nor do medical professionals
possess the confidence, ability or knowledge to provide exercise prescription
counseling to expectant mothers [4].
In a qualitative study of
women who participated in cross-fit while pregnant, participants noted that
medical practitioners provided advice and recommendations such as to stop
lifting anything heavier than a gallon of milk and to discontinue high
intensity interval training as it might harm their baby [6]. Misinformed advice
given to physically active pregnant women are not uncommon. Anecdotally, as the
first author is currently pregnant, she inquired with her medical professional
for recommendations of engaging in physical activity. Specifically, what her
target heart rate (THR) and rated perceived exertion (RPE) should be during
exercise throughout her third trimester. The practitioner’s response was, “I do
not know; I’ve never received this question.” She had been practicing medicine
for over 10 years.
Research reveals it is common
for pregnant women to have some concern about the well-being and health of
their babies and what exercise protocols are safe [1,7,8]. Further, current
research suggests pregnant women believe leisure-time physical activity during
pregnancy (LTPA) is somewhat safe and beneficial. “In contrast, it appears that
fewer pregnant women believe in the safety and health benefit of vigorous LTPA,
despite evidence that it is not detrimental and may be protective to mother and
baby” [1].
Many medical professionals
suggest that a proper intensity is one that allows for the woman to have a
conversation while exercising (i.e., talk test) [9]; though, any woman who has
been pregnant will attest that leisurely climbing 10 stairs might cause her to
not pass a talk test. For a woman who has engaged in rigorous physical activity
prior to and during pregnancy, the suggestion might seem unnecessarily low
considering her physical fitness and experience. Moreover, medical
professionals might advise pregnant women to avoid exercises with the use of weights
or resistance [9]. Thus, women who have exercised with both their entire adult
life might find the recommendation impractical.
Because exercise advice for
pregnant women is generally limited and is often vague due to care provider’s
limited knowledge on the subject [10], women are left to their own devices when
deciding whether or not to engage in exercise during pregnancy [11]. However,
The American College of Obstetrics and Gynecology (ACOG) [12] states that if a
person is healthy and the pregnancy is normal, it is safe to continue and begin
most forms of exercise. Entin and Munhall [13] determined that 52% of
obstetricians in the United States did not regularly discuss exercise with
their pregnant patients. Myths about exercise and pregnancy spread like
wildfire especially in the era of social media. The same myths often repeat
themselves throughout online forums despite recent research demonstrating the
benefits and safety of remaining physically active during pregnancy [11].
Modern research attempts to dispel these myths in order to create an awareness
and increase physical activity among pregnant women [11].
MYTH 1: REFRAIN FROM EXERCISE
IF PREVIOUSLY SEDENTARY
A common myth surrounding exercise and pregnancy states that pregnant
women should refrain from exercise if they have lived a sedentary lifestyle
prior to becoming pregnant [11]. The ACOG [12] published guidelines stating
that sedentary pregnant women can and should exercise but should increase
intensity gradually and progressively. The ACOG provides recommendations
indicating that pregnant women should reach at least 150 min of
moderate-intensity exercise each week. Additionally, according to the American College
of Sports Medicine (ACSM), in order to ensure safety of the mother and baby,
modifications should be taken when needed as it is important to listen to the
body at any stage of pregnancy [14]. Unfortunately, even though pregnancy may
be an ideal time to create healthy exercise habits, physicians are often
hesitant to encourage sedentary women to exercise during pregnancy [13].
MYTH 2: DO NOT EXCEED A HEART
RATE OVER 140 BPM
Another common myth that dissuades pregnant women from exercise states
that pregnant women should not exceed a heart rate intensity of over 140 beats
per minute (bpm). Furthermore, Entin and Munhall [13] reported 62% of women
indicated that their physician advised them to stay below this intensity level
during any stage of pregnancy. However, current research does not support the
need for heart rate limitations during pregnancy [13].
Contrary to evidence based research, the ACSM only recommends that
previously active women continue their exercise intensity if they were
accustomed to these levels prior to becoming pregnant [14]. Conversely, the
ACOG dispelled heart rate maximum intensity recommendations from their 1994
guidelines [15]. The ACOG recommends pregnant women, who have previously been
sedentary to begin with moderate-intensity exercise, monitor their heart rate,
listen to their body and make modifications as needed [12]. The general
consensus in research [12] appears to overemphasize the recommendations to
progress gradually and check in with one’s body frequently in order to maximize
the safety of both the mother and baby.
MYTH 3: AVOID ABDOMINAL
EXERCISES
Finally, pregnant women often believe that abdominal exercises are off
limits during any stage of pregnancy [15]. The ACOG [12] does not provide
explicit recommendations stating that abdominal exercise should be avoided
during pregnancy. However, pregnant women should avoid lying flat on their back
due to uterine pressure on a large vein that may decrease venous return or
blood flow to the heart [15]. Exercises to strengthen the abdominal core during
pregnancy, such as pelvic tilts and Kegel exercises may assist in the
prevention of low back pain [15]. Depken and Zelasko [16] determined that
muscular strength training could reduce the risk of abdominal muscle separation
that commonly results from weakened abdominal muscles during pregnancy.
Additionally, it was determined that abdominal strength training did not have
any harmful effects on the mother or baby [16].
Among their guidelines, the ACOG [12] includes warning signs and
exercises that should be avoided during pregnancy, the benefits of exercising
while pregnant and encourages mothers to continue exercise after the birth of
their child. It should be noted that while further research is needed to
determine exercise recommendations while pregnant, the ACOG [12] explicitly
states that it is indeed safe to exercise during pregnancy. Not only could
proper knowledge and recommendations from health care providers encourage
pregnant women to exercise, it would also dispel harmful myths that often
encourage sedentary pregnancies. Lastly, the general public’s misconceptions
about the myths have led to online bullying and making false accusations of
pregnant women who choose to exercise.
SOCIAL MEDIA AND PREGNANCY
Exercising while pregnant is not a new phenomenon, however, publicly
posting about it on social media is a recent trend. In fact, it has even
prompted popular hashtags such as, #moveyourbump, #fitpregnancy and
#runningpregnant among many others. As the popularity of publicly sharing
pictures and videos of exercising while pregnant has increased, so too has the
bullying and shaming of these women through unsolicited and hurtful comments.
Such comments and harassment are considered cyberbullying. Cyberbullying is
defined as an act of aggression over an electronic medium in which the
perpetrator’s goal is to pursue pleasure through the mistreatment of the victim
[17]. Online bullying has the potential to be more harmful than traditional
bullying [17] due to the publicness and accessibility by an infinite number of
individuals.
Through a brief online, social media-based analysis, the authors were
able to find numerous examples of online bullying of pregnant women who chose
to be physically active. Comments towards the women included personal opinions
against being physically active during pregnancy, that the women were trying to
kill their baby, they were being selfish, and even went as far as wishing harm
upon the mother and baby. One pregnant woman on Instagram, Emily Breeze, received
comments on her post of working out, such as, “this is an easy way for an
abortion or miscarriage” and “you know, if you didn't want a child you
shouldn't have had sex in the first place” [18]. Additionally, Duncan received
hurtful comments and direct messages to her posts including someone wishing her
baby was stillborn and another that her child would be born disabled [19].
Often, such sentiments prompted the women to create posts in an attempt
to defend themselves, their decisions, and ultimately hoped to quiet their
bullies. Duncan [20] wrote a post stating,
It's hard to believe how cruel some of these comments can be...I may
not read every comment, every article, every message but for the ones I have
briefly read it just blows my mind that someone whom I do not know, whom I've
never had any form of connection with could have so much anger and hate towards
me as I carry my first child. I am so confident in the team that supports my
journey and so in tune with my body that it does not discourage me. It's safe
to say there are people out there that underestimate the female body.
Sarah Stage [21] posted, #8monthspregnant and I am just doing the best
that I can and what I believe is the healthiest for baby and myself. There
STILL seems to be some confusion and harsh ignorant opinions about exercising
while pregnant and some of you believe it's putting baby in danger. Do your
research and you will see that working out while pregnant (with your doctor’s
consent) has many benefits for mom and baby! I feel fortunate that I'm still
able to exercise in my third trimester (even though it's far less often and
weigh less intense than my non Prego workouts). So for all of the women out
there who are doing the best they can, I am proud of you!!! Creating life inside
of us is a huge responsibility and we need to support each other instead of
judging!! #positivevibes #stopmomshaming
In a positive light, it would be remiss not to mention that social
media has also become a place for physically active pregnant women to build
community, social support, and inspiration for current and future mothers who
are thinking about and/or currently exercising. Throughout the analysis,
numerous encouraging comments were discovered such as this one written on Emily
Breeze’s [22] post by B'n'Wm Clothiers [23], “You go girl. So proud of what you
are doing. You inspire me daily.”
Despite available research, obstetricians and gynecologists remain
reluctant to advise exercise protocols to pregnant women, especially those who
have been previously sedentary, though the benefits are apparent. According to
Entin and Munhall [13], “this represents a missed opportunity to promote a
positive, potentially long-term behavioral change” (p. 453). Undoubtedly, in
this light, further research, education and consideration of pregnant women’s
previous fitness levels and experiences is necessary when delivering physical
activity recommendations and safety precautions for pregnant women and their
unborn babies. The prevention of health risks due to exercise and physical
activity while pregnant are complex and difficult to assess. As such, medical
practitioners can be the first ones to provide informed, educated and competent
counsel to pregnant women and in doing so potentially dismantle many of the
myths surrounding being physically active during pregnancy.
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RA, et al. (2016) The influence of risk perceptions and efficacy beliefs on
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medical practitioners may need support when prescribing exercise to pregnant
women. Aust J Rural Health 25: 62-63.
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4. Joy EA, Mottola MF, Chambliss H (2013) Integrating
exercise is medicine into care of pregnant women. Curr Sports Med Rep 12:
245-247.
5. Andersen RE, Blair SN, Cheskin LJ, Bartlett SJ (1997)
Encouraging patients to become more physically active: The physician’s role.
Ann Intern Med 127: 396-400.
6. Prewitt-White T, Feito Y, Connolly C, Bladek H, Hamel
L, et al. (2018) Breaking barriers: Women’s experiences of CrossFit training
during pregnancy. Women in Sport and Physical Activity Journal. Advance Online
Publication.
7. Eide J, Hovengen R, Nordhagen R (2010) Childhood abuse
and later worries about the baby’s health in pregnancy. Acta Obstet Gynecol
Scand 89: 1523-1531.
8. Hegaard HK, Kjaergaard H, Damm PP, Petersson K, Dykes
AK (2010) Experiences of physical activity during pregnancy in Danish
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study. BMC Pregnancy Childbirth 10: 33.
9. Bianchi C, Battini L, Aragona M, Lencioni C, Ottanelli
S, et al. (2017) Prescribing exercise for prevention and treatment of
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10. Ferrari RM, Siega-Riz AM, Evenson KR, Moos MK, Carrier
KS (2013) A qualitative study of women's perceptions of provider advice about
diet and physical activity during pregnancy. Patient Educ Couns 91: 372-377.
11. Ribeiro CP, Milanez H (2011) Knowledge, attitude and
practice of women in Campinas, São Paulo, Brazil with respect to physical
exercise in pregnancy: A descriptive study. Reprod Health 8: 31.
12. The American College Of Obstetricians and
Gynecologists (ACOG) (2019) Exercise during pregnancy. Retrieved April 22,
2019, from https://www.acog.org/Patients/FAQs/Exercise-During-Pregnancy
13. Entin PL, Munhall KM (2006) Recommendations regarding
exercise during pregnancy made by private/small group practice obstetricians in
the USA. J Sports Sci Med 5: 449-458.
14. Wing C, Stannard A (2016) Pregnancy and exercise
guidelines: Fifty years makes a... ACSM's Health Fitness J. Retrieved April 22,
2019, from https://journals.lww.com/acsm-healthfitness/FullText/2016/03000/Pregnancy_and_Exercise_Guidelines__Fifty_Years.4.aspx#O2-4-6
15. Piper TJ, Jacobs E, Haiduke M, Waller M, McMillan C
(2017) Core training exercise selection during pregnancy. Strength Cond J 32:
55-62.
16. Depken D, Zelasko C (1996) Exercise during pregnancy:
Concerns for fitness professionals. Strength Cond J 18: 43-51.
17. Patchin JW, Hinduja S (2006) Bullies move beyond the
schoolyard: A preliminary look at cyber bullying. Youth Violence and Juvenile
Justice 4: 148-169.
18. Gilbert K (2018) CrossFit athlete Emily Breeze on why
workout-shaming pregnant women needs to stop. Shape. Retrieved from: https://www.shape.com/lifestyle/mind-and-body/crossfit-games-athlete-emily-breeze-shaming-pregnant-women-working-out
19. (2017) Fitness mum reveals the horrific comments she
received during pregnancy. NetMums. Retrieved from: https://www.netmums.com/pregnancy/fitness-mum-reveals-the-horrific-comments-she-received-during-pregnancy
20. Duncan C (2016) It's hard to believe how cruel some of
these comments can be...I may not read every comment, every article, every
message but for the ones I have briefly read it just blows my mind that someone
whom I do [Instagram photo]. Retrieved from https://www.instagram.com/p/BDLAzP-Jb0e/?utm_source=ig_web_copy_link
21. Stage S (2017) #8monthspregnant and I'm just doing the
best that I can and what I believe is the healthiest for baby and myself
[smiley] There STILL seems to be some confusion and harsh ignorant opinions
about exercising while pregnant and some of you. Retrieved from: https://www.instagram.com/p/BYdv66_HRRy/
22. Breeze E (2018) OMG I’m in my final MONTH before I
become a MOM of TWO!!! I’m feeling great and I continue to attribute that to
movement!! Before you guys go all crazy on me - remember that I’m a real life
human who. Retrieved from https://www.instagram.com/p/BhcK5arHvhE/?utm_source=ig_embed
23. Clothiers B (2018) Re: OMG I’m in my final MONTH
before I become a MOM of TWO!!! I’m feeling great and I continue to attribute
that to movement!! Before you guys go all crazy on me - remember that I’m a
real life human who. Retrieved from: https://www.instagram.com/p/BhcK5arHvhE/?utm_source=ig_embed
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