Should I Exercise When I Am Pregnant? – Exercise, or physical activity (PA), is established as a critical component of health across the life span, yet only recently have we begun to realize the powerful influence of prenatal exercise for optimizing the health of two generations, the mother and the to-be-born child. Traditionally, women were told to rest and relax when they became pregnant. However, this changed in 1985 with the publication of the first set of guidelines for exercise during pregnancy by the American College of Obstetricians and Gynecologists (ACOG) (⁸). These guidelines were rapidly followed by the development of similar recommendations in Spain, Canada, Norway, Japan, Australia, France, Denmark, the United Kingdom, and many other countries around the world (⁹). Since then, empirical evidence supporting the safety and benefits of prenatal exercise has grown significantly, and global guidelines now recommend engaging in at least 150 minutes of moderate-intensity PA spread over three or more days of the week (see Figure). Indeed, our current view of prenatal PA has shifted away from focusing on the potential risks of exercise, toward prescribing exercise to improve maternal–fetal health (^11,12).

Recent data demonstrate that PA during pregnancy decreases the odds of having major pregnancy complications (gestational diabetes mellitus, preeclampsia, gestational hypertension, delivering a large baby) by approximately 40% and decreases the odds of developing depression by nearly 70% (^2,13–15). Interventions to prevent these complications may also reduce the odds of developing chronic diseases, including cardiovascular disease, obesity, and diabetes in both mother and baby. This evidence supporting PA during pregnancy also indicates no increased risk of having a miscarriage, small baby, or preterm birth related to the exercise (^14–16). Based on the dose–response curves of randomized controlled trials of exercise compared with no exercise, the recommendation of 150 minutes/week of moderate-intensity PA is associated with at least a 25% reduction in the odds of developing each of preeclampsia, gestational hypertension, gestational diabetes, and excessive weight gain and reduces the severity of depressive symptoms (^2,13,17). This 150 minutes/week threshold parallels the majority of prenatal guidelines around the world. We now have the strongest empirical evidence to date clearly demonstrating the safety and benefits of being physically active throughout pregnancy for both mother and baby.

Should I Exercise When I Am Pregnant?

Recent data demonstrate that PA during pregnancy decreases the odds of having major pregnancy complications (gestational diabetes mellitus, preeclampsia, gestational hypertension, delivering a large baby) by approximately 40% and decreases the odds of developing depression by nearly 70% (^2,13–15). Interventions to prevent these complications may also reduce the odds of developing chronic diseases, including cardiovascular disease, obesity, and diabetes in both mother and baby.

Yet, despite compelling evidence, only 15% of women in the United States meet current guidelines for PA (¹⁸). Lack of time, financial cost, social support, work and family duties, and cultural practices continue to prevent many women from taking part in PA while pregnant (¹⁹). Many women also are reluctant to be physically active due to fatigue or feeling unwell, or for some women, fear for the safety of their fetus. However, these fears can be alleviated by recent, comprehensive reviews of the literature that have shown that exercise within the scope of current guidelines confers significant physical and psychological benefits, without evidence of harm to either mother or baby. Exercise professionals are ideally positioned to empower women from all socioeconomic and cultural backgrounds to engage in PA throughout their pregnancy. Indeed, there should be a focus on the risks of not being physically active during pregnancy, as those tend to present more concern than for being active. This is also an important time to place a focus on the social, emotional, and spiritual aspects of wellness, as pregnancy is joyous for many, but also can be very stressful for most.

Messaging should emphasize that prenatal PA can be a simple, low-cost therapy to reduce the risk of developing pregnancy complications and can improve many other aspects of wellness. For instance, including friends, a partner, or other children in a bout of exercise can build social and emotional support, which is so important during pregnancy. An exercise professional can offer group exercise classes that include both pre- and postnatal moms, dads, and even other family members. Being active, especially in nature, releases endorphins that can boost your mood. Encourage walking in the woods, gardening, or playing at a park to reduce stress and revitalize feelings of well-being. Practicing mindfulness and being present and aware of one’s thoughts and emotions during PA, including walking, yoga, or tai chi can encourage further feelings of well-being, reduce stress, and allow time for reflection and focus, for example, leading a walking activity while coaching clients through mindful breathing techniques. Finally, emphasizing that any amount of PA is beneficial, i.e., “some is better than none”; thus, incorporating even minimal amounts of PA is a good thing. In fact, a brisk walk for just 10 minutes per day can reduce the odds of developing preeclampsia by 25% (²), and increasing to just 15 total minutes per day has the same positive effect on the development of gestational hypertension and excessive weight gain during pregnancy (^2,17).

Being active, especially in nature, releases endorphins that can boost your mood. Encourage walking in the woods, gardening, or playing at a park to reduce stress and revitalize feelings of well-being. Practicing mindfulness and being present and aware of one’s thoughts and emotions during PA, including walking, yoga, or tai chi can encourage further feelings of well-being, reduce stress, and allow time for reflection and focus, for example, leading a walking activity while coaching clients through mindful breathing techniques.

When prescribing exercise for the pregnant woman, it is important to recognize that many women can feel isolated or feel a lack of emotional support, which makes initiating exercise that much more difficult. Depression affects approximately 13% of pregnant women, and prenatal depression strongly predicts postpartum depression (⁵). Depression and anxiety are associated with reduced self-care, preterm labor, and low birth weight, as well as compromised caregiving and bonding with the infant after delivery. However, data show as much as a 67% reduction in the odds of developing depression in women who exercise during pregnancy (¹³). Even in women not diagnosed with clinical depression, exercise can substantially reduce the severity of depressive symptoms. Although it is not clear whether prenatal exercise can reduce the odds of developing postpartum depression, significant mental health benefits have been observed when women resume exercise in the postpartum period after recovery from delivery (²⁰). Further, group exercise can provide an extra level of motivation, as you are accountable to others, while also increasing valuable social time. Socialization with other women, even the opportunity to interact with exercise leaders or personal trainers, can provide women with the social and emotional support that is critical to positive mental health and overall wellness during pregnancy.

IS THERE A TIME WHEN IT IS NOT SAFE TO EXERCISE DURING PREGNANCY?

Although most women benefit from exercise during pregnancy, there are several medical conditions (“contraindications”) where moderate- to vigorous-intensity PA (MVPA) may adversely affect the health of the mother and/or fetus (²¹). Ensuring pregnant women are being followed by a medical professional is critical to identifying these conditions. Although these situations are uncommon, they do occur; therefore, specific cautions are warranted when prescribing exercise, and under certain circumstances, exercise should be avoided. An absolute contraindication is a condition where MVPA should be avoided because of an elevated risk of adverse events for either the mother or the fetus. Absolute contraindications may vary between specific guidelines (ACSM, ACOG, CSEP/SOGC, etc.) but most often include serious pregnancy complications such as preeclampsia and intrauterine growth restriction, as well as pre-existing cardiovascular or respiratory diseases (see Table 1) (⁹).

However, it should be stressed that even in these scenarios, activities of daily living may be encouraged as directed by their health care provider. By contrast, relative contraindications warrant a discussion between the pregnant patient and her obstetric health care provider to determine the potential risks and benefits of PA during pregnancy. Conditions such as mild respiratory disorders or symptomatic eating disorders may warrant a reduction in the intensity, duration and/or volume of activity, or avoidance of MVPA, depending on individual risk (²¹). The development of contraindications can be associated with increased rates of depression and anxiety in pregnant women, which of course presents its own paradox, because the PA typically is what reduces these very same conditions as part of increased wellness. Therefore, it is especially important to care for the mental health and well-being of women who are restricted from activity during pregnancy. Encouraging regular social contact with friends and family and promoting the continuation of light activities of daily living, including such as light-intensity walking, cooking, cleaning, and other activities (as recommended by their health care provider), will support the social, emotional, and spiritual health of pregnant women. In addition to PA, other components of a healthy lifestyle are encouraged. These include adequate and quality sleep and nutrition, as well as avoidance of smoking, alcohol, and all forms of cannabis use (^22–25). A savvy exercise professional can create or refer to non-PA workshops, such as healthy cooking, healthy food shopping, and planning for life with a newborn.

In addition to the assessment of relative and absolute contraindications to exercise, during pregnancy, there are types of exercise where additional caution is also warranted. First, women are recommended to avoid activities with a high risk of physical contact or falling. This may include horseback riding, downhill skiing, riding a nonstationary bike, playing soccer, hockey, or other team sports. Although there is some protection of the fetus through the uterus and amniotic fluid, direct trauma to the abdomen can cause harm to the fetus through loss of amniotic fluid, placental abruption, and or premature labor. Second, there is limited evidence regarding the safety of pregnant women exercising in excessive heat (especially with high humidity such as hot yoga) because of an elevated risk of dehydration. Instead, exercise is recommended to be performed under cooler conditions such as in air conditioning or by avoiding the midday heat by exercising in the shade or in the early morning or evening. Other activities such as scuba diving and high altitude exercise (for those living at sea level) are not recommended (^11,12,26).

There also are reasons for pregnant women to stop PA and speak to a health care provider, such as the onset of persistent excessive shortness of breath, severe chest pain, regular and painful uterine contractions, vaginal bleeding, persistent loss of fluid from the vagina, and persistent dizziness or faintness that does not resolve upon rest. These signs and symptoms can represent the initiation of labor or be a symptom of a clinically relevant complication. In these cases, women should cease exercise and seek medical attention.

ENCOURAGING PA DURING PREGNANCY AS PART OF THE WELLNESS CONTINUUM

For decades, women who were not physically active before pregnancy were discouraged from starting after becoming pregnant. This misconception has been debunked by recent studies demonstrating that women who were not active before pregnancy can derive clinically meaningful benefits by beginning to engage in regular PA after conception, even at levels well below current recommendations. Counseling women to start with a low intensity and duration of exercise and taking small steps toward increasing PA is recommended. From getting off the bus a stop early, parking the car farther away, or taking a short evening walk are all great ways to encourage a physically active lifestyle. For those women experiencing back pain or aching joints, water exercise can be a quick and easy way to find relief while getting a great workout. Doing these same activities with others, friends, family, or fellow gym members, also can improve the social, emotional, and spiritual aspects of wellness, which in turn decreases symptoms or risk for pregnancy-related depression and anxiety (Table 2). Walking remains a simple, low-cost mode of exercise and something that every exercise professional should promote. For example, for women who are inactive at conception, encouraging as little as 5 to 10 minutes of moderate walking is a great way to start. If possible, gradually increasing this 1 to 2 minutes per week as pregnancy progresses, even up to 150 minutes per week, will provide even greater benefits to both the mother and fetus. For those who find walking too uncomfortable or difficult, water-based exercises, where available, can be a great alternative.

Should I Exercise When I Am Pregnant?

Women who were active before pregnancy can continue to be active during pregnancy; however, their activities may need to be adapted. Women who wish to substantially exceed current guidelines (e.g., vigorous and or long duration exercise) should do so in consultation with their health care provider, as there is limited empirical evidence to guide global recommendations for highly active women. Heart rate zones for pregnancy have been developed to allow women to monitor their exercise intensity (¹¹), and alternatively, the “talk test” is a simple way to determine whether exercise intensity is too high, as women should be able to carry on a conversation during moderate-intensity exercise (²⁶).

Historically, women with certain conditions, including preeclampsia or intrauterine growth restriction, were prescribed bed rest with the goal of improving maternal and fetal health outcomes. However, this practice is no longer recommended as empirical evidence now suggests that bed rest induces negative effects on maternal health such as anxiety, depression, muscle atrophy, bone loss, venous thromboembolism, and gestational diabetes. Fetal outcomes are not improved, and some evidence suggests that earlier delivery may occur (²⁷).

Historically, women with certain conditions, including preeclampsia or intrauterine growth restriction, were prescribed bed rest with the goal of improving maternal and fetal health outcomes. However, this practice is no longer recommended as empirical evidence now suggests that bed rest induces negative effects on maternal health such as anxiety, depression, muscle atrophy, bone loss, venous thromboembolism, and gestational diabetes. Fetal outcomes are not improved, and some evidence suggests that earlier delivery may occur (²⁷).

Summary

As exercise and health professionals, it’s important to consider a woman’s physical, mental, social, and spiritual health when prescribing exercise. Health and fitness professionals can encourage women during this period to be active and to include other areas of wellness by inviting friends to be active with them, or practicing mindfulness during PA, or joining group exercise session for increased social interactions. During pregnancy, there will be days where a woman feels tired or unwell, encouraging adequate rest and sleep to ensure recovery is as important as encouraging a resumption of activity after recovery. Consider the individual’s goal, whether it be disease prevention, stress reduction, or mood enhancement, in the design of an exercise plan or in making recommendations regarding PA. Although prescribing exercise during pregnancy requires additional considerations beyond a non-pregnant women, such as time constraints, fatigue, and caring for other children, it is possible to develop effective strategies that increase PA while at the same time improving different aspects of wellness, particularly socio-emotional well-being. And all of these can occur with as little as 10 minutes a day of PA!

BRIDGING THE GAP

Extensive evidence now supports the safety and benefits of prenatal PA to support the health and wellness of pregnant women. Therefore, it is critical that women and exercise professionals shift their individual and collective perspective of prenatal PA away from the potential risks of exercise, and instead realize that an effective exercise prescription can improve health, with subsequent benefits to many other dimensions of wellness. In fact, it may be just as important to consider the many risks of not being physically active during pregnancy.

The Top 20 Tips To Ensure Weight loss In 2020 – Belly fat is not just a pesky thing that makes your clothes too tight. Inside the abdomen there is something called visceral fat and this is quite harmful. This type of fat is a major risk factor for type 2 diabetes and heart disease among others. Some health organizations use the BMI (body mass index) to predict the risk of diseases. Individuals with a lot of visceral abdominal fat run an increased risk, even if they look thin on the outside. Although losing belly fat can be difficult, there are a number of things you can do to achieve this.

Here are 20 effective tips for weight loss that are scientifically proven!!!

1. Eat lots of Fibre

Soluble fibers absorb moisture and form a jelly that ensures that your food passes through the digestive system slowly. Studies show that this type of fiber promotes weight loss because it helps you feel saturated, so you naturally start eating less. It can also reduce the amount of calories that your body gets from food. And most importantly, soluble fiber can help you fight belly fat. A large observational study with more than 1,100 adults found that the increase in abdominal fat decreased by 3.7% in 5 years for each 10 gram increase in soluble fiber intake. Do your best to eat fiber-rich foods every day. Excellent sources of soluble fiber include linseed, shirataki noodles (konjac noodles), Brussels sprouts, avocados, legumes and blackberries.

2. Stay away from trans fats

Trans fats are in some margarine’s and some types of spreads (such as peanut butter, hazelnut pastes, etc.) they are also added to certain packaged foods. These fats are associated with inflammation, heart disease, insulin resistance and an increase in abdominal fat, according to observational research and animal studies. A 6-year study found that monkeys who ate a diet rich in trans fats received 33% more belly fat than monkeys who ate a diet rich in unsaturated fats. If you want to reduce the amount of belly fat and protect your health, read all labels carefully and stay away from trans fats. They are often listed as “(partially) hydrogenated”

3. Take it easy on the alcohol

Alcohol can still be healthy in small quantities, but it is extremely harmful if you drink too much. Research also shows that too much alcohol can cause an increase in belly fat. Studies show links between heavy alcohol consumption and significantly increased risks of excessive fat storage around the waist. You don’t have to give it up completely if you like it, but limiting the amount you drink in a day can help. More than 2000 participants showed that those who drank alcohol daily, but on average less than one drink per day, had less belly fat than those who drank alcohol less often, but took more on the days they did drink.

4. Make sure you get your protein!!

Protein is a very important nutrient for weight control. A high protein intake increases the release of the saturation hormone PYY, which reduces appetite and increases the feeling of being full. Protein also increases the metabolic rate and helps maintain muscle mass with weight loss. Studies show that people who eat more protein, often have less belly fat than those who eat less protein. Make sure you eat a good source of protein with every meal, such as meat, fish, eggs, dairy, whey protein, or nuts.

5. Keep Calm and Carry On

Stress can lead to an increase in abdominal fat because it stimulates your adrenal glands to make cortisol; the hormone that is also known as ‘stress hormone’. Research shows that high cortisol levels increase appetite and stimulate the storage of abdominal fat. Men and Women alike who already have a large waist size often produce more cortisol in response to stress. Increased cortisol provides even more fat storage around the waist. Develop fun and relaxing activities that reduce stress. Try to engage in Tai Chi, Yoga or weight lifting to reduce levels of stress and release of cortisol.

6. Stop eating so much sugar!!!

Sugar contains fructose, which in excessive use has been associated with various chronic diseases, including heart disease, type 2 diabetes, obesity and liver cirrhosis. Studies show a link between high sugar intake and increased fat around the waist. It is important to realize that it is not just about refined sugar. Even ‘healthier’ types of sugar (such as real honey) must be eaten in smaller amounts.

7. Do your cardio lazy!!

Aerobic training or cardio is a good way to improve your health and burn calories. Research shows that it is one of the best ways of to reduce fat. However, the results are mixed when it comes to the type of training that is better now, with moderate intensity or high intensity. Apart from intensity, it is important how often and for how long you train. A study shows that postmenopausal women throughout the body lost more fat at 300 minutes of cardio per week than at 150 minutes of cardio per week (always spread over 5 days).

8. Eat fewer carbohydrates, especially refined ones

Lowering your carbohydrate intake can work well if you want to lose fat. Diets with less than 50 grams of carbohydrates per day cause abdominal fat loss in overweight people, people at risk for diabetes. You don’t even have to follow a very strict low-carb diet; some studies show that replacing refined with unrefined starchy carbohydrates can already improve metabolism and reduce belly fat. In the famous Heart Study, people who ate the most whole-grain cereals were 18% less likely to have excess belly fat than those who ate many refined grains.

9. Replace your cooking oil with Coconut!

Coconut oil is one of the healthiest fats you can eat. Research shows that the medium-chain fatty acids in coconut oil can stimulate the metabolism and can reduce the amount of fat that you store in response to a high calorie intake. There are so many indicators in controlled studies that it leads to a decrease in abdominal fat. In one study, obese men used coconut oil for 12 weeks a day and lost 1 inch of their waist circumference without intentionally making changes in diet or exercise. The best way to eliminate belly fat is by taking about 2 tablespoons of coconut oil daily; the amount that has been used in most studies and that produces good results. However, keep in mind that coconut oil still contains many calories. So do not add extra fats to your food, but replace some of the fats that you already eat with coconut oil.

10. Make sure you do some weight lifting

Resistance training or weightlifting is important for maintaining and increasing muscle mass. Research shows that this type of training can work well to lose abdominal fat in people with prediabetes or type 2 diabetes –  and with fatty liver. One study with overweight teenagers even showed that a combination of strength training and cardio led to the largest decrease in abdominal fat. If you want to start weightlifting it is good to ask for advice from a medical professional. Also seek the assistance of a personal trainer!!

11. Avoid sugary drinks

Studies show that sugar-rich drinks lead to more fat stored in the body. A 10-week study showed that people who received fructose-rich drinks had a significant increase in abdominal fat. Sugar-rich drinks turn out to be even worse than solid foods with a lot of sugar because they get absorbed rapidly in the blood stream. Since your brain does not process liquid calories in the same way as solid, it is likely that you will eventually spike insulin levels that assist in storing fat. This includes the use of alcoholic beverages. Be aware that many alcohol drinks contain high amounts of sugar and access calories.

12. Ensure adequate sleep

Sleep is important for many aspects of health, including your weight. Studies show that people who do not get enough sleep usually  store more abdominal fat. A 20-year study involving more than 59,000 women found that those who slept less than 6 hours a day were significantly more likely to gain weight than those who slept 7 or more hours a night. The condition known as apnea, where breathing occasionally stops during the night, has also been associated with excess belly fat. In addition to at least 7 hours of sleep per night, you must also ensure that your sleep is of sufficient quality.

13. Keep track of what you eat and how much you train

Many criteria can help you lose weight and belly fat, but eating fewer calories than your body needs to keep its weight is the most important. This is called a caloric deficit. It can help keep track of your calorie intake through a food diary (or on a fit bit app or fitness pal app). This appears to be a good strategy for losing weight. In addition, these types of tools help you keep track of how many proteins, fats, carbohydrates, fibers and micro-nutrients you consume. Many of them also offer the possibility to keep track of your training and exercise. You can find apps / mobile apps to keep track of your diet and calorie intake.

14. Eat fish every week

Fish is rich in high-quality proteins and omega-3 fats that protect you against diseases. There is also some evidence that these omega 3 fats help in reducing belly fat. Studies with adults and children with fatty liver indicate that fish oil supplements can cause a significant decrease in liver and belly fat. The goal is to eat 2 to 3 servings of fatty fish a week, such as salmon, herring, sardines, mackerel and anchovies.

15. Stop drinking fruit juice

Although fruit juice contains vitamins and minerals, it contains just as much sugar as in soft drinks and other sweetened drinks so it is very deceiving. If you drink a lot of it, you run the same risk of increasing the belly fat. A glass of apple juice contains 26 grams of sugar, half of which consists of fructose.

16. Add apple cider vinegar to your diet

Apple cider vinegar is very good for health, it can, among other things, lower blood sugar levels. It contains acetic acid, a substance that can reduce belly fat storage in animals, according to various studies. A controlled study of obese men who were given 1 tablespoon of apple cider vinegar a day for 12 weeks showed that their waist size decreased on average by 1.4 cm. Although no human studies have been done yet, it is safe for most people to take 1 to 2 tablespoons of apple cider vinegar per day; this could lead to a modest reduction in fat.

17. Eat Probiotic food or take a supplement

Probiotics are bacteria that occur in some foods and supplements. They are very healthy for a variety of reasons, including the intestines and stronger immune. Researchers have discovered that different types of bacteria play a role in weight regulation and the right balance in gut microbiome can help with weight loss, including loss of abdominal fat. The species that appear to help with the loss of abdominal fat include strains of the Lactobacillus family.

18. Try intermittent fasting

Intermittent fasting has recently become very popular for losing weight. A popular version is that where you get fast for 24 hours 1 or 2 times a week. In another method, you fast 16 hours a day and eat all your food within 8 hours. In a survey of intermittent fasting and every-day fast, participants were found to experience 4-9% reduction in fat in a 6 to 26 week period.

19. Drink green tea

Green tea is a very healthy drink. It contains caffeine and the antioxidant epigallocatechin gallate (EGCG). Both stimulate digestion. The catechin EGCG has been shown to be effective in getting rid of abdominal fat according to various studies. That effect can be multiplied if drinking green tea is combined with exercise.

20. Change your lifestyle and combine different methods

If you want good results, you have to combine different methods that prove to work well. It is amazing that many of the methods are the same things that we usually associate with healthy eating and healthy lifestyles in general but do not implement. It is true that the key to abdominal fat loss consists of a lifestyle change. If you have healthy habits and eat good and unprocessed food, fat loss often follows naturally.

American Food Guide