Getting Started
Have you ever considered exercise as medicine? Well being physically active during pregnancy has many benefits.
(The video mentions the Parmed X For Pregnancy form. Here is the link: http://www.csep.ca/CMFiles/publications/parq/parmed-xpreg.pdf)
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Getting Started
Have you considered exercise as medicine? Well, being physically active during pregnancy has many benefits. It can help you during your pregnancy but also improve the future health for both you and your baby. It is like a medicine for a healthy pregnancy and beyond.
Benefits of Physical Activity
During pregnancy being physically active, can help you control your blood sugar levels. In fact, simply going for a walk and increasing your daily step counts has shown to reduce high blood sugars and this can help you manage your gestational diabetes. Being active will also help you regulate how much weight you gain. During pregnancy we want to see gradual, healthy weight gain and being active can help you achieve that. Appropriate weight gain and controlled blood sugars will help your baby grow at a healthy speed.
Being physically active and trying to add more steps into your day may also improve your energy level and mood. And that’s not all: the benefits of physical activity go beyond your pregnancy and delivery. Research has shown that moms who are physically active during pregnancy and stay active after pregnancy have a lower chance of developing diabetes later in life. Their child’s risk for diabetes also goes down. You may also be less likely to hang onto the extra weight you gain during pregnancy, a problem called postpartum weight retention. So now the question is, how do you get start getting active?
First Steps
If you haven’t already, start by visiting your health care provider to discuss being active during pregnancy. If you were active before your pregnancy this may mean making some changes to your previous routine. If you weren’t, you can still start during pregnancy. You should tell your healthcare provider about the types of activities and exercises you did before pregnancy. You can then discuss your activity goals now that you are pregnant. To guide these conversations, consider using the PARmedX for Pregnancy. You will be asked to complete a series of questions that will help you and your health care provider decide on safe ways for you to be active, based on your previous activity levels, health history and current pregnancy. After you complete the first page, you and your healthcare provider will figure out if there are any reasons that may mean you cannot be active.
Reasons to Limit Physical Activity
There are some things that will really prevent you from being active during pregnancy. They are not common but if you have any of these, your health care provider may put limits on your physical activity.
- Premature or early labour in a previous pregnancy.
- Early contractions and dilation in your pregnancy now.
- Ruptured your membranes (‘broken water’) early in your last pregnancy or in your pregnancy now.
- Bleeding from the vagina during pregnancy.
- Placenta previa is a reason to not be very active during pregnancy. Ask your health care provider about this.
- If your blood pressure cannot easily be brought under control or you have a complicated type of high blood pressure in pregnancy called pre-eclampsia.
- Weak cervix (called an incompetent cervix)
- If your baby is not growing well (intrauterine growth restriction)
- Carrying more than two babies (triplets or more)
- Any medical condition or disease that is not well controlled Please discuss this with your doctor. Many of these conditions and possible problems are listed on the PARmedX form.
Let’s get started!
If your health care provider has given you the okay to exercise and lead an active lifestyle, you are ready to get started. Keep in mind, should you develop reasons not to be physically active later on during your pregnancy, like the problems we have mentioned, you should inform your health care provider and together you can re-evaluate your goals and routine.
Adding Physical Activity Throughout Your Day
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How To Be Physically Active Throughout Your Day
Physical activity is any activity that gets your body moving or activates your muscles; it may be accumulated throughout the day as you do your usual routine. It also includes exercise. Exercise refers to focused physical activity, usually for at least 10 minutes or more at a time.
Start With Walking
We will concentrate on walking as a way of increasing your daily steps. Some walking may be exercise with a focus on going for a planned walk for at least 10 minutes or more. Other times you may accumulate some steps throughout your day, for example as you go upstairs or pick up some food at a grocery store down the street. Increasing your daily step counts and adding walks into your day are great ways to get active and have a healthy pregnancy.
You may want to use a step counter to track your steps. You can set a daily step count goal for yourself. In general, 8000 to 10000 steps per day is considered an active day. But remember, all walking and all steps count, so start at a level that works best for you. If you have always been pretty active, 8000 to
10000 steps may be a good goal. If you haven’t been as active, you may want to start lower and build up. You can gradually progress as you feel comfortable.
Here are some tips and tricks to help you achieve your step goals”
- Use a step tracker to see how you’re doing.
- Take quick walking breaks during long periods of sitting. For example, at work you could walk to the further washroom to add more steps.
- Schedule your walks so it is already planned into your day.
- See if you can replace a time that you normally aren’t getting steps with some more movement such as taking the stairs instead of the elevator, and choose activities that you enjoy but will also get you up and moving such as walking with your kids, walking at the mall, or walking with a friend.
In addition to walking and step counts, some other exercises you may want to consider include stationary bicycles, pool exercises, and light intensity aerobic classes for pregnancy. The activities you choose should focus on your large muscle groups. Avoid activities that increase your risk of falling.
Light to Moderate Intensity
When you are walking or doing any other exercise, you want to aim for what is called a light to moderate intensity. What is moderate for one person may be different for someone else, though. There are three ways you can make sure that you are exercising at an appropriate intensity level for you.
- You can think about how you’re feeling and your level of tiredness. You want to be working at a rate that you would classify as “somewhat hard”, or in other words, on a scale of 1-20 you’re working at about level 12 to 14.
- You can also use the ‘talk test’. While you’re out for a walk, you should be able to
maintain a conversation without feeling short of breath- but you may not be able to sing. - If you have access to a heart rate monitor, you can also use this as a measure of intensity by making sure you are within target heart rate zones. The target heart rate zones are listed in the PARmedX for pregnancy.
Resistance Training
You can also do some light resistance training. Choose lighter weights, ones that will allow you to achieve at least 12-15 repetitions without difficulty and without holding your breath. Or consider using a resistance band if that is more comfortable.
And you don’t have to be in a gym or use gym equipment to do resistance training. You could use items you have at home, such as large soup cans, and incorporate these exercises into your daily routine, maybe while you enjoy a TV show.
Sample Program
Here is an example of a walking program you may want to consider.
- Frequency of exercise: Maybe add a walk 3-4 times per week, and think about
can add activity throughout your day to increase your daily steps. - Intensity of exercise: Aim for a light to moderate intensity, listen to your body.
- Time of exercise: Start at 10-15 minutes and as you feel comfortable progress to 30 minutes for a planned walk. But remember, activity can be added throughout your day in short bouts of movement, striving towards your daily step count goals.
- Type of exercise, walking is an amazing exercise that gets all your major muscle groups moving!
This is called a FITT goal, which means it is a specific goal that includes frequency, intensity, time and type. When we make specific and daily goals, we are more likely to follow through but remember, you can modify your goals at any time. If there is ever a day you miss, that is okay! Start where you feel comfortable and make changes as needed. As you progress to the end of your pregnancy, we want to still encourage you to be active but if you do not reach your goal, do not be discouraged. Just do your best. Tomorrow is another new day.
Blood Sugar Management During GDM
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Blood Sugar Management During GDM
Let’s talk about your blood sugar levels before, during, and after exercise. It is important to check your blood sugar levels before an exercise session, such as a 30 minute walk or a 15 minute stationary bike ride. We don’t want sugar levels to be either too low or too high before we exercise. If it has been 2 or more hours since your last meal or snack, it is particularly important to check your blood sugar levels before exercising. It is especially important if you use insulin or other blood sugar lowering medication.
If your blood sugar levels are 3.6 mmol/l or lower… you are hypoglycemic and need a fast source of sugar. Treat yourself for hypoglycemia and don’t exercise right now. Take 15 grams of carbohydrate in the form of glucose tablets. If you don’t have these, take 2/3 cup of juice or 1 tablespoon of sugar dissolved in water. Wait 15 minutes and check your sugar again. If it is still 3.6 or less, take another 15 grams of carbohydrate. Keep repeating these steps until your blood sugar levels come up to 4 or more. You may need to discuss how to prevent sugar lows with your doctor if this happens regularly. Your medications may need to be adjusted. If you take insulin, you may need to consistently lower your insulin dose that you take for the meal before you exercise. For example, if you exercise in the afternoon, you may have to lower your lunch time insulin dose. Speak with your doctor to have a clear understanding of your insulin dose and when you should be taking this.
If your levels are 3.7 to 4.9 mmol/l before exercising… have a snack that includes 15 grams of carbohydrate. This could be a fruit with a bit of cheese. It could be a slice of whole grain bread with peanut butter. It could be 2/3 cup of yogurt. Why? During exercise, your body will use your blood sugar and your sugar may dip too low if you are low when you start to exercise. Wait at least 15 minutes after the snack and check your blood sugar levels again to make sure your sugar level is 5 or more before you start. You want to then check your blood sugar levels after your session as well or even during the session if you feel like your blood sugar levels are low.
Symptoms for low blood sugar levels include:
- Feeling shakiness
- Anxiety
- Trembling
- Nausea
- Weakness
- Sweating excessively
- Irregular heartbeat
- Feeling as though you cannot concentrate.
If your sugar levels are 4 mmol/L or less after exercise, make sure you have a snack.
If your sugar levels are between 5 and 10 mmol/l before your exercise, go ahead and exercise if you feel well.
If your sugar levels before you start to exercise are higher than 10 mmol/l… you may exercise if you feel okay but check your sugar level again 10 minutes into exercising. If your sugar level is still at 10, or even higher, stop exercising. Wait until your sugar levels are under better control. You may have to speak with your healthcare provider if you find that your sugar values are often high.
If you are between 5 and 10, you may continue exercising.
When should you check your blood sugar?
When you are just adding movement into your day, such as taking the stairs instead of the elevator or taking a standing break at work, you do not need to check your blood sugar levels. However if you are going for a planned walk for at least 15 to 20 minutes or more, or any other continuous exercise then you need to check your blood sugars both before and after your activity, and during exercise if you start to feel like levels are low.
While you exercise, it is possible your sugars will go down so you should be aware of any symptoms that signal this. Again, symptoms for low blood sugar levels include feeling shakiness, anxiety, trembling, nausea, weakness, sweating excessively, having an irregular heartbeat and feeling as though you cannot concentrate. Some of these symptoms are actually normal during pregnancy such as feeling tired or nausea, but this is why it is important to check your blood sugar levels both before and after your exercise session.
Precautions
It may be a good idea while you exercise to have a juice box nearby or the dextrose tablets your health provider has given you. It is important to only have the juice if you require a rapid dose of sugar, otherwise continue to stay hydrated during your exercises by drinking water. You should have 8-10 cups of water throughout your day, but certainly can have more as you need it. Especially when you exercise, take a water bottle with you.
If you are using insulin during your pregnancy, please avoid injecting in a muscle group that you are exercising. It is also important not to exercise during the peak insulin time point. You can ask your health care provider when that is for you based on your insulin prescription. This is because exercise can make your body more sensitive to insulin, or in other words give you an insulin boost. You may also notice that once you become active you often have lower blood sugar levels. This could mean your insulin dose needs to change. You should let your healthcare provider know right away.
Safety Precautions for Physical Activity During GDM
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Safety Precautions for Physical Activity During GDM
Let’s think about your environment where you are completing your exercises. In Canada we have extreme temperatures. You want to avoid exercising in hot and humid weather and in cold conditions. So perhaps on hot days consider walking inside or stay in the shade or wear a wide brimmed hat. During cold temperatures, consider exercising indoors or if you are outside dress in layers and use footwear with good grip in icy or slippery conditions.
Changes in Your Body
Now we will review some changes your body is experiencing and how that will require you to modify your exercises. During pregnancy, your joints may be looser than before. This means you should avoid overstretching, exercises that require rapid changes of direction, and activities that increase your risk of falling such as downhill skiing or soccer. After your first trimester you also want to avoid exercises lying flat on your back as this can cause extra pressure on your back and reduce blood flow. You can still perform exercises to help strengthen your abdomen or belly area during pregnancy but make changes such as placing support at your lower back so that you are sitting at least at a 45 degree angle, doing the exercises on your side or from a seated position.
Another condition to be aware of is diastasis recti. It can be described as a gap or separation of the muscles on your abdomen. You can identify this condition by placing your fingers in the centre of your abdomen and noticing if you feel a separation that is greater than two fingers-width apart. You may also notice a bulging or a ripple at the centre of your abdomen. If this occurs, or even if you have any questions or concerns, stop any exercises for your abs and consult your healthcare provider.
How Intense?
You want to make sure that you are breathing throughout your exercise routine and are not performing any exercises that you have to hold a position for a long period of time or heavy lifting that would lead you to holding your breath. Avoid overexertion. Think back to our intensity measures presented in video 2 – How are you feeling? Your exercise should only be somewhat hard, or 12-14 on a scale of 1-20. Can you continue talking? Maybe you cannot sing but you should be able to carry a conversation still without feeling short of breath. During pregnancy it is natural to feel tired. Know your body and how far you should push yourself. Avoid high intensity exercises, especially those that you are not familiar with.
Here are some reasons you should stop your exercises and consult your health care provider immediately:
- Any chest pain
- Painful uterine contractions
- Feeling dizzy or faint during or after exercise
- Any vaginal bleeding or gush of vaginal fluid.
Please also review the cautions and precautions we discussed in video one.
Let someone know
It is a good idea to let someone know about your activity goals during pregnancy and about your gestational diabetes. By letting others around you know that you are pregnant, especially if you are using insulin, they can keep an eye out for you. This is particularly important if you do decide to join a gym. Let the staff know you have gestational diabetes and whether or not you are using insulin or other blood sugar lowering medication. They will most likely require a note from your healthcare provider before you start exercising there.
Physical activity including exercise during pregnancy can help you manage gestational diabetes. In fact, it can help prevent the need for insulin injections or reduce your dose. Every woman and every pregnancy is very different, so listen to your body and make any necessary changes. For example, maybe you feel tired in the evening so you can exercise in the morning. Maybe you prefer two short 15 minute walks instead of one 30 minute walk. Do what is best for you and fits with your schedule and preference.
Keep your health care team informed. Keep an eye out for any signs that might require a reduction in your exercise or activity. Keep these safety reminders in mind and of course consult your health care provider if you have any questions, or experience changes that you are worried about. Be safe and be as active as you can.
18 Ways to Step Up Your Day
- Take stairs whenever possible.
- Snowy? Icy? Walk around the shopping mall.
- Treat the dog to a longer walk.
- While chatting on the phone, walk around your house.
- Walk in place while watching TV.
- Walk to get the mail.
- Make a walking date with a friend, instead of calling her.
- Instead of carrying all the laundry upstairs at once take several trips.
- Make it a family habit to take a 15 or 20-minute walk before supper or breakfast
- Grab your significant other and get out there together.
- Take a walking tour of your city. If you are brave, sign up for a haunted walk!
- When grocery shopping, walk through every aisle.
- Choose a parking spot far from the store entrance — or just walk to the store!
- Return the shopping cart all the way to the store.
- Instead of emailing your coworker down the hall, walk over to her office.
- Taking public transportation usually means actually walking more as well.
- Before lunch, take a 15-minute walking break.
- At your children’s sports game? Don’t just sit in the stands, walk around the field!