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Current knowledge suggests that early exercise intervention for individuals experiencing a pregnancy loss may be a feasible method to reduce the risk of psychological morbidity, while also improving physical wellbeing.
“Your pregnancy is no longer viable” is not an uncommon phrase. In fact, around one in every four women will hear some iteration of this during their conception journey. Pregnancy loss is often referred to as a silent trauma and produces significant physical and mental health outcomes in previously expectant women. Depression can be approximately four times higher in those who have experienced pregnancy loss and of those women, around 33% may experience thoughts of self-harm.
The trauma associated with such a loss is well recognised. One study reported that although a significant portion of women experienced anxiety and depression following pregnancy loss, a further 28% of women met the criteria for post-traumatic stress disorder, of which symptoms may persist for three months following the loss. Further, in a longitudinal study, 55% of women experienced probable psychological morbidity within the three months following the loss, and while this gradually declined over time, some women were still experiencing psychological morbidity one year after the pregnancy loss.
It is common during the period following a pregnancy loss for women to report detachment from their physical body, to experience feelings of shock, guilt, distress and shame, and abandonment and dissatisfaction with follow-up, particularly emotional support, from health care professionals. Considering the significance of any of these factors individually and/or together, change is warranted to provide women with an acceptable level of support for their physical and psychological wellbeing to enhance their current health status in such times of need and for the benefit of any future pregnancies. Currently, there are limited strategies to prevent psychological morbidity and promote both the physical and mental wellbeing of previously expectant women following a loss. Evidence suggests that an early exercise intervention may be a feasible and cost-effective strategy to reduce the risk of psychological morbidity and improve clinical symptoms of depression while improving physical wellbeing and fecundability.
How can exercise support women who have experienced pregnancy loss?
Exercise can elicit multiple physical and mental health benefits, including improved cardiovascular function, favourable metabolic changes, weight management, and improved psychological benefits associated with body image, perceived health status, and reduced symptoms of depression.
Psychological wellbeing
The mood-regulating effects of exercise are well established and have been suggested to improve physiological parameters that increase the risk or severity of psychological morbidity. Exercise is a known treatment modality for depressive symptoms, with efficacy purported to be similar to pharmacological treatments in certain settings. Exercise has also been shown to improve emotional wellbeing and reduce symptoms of anxiety in the post partum period. While a recent meta-analysis suggests a positive dose-dependent association between higher levels of physical activity and lower depression risk, regular exercise may exert protective effects against future depression regardless of exercise intensity. Even singular bouts of moderate intensity exercise have been shown to positively benefit emotional regulation and can support emotional recovery following a stressor. Such effects may be observed with as little as 15 minutes of exercise, with improvements in the regulation of both anger and anxiousness being observed following a stressful event.
Fecundability, fertility and future pregnancy
Exercise can produce favourable outcomes on fertility, with moderate intensity physical activity being associated with improved fertility for all women, and vigorous intensity exercise being associated with improved fertility for women classified as obese or overweight. These outcomes extend to infertility, with a 2022 meta-analysis reporting an inverse relationship between physical activity and infertility, with moderate to high levels of physical activity identified as a protective factor. Walking for greater than ten minutes in a single bout of exercise has been found to improve fecundability in women classified as overweight or obese with a history of pregnancy loss.
Current knowledge suggests that an early exercise intervention for individuals experiencing a pregnancy loss may be a feasible method to reduce the risk of psychological morbidity and improve clinical symptoms of depression, while also improving the physical wellbeing of the woman. Therefore, clinicians providing support to women during the period following a loss should consider recommending women seek guidance from suitably trained allied health practitioners, such as an accredited exercise physiologist (AEP), who can support women in engaging in an individualised regime that promotes a gradual increase in the volume of exercise performed over time.
What is an AEP and how can they support women who have experienced pregnancy loss?
AEPs are university-qualified allied health professionals who are equipped with the specialised knowledge, skills and competencies to safely and effectively design, deliver, evaluate and adapt movement, physical activity and exercise-based interventions to facilitate and optimise health status, function, recovery and independence for people with acute, subacute or chronic medical conditions, injuries or disabilities. Their knowledge and training allow them to provide tailored exercise programs that consider the individual’s medical history, exercise history, and complications associated with pregnancy and loss, and other relevant health conditions, which is based on objective testing and assessments to ensure an individualised and gradual return to previous activity is achieved.
Where can I find an AEP?
You can find an AEP in your local area by looking at the online directory provided by Exercise and Sports Science Australia (ESSA), the accreditation body for exercise and sports science professionals: www.essa.org.au/find-aep.
What needs to be done?
Our current understanding of exercise in the immediate period following a pregnancy loss are limited. Research is warranted to (i) determine the specific exercise prescription-related components (frequency, intensity, time and type) required to improve psychological morbidity and physical wellbeing, and (ii) improve our understanding of women’s unique exercise-related needs during this period to optimally cater for and support women following a pregnancy loss.
Dr Tegan Hartmann is a Senior Lecturer in Exercise Science at Charles Sturt University.
Dr Danielle Girard is an accredited Exercise Physiologist with Exercise and Sports Science Australia and a lecturer in Clinical Exercise Physiology at the University of South Australia.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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We totally agree with you Christy, so many factors to consider following a loss. Dr Girard and I are currently doing some research in this space, to guide evidenced based exercise prescription.
one thing re exercise: If life circumstance is saddening, and well meaning friends are guiding you toward a chair, with water and tranquillizer in hand, first think of exercise, for that is when you need it .
It would be great to have some guidelines around exercise considerations following pregnancy loss possibly based on when the pregnancy was lost, as those early weeks of pregnancy are when the body is going through significant changes (increase blood volume, increased oxytocin impacting joint laxity etc.) which may need to be accounted for when commencing/recommencing/continuing exercise after pregnancy loss.