The Importance of Exercise in the Preconception Period

by georgia hartmann

Women’s Health Expert

When it comes to optimising fertility and preparing for pregnancy, there are numerous factors that must be considered一alcohol, caffeine, sugar and trans fat consumption, sleep quality, stress management, nutrient status, underlying health conditions, smoking, exposure to endocrine-disrupting chemicals, weight, the list goes on…

One factor that we can all start prioritising today is regular exercise. Not only is exercise beneficial for reducing the risk of 40 chronic health conditions including type 2 diabetes, cardiovascular disease, and cancer, but it is also incredibly beneficial in balancing hormones.[1-2] 

Here’s an insight into exactly how.

Exercise helps to balance hormones associated with excess weight

It is well known that carrying excess weight increases the risk of infertility and miscarriage. We also know that moderate exercise influences IVF outcomes. A recent meta-analysis found a 1.96-fold increase in clinical pregnancy rate and 1.94-fold increase in live birth rate in physically active women compared with physically inactive women. The effect is due to the positive influence of exercise on insulin sensitization and ovarian function. Influencing levels of insulin is incredibly important in those carrying excess weight as this hormone is commonly elevated. [3-4]

Exercise helps to balance hormones associated with high stress

Elevated, uncontrolled stress is associated with infertility, cycle irregularities, poor sperm quality, and miscarriage risk. It can be challenging to find time to exercise when you are feeling stressed and overwhelmed. However, this is the perfect time to do so. What we know about stress is that it is associated with increased production of cortisol, one of our stress hormones. Research consistently shows us that regular exercise reduces cortisol levels. And if you have exercised prior to entering a stressful situation, your cortisol levels are much lower─ meaning you are able to cope with stress more. A recent study of almost 400,000 individuals also found that those who had a physically active lifestyle had around 60% lower risk of developing anxiety─again, through the positive impact of exercise on our stress hormones. [5-7]

Exercise helps to balance hormones associated with poor sleep

Sleep not only affects hormonal balance, but also sperm function and IVF outcomes. While approximately 30% of the general population experience sleep troubles, a readily-available, non-pharmacological therapy without side effects is regular exercise. Recent randomized controlled trials have confirmed that exercise reduces insomnia severity, and improves ability to fall asleep, stay asleep, and overall sleep quality. From a fertility standpoint, we know that both female and male fertility, as well as IVF outcomes may be affected by short sleep duration and shift/night work schedules. In order to have adequate levels of our sleep-promoting hormone, melatonin, exercise is best performed in the morning rather than afternoon or evening.[8-10]

Exercise helps to balance hormones associated with reproductive conditions

Regular exercise is increasingly being recommended to manage a range of chronic health conditions including painful periods and endometriosis. While some research suggests exercise can exacerbate painful symptoms in women with endometriosis, a recent study assessing endometriosis self-management strategies during the COVID-19 pandemic reported that exercise undoubtedly has an overall positive impact on well-being.[11]

In the case of polycystic ovary syndrome (PCOS), which is a leading cause of fertility difficulties among reproductive-aged women, exercise has shown beneficial effects on lipid profiles, waist circumference, blood pressure and fasting insulin. It has also been shown to balance hormones, particularly androgens and oestrogens. [12-14]

So, if you are considering conceiving, now is the time to prioritise regular exercise.

[1] Ruegsegger, G.N., et al. Health Benefits of Exercise. Cold Spring Harbour Perspectives in Medicine, 2018. 8(7). PMID: 28507196.

[2] Ennour-Idrissi, K., et al. Effect of physical activity on sex hormones in women: a systematic review and meta-analysis of randomized controlled trials. Breast Cancer Research, 2015. PMID: 26541144.

[3] Harrison, C.L., et al. The Role of Physical Activity in Preconception, Pregnancy and Postpartum Health. Seminars in Reproductive Medicine, 2016. 34(2). PMID: 27169984.

[4] Rao, M., et al. Maternal physical activity before IVF/ICSI cycles improves clinical pregnancy rate and live birth rate: a systematic review and meta-analysis. Reproductive Biology and Endocrinology, 2018. 16(1). PMID: 29415732.

[5] Khaled, K., et al. Perceived stress and diet quality in women of reproductive age: a systematic review and meta-analysis. Nutrition Journal, 2020. PMID: 32859204.

[6] Wood, C.J., et al. Physical fitness and prior physical activity are both associated with less cortisol secretion during psychosocial stress. Anxiety, Stress and Coping, 2018. 31(2). PMID: 29037088.

[7] Svensson, M., et al. Physical Activity Is Associated With Lower Long-Term Incidence of Anxiety in a Population-Based, Large-Scale Study. Frontiers in Psychiatry, 2021. PMID: 34566716.

[8] Caetano, G., et al. Impact of sleep on female and male reproductive functions: a systematic review. Fertility & Sterility, 2021. 115(3). PMID: 33054981.

[9] Banno, M., et al. Exercise can improve sleep quality: a systematic review and meta-analysis. PeerJ, 2018. PMID: 30018855.

[10] Carlson, L.A., et al .Influence of Exercise Time of Day on Salivary Melatonin Responses. International Journal of Sports Physiology and Performance, 2019. 14(3). PMID: 30160559.

[11] Leonardi, M., et al. Self-management strategies to consider to combat endometriosis symptoms during the COVID-19 pandemic. Human Reproduction Open, 2020. PMID: 32509977.

[12] Benham, J.L., et al. Role of exercise training in polycystic ovary syndrome: a systematic review and meta-analysis. Clinical Obesity, 2018. PMID: 29896935.

[13] Shele, G., et al. A Systematic Review of the Effects of Exercise on Hormones in Women with Polycystic Ovary Syndrome. Journal of Functional Morphology and Kinesiology, 2020. 5(2). PMID: 33467251.

[14] Smith, A.J., et al. The Effects of Aerobic Exercise on Estrogen Metabolism in Healthy Premenopausal Women. Cancer Epidemiology, Biomarkers & Prevention, 2013. 22(5). PMID: 23652373.

by georgia hartman

Women’s Health Expert

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