Can you exercise during pregnancy? What you need to know!

There’s a lot of conflicting information regarding exercise during pregnancy. It can be extremely overwhelming and stressful, where it can lead to the athlete not exercising at all during pregnancy and perhaps being too overly relaxed post pregnancy.

In this episode, we will discuss specific guidelines to exercising safely and address the misconceptions about exercise during pregnancy. 

Firstly, let’s discuss why exercise is not only safe, but also extremely beneficial for pregnant women.

According to the American College of Sports Medicine, exercising during pregnancy can prevent excessive weight gain, symptoms of depression, and postpartum weight retention.

It can also decrease risk of gestational diabetes, risk of high blood pressure, postpartum recovery time, risk of low back pain, risk of urinary incontinence, and risk of cesarean delivery.

So, if exercise during pregnancy is safe, should you just continue doing what you were already doing before pregnancy? And the infamous answer here is “it depends.” Pregnant women who were engaged in regular high-intensity exercise going into pregnancy can continue with this program at first, providing they feel well. However, things may need to be adjusted and adapted depending on how the women feels and whether any complications arise.

But for those who have uncomplicated pregnancies, women should be encouraged to engage in aerobic as well as strength and conditioning exercises during and after pregnancy.

Now what about the women you haven’t been doing any exercise before pregnancy? Is it too late for them to start and should they just wait until after pregnancy? Typically, no. The previous benefits of exercise are even more valuable to those who haven’t been exercising before pregnancy and if the woman is ready to start, then absolutely exercise during pregnancy is recommended and encouraged. For women in this situation, I would recommend for her to start out at lower intensities and for shorter periods of time. Then gradually increase the time and intensity of the program, depending how she is feeling and progressing.

Let’s now take some time to discuss specific activities that are considered safe and can be continued if the woman was performing these movements before pregnancy. Such activities include yoga and Pilates, although specific movements and positions may need to be modified, strength training, low-impact aerobic activity (such as swimming, walking, and cycling) and even running and jogging.

Please note that it is often a good idea to ensure you are cleared to strength train, run, and/or jog if you are new to these activities and to have these activities regularly monitored by your medical professional.

Now it should be no surprise that there are certain activities that should be avoided during pregnancy, which include scuba diving, activities in high temperature like hot yoga, contact sports and activities that have a high risk of falling, such as surfing, horseback riding, and mountain biking.

During exercise, regardless of if you are pregnant or not, you need to ensure you listen to your body and stop any movement that doesn’t feel right. When you are pregnant, the importance of this skillset increases tremendously. Knowing when your body is telling you to stop an exercise is imperative. Any pain or discomfort during an exercise can be due to a variety of factors. Therefore, it’s important to address the issue versus ignore it and exercise should stop immediately when experiencing painful contractions regularly, amniotic fluid leakage, vaginal bleeding, shortness of breath before exertion of a movement, chest pain, calf pain or instability.

While exercising during pregnancy is safe, there are specific modifications that must be made to the training program depending on the trimester. Before we get into the specifics of those modifications, let’s touch on basic exercise prescription during pregnancy in general.

The ASCM recommends that pregnant women engage in a total of at least 150 minutes of moderate-intensity exercise per week, which is to be spread out over 4 to 7 days for 20-30 minutes. This is just a basic recommendation, where the intensity, duration and frequency of the program will depend on the athlete’s current schedule and fitness level. But when it comes to this basic recommendation, it’s important to note that enjoyment and sustainability are more important considerations than what is quote, unquote “optimal.” If you simply aren’t enjoying what you are doing, then I would recommend revisiting your program to adjust things to what you are more likely to easily stick to. And it’s important to note that these preferences and changes may need to vary from trimester to trimester, which is normal.

At the end of the day, movement during pregnancy is our top priority. Even if all you can commit to is a daily walk. It’s better than nothing. The reason movement is so important is because it improves glucose utilization, strength, body image and psychological well-being. Movement also decreases risk of gestational diabetes, physical discomfort, risk of preeclampsia and risk of urinary incontinence. In addition, it aids in the maintenance of good posture and alignment, which helps the baby sit in a position that allows for an easier labor and delivery experience.   So again, if all you can do during a given day, week or trimester is a daily walk, remember that there is nothing wrong with that.

Now let’s take some time going over specific modifications that are worth considering and implementing during the different stages of pregnancy.

Let’s start off by discussing core training, as there is a lot of conflicting information regarding proper core training during pregnancy. A lot of people think that core training just involves the abdominal muscles. However, there is a lot more to it than that. The full musculature of the core allows movement from the pelvis all the way up to the shoulders, which is why the spine relies on the core for support. Therefore, exercises that involve the spine flexing, extending, and rotating may be carefully included in the athlete’s program during pregnancy. Appropriate exercises that may be included are pallof presses, planks, and side planks. As the athlete progresses to the 2nd and 3rd trimester, front planks may need to be removed, as the abdomen continues to grow.

When performing plank variations, it’s extremely important to ensure the athlete is breathing correctly and not holding her breathe. In addition, be sure not to hold the position for prolonged periods and avoid using heavy loads. We don’t want to create issues related to the core and pelvic floor by overdoing it.

During the each trimester, prioritizing diaphragmatic breathing and core-pelvic floor connection before each training session can be extremely beneficial for activating your awareness with your body. This is known as the connection breath and working on this can help ensure the core and pelvic floor are functioning together to stabilize the core during strength training, which is a great way to increase awareness of how the pelvic floor engages during the workout. If you are unsure how to implement this intervention, be sure to search on YouTube “The connection breath” to get a video demonstration of how you can implement this into your warmup routine.

When it comes to strength training, if the pregnant woman is feeling good during the 1st trimester, then there aren’t a lot of training modifications that need to be made at this point. However, it may be a good idea to ensure you are performing your exercises within a moderate rep range versus a low rep range. The reason for this is because we don’t want the athlete holding her breathe and performing the Valsalva maneuver breathing technique that is often used during heavy lifting. This has been shown to increase blood pressure and the heavy loads can increase intra-abdominal pressure and cause excessive downward pressure on the pelvic floor. Therefore, keeping the rep ranges between 6-10 reps is a more appropriate goal to mitigate these risks versus a lower rep range of say 3-5. 

The goal during the 1st trimester is to focus on increasing strength, muscle mass and core strength. Depending on where the athlete is currently at, it may be a good idea to prioritize increasing strength in the glutes and upper back. Having stronger glutes can help the athlete maintain a more neutral position, which will help reduce any unnecessary stress on the pelvic floor muscles as she progresses through her pregnancy. In addition, having a stronger upper back will provide additional support for the athlete’s increase in her breast size as she progresses throughout pregnancy. 

When it comes to cardiovascular training during the 1st trimester, having an aerobic base is recommended, as it helps the pregnant women’s body prepare for physiological and psychological stresses during pregnancy. As we previously discussed, focusing on a low to moderate intensity during cardiovascular training is safe throughout pregnancy. Paying attention to how you feel versus relying on heart rate monitors is more accurate, as pregnancy naturally increases heart rate. Using a perceived effort scale can be a helpful guide when trying to determine if you are training at an appropriate intensity level. Google the Borg’s rating or perceived exertion to use as your guideline. The goal is focus on feeling a “somewhat difficult” intensity when performing cardiovascular activities. However, for athletes who were well conditioned prior to pregnancy, they can focus on a higher intensity, which is closer to an 8 out of 10, which is a “hard” intensity level.  

Experiencing a shortness of breath and more demand on your core can be normal during the 1sttrimester. Therefore, it’s best to always focus on how you are feeling and be more conservative as needed.

During the 2nd trimester, it’s normal for previous activities that felt ok to start feeling a bit off. Your body may start to send you signs that what was previously working is no longer working. And it’s important to understand that this is 100% normal and is ok. This is in no way an indicator of failure. Instead, we should look at this as an opportunity to try some new activities and challenge yourself in new ways moving forward. As we move into the 2nd trimester, our training goals start to change, where the focus now includes prioritizing good posture and alignment, reducing any back or pelvic pain, maintaining muscle, strength, and cardiovascular endurance. A lot of pregnant women often feel their best during the 2nd trimester, as they typically aren’t as fatigued and are no longer dealing with morning sickness. However, there are still some training modifications that are recommended during this time.

Firstly, it’s important to pay attention to how you are feeling when you are lying flat on your back. If you notice that you are feeling light-headed or experience any discomfort or tingling in the legs, any exercises where you are lying on your back may need to be removed. However, modifying these exercises where you perform them on a slight incline is acceptable. A lot of the research and suggestions are conflicted. Some sources recommend not lying on your back at all after 16 weeks, others recommend 28 weeks, and then other sources say it’s fine if you notice none of the previously mentioned symptoms. Therefore, it’s best to keep checking in with yourself to ensure you aren’t experiencing any of the symptoms previously mentioned. To lessen any possible concerns, perform the movements on a slight incline just to be safe.

Let’s go over some additional changes to consider with strength training. There may be some barbell exercises that need modification as the abdomen expands. We don’t want to increase the risk of injury if the athlete is trying to get the bar to go over the bump. Barbell deadlifts are a good example here. Therefore, it may be a good idea to switch to using dumbbells or even a trap bar going forward. Continuing with back loaded movements, like back squats or overhead press is totally fine if the athlete feels comfortable doing so. However, modifications may need to be made if the athlete starts to experience heaviness in her pelvic floor. Any abdominal work needs to be monitored to ensure the abdominal wall is not bulging in the midline. If this is occurring, then a modification or overall removal of the movement is advised. And lastly, when it comes to the load, the athlete may need to start using lighter weight during this trimester. Due to the physical and hormonal changes occurring, the amount of force the athlete can generate is likely going to go down, which is completely normal.

When it comes to cardiovascular training, continuing to monitor the perceived effort scale is best during this time. Understand that if you must reduce your intensity because things feel off, it’s completely normal and necessary. Always listen to your body and opt for lower-impact aerobic work if you notice any heaviness or pain in your pelvic floor.

Lastly, let’s consider what modifications are necessary during the 3rd trimester. The overall goals are to reduce any discomfort and minimize any pressure on the pelvic floor and bulging in the core.

There are specific strength training modifications that are necessary during the 3rd trimester, due to the extra load on the pelvic floor and significant changes in the abdominal musculature. Monitoring your abdomen during exercises that require a lot of effort from the abdominals is extremely important during the 3rd trimester. Even though 100% of women develop diastasis rectus during the final trimester, we still want to avoid exacerbating the issue. Additional changes to consider are going to vary from athlete to athlete. It is best to ensure you make the changes with your coach or based on what you feel is best. Always remember what the main goal is during a given trimester, where during the 3rd trimester, reducing any discomfort is most important.

Regarding load, the same strategies need to be applied as already mentioned in the 2nd trimester. For cardiovascular training, the intensity will likely continue to decrease, especially as you approach those final weeks, which is ok and completely normal. Be sure to continue using the perceived effort scale.

Overall, exercise is very beneficial during pregnancy and should be explored regardless of if the individual was exercising or not before she became pregnant. There are going to be a lot of physical and hormonal changes during pregnancy and navigating through these changes can be challenging. But being adaptable with your training and taking this as an opportunity to listen to your body versus trying to fight it can help mitigate some of these challenges and help make the experience as positive as possible.

Please note that this information is not medical advice, and you should speak to your health care practitioner to help guide you through your pregnancy experience.

Hope this was helpful!

Coach Krys