Over the last several years, we’ve seen the pendulum swing widely with respect to prenatal fitness.
First pregnant people were told to take it easy- to keep their heart rate under 140 bpm, to not lift anything heavier than 10 lbs, and certainly not to run or engage in anything more strenuous than walking or yoga.
One popular childbirth preparation book on my shelf suggests “Brisk walking is good from the beginning to the middle of your pregnancy. After that you may want to slow down a bit so that your baby is not jostled too much.” I’m guessing the authors never tried to wrangle a toddler while pregnant!
On the flip side, now we’re told that pregnant people can “keep doing what they were doing before they got pregnant” and to “listen to their bodies” without much guidance as to what that really means. We’re now flooded with images of pregnant Crossfit athletes and professional athletes competing at high levels.
Where does the truth lie?
The Benefits of Exercise During Pregnancy
There’s no debate that exercise during pregnancy benefits the pregnant person and the baby in so many ways (1,2). A non-exhaustive list of benefits conferred by prenatal exercise includes:
- Prevention of excessive weight gain during pregnancy
- Reduction of the risk of pregnancy complications including gestational diabetes and preeclampsia
- A decrease in maternal discomfort and injury, including the occurrence and severity of low-back pain
- Prevention and improvement in the symptoms of depression
- Possible reduction of the risk of medical interventions, including cesarean or instrument-assisted delivery
- Improvement in the growth and functional capacity of the placenta which may provide protective reserves for baby if complications arise in labor
There is no evidence that recreational exercise as a part of an uncomplicated pregnancy causes any harm to the developing baby (1,2). There is some data from a study of pregnant Olympic athletes suggesting that exercise over 90% maximal heart rate may compromise fetal blood flow (3), but most of us aren’t pushing that type of intensity. And so most if any concern over prenatal fitness should revolve around keeping the pregnant person’s body (and specifically, their core and pelvic floor) happy and healthy.
So, what do you need to know to continue your exercise routine into pregnancy?
The “Official” Pregnancy Exercise Guidelines
The American College of Obstetricians and Gynecologists (ACOG) recommends that people experiencing uncomplicated pregnancies engage in aerobic and strength training programs (1).
Specifically, they recommend pregnant people engage in at least 150 minutes of moderate-intensity work every week (spread over multiple days). Moderate-intensity equates to a 4 to 6 out of 10 on a scale of perceived exertion. Another way to measure exertion is using the “talk test”. You should be able to talk (but not sing) while carrying on their activity. For a variety of reasons, heart rate is not an accurate measure of workload during pregnancy and should be avoided.
Other common sense pregnancy exercise recommendations include maintaining adequate hydration, avoid overheating and watch out for warning signs to discontinue exercise. These warning signs include vaginal bleeding, regular painful contractions, amniotic fluid leakage, breathlessness before exertion, dizziness, headache, chest pain, muscle weakness affecting balance or calf pain or swelling.
What Are the Safest Exercises To Do While Pregnant?
Let’s flip the question on it’s head- because there are a lot fewer unsafe activities during pregnancy than safe ones. Most activities and exercises are going to be safe or can be modified in a way to be appropriate.
The only activities deemed unsafe for pregnancy (by ACOG) are scuba diving and activities with fall hazards (like, horseback riding). ACOG also recommends avoiding contact sports that carry a risk of trauma to the abdomen. These are all pretty common sense recommendations.
Everything else is more or less fair game. You can run, spin, hike, lift weights and swim (just a sample!). I encourage you to consider the potential risks and rewards of any activity you choose to do while pregnant (see Can I Run While Pregnant? 3 Essential Considerations to Help You Decide For Yourself as an example). Choose activities with an acceptable risk profile that will get you moving.
Is There a “Best” Type of Exercise To Do During Pregnancy?
If I had to choose just one, I would recommend strength training.
Strength training is a great tool to help maintain core strength and function, maintain muscle mass, and counter postural compensations.
It’s adaptable for all trimesters and modifiable for any pregnancy related complication like pubic symphysis pain, low back pain, tailbone or sacroiliac joint pain. There’s always something you can do.
Strength training is also hands down the first type of exercise you should engage in during the fourth trimester, if you’re up for exercising that early.
Basic Prenatal Exercise Strategy: Start With the ABCs
There are three basic strategies you can implement into your prenatal fitness program to keep your core and pelvic floor healthy and happy throughout your pregnancy. These strategies involve manipulating your body alignment, breathing technique and optimizing your exercise variables. If it’s an option, consider working with a prenatal fitness specialist or pregnancy and postpartum athleticism coach to dial in your specific program since every body and every pregnancy is unique.
While there is no such thing as a “perfect” alignment, there is an alignment strategy that may be more optimal for the coordination and function of your core and pelvic floor and may be particularly interesting to explore during pregnancy and postpartum.
This basic strategy is a “stacked” or “ribs over hips” alignment. You want to make sure that your pelvis isn’t thrust way out in front of your ribs, such that it begins to tuck under. Nor do you want to have your ribs thrust way out in front of your pelvis.
During pregnancy, practicing a stacked alignment may help decrease the severity of diastasis recti (the temporary separation of abdominal muscles that occurs during pregnancy) and the incidence of incontinence. It can also improve fetal alignment in the uterus and enable easier breathing.
How do you know if you’ve dialed in your alignment?
Your optimal alignment is the one in which you can best access your diaphragm and pelvic floor (–> the alignment where you can get the best, easiest breath).
Pay attention to how you feel when you breath and perform your exercise movements or activities of daily living (like picking up your kid) from the starting point of a certain alignment.
Can you take a better breath (also refer to the next section of this post)?
Do you feel stronger and more supported when you perform a movement?
Do you have any pelvic floor symptoms that crop up or go away when you hold your body in a different manner?
Find an alignment that allows you to breath more effectively, feel strong and minimizes any pelvic floor or core discomfort.
B) Breathing for stability and support
Your breath is your most powerful tool to stabilize and support your body during movement, manage intra-abdominal pressure and keep your body strong and healthy during your pregnancy. Take a look at what happens every time you take a breath:
During a normal breath cycle, the pelvic floor mirrors the diaphragm. The diaphragm contracts (and descends towards your pelvis) to draw air into the lungs and the rib cage should expand 360 degrees (picture an umbrella opening). In response, the pelvic floor lengthens and descends. The abdominal muscles lengthen and expand outwards slightly. On exhale, everything reverses; the diaphragm and pelvic floor rise and the abdominals contract inwards.
There are several breathing strategies you can use to complement your fitness and daily movements; they are all based on the fundamental “Connection Breath” (also called the “Piston Breath”).
The Connection Breath
The connection breath trains the coordination and optimal function of the core and pelvic floor. You may practice this breath lying on your back with your knees bent or sitting with stacked alignment on a stability ball. As you practice, you may place one hand on the side of your rib cage and one hand on your belly to help yourself feel the movement of your ribs and belly.
To perform this breath, first focus on the inhale. Expand your rib cage, bringing awareness to its expansion from front to back and side to side. At the same time, relax and release your pelvic floor.
On the exhale, blow out all your air through pursed lips and focus on contracting the pelvic floor (just like performing a kegel, at 30 percent max effort or so).
Over time this pelvic floor contraction will become reflexive with your breath cycle.
C) Coordinate your breath to your movement: “Exhale on Exertion”
Once you have mastered this breath, apply it during exercise and practice “exhale on exertion”.
Inhale during the easy portion of the movement (e.g. descending into a squat) and exhale during the effortful portion of the movement (e.g. rising from the squat).
As you work on becoming familiar with “exhale on exertion”, remind yourself to gently contract your pelvic floor during your exhale. The strength of your exhale and pelvic floor contraction will vary depending on the demand of the exercise you are performing. Experiment!
During movements that require a lot of effort, exhale through pursed lips, like you are blowing out birthday candles. This will increase the response of the pelvic floor.
Finally, avoid holding your breath during exercise or daily activities like lifting a child. Breath-holding is a strategy that puts a lot of pressure on a pelvic floor already strained from the demands of a growing uterus.
There are a lot of nuances and variations to breath work during exercise (too many to delve into here!) so if this doesn’t feel intuitive, or if it doesn’t feel like enough to support your movement, consider downloading my free resource, The No B.S. Guide to a Stronger, Drier Pregnancy and Postpartum; This guide dives deep into how to perform the Connection Breath and apply it to movement.
Modifications To Activities And Exercises During Pregnancy
As your pregnancy progresses, you may need to modify your activities. That may mean switching from running to walking. Or eliminating other high impact activities like jump roping. It may mean adjusting your strength training routine.
With respect to strength training, you will find that as your pregnancy progresses you will naturally want to decrease the weight you lift. When lifting lighter weights, you may consider increasing the challenge by increasing the number of reps you perform or your time under tension (i.e. performing your lifts more slowly).
There are a whole host of modifications that may make sense later in pregnancy, from eliminating overhead lifts, avoiding front-loaded abdominal exercises (like planks or crunches). to avoiding strict supine exercises if they cause nausea, dizziness or discomfort. Remember to increase the amount of rest you take between sets or sessions, depending on how your body is responding to and recovering from your exercise selections.
For more on running during pregnancy, check out:
For more on core training during pregnancy (as well as trimester-specific workouts), check out:
For more on modifying specific exercises during pregnancy, check out:
If you need to modify your exercise for pelvic girdle pain (SIJ or SPD):
“Listen to your body”
In addition to the warning signs provided by ACOG (listed above), be aware of signs and symptoms that you might be overdoing it with respect to your core and pelvic floor.
Keep in mind the ‘4 Ps’:
If you experience any leaking during exercise, pain in your pelvic floor or elsewhere, or pressure through your pelvic floor or abdominal midline, it’s time to take a step back. If you see peaking, coning or bulging of your abdomen along your midline, that is a red flag that you need to pause that particular lift or exercise, and consult with a qualified coach or pelvic floor physical therapist to evaluate your breathing and movement strategies.
Focus on the long game. Be flexible day to day, trimester to trimester. Be mindful that there will be days where you are fatigued, slept poorly, experience morning sickness, or otherwise don’t feel like exercising. Listen to those signals. Approach your body and workouts with compassion.
Pregnancy is a temporary chapter in your life. Everything you do now should set you up for a strong postpartum recovery. Even though you need to modify your work right now, you will have an opportunity to return to your sport or activity of choice after your recover from your baby’s birth.
It’s time to get moving!
By following these guidelines and tips, you’re setting yourself up for a healthy, fit, and energized nine months.
Remember to always listen to your body and modify exercises as needed- there is no “one size fits all” approach to prenatal fitness. If something doesn’t feel right, stop doing it. If you have any questions or concerns, please consult with your healthcare provider. And finally, have fun with it! Exercise should be enjoyable so that you stick with it throughout your pregnancy.
If you use these tips, please leave a comment below and let me know how it goes!
(1) American College of Obstetricians Gynecologists. 2020. Physical activity and exercise during pregnancy and the postpartum period. Committee Opinion No. 804. Obstet Gynecol 135: e178-188
(2) Clapp III JF, Cram C. 2012. Exercising through your pregnancy: Addicus Books
(3) Salvesen KÅ, Hem E, Sundgot-Borgen J. 2012. Fetal wellbeing may be
compromised during strenuous exercise among pregnant elite athletes. Br J Sports Med 46: 279-83
Continue Exploring Prenatal Fitness:
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Contact me if you have questions about exercise or pelvic health pertaining to pregnancy or postpartum. I also offer personal training services and consultations to folks locally (Seattle, Bellevue, Redmond, Kirkland) and online.