Exercising Safely in Pregnancy

The second you get the positive results, whether it’s a missed period, or peeing on a stick, or a urine test from your doctor’s office, or bloodwork, or an ultrasound….you become acutely aware that the decisions you make affect more than just you.  From what you eat and drink (to what you can no longer eat and drink) to how much sleep you get or how much weight you lift, you don’t want to do anything to hurt the baby.  And if you’ve ever experienced a pregnancy loss, this last bit can have you more fearful to move than most.  

But you’re pregnant, not made of glass, and in most cases, exercising in pregnancy has way more benefits than risks.  Read this blog on the benefits of exercising in pregnancy.

Pregnancy Conditions to Be Aware Of

Let’s get the fine print out of the way.  If this were a radio ad or TV commercial, this is the part I would be talking about super fast. 

According to the American College of Obstetricians and Gynecologists, there are certain conditions that make exercise in pregnancy unsafe including certain types of heart or lung diseases, cerclage (a stitch used to sew your cervix closed), multiple gestations at risk for preterm labor, placenta previa (when the placenta partially or completely covers the cervix) after 26 weeks, preterm labor or ruptured membranes, pre-eclampsia or pregnancy-induced hypertension, and severe anemia.  There are other more “relative” contraindications for exercise that include cardiac arrhythmia, chronic bronchitis, poorly controlled Type I diabetes, extreme morbid obesity, being extremely underweight, intrauterine growth restriction, poorly controlled hypertension/hyperthyroidism/seizure disorder, being a heavy smoker, or having certain orthopedic limitations. Sigh, moving on!

When To Stop Exercising During Pregnancy

There’s also a list of warning signs you should be aware of to terminate exercise.  I don’t know about you, but if I had fluid gushing from my vagina during a weightlifting routine, I’m certainly not finishing my set.  The rest of these seem fairly obvious as well, but in the interest of being extremely thorough, here are reasons you should terminate exercise:

  • Bleeding from the vagina
  • Feeling dizzy or faint
  • Shortness of breath before starting exercise
  • Chest pain, Headache, Muscle Weakness
  • Calf pain or swelling
  • Regular, painful contractions of the uterus 
  • Fluid gushing or leaking from the vagina (duh!!!)

Again, seems pretty straightforward to me, but there you go!  Now that we got that out of the way, let’s get to the fun stuff!!!

Defining What Exercises Are Safe During Pregnancy

But first, when designing exercises, are there any you should leave out???  You should avoid high contact sports, situations where there might be a loss of balance, and the extremes of temperature….so time to put that Hot Yoga membership on hold.

When determining if an exercise is safe during pregnancy, you need to look at your program through 3 different lenses.

First of all, you need to appreciate the changes that are happening in your cardiovascular system.  Your resting heart rate will increase.  Rather than focusing on an arbitrary heart rate number, I advise following the Rating of Perceived Exertion Scale where pregnant women should stay in a range of 11-13/14 (somewhat hard, it feels like an effort, but you can continue) or use the “talk” test to make sure you are able to carry on a conversation while exercising and not be gasping for air.

Your body may need some extra time to get adjusted to changes in position so I recommend avoiding exercise programs that have you popping back and forth between sitting, lying down, standing, etc

Your pregnant body will have a slightly more difficult time keeping you cool, so be sure to wear moisture-wicking clothing, stay hydrated, and avoid exercising in extreme temperatures.

Secondly, you need to appreciate the hormonal changes that occur with pregnancy, mainly the increase in progesterone and relaxin.  These hormones serve to soften the connective tissue all over the body, not just in the pelvis, so avoiding aggressive over-stretching is essential.  There are also two areas of vulnerability that should be considered: your deep abdominals and pelvic floor.  Your rectus abdominus (or 6-pack) muscles have a tiny band of connective tissue running directly down their center called the linea alba.  This is not a flaw in the way you were designed because we WANT there to be connective tissue in that region and we want it to stretch to accommodate your growing baby and uterus.  However, certain exercises may put too much strain on an already vulnerable area making it hard for you to control the intra-abdominal pressure and you may develop something called Diastasis Rectus Abdominus.  Read more here.  Choose exercises that engage your deepest abdominal muscle, your transversus abdominus, and avoid exercises that might increase the intra-abdominal pressure beyond the demands of the connective tissue including weighted twists, double leg lowering, sit-ups, and crunches, and excessive time in the all 4’s position.

Lastly, know the demands of your event!  If I was training a woman for a triathlon, I would choose activities to help her maximize her swimming, biking, and running abilities.  Likewise, when I train a pregnant woman, I treat the day she gives birth like an event and design exercises to make her successful.  There should be a strong focus on not only strengthening her pelvic floor but ALSO relaxing the pelvic floor muscles.  After all, these muscles are in charge of sliding the baby out so we don’t want to just create angry/tight/overactive muscles down there.  I want to be sure she knows how to activate her deep abdominals in all positions: supine, side-lying, all 4’s, and squatting so those muscles will be there for her if she requires coached pushing.  Hip flexibility and strength are a MUST.  And let’s not forget upper body strength.  Eventually, she’ll be soon carrying a baby in her arms not her belly (along with a car seat, diaper bag, purse, and perhaps a toddler!!!)

When To Start Exercising During Pregnancy

Many women want to know how soon they can start exercising after they find out they are pregnant. In the “olden days” the recommendation was “if you were exercising before pregnancy, you can most likely continue it during pregnancy.”  But this left our more sedentary sisters scratching their heads.  So ACOG re-defined their opinion in 2002 to address exercise recommendations for all people and how that relates to pregnant women: …an accumulation of 30 minutes or more of moderate exercise a day should occur on most, if not all days of the week. 

In the absence of medical or obstetric complications, pregnant women can also adopt this recommendation.”  Currently the ACOG website recommends “pregnant women should get 150 minutes of moderate-intensity aerobic activity per week.  If you are new to exercise, start out slowly and gradually increase your activity.  Begin with as little as 5 minutes a day.  Add 5 minutes each week until you can stay active for 30 minutes a day.”

The other important factor is how you are feeling.  Many women in the first 12-17 weeks of pregnancy are feeling tired or nauseous or weak.  Forcing yourself to pound the pavement when your body is begging for rest isn’t a great idea.  Strive for slow walks or gentle stretching until you are feeling better.  Most “first” trimester symptoms seem to be alleviated by the 16-17 week mark so continue to listen to your body and satisfy your appetite for movement in ways that are agreeable to your current state.

Exercise Programs That Are Safe for Pregnant Women

In terms of which specific exercise programs are safest and best for pregnant women, there are many to choose from.  Brisk walking in nature (avoiding extremes of temperature) can be a total body workout that also calms your mind.  Water workouts can be a way to enjoy a semi-weightless form of movement that may minimize discomfort in your joints or help with other orthopedic limitations but it shouldn’t be the only way to get in your movement.  You need to carry your pregnant body around the world and into your delivery scenario so remember to make your workouts “event-specific.” 

Yoga that utilizes modifications for certain positions can be helpful, but my all time favorite Prenatal exercise routine has always been Prenatal Pilates.  Learn more about why Pilates is perfect for your pregnant body here.

Participating in exercises during your pregnancy that appreciate the cardiovascular and hormonal changes that are occurring in your body along with the demands of your upcoming “event” is one of the best gifts you can give to yourself and your baby.  Let’s get moving!!!

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