Contributors:
Rosie Naccarato, DPT
Abby Walter, DPT

Is it safe to exercise during pregnancy?

The short answer is yes.

Assuming she is otherwise healthy, pregnant mothers not only can exercise, but they should. The American Center for Obstetrics and Gynecology recommends a minimum of 150 minutes of exercise weekly for the optimal health of the woman and growing child.

In this blog, women’s health specialists Rosie Naccarato and Abby Walter answer commonly asked questions about exercising during pregnancy and the postpartum period. In addition to sharing the benefits of maintaining an exercise program, they provide modifications by trimester and discuss common conditions that may affect which exercises are safe and comfortable.

Important: women should always consult with their doctor before starting any exercise program. It is important to keep in mind the concept of bio-individuality: we are all unique in our biological makeup and requirements. Some women may be able to participate in high-level exercise with good form and without discomfort. Others may need to modify significantly. This is not necessarily a reflection of general health or athletic ability. In this blog, we cover broad recommendations for the average individual.

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Introducing Rosie Naccarato & Abby Walter

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Question & Answer

1. Is it safe to exercise during pregnancy?

Yes! The American Center for Obstetrics and Gynecology recommends pregnant women exercise for a minimum of 30 minutes, 5 days a week. For optimal benefit, exercise should include both aerobic activity and resistance training (weights). The intensity of exercise should be within the “moderate” to “somewhat hard” range. Intensity can be determined by the “talk test” — you should be able to hold a conversation while exercising.

Despite the research demonstrating the benefits of exercise, there is a lot of misinformation and barriers that prevent women from doing so. Family and friends with conflicting beliefs may pressure or judge pregnant women. Medical providers may not give adequate information on safe exercise. Pregnancy symptoms such as fatigue, nausea and a changing body may also prevent women from getting enough physical activity. The more educated women are, the more we can break through these barriers.

2. What are the benefits of exercising during pregnancy?

Benefits for pregnant woman include, but are not limited to:

• Improved sleep
• May reduce excess weight gain
• Decreased risk of gestational diabetes
• Decreased risk of gestational high blood pressure (pre-eclampsia)
• Lower incidence of pre-term birth
• Decreased risk of c-section birth
• Decreased incidence of urinary incontinence
• Fewer backaches, constipation, bloating and swelling
• Decreased anxiety and depression. Overall mood boost.
• Improved functional strength for lifting/holding baby postpartum

Benefits for the baby may include:

• Healthy birth weight
• Decreased risk for congenital abnormalities
• Improved heart strength
• Improved brain and nervous system development
• Improved fetal response to stress during labor

3. What precautions should pregnant women take while exercising?

Women should take caution when exercising in a very hot environment as it may increase internal body temperature (monitor dizziness/nausea). Pregnant women should not lift to max effort and should avoid holding their breath during a lift (valsalva maneuver) as this puts increased pressure on the pelvic floor. Again, the “talk test” is a great way to measure the intensity at which you should be working. If you can not hold a conversation, you may need to scale back.

 

4. What are warning signs that a woman should not exercise or should scale back?

Although exercise during pregnancy is generally good for both mother and baby, your doctor might advise you to scale back on exercise if you have:

• Increased vaginal bleeding
• Abdominal pain or regular painful contractions
• Amniotic fluid leakage
• Difficulty breathing at rest
• Calf pain or swelling
• Muscle weakness affecting balance
• Chest pain

A doctor may advise discontinuing exercise all together if any of these contraindications* are present:

• Incompetent cervix
• Pre-eclampsia
• Placenta Previa
• Heart or lung disease
• Preterm labor during your current pregnancy
• A multiple pregnancy at risk of preterm labor
• Premature rupture of the membranes
• Severe anemia

*This list is not inclusive of all possible contraindications. The ability to exercise with these conditions, and others, varies greatly by each individual. Please always consult with your provider. 

5. How should exercise be modified in each trimester?

There is not a one-size-fits-all approach for exercising during pregnancy. Some women may need to modify movements earlier in their pregnancy. It is important to listen to your body and always follow the advice of a physician.

First Trimester (0-13 weeks):
Most women can continue working out as normal. However nausea, dizziness, and fatigue due to hormonal fluctuations and growth of the placenta may become limiting factors.

Second Trimester (14-26 weeks):
During the second trimester, women start to experience a shift in their ability to sustain cardiovascular activities.

Around 17-23 weeks, prolonged periods in the supine position (laying on the back) may become uncomfortable. The added weight can press down on the spine and may compress the large vessels that carry oxygen and blood supply to both the mother and baby. Moving to quadruped (table top), front plank (from toes or knees) or standing position may be more comfortable.

During this period and onward, women should watch for abdominal coning (a ridge-like appearance in their abdomen). This indicates insufficient core stability. If this occurs, women should consult with their coach about an exercise modification and/or should scale back on resistance/weight.

Avoid repetitive jumping, especially if there is a risk of falling. Jumping puts increased strain on tendons/ligaments, joints, and pelvic floor.

Third Trimester (27-40 weeks):
During this trimester, there is increased arching of the low back and more pressure pushing down on the pelvic floor. Ligaments and joints become looser as the body prepares for birth. Therefore, more emphasis should be placed on posture during exercise. Women should consider decreasing resistance/weights, and should be even more aware of abdominal coning. 

Fourth Trimester/Postpartum:
A mothers body is “shape-shifting” back to its non-pregnant state. If breastfeeding, the body will continue to release hormones that can make ligaments and joints loose. This can affect balance and increase the risk of injury. Move very slowly and ease back into exercise. For the first six weeks, the focus should be on connecting your core to your breath, pelvic floor strengthening, and light walking.

6. When can women safely return to exercise after a vaginal delivery?

The general recommendation is that women wait six weeks to allow for sufficient healing prior to returning to weight-training and higher intensity exercise. However, the amount and length of bleeding may prolong the return to exercise, as may tearing and healing of the pelvic floor.

Upon return to exercise, women should continue to focus on core stability (no coning). Coning and urinary incontinence are signs that exercises should be modified until further healing and strengthening has taken place. Continue pelvic floor exercises at this point.

7. When can women safely return to exercise after a cesarean delivery?

The general recommendation is six weeks and the same considerations as vaginal delivery apply. Focusing on core control and stability is imperative after abdominal surgery. Women may also need to work on scar mobility, as it may feel restricted after it has healed.

 

8. Can women run during pregnancy & postpartum?

Many women feel comfortable running in the first trimester. Experienced, high-level runners may continue into the second and third trimesters if they have no joint/ligament pain and no increase in urinary leakage. However, these runners will likely need to modify the volume of running as pregnancy progresses. The majority of women will feel increased stress/strain on their body during the second trimester and will opt for lower intensity movements.

During the postpartum period, the body is healing from the trauma of birth and the postural changes that occurred during pregnancy. For most women, it is not recommended to return to running until 12 weeks postpartum. Running should only ensue when the mother has adequate control of her pelvic floor, core and hips.

Below are tips for evaluating whether your pelvic floor is ready for running and other high-impact exercises.

Pelvic Floor Readiness–Can you complete the following?

• 10 fast full pelvic floor contractions (kegels) in a row
• 8-12 repetitions, 6-8 seconds max voluntary contractions
• 60 seconds hold, 30-50% sub maximal contraction

Load Preparedness – Can you perform the following without pelvic pain, heaviness or leakage?

• Walk 30 minutes
• Single leg balance – 10 seconds/side
• Single leg squats – 10 reps/side
• High knees – 1 minute
• Forward bounding – 10 reps/side
• Single leg hopping – 10 reps/side

9. What are some of the more common conditions that occur during pregnancy and postpartum, and what modifications should be made for them?

Diastasis Rectus Abdominis (DRA)
This is a normal and expected adaptation of abdominal wall tissues in response to fetal growth during the later months of pregnancy. DRA is characterized by thinning/widening of the linea alba as a consequence of increased intra-abdominal pressure. During pregnancy and postpartum, women may see a coning appearance down the midline of their abdominal region. Avoiding exercises that overly stress this region and learning how to properly engage the transverse abdominis (deep core muscles) can help reduce dysfunction in this area.

Sacroiliac Joint Pain
The sacroiliac joint is the point where the spine connects to the hips. Stability in the region allows for effective load transfer between the upper and lower body. As the body prepares for birth, hormones may cause this joint to be more mobile, which can become painful. When it is painful, exercises that emphasize single leg stability and/or leg shearing (one leg going forward and one leg going back), can cause symptoms. These unilateral movements include lunges and step-ups. To reduce discomfort, women should focus on bilateral strengthening through the posterior chain (hamstrings, glutes, low back and lats). Bilateral movements produce force using both sides of the body simultaneously. Squats and deadlifts are good examples.

Low Back Pain
This is a common complaint and is due to the increased pull from the belly getting bigger and the low back arching to compensate. The muscles through this region may become tight as increased pressure is placed through the spine. Gentle strengthening of the low back musculature and ROM (range of motion) exercises such as cat/cow and goddess squat can help relieve symptoms.

Pelvic Floor Dysfunction
Increased pressure on the pelvic floor for nine months, followed by extreme stretching or tearing during childbirth can result in tightness, weakness or incoordination of the pelvic floor. Dysfunction often presents as stress urinary incontinence (urine leakage during activities that place increased pressure on the pelvic floor). This may include laughing, coughing, jumping, sneezing, running, or even walking. These symptoms may continue for months (or years) postpartum. Learning how to properly relax, contract, and strengthen your pelvic floor can prevent and/or improve these issues.

Pelvic Organ Prolapse (POP)
This occurs when muscles or tissues are unable to sufficiently support your pelvic organs because of weakness or mismanagement of pressure. Signs and symptoms include a sensation of pressure/heaviness in the vagina or feeling a bulge in or coming out of the vagina. This sensation might increase with exercise, especially jumping or running. If it is affecting your daily functional mobility or ability to exercise, it is recommended to see a pelvic floor specialist.

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Exercises & Modifications

Please talk to your Vie coach if you have any questions about how to properly perform these movements. 

Supine Abs
Bridges, bird dog, planks from knees with proper core engagement

Box Jumps
Step ups, squats

Burpees
Incline burpee: place hands on elevated surface, step out and back. Perform high knees instead of jump.

Pull-ups
 Lat pulldown with band

Abdominal exercises hanging from bar
Lat pulldown with march, pallof press rotation, diagonal chop

High impact movements (running, jumping)
Marching high knees, MB taps, standing banded lateral steps

Barbell Squats, Cleans, Deadlifts
Generally safe but may need to lower weight and swap for dumbbells if belly prevents proper bar path.

Overhead Press
If abdominal coning occurs, lower weight.

Asymmetrical Movements (lunges, single leg deadlifts, box step-ups)
Only need to modify if painful. Switch to bilateral movements such as squats or deadlifts.

Disclaimer: The information provided in this blog (including but not limited to, text, graphics, images) is for educational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health provider regarding a medical condition.

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Contact Info:

Rosie Naccarato
Naccarato.Rosemary@gmail.com
Instagram: @RevitalizewithRosie

Abby Walter
abby.walter19@gmail.com
Instagram: @PhysioStrength

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Questions for Rosie and Abby? Please post them below!