Subscribe to my mailing list!

For weekly sports injury advice

I get commissions for purchases made through links in this post - learn more.

Exercise And Pregnancy - Everything You Want To Know!

Exercise in pregnancy is a common topic of concern for mums-to-be.  There are vast resources of information online but this can be overwhelming and it may be difficult to discern which advice is best to follow.



Some women may feel anxious because the advice they receive from their peers or health care professionals is inconsistent with the information available online and they do not know who or what information to trust.


In this article woman’s health physio, Kim van Deventer, answers common pregnancy exercise related questions. Kim is the founder of Mastermum - an online physiotherapy clinic for mums focussing on antenatal and postnatal fitness and rehabilitation as well as women’s health issues in the childbearing years.


In this article:

  • Is exercise safe during pregnancy?

  • Why is it good to exercise during pregnancy?

  • How can I make sure that I am exercising safely?

  • Exercises that are encouraged or should be avoided during pregnancy

  • When is exercise not safe in pregnancy?

  • What if I can’t exercise because of other issues?

  • When and where to get help

One of the first questions I usually get from a new mum-to-be is "What exercise should I be doing now that I am pregnant?".


Once the reality sinks in that she is now responsible for growing a little life inside of her, more questions seem to stream out with anxious desperation.  "What should I avoid?", "How much should I be doing?" and "How will I know when I am overdoing things?".


No matter what a pregnant woman’s previous level of activity is, most usually have same concerns about exercise during pregnancy.


So let’s answer a few important questions and put your mind at ease.


Is exercise safe during pregnancy?


Yes, it is.  During an uncomplicated pregnancy physical exercise is safe and beneficial for the baby and the mother.


Regular, moderate intensity exercise is encouraged in healthy pregnant women and it is not associated with increased risk of preterm birth.


According to some low quality studies, however, there may be an increased risk for miscarriage when there is intense exercise at the time of implantation and it is advised that if you want to become pregnant you may want to consider limiting the intensity of high-impact exercise in the week after ovulation, and refrain from repetitive heavy lifting in the first trimester.


Why is it good to exercise during pregnancy?


What a relief it is to know that there are so many benefits to exercising during pregnancy that it is too difficult to discuss all of them in detail in one article.


I have summarised a few of the major benefits for mum and baby in the table below.



The above table shows that not only is exercise beneficial for mothers, it is also substantially beneficial for foetal health and well-being which may extend into childhood and adulthood.


The programming effect

Regular exercise during pregnancy seems to elicit what scientists call a "prenatal program­ming effect".  This means that foetuses adapt to an impaired nutrient supply (either under- or over nutrition) by changing their physiology and metabolism in utero.


It has been found that low birth weight is more likely associated with changes in the cardiovascular system whereas a higher than normal birth weight, due to a maternal “obesogenic” environment, is more likely associated with disorders of glucose metabolism such as obesity and diabetes mellitus.


This "programming effect" highlights the importance of managing maternal body composition and dietary balance during pregnancy.


Essentially, what the science says is that if you are fitter and healthier during pregnancy and if you create a healthy environment in utero dur­ing the critical time of foetal organ development, your baby will also be fitter and healthier at birth.


Using this time in your life is a good way to make lifestyle changes that stick for you and your child.


How can I make sure that I am exercising safely?


Up until recently women were advised to avoid strenuous aerobic exercise during pregnancy, but new research has shown that most women can continue with their pre-pregnancy exercise routines with no adverse effect.


1. Understand how your body changes


To make sure that you exercise safely during pregnancy it is important to understand the changes that occur in your body during pregnancy and how they affect you and your baby.

Everything from your hormones and connective tissue to your joints and organs will experience phenomenal change.


A few of these changes include:

  • Your blood volume increases by almost 50% and there is up to 50% increase in your cardiac output (how hard your heart has to work to move all the extra fluid around).

  • You will have 20% more oxygen consumption and an increased sensitivity to CO2 in your bloodstream.

  • Your rib cage expands and your diaphragm is pushed up by 4cm.

  • There is a 30% increase in kidney volume and the length of your kidneys increases by 1 to 1.5 cm.

  • Your joints loosen, your centre of gravity shifts and your stability is reduced which causes your stance width to increase and your step length to decrease during walking.

In addition to this your baby’s core temperature is approximately 0.6 ˚C more than yours.


It may be a little easier to understand why you swell up, why you feel out of breath, why you need to go to the toilet more often, why you waddle and why you feel like a human furnace most of the time.  Even in the snow.


2. Understand the aims of exercise during pregnancy


The aim is to maintain current fitness levels if previously active and to improve fitness levels and develop healthy lifestyle habits if you have not previously been physically active.


Avoid aiming to achieve peak athletic levels during pregnancy.  After pregnancy the aim is to regain your previous level of fitness or if you were not previously exercising, to improve on what you have achieved during pregnancy.


3. Training Volume


The UK’s Royal College of Obstetricians and Gynaecologists (RCOG) recommends that women engage in 30 minutes of moderate intensity aerobic activity each day or approximately 210 minutes (3.5 hours) per week.


Studies have shown that doing more than 270 minutes each week could potentially lead to pre-eclampsia in some women.


For previously sedentary pregnant women and recreationally active pregnant women the guidelines for exercising in pregnancy are now almost the same as for non-pregnant women.  Get fit slowly and build it up gradually, or maintain it.


4. Monitoring workout intensity


Traditionally, measuring your heart rate during exercise outside of pregnancy is accepted as the most effective way to monitor exertion and gauge exercise intensity levels.  However, during pregnancy your heart rate response varies day to day due to the previously highlighted physiological changes and using a heart rate monitor is not as reliable.


You should aim to avoid over-exertion but you do not need to keep your heart rate below any particular number.  Instead you should use measures that gauge the intensity of your physical activity using perceived rate of exertion like that of the "Talk Test" or "Borg Scale".


Keep in mind that every pregnant woman will have her own level of perceived exertion.  Exercising with a friend is a good way to monitor your intensity. The talk test is a simple and reliable gauge that will help to ensure that you meet your cardiovascular and metabolic demands during exercise when pregnant.


I find the talk test easier and more practical for pregnant ladies to use. If you are able to maintain a conversation while exercising without feeling out of breath or uncomfortable, then you know you are working at the right level.


The Borg Scale is a little tricky to remember each level of intensity if you haven’t used it before and some women have reported that it is also not as easy as the talk test to use on a whim.


In pregnant elite sportswomen there may be a limit to how intensely they should exercise. There is evidence that exercising at intensities above 90% of your maximum heart rate may compromise foetal wellbeing. It is advised that elite athletes, trying to keep within ‘safe’ ranges of exercise intensity, should measure heart rate directly.


5. Temperature Regulation:

  • Maternal temperatures above 39 degrees Celsius may harm your baby. Make sure that you do not overheat by choosing cooler times of the day to exercise in, staying well hydrated and wearing loose, breathable clothing.

  • If you exercise in a pool make sure that the temperature of the water is less than 33 degrees Celsius.

6. Risk of falls:

  • You are more susceptible to injury when you are pregnant so you may need to alter your routine if you usually participate in sports or activities that might pose a risk of injury.

  • During pregnancy you will experience temporary balance impairments and you should avoid anything that puts you at risk for abdominal and joint injury due to falls. This includes most contact sports, vigorous racquet sports, and exercise involving balance.

7. Progressing exercise:

  • If you are pregnant with no complications and are new to exercise, start slowly and as low impact as possible and then build it up as you are able. Start with 15 minutes, 3-4 times a week and slowly increase it to 30 minutes every day.

  • If you are already recreationally active and have no pregnancy complications then you can continue to do what your body is used to. Adjust things as your talk test allows.

  • If you are healthy and have no pregnancy complications, adding brief higher intensity intervals to your workout will help you burn more energy and enhance your enjoyment of exercise in late pregnancy.

  • Just remember to keep the intensity below 90% of maximum heart rate.

8. Good to know:

  • Avoid lying on your back for prolonged periods of time during exercise (especially after 16 weeks) if you have symptoms such as faintness or light-headedness.

  • Yoga has been shown to be safe and more effective than walking or general antenatal exercises.

  • Remember that some exercise is better than no exercise so find an exercise you enjoy and stick with it.

Exercises that are encouraged or should be avoided during pregnancy


Many women often ask me for a list of specific exercises that they should be doing or that they should avoid.


In the table below I have listed specific exercises that are encouraged during pregnancy and some of those that are best to be avoided during pregnancy.



*Please note:  Exercises should only be done if they are within your capabilities and according to your talk test.  Do not start new high impact or higher intensity activities if you are not accustomed to them.


Every day during pregnancy your body is dealing with different changes, so from a fitness and energy perspective your abilities and performance may also change from day to day.  Take exercise one day at a time and always listen to your body.


Only do what your body can manage for that day.


When is exercise not safe in pregnancy?


Exercise is not safe if you have:

  • Vaginal bleeding

  • Reduced foetal movement

  • Serious heart, lung, kidney or thyroid disease

  • Poorly controlled Type1 diabetes

  • History of miscarriage, premature labour or "small for dates" babies in this or previous pregnancies

  • High or low blood pressure (discuss with your doctor)

  • Placenta praevia after 26 weeks (discuss with your doctor)

  • Acute infectious disease

Seek medical advice before commencing exercise in pregnancy if you have (or are):

  • Asthma

  • Controlled Type 1 Diabetes (discuss with your doctor)

  • History of miscarriage

  • High blood pressure

  • Early placenta praevia

  • Anaemia

  • Extremely overweight or underweight

  • Heavy smoker

  • Pelvic or low back pain

Stop exercising immediately and call your doctor/ midwife as soon as possible if you experience the following:

  • vaginal bleeding and/or fluid leaking from your vagina

  • uterine contractions

  • dizziness

  • chest pain or uneven heartbeat

  • headache

  • severe and abnormal abdominal, calf, back or pelvic joint pain

  • difficulty in walking

What if I can’t exercise because of other issues?


Pregnancy complications


If you have any pregnancy complications you may be limited in what you are able to do, but there may also be certain types of exercises which are still suitable for you.


Discuss this with your obstetrician and get clarity about what you may and may not do.  Once you have this information your physiotherapist can help determine if there is an exercise that is appropriate for you.


Common complaints


During pregnancy there are common physical complaints that you may experience.  These can cause barriers to starting exercise or continuing with an existing exercise routine.


Low back and pelvic girdle pain (PGP, SPD etc.) is estimated to affect about 50% of women during pregnancy.


This condition can be debilitating, but it does not have to be that way for you. There is specific advice for you and a few simple exercises that you can do to help yourself become pain free and stay that way.


Pelvic floor dysfunction and urinary incontinence result in many pregnant women avoiding physical activity during pregnancy (and after).  If you learn how to correctly activate and strengthen your pelvic floor muscles, you can help prevent these issues or cure them. Having a healthy and responsive pelvic floor can help make labour easier for you too!


When and where to get help


If you have any physical problems during pregnancy the secret is to get help early. 

The sooner you are diagnosed the easier it will be to manage and the quicker you can get back to enjoying your pregnancy.


If you are ever unsure of anything and would like to have information about antenatal, postnatal and women’s health and fitness issues then POGP is a great resource.

Physiotherapists, especially those who are specialised in antenatal and postnatal rehabilitation, are able to provide you with the information and guidance that can get you (and keep you) safely exercising and help you manage any of your physical complaints during pregnancy.


In the meantime


Educate yourself, be kind to your body, appreciate it for what it is accomplishing and learn to really listen and respond appropriately.


I am happy to help if you have any concerns relating to pregnancy fitness and wellbeing so please contact me if you need any help.

Happy and safe exercising mums!

Kim


Kim is a sport and women’s health physiotherapist and the founder of Mastermum. An online physiotherapy clinic for mums focussing on antenatal and postnatal fitness and rehabilitation as well as women’s health issues in the childbearing years.

Contact her via her website http://mastermumphysio.com/ and join her community at https://www.facebook.com/mastermumphysio/.


References:


1) Di Mascio, Daniele et al.  Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.  American Journal of Obstetrics & Gynecology , Volume 215 , Issue 5 , 561 – 571.

2) Silvia Sookoian, Tomas Fernández Gianotti, Adriana L. Burgueño & Carlos J. Pirola.  Fetal metabolic programming and epigenetic modifications: a systems biology approach.  Pediatric Research (2013) 73, 531–542.

3) Godfrey KM, Barker DJ. Fetal programming and adult health.  Public Health Nutr. 2001 Apr; 4(2B):611-24.

4) Moyer et al. The Influence of Prenatal Exercise on Offspring Health: a Review. Clinical Medicine Insights: Women’s Health 2016:9 37–42.

5) Taniguchi C, Sato C. Home-based walking during pregnancy affects mood and birth outcomes among sedentary women: A randomized controlled trial. Int J Nurs Pract. 2016 Oct; 22(5):420-426.Epub 2016 Jun 7.

6)  Mottola MF, Artal R. Role of Exercise in Reducing Gestational Diabetes Mellitus. Clin Obstet Gynecol. 2016 Sep;59(3):620-8.

7) Davenport MH, Skow RJ, Steinback CD. Maternal Responses to Aerobic Exercise in Pregnancy. Clin Obstet Gynecol. 2016 Sep;59(3):541-51.

8) Christie Ward-Ritacco, Mélanie S. Poudevigne, and Patrick J. O’Connor. Muscle strengthening exercises during pregnancy are associated with increased energy and reduced fatigue. Journal Of Psychosomatic Obstetrics & Gynecology Vol. 37 , Iss. 2,2016

9) Kissler K, Yount SM, Rendeiro M, Zeidenstein L. Primary Prevention of Urinary Incontinence: A Case Study of Prenatal and Intrapartum Interventions. J Midwifery Womens Health. Jul 2016;61(4):507-11. doi: 10.1111/jmwh.12420. Epub 2016 Mar 11.

10) Haakstad LA, Edvardsen E, Bø K.  Effect of regular exercise on blood pressure in normotensive pregnant women. A randomized controlled trial.  Hypertens Pregnancy.  2016 May;35(2):170-80. doi: 10.3109/10641955.2015.1122036. Epub 2016 Feb 24.

11) Sanabria-Martínez G, García-Hermoso A, Poyatos-León R, González-García A, Sánchez-López M, Martínez-Vizcaíno V. Effects of Exercise-Based Interventions on Neonatal Outcomes: A Meta-Analysis of Randomized Controlled Trials.  Am J Health Promot. 2015 May 14. [Epub ahead of print]

12) Ong MJ, Wallman KE, Fournier PA, Newnham JP, Guelfi KJ. Enhancing energy expenditure and enjoyment of exercise during pregnancy through the addition of brief higher intensity intervals to traditional continuous moderate intensity cycling. BMC Pregnancy Childbirth. 2016 Jul 15;16(1):161. doi: 10.1186/s12884-016-0947-3.

13) Owe KM, Nystad W, Stigum H, Vangen S, Bø K. Exercise during pregnancy and risk of cesarean delivery in nulliparous women: a large population-based cohort study. Am J Obstet Gynecol. 2016 Dec;215(6):791.e1-791.e13. doi: 10.1016/j.ajog.2016.08.014. Epub 2016 Aug 23.

14) Baker JH1, Rothenberger SD2, Kline CE3, Okun ML1,4. Exercise During Early Pregnancy is Associated With Greater Sleep Continuity. Behav Sleep Med. 2016 Oct 14:1-14. [Epub ahead of print]

15) Artal R. Exercise in Pregnancy: Guidelines. Clin Obstet Gynecol. 2016 Sep;59(3):639-44. doi: 10.1097/GRF.0000000000000223.

16) Pivarnik JM, Szymanski LM, Conway MR. The Elite Athlete and Strenuous Exercise in Pregnancy. Clin Obstet Gynecol. 2016 Sep;59(3):613-9. doi: 10.1097/GRF.0000000000000222.

17) Salvesen KÅ, Hem E, Sundgot-Borgen J.  Fetal wellbeing may be compromised during strenuous exercise among pregnant elite athletes. Br J Sports Med. 2012 Mar;46(4):279-83. doi: 10.1136/bjsm.2010.080259. Epub 2011 Mar 10.

18) Błaszczyk JW, Opala-Berdzik A, Plewa M. Adaptive changes in spatiotemporal gait characteristics in women during pregnancy.Gait Posture. 2016 Jan;43:160-4. doi: 10.1016/j.gaitpost.2015.09.016. Epub 2015 Sep 28.

19) Cakmak B, Ribeiro AP, Inanir A. Postural balance and the risk of falling during pregnancy. J Matern Fetal Neonatal Med. 2016;29(10):1623-5. doi: 10.3109/14767058.2015.1057490. Epub 2015 Jul 27.

20) Leite CF, do Nascimento SL, Helmo FR, Dos Reis Monteiro ML, Dos Reis MA, Corrêa RR. An overview of maternal and fetal short and long-term impact of physical activity during pregnancy. Arch Gynecol Obstet. 2016 Oct 19. [Epub ahead of print]

21) Jiang Q, Wu Z, Zhou L, Dunlop J, Chen P.  Effects of yoga intervention during pregnancy: a review for current status. Am J Perinatol. 2015 May;32(6):503-14. doi: 10.1055/s-0034-1396701. Epub 2014 Dec 23.

22) Mottola MF. Components of Exercise Prescription and Pregnancy. Clin Obstet Gynecol. 2016 Sep;59(3):552-8. doi: 10.1097/GRF.0000000000000207.

23) Bø K, Artal R, Barakat R, et al. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1—exercise in women planning pregnancy and those who are pregnant. Br J Sports Med 2016;50:571–589. doi:10.1136/bjsports-2016-096218

24)  Bø K, Artal R, Barakat R, et al. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 2—the effect of exercise on the fetus, labour and birthBr J Sports Med 2016;50:1297–1305. doi:10.1136/bjsports-2016-096810

25) Nascimento SL, Surita FG, Cecatti JG.  Physical exercise during pregnancy: a systematic review. Curr Opin Obstet Gynecol. 2012 Dec;24(6):387-94. doi: 10.1097/GCO.0b013e328359f131.

26) El-Rafie MM, Khafagy GM, Gamal MG. Effect of aerobic exercise during pregnancy on antenatal depression. . Int J Womens Health. 2016 Feb 24;8:53-7. doi: 10.2147/IJWH.S94112.

27) Cheung KL, Lafayette RA. Renal physiology of pregnancy. Adv Chronic Kidney Dis. 2013 May;20(3):209-14. doi: 10.1053/j.ackd.2013.01.012.

28) Hall, Michael E., Eric M. George, and Joey P. Granger. “The Heart During Pregnancy.”  Rev Esp Cardiol. 2011 November ; 64(11): 1045–1050. doi:10.1016/j.recesp.2011.07.009.

29) FitBack and Bumps. Ante Natal Programme, 2009.

30) Pelvic Obstetric and Gynaecological Physiotherapy. Fit and Safe: Exercise in the Childbearing Year. Advice for mothers-to-be and new mothers. 2015.

31) Royal College of Obstetricians and Gynaecologists. Exercise in pregnancy (RCOG Statement No. 4, 2006).

32) Royal College of Obstetricians and Gynaecologists. Exercise in pregnancy (RCOG statement on exercise during pregnancy and pre-eclampsia, 3 December 2008)

33) Labonte-Lemoyne E1, Curnier D1, Ellemberg D1.  Exercise during pregnancy enhances cerebral maturation in the newborn: A randomized controlled trial. J Clin Exp Neuropsychol. 2016 Sep 13:1-8. [Epub ahead of print]

Contact

  • White LinkedIn Icon
  • White Facebook Icon
  • White Twitter Icon
  • White Instagram Icon
  • White YouTube Icon

Sports Injury Physio is owned by ML Physio Ltd. (England No. 7434251) trading as Sports Injury Physio. Registered office: 9 Acacia Court, Herbert Road, Brighton, BN1 6PB, UK

© 2020 by ML Physio Ltd.