FITNESS DURING PREGNANCY & POSTPARTUM
Inactivity during pregnancy is the norm in the US, with only 40% remaining active during pregnancy. Of those 40%, only 15-38% of pregnant women following recommended physical activity guidelines. There are many reasons that women may choose or not able to be active during pregnancy, but let’s bust a couple of myths:
Myth 1: Vigorous exercise during pregnancy can cause miscarriage
Many women are scared of miscarriage, especially in their first trimester, as most miscarriages occur before the 12th week of pregnancy
Many women do NOT exercise during this time because of that fear
Prenatal exercise is NOT associated with increased odds of miscarriage or perinatal mortality
Multiple studies have not identified any association between volume, intensity or frequency of exercise and fetal or newborn death
Myth 2: You shouldn’t start a new fitness regime or physical activity while pregnant
There is no evidence that you cannot begin to exercise when you become pregnant if you did not prior to becoming pregnant
Myth 3: Vigorous physical activity will induce labor or cause pre-term birth, or “you can’t lift heavy or run a marathon during pregnancy”
There is no evidence to show any association between volume, intensity, or frequency of exercise and pre-term birth or induction of labor at any trimester
Benefits of exercise during pregnancy include:
Decreased risk of pre-eclampsia, gestational hypertension (high blood pressure), gestational diabetes, cesarean section or instrumental delivery, urinary incontinence, excessive gestational weight gain, and depression
Decreased severity of low back and hip pain
Improves outcome for postpartum recovery
Better quality of life during pregnancy and postpartum
Exercise during pregnancy can decrease the first stage of labor
So, what ARE the exercise guidelines for during pregnancy?
(Refer to American College of Obstetricians and Gynecologists and 2019 Canadian guideline for physical activity throughout pregnancy)
Accumulate 150 minutes of moderate physical activity each week to achieve clinically meaningful reductions in pregnancy complications
Physical activity should be accumulated over a minimum of 3 days per week, however being active every day is encouraged
Pregnancy women should incorporate a variety of aerobic (cardio!) exercises and resistance training activities for greater benefits
If you are new to exercise, start out slow and gradually increase your activity
General guidance for exercise for each trimester
First trimester
Unless there’s an absolute contraindication, exercise should be performed regularly, and no significant changes need to be made
Respect the symptoms of the first trimester
No contact sports
Second trimester
If you’re a lifter, breathing and bracing mechanics may change – changing from a Valsalva (holding your breath during a lift) vs exhaling on exertion to reduce stress on the pelvic floor
The abdominal muscles and tissue start to stretch, and core exercises are important to continue
Growing baby affects bar path in barbell athletes, so movement modifications will likely be necessary
Monitor for supine hypotensive syndrome (blood pressure drops with lying on your back), so modify barbell bench to incline bench press
Third trimester
Rapid expansion of the belly affects ability to maintain balance and trunk stability
Intensity of exercise can continue, but modifications in strength and cardio training are likely being made again in this trimester – use effort or rate of perceived exertion to modify intensity of your workouts
Pelvic floor issues can become more common in this trimester due to weight of baby (e.g. urinary incontinence, constipation, etc.) – if these symptoms occur, this is a great time to reach out to a pelvic floor therapist (like me!) to help
Core exercise remains important, as it can help women to effectively push during labor
What are contraindications for exercise during pregnancy?
Absolute contraindications
Unexplained persistent bleeding
Pre-eclampsia
Ruptured membranes
Placenta previa after 28 weeks gestation
Intrauterine growth restriction
Incompetent cervix
Triplets or + high-order multiple pregnancy
Uncontrolled type 1 diabetes, hypertension, or thyroid disease
Other serious cardiovascular, respiratory, or systemic disorders
Relative contraindications
(check with your healthcare provider)
Recurrent pregnancy loss
Gestational hypertension
History of spontaneous preterm birth
Mild/moderate cardiovascular or respiratory disease
Symptomatic anemia
Malnutrition
Eating disorder
Twin pregnancy after 28th week
Reasons to STOP exercise and contact a healthcare provider
Vaginal bleeding
Regular and painful uterine contractions
Persistent loss of fluid vaginally indicating rupture of membranes
Persistent excessive shortness of breath
Chest pain
Headache
Calf pain or swelling
Persistent dizziness or faintness that doesn’t resolve with rest
If you have any questions or concerns about becoming active or staying active during pregnancy, always best to consult your healthcare provider first before starting!
About Diana Jordan
Diana Jordan is a physical therapist who specializes in working with people who have pelvic floor dysfunction. She graduated from Pitt's Doctor of Physical Therapy program in April 2023. Her passion is combining the worlds of orthopedic and pelvic floor, and loves helping people who are experiencing hip, back, and pelvic pain or symptoms that's holding them back from participating in exercise to the best of their ability. She has been participating in powerlifting and weightlifting for over 6 years and recently got her USAW-L1 certification. She recently started her own business, Strive Physical Therapy LLC, and works out of the PFP space. She is the emotional-support human to her dog, Kimchi, who tolerates visiting PFP from time to time.