The guidelines that do exist are primarily shaped by concerns over safety, as well as a lack of comprehensive studies that follow women through different stages of pregnancy. Therefore, many doctors and practitioners recommend moderate activity as a middle ground and recommending moderate intensity exercise while being more cautious in their recommendations of increasing intensity.
Yet, the science that is available indicates that exercising during pregnancy has significant benefits not just for Mom, but also for the baby’s development. Regular, moderate-intensity physical activity can help reduce the risk of gestational diabetes, hypertension, and excessive weight gain. It can also promote healthier weight for the baby and potentially improve neurological development. Let’s dive into the fundamental things you need to understand before exercising during pregnancy, including what the current guidelines suggest, red and yellow flags to watch out for, and how to safely stay active during these precious nine months.
Guidelines for Exercise in Pregnancy
The guidelines for physical activity during pregnancy have been refined over time, with leading organizations like ACOG, the National Strength and Conditioning Association (NSCA), and the World Health Organization (WHO) outlining recommendations that promote Momma and baby health.
ACOG encourages pregnant women to engage in the same typical guidelines of non-pregnant people of at least 150 minutes of moderate-intensity aerobic activity per week, spread throughout the week. This is similar to the recommendation for non-pregnant adults and includes activities such as walking, swimming, or stationary cycling. The ACOG also advocates for strength training exercises at least 2 times per week, as resistance training can help maintain muscle mass and support the extra weight gained during pregnancy.
On the global stage, the WHO also recommends 150 minutes of moderate-intensity physical activity per week for pregnant women, emphasizing the importance of moving regularly and avoiding long periods of inactivity. They, too, suggest combining aerobic exercises with muscle-strengthening activities for overall health benefits.
Typical Exercise Guidelines for Non-Pregnant Individuals
Before we dive into the specifics of exercising during pregnancy, it’s important to understand the typical exercise recommendations for non-pregnant people. The NSCA and WHO provide universal guidelines to maintain health and prevent chronic diseases:
- 150-300 minutes of moderate-intensity aerobic activity or 75-150 minutes of vigorous-intensity aerobic activity per week.
- Muscle-strengthening activities involving major muscle groups should be performed on 2 or more days per week.
- Include flexibility and balance exercises to prevent falls and improve mobility.
While these guidelines are a great foundation, pregnancy may require modifications to your workout routine so let’s talk a little more about the specific considerations for exercising during pregnancy!
Red Flags to Exercise During Pregnancy
While talking about red flags isn’t always fun, it’s important to acknowledge hard STOPS to exercise. Pregnancy is a delicate balance between having good physical activity and ensuring the safety of both momma and baby. There are certain conditions or symptoms, known as red flags, where exercise should be completely avoided. If any of these apply, it’s important to consult your OB-GYN or birth provider before continuing any physical activity. According to ACOG and WHO guidelines, the following are red flags that warrant stopping exercise:
1. Severe respiratory diseases (e.g., chronic obstructive pulmonary disease, restrictive lung disease, cystic fibrosis)
2. Severe acquired or congenital heart disease with exercise intolerance
3. Uncontrolled or severe arrhythmia
4. Placental abruption
5. Vasa previa
6. Uncontrolled type 1 diabetes
7. Intrauterine growth restriction (IUGR)
8. Active preterm labor
9. Severe pre-eclampsia
10. Cervical insufficiency
You don’t have to know any of the specifics of these conditions if you have not been clinically diagnosed with any of these issues by your healthcare provider or OB-GYN, but it’s important to talk with them if you have any concerns of these issues through your pregnancy. These conditions can significantly increase the risk of complications during pregnancy and exercise. Women with these conditions should avoid physical activity until cleared by a medical professional as they can put momma and baby at risk for medical complications.
Yellow Flags: Precautions for Exercising During Pregnancy
In addition to red flags, there are yellow flags or precautions that may require modifications to your exercise routine, but they don’t necessarily require stopping physical activity altogether. These include conditions that, if properly managed, allow for safe exercise during pregnancy:
1. Mild respiratory disorders
2. Mild congenital or acquired heart disease
3. Well-controlled type 1 diabetes
4. Mild pre-eclampsia
5. Preterm premature rupture of membranes (PPROM)
6. Placenta previa after 28 weeks
7. Untreated thyroid disease
8. Symptomatic, severe eating disorder
9. Multiple nutrient deficiencies or chronic undernutrition
10. Moderate to heavy smoking (20+ cigarettes per day) with comorbidities
If you have any of these conditions, it’s important to consult with your healthcare provider to determine what level of exercise is safe for you so you can better make an informed decision moving forward in your work out routine. In many cases, moderate, low-impact activity is still beneficial and can improve overall pregnancy outcomes.
Green Flags: General Exercise Guidelines for Pregnancy
For women without the conditions above, the ACOG and WHO agree that a typical healthy and non- complicated pregnant momma are free to exercise with guidelines noted above of:
- 150 minutes of moderate-intensity aerobic exercise per week, spread across several days.
- Resistance training 2 times per week, focusing on maintaining muscle mass and overall strength.
Pregnancy is not the time to push your limits or strive for new fitness records. Instead, aim to maintain a consistent level of activity, which will benefit both you and your baby’s health. Studies suggest that babies born to mothers who exercised during pregnancy may have better cardiovascular and neurological development.
Important Considerations When Exercising During Pregnancy
Exercising during pregnancy is highly recommended, but there are specific considerations you need to keep in mind to ensure safety.
1. Continue your pre-pregnancy exercise routine: If you were exercising regularly before pregnancy, you can usually continue your activities with modifications noted below
2. Don’t bump the bump! Modify exercises to avoid excessive pressure on the abdomen and pelvis: Modify exercises to avoid lying flat on your belly, having a weight lifting bar or dumbbells hit your belly, or any impactful activity that may hit your abdomen. Avoid weight lifting belts during pregnancy to avoid the extra pressure on your belly.
3. Try not to Valsalva: Holding your breath and bearing down during lifting can increase intra-abdominal pressure and can place strain your pelvic floor. Instead, focus on exhaling as you lift to protect your core and pelvic floor if you are able to. If you are keeping up with heavier lifting through pregnancy, make sure you are at least using a partial exhale and check with a pelvic floor therapist to make sure you are bracing your pelvic floor and abdominals in the most functional way possible to not bear down through them.
4. Avoid Pain: Don't exercise to an intensity that brings on back or pelvic girdle pain, urinary leakage, gas leakage, or feelings of pressure or bulging in vagina. If you notice any of these issues, it is not that you have injured something most likely, but that your pelvic floor, core, or back muscles are not able to manage well with the exercise intensity and it may need to be modified. Example modifications: If squat jumps cause you leakage, try quick air squats for now. If double unders are causing you issues, try single unders. If running causes you discomfort, try speed walking, biking, or swimming to get your cardio right now.
5. Be aware of your heart rate: While heart rate guidelines during pregnancy have evolved, a general recommendation is to keep your heart rate below 150 beats per minute during exercise. This varies on the individual, medical background, and their symptom. Monitor how you feel, avoid feelings of light headedness or dizziness, and try and shoot for an intensity where you are atleast be able to speak aloud without feeling like you can’t breathe.
6. Be cautious of lying on your back for >8 minutes or any period where you may be starting to get dizzy or light headed. Lying on your back towards the end of your pregnancy can compress the vena cava, a major blood vessel, which can reduce blood flow to the baby and cause dizziness for momma, but again this is once you are much bigger and doesn’t affect every momma the same. Modify exercises that you get symptoms in and get out of these positions if you start to feel any dizziness or lightheadedness.
7. Monitor blood pressure changes: During pregnancy, expect a drop in blood pressure, but rapid positional changes (like standing up too quickly) can lead to dizziness. Move slowly when transitioning from sitting or lying to standing. Watch for signs of pre-eclampsia, which include blood pressure elevations of 10+ points systolic or diastolic above your normal. You should immediately reach out to your OB—GYN or medical provider if your systolic blood pressure (top number) is 160 mm Hg or higher or diastolic blood pressure (bottom number) is 110 mm Hg or higher
Okay, I am Clear to Continue to Exercise, What Should I Focus On?
Strength training during pregnancy, especially for muscles like the glutes, hamstrings, hip abductors, and hip internal and external rotators, is vital for supporting the pelvis as it undergoes significant changes. These muscle groups play a critical role in stabilizing the pelvis and lower back, which bear much of the added weight during pregnancy. Strengthening these muscles can help reduce discomfort in the hips and lower back, promote better posture, and improve overall mobility, making daily activities easier and less strenuous. In addition, working on the core and pelvic floor connection is crucial for maintaining stability, as the core is responsible for protecting the spine and supporting pelvic organs. Strong pelvic floor muscles can also help prevent or manage common issues like urinary leakage and pelvic organ prolapse, especially during and after pregnancy.
Single-leg strength, stability, and balance exercises are equally important throughout pregnancy because they mimic real-life movements and help maintain functional strength as your center of gravity shifts. Working on single-leg exercises like lunges or step-ups can improve stability and prevent falls, which is critical as balance naturally becomes more challenging. Cardiovascular exercise works well with strength training by enhancing overall endurance, supporting healthy blood flow, and improving oxygen delivery to both you and baby. It can help reduce the risk of gestational diabetes, manage weight gain, and boost your mental health, keeping you physically and emotionally resilient throughout pregnancy. Maintaining a well-rounded fitness routine that includes both strength and cardio ensures you are better prepared for labor, delivery, and the postpartum recovery period.
Finally: The Importance of Exercise Throughout Pregnancy
Exercise during pregnancy offers numerous benefits for both you and baby. It can reduce the risk of pregnancy-related complications like gestational diabetes and high blood pressure, improve mental health, and promote healthier weight gain. For the baby, maternal exercise can enhance cardiovascular health, support neurological development, and improve birth weight outcomes.
However, it’s important to exercise with precaution. Regular check-ins with your OB-GYN, monitoring blood pressure, and modifying your workout routine for comfort and taking into account growing belly and other energetic and medical changes that may occur as your pregnancy progresses are key to maintaining both your health and your baby’s well-being. Keep track of your overall health by staying active, eating well, managing stress, and attending all prenatal appointments.
The best approach to exercise during pregnancy is one that balances activity with rest, aiming to maintain fitness while adapting to the body's changing needs and fueling your body.
Resources:
- American College of Obstetricians and Gynecologists. (2020). Physical Activity and Exercise During Pregnancy and the Postpartum Period.
- World Health Organization. (2020). Guidelines on Physical Activity and Sedentary Behavior.
- National Strength and Conditioning Association. (2019). Pregnancy and Strength Training Guidelines.
- American College of Obstetricians and Gynecologists. ACOG Committee opinion No. 650: Physical activity and exercise during pregnancy and the postpartum period. Obstetrics and Gynecology 126(6): e135-142, 2015.
- American College of Obstetricians and Gynecologists. ACOG Committee opinion No. 548: Weight gain during pregnancy. Obstetrics and Gynecology 121: 210-212, 2013
- Guinhouya BC, Duclos M, Enea C, Storme L. Beneficial Effects of Maternal Physical Activity during Pregnancy on Fetal, Newborn, and Child Health: Guidelines for Interventions during the Perinatal Period from the French National College of Midwives. J Midwifery Womens Health. 2022 Nov;67 Suppl 1(Suppl 1):S149-S157. doi: 10.1111/jmwh.13424. PMID: 36480665; PMCID: PMC10107927.
