There are often many questions surrounding pregnancy and exercise…

What modifications do I need to make and when?

How do I avoid issues like diastasis recti or prolapse during pregnancy and postpartum?

What is truly safe for me and baby during this time?

The list goes on. I’m Dr. Kayla Ives, pelvic floor physical therapist and owner of the pelvic physio, a specialty women’s health and pelvic floor physical therapy clinic in Omaha. It is my job to find answers to these common questions! As a pelvic floor physical therapist, my goal is to help people stay active during pregnancy, address and avoid common pregnancy-related issues (pelvic/hip/low back pain, bladder leakage, diastasis recti, prolapse, etc.), and help set people up for optimal labor and delivery outcomes.

When it comes to exercise during pregnancy, it seems we don’t have great answers. And sometimes we may get conflicting answers depending upon who you ask. Why is this the case? First, we must consider that all pregnancies, prior fitness levels, and medical histories are unique to the individual. That makes it very difficult to give one-size-fits-all advice when it comes to anything during pregnancy. Some can run marathons and compete in CrossFit competitions while pregnant, where others only feel comfortable (or up for) walking short distances. Another reason for the lack of information is we can’t ethically do a lot of clinical research studies on pregnant people. No researcher would ever want to do anything that could cause harm to the pregnant person or the baby, so, because of this, the exercise recommendations we get from our doctors are typically very outdated.

*There are pregnancies where exercise is not recommended. If your doctor or provider has told you to avoid exercise altogether due to a medical condition, that is VERY important to follow! *

With that in mind, let’s dispel some common myths:

• Keep your heart rate below 140 bmp: Recent research has shown this to be unnecessary. Originally, it was believed that a heart rate above 140 bpm would divert blood flow away from a developing fetus. Multiple studies have shown this to be untrue, and it is perfectly safe (even beneficial) to increase your heart rate to up to 90% of your maximum heart rate.¹
• Avoid core exercises: It was believed that doing core exercises could increase the presence of diastasis recti during pregnancy and postpartum. What we’ve recently learned, however, is that diastasis recti happens in 100% of pregnancies in the third trimester (this is physiologically what the body is supposed to do!). General core strength is the leading indicator of abdominal healing postpartum. Your core muscles need to be strong to support you during pregnancy and postpartum!
• Avoid heat: Recent research has shown that heat (specifically hot yoga) is perfectly safe while pregnant, if it is something you’ve been doing regularly prior to pregnancy. If you start to feel off, then skip the heat. Feel fine? Continue as you’d like!²
• Avoid lying on your back: While this advice is true late in the third trimester, you can typically continue to exercise on your back through the second trimester.

Now that we’ve dispelled some common myths, here are some helpful recommendations:

• Consider your prior activity level: It is very safe to continue with your previous exercise routine, even well into the third trimester. Your body is very smart! If you feel up to it, continue! Even if you haven’t been as active pre-pregnancy as you’d like, you can begin an exercise routine, including cardio and strength training. This will benefit both you and baby.
• Strength over stretching: During pregnancy y our body creates a hormone called Relaxin that allows your muscles, joints and ligaments to loosen and stretch to accommodate a growing baby. Because of this, your body relies more heavily on your muscles for stability. Staying strong not only decreases pregnancy-related pain, but also encourages quicker healing postpartum.
• Modify, don’t quit: It is better for your body and baby to be active and strong during pregnancy. Consider modifications like adding a block to elevate the height of a surface, kneeling on your hands and knees instead of lying on your stomach, etc. instead of stopping activities altogether.
• Avoid abdominal coning or doming (sort of…): While there isn’t a ton of research to support that coning or doming of the abdominal muscles during exercise causes long term issues, we do know that it’s not the strongest position for you to be in. There are, however, ways to recruit your abdominals doing the exact same exercises to avoid coning, or you can modify the exercise altogether to achieve the same result without creating excess force across the abdominal wall.
• Slow down as needed: As always, dizziness, nausea, blurred vision, sudden headache, and chest/upper belly pain are indicators that you might be overdoing it. Listen to your body, and slow down or stop if you experience any of these issues.

At the end of the day, there are really no “safe” or “unsafe” exercises. Every pregnancy and pregnant person is different. Trust your body, stay as strong and active as you can, and consider finding a pelvic floor PT to help guide you on your pregnancy journey. Best of luck!

References

1. Beetham KS, Giles C, Noetel M, Clifton V, Jones JC, Naughton G. The effects of vigorous intensity exercise in the third trimester of pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2019;19(1):281. doi:1186/s12884-019-2441-1
2. Patterman et al. (2020) Safety of Hot Yoga in Pregnant Women. Int J Res Ex Phys. 15(2):14-23.