Welcome back, readers! In previous blogs, we have discussed different topics regarding pelvic floor dysfunction, abdominal changes during pregnancy, and different modifications to incorporate if symptoms are present. However, I haven’t even addressed if exercise was safe or okay to continue to do during pregnancy… The short answer is, Yes! In this blog, I thought it would be beneficial to discuss the recommended guidelines and specifically the symptoms we need to recognize as indicators to start modifying in the gym.
Over the last 100 years, the recommendations for exercising during pregnancy have evolved quite a bit. Initially, in the early 1920-1930s, recommendations focused predominantly on maintaining moderate physical activity, which was defined as walking and house chores. Gradually research evolved, and in 1985 the American College of Obstetricians and Gynecologists issued the first guidelines which indicated moderate physical activity of 15 minutes at a time with emphasis on heart rate and body temperature restrictions, including no more than 140 beats/minute and 100.4 degrees Fahrenheit (Downs et al., 2012).
As more research was conducted over exercise and pregnancy, the American College of Obstetricians and Gynecologists (ACOG) updated the guidelines in 2002, which were adopted by the US Department of Health and Human Services Physical Activity Guidelines for Americans (2018). They include the following:
● 150 minutes of moderate-intensity aerobic activity throughout the week.
○ This intensity is indicated as a 5-6 on a rate of perceived exertion scale of 1- 10. This scale allows athletes to rate their own exertion or intensity of exercise based
on the scale with 1 indicating very easy exercise and 10 indicating the greatest
● Females who have been participating in vigorous exercise can continue to do so, as
long as there are no complications and they consult their healthcare providers while continuing to be active.
● Women who are pregnant should work with a healthcare provider to monitor their
pregnancy and make adjustments to exercise as they progress through pregnancy.
● It is recommended that after the 1st trimester, women should avoid exercises that
require women to lay on their back to prevent blood flow restrictions to the uterus and
This update included removing restrictions on many forms of physical activity, as well as heart rate and body temperature guidelines. The release of these new guidelines also included that women who participated in vigorous physical activity can continue to do so as long as there are no significant medical complications during the pregnancy (ACOG, 2002). During the development of these guidelines, research indicated that there was no correlation of vigorous exercise to preterm pregnancy, pregnancy loss, or risk for low birth weight compared to the sedentary population and women actually found physical and mental health benefits with continuing to be active (Downs et al., 2012).
As mentioned, these standards apply to most normal/healthy pregnancies without any medical complications. It is important to work closely with your healthcare providers to rule out any significant cases or complications that may impact your exercise routine, such as abnormalities with the placenta, maternal or fetal cardiovascular concerns, and/or gestational diabetes. It should be warranted that not all of these conditions indicate that you should cease or stop exercising, but may require more modifications than the “normal/healthy pregnancy”.
The problem we run into with these guidelines is that they are still over 20 years old, and there is a clear gap between practice and research regarding this population and the safety of exercise. Many of the recommendations we still hear are made due to expert opinion or lack of evidence, however, since the publication of those guidelines, multiple studies have been published to address some of the recommendations we may have questions about. For example:
●· Avoid supine exercises after the 1st trimester to prevent blood flow restrictions to the
uterus and fetus.
○ In a research study by Mottola et al. (2019), it was found that no adverse events
occurred with pregnancy outcomes and lying supine while exercising. Prevett et al.
(2023), found similar results in their study as well, and that there was no increase
in reproductive complications in 71% of the participants who performed supine
exercises vs. those who did not.
○ Based on this information, females who are pregnant can perform supine
exercises (like bench press) as long as no symptoms of dizziness or
lightheadedness were experienced during that time.If so, move to a more elevated
○ It was noted that while sleeping, it is still recommended to sleep on your left side
to reduce cardiovascular and fetal concerns during sustained positioning vs.
short term (Prevett et al., 2023).
● Keep your heart rate at or below 140-150 bpm or stay in that moderate intensity.
○ In a recent research study it was found that there is no difference in maternal
weight gain, fetal birth weight, or adverse events with women who participated in
vigorous exercise during the 3rd trimester of pregnancy compared to those who
did not (Beetham et al., 2019).
● Pregnant and postpartum females should avoid core exercises that cause doming in
the abdominal wall.
○ In theory this was thought to increase laxity of the linea alba and abdominal
musculature, however, there is no evidence to support that doming causes
increased laxity in the abdominal wall. Instead, we should use it as a sign to
improve abdominal engagement and pressure management (Gingerich & Prevett,
While there is still quite a bit to learn about physical activity and pregnancy, this more updated research with the guidelines can allow our pregnant female athletes to be more active in the gym based on their goals and choices. Lastly, when in the gym and working out, what are some symptoms that we may need to modify or scale during exercise? Some symptoms to keep an eye on include:
Still unsure of where to start? Contact us for an assessment to help you learn customized modifications and keep you training. We use a 3 step process to help athletes feel and move better, including:
1. Fixing your pain.
2. Figuring out the root cause.
3. Providing you the necessary tools to get back to being active and not dealing with this
ACOG:Committee Obstetric Practice. (2002). ACOG Committee opinion. Number 267, January
2002: exercise during pregnancy and the postpartum period. Obstetrics and Gynecology,
99(1), 171–173. https://doi.org/10.1016/s0029-7844(01)01749-5
Beetham, K. S., Giles, C., Noetel, M., Clifton, V., Jones, J. C., & Naughton, G. (2019). The effects of
vigorous intensity exercise in the third trimester of pregnancy: a systematic review and
meta-analysis. BMC pregnancy and childbirth, 19(1), 281. https://doi.org/10.1186/s12884-
Department of Health and Human Services.(2018).Physical Activity in women during pregnancy
and postpartum. Physical_Activity_Guidelines_2nd_edition.pdf
Downs, D. S., Chasan-Taber, L., Evenson, K. R., Leiferman, J., & Yeo, S. (2012). Physical activity and
pregnancy: past and present evidence and future recommendations. Research quarterly for
exercise and sport, 83(4), 485–502. https://doi.org/10.1080/02701367.2012.10599138
Gingerich, J. & Prevett, C. (2023, April). CMFA: Pregnancy & postpartum [Powerpoint slide].
Institute of Clinical Excellence.
Mottola, M.F., Nagpal, T.S.,& Bgeginski R, et al. (2019).Is supine exercise associated with adverse
maternal and fetal outcomes? A systematic review.British Journal of Sports Medicine,