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Certain exercises are recommended depending on which stage of pregnancy you are in. 

Pregnant women should definitely
exercise, but exercise with prenatal guidelines in mind.

If you're pregnant, keeping up with a routine of prenatal exercises will help you deliver a healthy baby. Depending on which trimester you're in, certain exercises are great, but take caution: others will put your baby at risk.

Now that more and more women are weight training seriously, there is concern regarding how best to adapt training to the demands of pregnancy. The good news is that active women with normal, low-risk pregnancies do not have to give up weight training or most other exercises in order to keep themselves and baby healthy. Early guidelines about training while pregnant were based more on speculation and expectations about women's roles than they were on clinical research. Luckily these guidelines have been updated. Numerous studies indicate that regular exercise has a number of benefits (and few drawbacks) for women. Ideally, women should be fit and active before getting pregnant, so if you are thinking of conceiving, begin an exercise program now. Pregnancy is not the time to begin a strenuous exercise program. In fact, pregnancy is not the time to make any drastic changes to your activity level or lifestyle.

However, pregnant women who are already accustomed to regular activity and exercise shouldn't find much disruption to their normal routine, and previously sedentary women can safely begin a moderate exercise program as late as the second trimester. Visit my home workout page for descriptions of exercises you can perform while pregnant during the first two trimesters. Be sure to come back to this page to read about special issues for the pregnant exerciser, particularly in the later third of the pregnancy.

Maintaining an Exercise
Routine While Pregnant

"Muscle conditioning" exercises such as weight training are considered low-risk and safe, even for pregnant women. Self-monitoring of training is essential when you're exercising while pregnant, however. This is a good time to keep a journal that records eating, training, workout reports, notes on how you feel, heart rate, recovery, etc. Here are some special concerns for exercising during pregnancy: Joint laxity. This is a crucial issue for pregnant weight trainers. The body "softens" connective tissue in order to prepare for delivery. While this is necessary for pelvic expansion during delivery, it's not so great when you're trying to do your exercises! However, strong muscles help to hold things together and improve overall stability, so strength training will be helpful and increase your health and wellness while pregnant, as long as you're careful. Avoid exercises such as the pec fly and deep squats: any that require a large range of motion in the joints should be avoided at this time.

Overheating. Another significant issue for pregnant weight trainers. Dress to stay cool, with layers you can peel off (don't be shy about your growing body: you have a good excuse!) Be sure to drink lots of fluids (even though you'll feel like you have to pee every ten minutes), and point a fan on you if possible. Overall, make sure to pay attention and monitor the situation during your training sessions. Sometimes overheating happens quite rapidly, especially if you're pregnant: you can be fine one minute, and be burning up the next. Aerobic sessions should generally be limited to 20 minutes, unless you're doing something extremely low-key like slow walking, low-key water aerobics, or easy pedaling on a recumbent bike (Side note: recumbent bikes are an ideal form of exercise for pregnant women). No matter what your type of exercise, do not allow your heart rate to rise above 145 beats per minute. Keep in mind that your heart rate will rise faster when you're pregnant, so don't assume that your heart rate is low enough just because you're going slow. If you need a break to cool down, take one. Oxygen has to be divided between you and your baby, and you will find that in later months of pregnancy, the baby presses upwards on your diaphragm, making it harder to breathe deeply.

Nutrition. Good nutrition is essential during pregnancy, and will allow you to get the most benefit from your exercises. It is often difficult for female athletes to accept the inevitable weight gain that occurs during pregnancy, but this isn't a time to diet or be nutritionally stingy. You may notice wild fluctuations in blood sugar (leading to a feeling of "I have to eat NOW!!"), so try to eat at regular intervals, and avoid going more than a couple of hours without a small meal. In the first trimester you may be limited in what you can tolerate, and foods that used to be appealing to you may make you feel sick--but this is usually restricted to the first three or four months. On the other hand, you may experience an increase in appetite while pregnant, including nearly uncontrollable cravings for carbohydrates. This does not signify weakness or gluttony on your part; let the hormones do their work and get a balanced diet as best you can. Take in at least 300 calories over maintenance each day.

Supplementation. In general, you should avoid taking any supplements while pregnant or breastfeeding other than a good-quality whey protein and a multivitamin (your doctor may recommend additional vitamin or mineral supplementation). Given the issues with overheating and heart rate, thermogenics and stimulants are contraindicated (this includes caffeine, so cut down on this as much as you can). Fish oil has been suggested as a desirable supplement for pregnant women, but due to mercury and other concerns, the research suggests that more study needs to be done before this is a given. Medical supervision and ongoing monitoring. As part of your regular medical checkups, have your doctor advise you on possible changes in your body (e.g. cervical dilation, threatened miscarriage, hypertension etc.) that may require you to modify your program. Ensure that you keep your doctor up-to-date on what kinds of activities and exercises you're engaging in, and whether you notice any worrisome symptoms such as persistent bleeding. Exercise choice. As the pregnancy progresses, avoid exercises which involve lying on the back, or pressing against the stomach (such as chest-supported rows). Also avoid overhead movements, as they can cause blood pressure to spike. Avoid exercises that require a strong grip for the same reason (such as strenuous bench-pressing or dumbbell chest-pressing). Never hold your breath during exercise. You may find that you need to modify or eliminate exercises which involve excessive head movement, such as stiff-legged deadlifts, as they may cause nausea or dizziness in a pregnant woman. Avoid prolonged periods of standing. Balance will eventually be a concern, so in the second and third trimester, reduce and eventually eliminate the Olympic lifts and perform demanding overhead lifts while seated (see the section on fitness ball use below). One of the most typical problems encountered by pregnant women is back pain. Their center of gravity shifts and extra weight is added over the nine months. Women tend to slouch the shoulders and arch the lower back to compensate for these changes, which of course leads to discomfort. A strong abdominal column as well as a strong back gained through weight training exercises before pregnancy can alleviate much of this problem, so assistance work geared to this need is helpful. Bodyweight exercises, such as unweighted squats, present a useful alternative as the pregnancy develops, as do exercises which take some weight off the joints, such as swimming or cycling. Exercising for two. A growing fetus is a greedy little thing (as parents will attest, not much will change in that respect once it's born, either). The body will adjust its substrate utilization to ensure that the baby gets the best of what you have. Your nutritional needs will change as will your body's response to exercise. Pregnancy dramatically alters glucose and insulin response to prolonged exercise, as well as blood lipid profiles. These should return to normal postpartum. It has been speculated that this represents a glucose conservation mechanism and a protective shunting of energy substrate for fetal use. In other words, physiology dictates that fetus gets priority when it comes to getting first dibs on the good stuff. Recovery. Be prepared for reduced recovery capacity and adjust your training accordingly. Be aware that some of the modalities you may use for active recovery, such as hot tubs, may be inappropriate during this time. As far as getting enough recovery time, you'll probably want to do a lot of sleeping, anyway. Don't fight it: you need your rest, now more than ever.

Training Frequency While Pregnant

An interesting finding of recent research on pregnancy is that exercise frequency is a determinant of birth weight (the higher the birth weight, in general, the healthier the baby), and that too much exercise can be just as detrimental as too little. Women who exercised more than 5 times per week AND less than 2 times per week were BOTH at risk for having lower birth weight babies (interestingly, intensity did not appear to be as significant a factor as frequency). This finding points to a "happy medium" of 3-4 weekly sessions of structured exercise for pregnant women. Other research suggests that a lower volume of exercise in the second and third trimester is associated with better fetoplacental growth (although the mother demonstrates more fat gain rather than lean body mass gain relative to a higher volume of exercise). The more recent ACOG document (2002) argues that daily or near-daily moderate exercise of 30-minute sessions is recommended. It seems evident that total workload should be reduced as the pregnancy progresses. For most women this is intuitive, since the demands of a growing fetus tend to reduce their desire to go all-out in the gym. Few women have the urge to do a maximal lift while eight months pregnant; the idea of a nice nap is likely more appealing! However, some athletes feel that they cannot tolerate a reduction in training volume or intensity. For these women, the research gives a clear caution which must be heeded.

Weight Training Specifically

A difficulty encountered with the research on pregnancy and exercise is that the majority of studies look at cardiovascular exercise, and will often use endurance athletes as a population or sample--and in many cases, trying to extrapolate the advice to sedentary or women who weight train. While we can certainly make inferences from this work, we cannot expect that all elements will apply precisely to all women if we're studying mostly endurance athletes. Guidelines on weight training are sparse, and hint at using lower intensities by defining appropriate rep ranges (between 15 and 25 reps per set). This appears to indicate a lack of familiarity with structuring weight training programs, as well as the needs of experienced weight trainers for whom such a low intensity may be inadequate. Thus we need to begin to theorize about how best to develop a strength-training program based on the evidence we have. Given concerns about joint laxity, heart rate, oxygen consumption, and overheating, it seems inappropriate to suggest that weight trainers build their program around long sets of lower intensity. Rather, it is sensible to take an approach which uses shorter sets combined with a lower intensity, resulting in a similar overall volume. So, for example, let us say that our pregnant trainee normally performs 3 sets of 10 reps in the squat, using a weight which is somewhere around 65-70% of her 1RM. For an experienced trainer this is a relatively low intensity to be using, so we assume that she can continue to use it as long as she is comfortable with it. However, we might modify her program so that she is performing something like 6 sets of 5 reps each, or even 10 sets of 3 reps, for the same total volume, but changing the demands of each set to reflect the increased need for rest and moderation. Eventually you might also substitute some machines for certain free weight exercises to reflect challenges to balance (though bear in mind the challenge of joint laxity, and choose machines wisely, avoiding those which require you to exert the most force in the weakest position, such as pec decks). For example, the bent-over position assumed during a one-arm dumbbell row might produce dizziness and back pain, so an intelligent substitute might be seated cable rows, or even a modification to the free weight exercise which includes a higher support and less of a forward lean. Many of these considerations do not come into play until the second or third trimester. Many women have successfully met significant athletic challenges while in their first trimester. In the first trimester, the primary concern is usually nausea, dizziness, and blood sugar swings. Attention to hydration and nourishment should help; sipping on a carb drink such as Gatorade (if you can tolerate it) during the workout can be useful. Training can remain normal for the most part during this period. However, you should begin to consider decreasing intensity and volume from the fourth or fifth month onwards.

If you would like some help with a prenatal exercise routine, visit this page to learn about hiring a personal trainer knowledgeable in prenatal exercise.

Fitness Ball

A piece of gym and home equipment which is beginning to be used as a pregnancy aid is the fitness ball (the giant plastic or vinyl inflated ball). These are relatively cheap, and it's not a bad idea to pick one up.

In later months of pregnancy, many women experience significant pelvic pain as the weight of the baby presses downward and ligaments are stretched. One undignified but useful position which appears to alleviate this pain is getting down on hands and knees and hugging the ball, resting the weight of the upper body on it, and rocking back and forth if desired.
Bridging exercises with the fitness ball can help relieve back pain and strengthen torso and hip extensors (Lie on your back with your palms on the floor. Dig your heels into the ball and straighten through the hips, lifting your butt off the floor. Lower and repeat.

Pregnant women may also find it more comfortable to use the ball in place of a chair or bench while sitting during normal activities (such as desk work or watching TV), as well as during exercise. The squishiness of the ball provides cushioning for increased weight, and the instability of the ball helps with torso mobility and awareness. Women in later stages of pregnancy can use the ball to help modify common exercises, such as squats. Wall squats with the ball are performed by placing the ball between your back and the wall, and rolling down the wall with it into a squatting position. Finally, women in labor may find some relief from sitting on the ball during contractions and rocking back and forth. Overall, you can still perform most of the same exercises you're used to doing for the majority of your term. The most important things to watch out for are overheating and letting your heart rate spike too high. If you drink plenty of fluids and exercise with air conditioning or a fan you won't have such a hard time. Also, limit your cardio to 20 minutes at a time after the first trimester (you can do 20 minutes later as well, if you like, after you've cooled down a bit) and shorten your weight-lifting sets to fewer reps (8 instead of 12, for instance--perhaps do more sets to make up for it), but try to use the same amount of weight to continue challenging your muscles. Maintaining as much muscle mass as possible while pregnant by sticking with your weight lifting exercises will make it much easier to shed the excess weight after you've had your baby. Also, your little one will get big fast--and you'll want to be able to lift him or her with ease! Already had your baby? Click on Postpartum Exercise

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