How to exercise safely in pregnancy

LloydsPharmacy is delighted to partner with The Bump Room to provide expert led pregnancy and postnatal care for women.  

Exercising in Pregnancy

Finding out you are pregnant is a wonderful time but slowly the worries can creep in. You may have so many questions on how to do everything right. You might wonder if you are exercising too much or maybe you have let exercise slide down your list of priorities lately. Read on to find out how to exercise safely during your pregnancy. 

Before I unpack this, I’d like to acknowledge how amazing our bodies are during pregnancy and beyond. Not only do we make a human being, in some cases more than one! We also grow a new organ called the placenta and deal with all the system changes: cardiovascular, respiratory, hormonal, musculoskeletal and my personal favourite, neurobiology. Yes, our brains change too during pregnancy and beyond. 

So, it’s pretty important to keep the body in the best condition it can be in to cope with all this transformation. In more recent years the evidence is indicating that exercise in pregnancy is in fact a therapy.

Davies et at (2019) in the British Journal of Sports Medicine states “We should no longer view exercise as a pleasant behaviour to engage in but as a critical therapy to ensure a better pregnancy outcome”.

What are the better outcomes according to the evidence?

1. Helps reduce high blood pressure problems
2. Helps to prevent diabetes of pregnancy
3. Improves fitness
4. Helps control weight gain
5. Improves sleep
6. Improves mood
7. More rapid postnatal recovery.

In The Bump Classes I frequently refer to pregnancy like an endurance event and like any endurance event, it requires training.

What kind of training, what do the guidelines say?

According to the 2020 Australian Guidelines for physical activity in pregnancy

• Doing any activity is better than none. If you currently do no physical activity. Start by doing some, and gradually build up to recommended amount.
• Be active on most, preferably all, days every week.
• Accumulate 150-300 minutes (2.5 to 5 hours) of moderate intensity physical activity or 75 to 150 minutes (1.5 to 2.5 hours) of vigourous physical activity, or an equivalent combination of both moderate and vigourous activities, each week.
• Do muscle strengthening activities at least 2 days a week.
• Minimise the amount of time spent in prolonged sitting.

The Chief UK medical officer put these guidelines in a great infographic

There are some extra safety precautions recommended for exercise in pregnancy:

1. Stay well hydrated and avoid heat stress. Heat is transferred from the baby to the mother and because of all the system changes it is more challenging to cool down in hot conditions. So no hot yoga!
2. Avoid long periods of motionless posture especially if it causes light headedness.
3. Exercising in your back is recommended to be avoided after 16 weeks, however as recent evidence highlighted this recommendation for caution was not based on explicit evidence. Australian guidelines recommend you use your best judgment and let comfort be your guide.
4. Wear a supportive bra, over 80% of women have been reported to be wearing the wrong size bra. Particularly during pregnancy due to the changes to the breast tissue. A research group on breast health highlights that traditional bra fitting method does not give the best fit. They advocate a series of 'Best Fit' criteria. Check out this video with 5 simple steps for the perfect bra fit. https://vimeo.com/282459945
5. Avoid activities with significant changes in pressure, risk of contact/collision, risk of falling and heavy lifting.

Is exercise safe for the baby?

Yes, a 2019 systemic review identified no increase in maternal, foetal or neonatal complications. In fact, pregnancy in-activity was identified as an independent risk factor for pregnancy complications.

However, there are conditions where exercise in pregnancy is not advised or is a precaution. These are uncommon and do happen.

Exercise in pregnancy is not indicated with the following:

• Serious CVS, respiratory, renal or thyroid disease
• Poorly controlled Type 1 diabetes
• A known risk of premature labour with or without a history of IUGR
• Multiple gestation (triplets or higher number)
• Cervical incompetence
• Persistent second or third trimester bleeding
• Hypertension/hypotension (medical clearance from GP)
• Placenta previa after 26 weeks gestation
• Sudden swelling of ankles, hands or face
• Acute infectious disease
• Severe anemia

 Exercise in pregnancy is a precaution with the following:

• History of spontaneous miscarriage, preterm labour or fetal growth restriction
• Mild/moderate cardiovascular or chronic respiratory disease
• Pregnancy induced hypertension
• Poorly controlled seizure disorder
• Type 1 diabetes
• Symptomatic anaemia
• Malnutrition, significantly underweight or eating disorder
• Twin pregnancy after the 28th week
• Other significant medical conditions

(Consult your health care provider if you experience any of these)

I am expecting twins, can I exercise?

Yes, it is safe to exercise with twin pregnancies AND it is more challenging on the body. Therefore, we recommend women join classes early, aiming to start at 14 weeks. Modifications usually have to be given and it can get tough from 28 weeks onwards, so lets take it week by week after that, tuning in with how you are feeling.

I lift weights/do cross-fit can I continue?

Yes, and I will always ask this woman how is she feeling when she is doing it. The answer usually is “I am able to do some things the same, other exercises I have stopped because I don’t find them comfortable or I have reduced the weight”

Currently, there is limited studies that indicate on optimal intensity and frequency. There is also nothing on the level of resistance or loading. Therefore, listening to your body, trusting your body and adapting is the main guide. 

Do I need to be cleared by my doctor to exercise in pregnancy?

Current guidelines recommend that women who are healthy and already active do not need to seek medical clearance for physical activity/exercise during pregnancy, but those who are considering high volumes of exercise training (high intensity, prolonged duration, etc) should seek advice and guidance from a health professional.

Can I exercise if I have pelvic girdle pain?

Yes, and there is a goldilocks spot. Pregnancy-related pelvic girdle pain can vary from day to day depending on the level of physical/mental/emotional stress, quality of sleep and much more. There will be days when exercise will really help and there are days when rest is more important. What is important to know about pelvic girdle pain is all in this infographic which was produced in 2022 by Pulsifer et al. This infographic is evidence-based and highlights that the pelvis is;

• Stable: resilient and adaptable to demands of pregnancy
• Safe: postural and pelvic structural changes are normal for pregnancy and childbirth
• Self-manageable: a whole person approach is required, emotional wellbeing, sleep optimization, exercise and external supports

Will exercise help my birth?

NO & YES

The current evidence indicates there is no association between exercise in pregnancy and the following:

• Premature labour
• C-section
• Induction
• Length of labour
• Vaginal tears
• Injury

There are too many variables to be able to say to women that if you exercise in pregnancy you will have a great labour and birth.

AND YES,  anecdotally women in my classes have reported that staying active in the pregnancy helped them cope with whatever did happen during labour and birth.

There is evidence for a more rapid post-natal recovery.

More Information

For more information on the Bump Room and the services they offer please visit their website here 

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