Exercise In Pregnancy – The How, The What & The Why (& How Much Is Too Much)

Staying active has been shown to reduce to risk of tearing and minimize postpartum pelvic floor issues. There is a wide range of information (and misinformation) available about exercise in pregnancy. The pregnant clients I see in clinic are generally very active, but it is also important to note that if you haven’t been a regular exerciser, it is never too late to start.

Here are the key points from the most recent Canadian guidelines

① All women without contraindications should be physically active throughout pregnancy.

② Pregnant women should accumulate at least 150 min of moderate-intensity physical activity each week to achieve clinically meaningful health benefits and reductions in pregnancy complications.

③ Physical activity should be accumulated over a minimum of 3 days per week; however, being active every day is encouraged.

④ Pregnant women should incorporate a variety of aerobic and resistance training activities to achieve greater benefits.

⑤ Pelvic floor muscle training (PFMT) may be performed on a daily basis to reduce the risk of urinary incontinence. Instruction on the proper technique is recommended to obtain optimal benefits.

⑥ Pregnant women who experience light-headedness, nausea or feel unwell when they exercise flat on their back should modify their exercise position to avoid the supine position.

There are so many reasons to stay active in pregnancy, and one involves your baby’s brain development. According to a study out of the University of Montreal, 20 minutes of exercise, three times a week, can enhance your baby’s brain development. They advise moderate exercise that leads to slight shortness of breath.

I have many pregnant clients who range from recreational to professional athletes, and I often get asked about exercise recommendations when they want to continue training in pregnancy. I recommend listening to Sonya Looney’s podcast episode, Exercise Guidelines During Pregnancy and Post-Partum, with Catherine Cram. Catherine Cram coauthored Exercising Through Your Pregnancy, authored Fit Pregnancy for Dummies, and is a contributing author of Women’s Health Care in Physical Therapy: Principles and Practices for Rehabilitation Specialists. The podcast host, Sonya Looney, is a world champion professional athlete and Certified Health Coach who lives in Squamish.

So how much is too much exercise in pregnancy? Catherine Cram advises monitoring that you are gaining weight normally. If you aren’t, or you are losing weight, you need to examine your workouts and your diet. You also want to ensure that your baby is growing according to their gestational age. If they are not and your midwife or physician is concerned, it is a sign you may be overtraining. If you and your baby are gaining weight normally, you are sleeping well and feeling energized (as much as is possible while pregnant!), and your mental health is not suffering (depression can occur), these are signs that you are not overtraining.

Catherine Cram advocates that pregnant women work at a level that feels “moderate to somewhat hard”. This helps individualize the level of exertion, and empowers the pregnant person to tailor their exercise according to how they feel. She agrees with the “talk test”, that you “shouldn’t be working so hard that you are panting and out of breath”, but she also provided reassurance that even in those instances, you will feel very lightheaded and fatigued before it adversely affects your fetus, since your fetus is wired to get what it needs.

A common recommendation is to keep your heart rate below 140 beats per minute; however, the talk test (ensuring you could still hold a conversation) is a better indicator than heart rate due to the heart rate increases that happen in pregnancy.

Catherine goes on to say that “pregnancy is probably not the time to be doing really high intensity workouts for sustained periods of time, because in that instance we do see enough shunting and enough maternal core temperature upping that it could be possibly detrimental”, particularly in the first trimester.

If you are incorporating shorter bouts of high intensity exercise (e.g. 30 seconds), that isn’t a long enough time to caused impaired blood flow to the fetus; however, if you feel lightheaded before or after exercise, or you aren’t recovering well, listen to your body and to the feedback from your cardiovascular system. Avoiding exercising in high heat (particularly high humidity) environments to avoid overheating. Signs of this are profuse sweating or stopping sweating entirely, your face becoming red, and feeling very fatigued and dehydrated. For further details on this, please refer to the podcast episode.

Reach Out With Questions!

Contact me if you have any questions about exercise in pregnancy. Your pelvic floor should be considered during exercise to create a balance between pelvic floor strength and flexibility as you prepare for childbirth. As a former Team Canada 400 metre hurdler and mom of two, I’m here to help!

Mottola MF, Davenport MH, Ruchat S, et al. 2019 Canadian guideline for physical activity throughout pregnancy. Br J Sports Med 2018;52:1339-1346.

Tags: Pregnancy, Exercise, Pelvic Floor Physiotherapy, Squamish Physiotherapy.