Exercise during Pregnancy

Peri Hughes, prenatal fitness expert, @phmethod

One of the most-asked questions we get is — Can I continue my regular exercise routine during pregnancy? Hear directly from Peri Hughes, SF based prenatal fitness expert on the topic.

I’m pregnant and have a lot of questions about my current exercise routine. I hear a lot of conflicting advice and suggestions about safe levels of exertion. Can you clarify?

There is a huge amount of information out there when it comes to exercising while pregnant, and it can be incredibly confusing to know what you safely should and should not do. The bottom line — if you have a healthy and uncomplicated pregnancy and you had some level of physical activity prior to pregnancy, it is recommended to continue to exercise throughout pregnancy. 

There are many factors to take into consideration when it comes to physical output and exertion. The most current guidelines on prenatal fitness set by The American College of Obstetrics and Gynecologists  (ACOG) advises pregnant women to focus on Rate of Perceived Exertion (RPE) and a sliding scale from 1-10. When performing an exercise, you need to measure whether this exercise feels like a 10 (max capacity) in your body or, say, a 7 (moderate capacity). The higher the RPE, the fewer repetitions you would perform to maintain correct form and alignment before fatiguing. This is a safe way to measure exertion for pregnant women when exercising because it keeps the focus on the woman’s personal experience in that moment and how they are feeling energetically on that given day. 

My favorite classes are high intensity — I really don’t want to give them up. I’m early on in my pregnancy and everything still feels fine. Is that OK?

Under the guidelines of ACOG, if you are regularly performing moderate to high-intensity exercise prior to pregnancy and you have what is considered to be an uncomplicated and healthy pregnancy, it is fine (and recommended) to continue physical activity with modifications taken as needed. The type of exercise that you continue during your pregnancy, however, requires some attention. 

Even though you may not be able to visibly see physical changes to your body as early as the first trimester, there are definitely a lot of changes that are occurring internally, including important fetal developments and essential attachments between the uterus and the placenta. Because of this, aggressive twisting type exercises can potentially cause strain and discomfort to some of those attachments. 

Also, crunches and jumping will overtime put a strain on your pelvic floor and abdominal wall, especially in the second and third trimester. These types of exercises should be modified further along in pregnancy with a fitness professional to avoid an unnecessary build up of pressure on an already weakened and overstretched pelvic floor and abdominal wall.  

What happens to my core when I’m pregnant? How can I be mindful of this when exercising? (Can you talk a little bit about what the ‘core’ is, first?)

When we talk about the core during pregnancy, we are talking about the ‘core unit’ which is made up of your deepest core muscles: your transversus abdominis (think of this as your body’s internal corset), your multifidus, and your pelvic floor (which supports all of you pelvic organs - a lot more on that below). These muscles, along with your diaphragm, make up your ‘core unit’. On top of this, we have our internal and external obliques and our most superficial layer our rectus abdominis (also known as the ‘six-pack muscle’). 

It is the deepest core muscles that make up the ‘core unit’ that are most important when we exercise. This is the case especially while pregnant, given their role to support and stabilize the spine and pelvis. As your baby grows, intra-abdominal pressure (IAP) builds up in your core, putting a huge amount of pressure on the connective tissue that joins the rectus abdominis together (as well as on your pelvic floor). This connective tissue is known as the linea alba (running down the centre of your belly, which sometimes darkens due to the rise of pregnancy hormones). When this connective tissue becomes overstretched and weakened through pregnancy, it can eventually separate. This separation is known as diastasis recti (more on that below). 

If we perform advanced core exercises like full-formed planks, crunches, or sit ups during pregnancy when we are already experiencing an increase of IAP, this can lead to ‘coning’. This is when you might see a peak form along the centre of your belly from the ribs to the belly button. That ‘cone’ is a sign that there is a mismanagement of pressure and that the exercise being performed is not appropriate for the pregnancy phase you are in. The goal when we perform core work while pregnant is to be able to keep the bump looking smooth and round with no ‘coning’ present. Overtime, ‘coning’ can promote diastasis recti. 

The way we can reduce IAP when performing core work in pregnancy is by modifying planks onto knees, which reduces the frontal load on the abdominal wall and removing abdominal exercises that work your spine in flexion. Instead, performing core exercises with a neutral spine is your safest and most effective way to work the ‘core unit’.

Can you tell me more about diastasis recti? Who is prone to it? What causes it?

Diastasis recti simply means separation of the rectus sheath, the connective tissue that joins the sides of the rectus abdominis (‘six-pack’ muscle) together. This is an incredibly common condition in pregnancy and it is expected that over half of all pregnant women will experience it to some degree. As your baby grows in pregnancy, your abdominal wall becomes stretched and weakened to varying degrees. Overtime, this can lead to the sides of your abdominal wall separating. Anything from two inches or more is considered diastasis recti. The good news is that most cases will heal naturally on their own. For more severe cases, it is advisable to work individually with a prenatal or postpartum exercise specialist or pelvic floor physical therapist who will lead you through rehabilitative exercises. 

Although not as common, an abdominal separation could even occur if you consistently hold your breath during a strained bowel movement. Therefore, it is important to remember when exercising (and pooping!) to exhale during the exertion portion of the exercise while lifting and engaging your ‘core unit’. This will give you the most amount of internal support and help you manage the build up of pressure in your core.

I’ve heard a lot of talk about the pelvic floor. Why is it so important to consider, especially during pregnancy?

The pelvic floor (PF) is a group of muscles (14 in total) that make up the floor of your pelvis. The PF has four main functions: 1) to help support and maintain the position of the pelvic organs, 2) to manage sexual functions, 3) to support the three pelvic joints and 4) to control our bladder and bowels. To keep these functions optimal, the PF needs to be strong and supple so that it may successfully engage and fully release. Dysfunction in the PF is oftentimes caused by the PF being hypertonic (overly tight). This can lead to leaking, incontinence, and pelvic organ prolapse (POP).

Throughout pregnancy, the PF will be stretched and weakened due to your growing baby. So it is important to work on continuing to strengthen the PF up until around your 35th week (when the focus then shifts to opening and releasing the PF muscles to prepare the body for labor). When we perform deep diaphragmatic breathing along with deep core and PF engagement, we create a dynamic pumping action which helps to strengthen the PF and mitigate the build up of intra-abdominal pressure (IAP).

Is there a point in time that I should switch from my regular exercise routines to classes that are designed for pregnant people?

Personally, I believe the sooner you start with a prenatal fitness program that is catered to the specific needs of a pregnant woman's body, the better. When I work with clients I will start introducing pregnancy-safe modifications as early as the first trimester so that they can master the alignment of these positions before their body really starts to change. 

For many women, they might be somewhat hesitant about starting prenatal fitness because they have a preconceived notion that the workout will be too easy. This is one of the reasons I created my Train Like A Mother (TLAM) program. With TLAM, I empower women to feel confident with moving their bodies and building strength throughout their pregnancy. I want women to be at their strongest in mind and body by the third trimester so they are better equipped to deal with the challenges of labor and life as a new mother. In my class, we focus on building strength and endurance in a safe and mindful way that supports the ongoing alignment shifts occurring in a pregnant woman's body. 

That is not to say that you must throw out your favorite workout classes. However, you should make sure that you are performing exercises that are supportive of whatever stage of pregnancy that you are in. It can be challenging when participating in group fitness classes when they are not specifically catered to pregnancy. In these situations, you should make sure you have informed your fitness instructor of your specific needs, and that they are able to support you with the necessary modifications throughout class.

We love your new class, ‘Train Like a Mother.’  Particularly, the format of the class - how did you decide on its components?

Thank you so much! The idea of this class really was born at the same time my son Sebastian came into this world 2.5 years ago. I have always been deeply passionate about women's health and keeping women moving through pregnancy and postpartum. But it wasn’t until I became a mother myself that I really started to understand the female body’s needs to prepare for labor and the necessities of postpartum recovery.

I designed TLAM for new and expectant mothers to help prepare them for their biggest life events: giving birth and raising a child. The aim of this class is to reshape how we look at exercising while pregnant. Through this class, I want women to feel their strongest when they are at their heaviest in the third trimester so they are best prepared for the physical challenges of labor. I incorporate a blend of barre and pilates style exercises, Activities for Daily Living (ADL) drills while using 12-15 lb kettlebells to mimic the functional movements you will do while holding your baby, and LIIT (Labor Intensive Interval Training) endurance style drills lasting 90 seconds to mirror the length of a contraction wave. 

So often women are told to slow down when pregnant, and while for some high-risk pregnancies bed rest is required, in most healthy pregnancies, regular movement is recommended. Birthing a child is the biggest physical event your body will ever go through and we need to prepare your body for it appropriately. Think about it - you wouldn’t run a marathon without training for it, would you? Labor is like your life’s marathon. It makes good sense to prepare as best as you can.