Exercise During Pregnancy
Evidence-Based Guidance for Staying Strong and Safe
For most uncomplicated pregnancies, exercise is safe and recommended. The American College of Obstetricians and Gynecologists (ACOG) supports regular aerobic and resistance training throughout pregnancy in the absence of contraindications.¹
Current guidelines recommend:
At least 150 minutes per week of moderate-intensity aerobic activity¹
Muscle-strengthening activities on 2–3 days per week¹–³
When appropriately prescribed, exercise reduces maternal complications and supports fetal health.²,³
Monitoring Intensity: Why RPE Is Better Than Heart Rate
Fixed heart rate ceilings are no longer recommended because pregnancy increases resting heart rate and alters cardiovascular response.¹
Instead, use:
Rate of Perceived Exertion (RPE): Moderate effort (13–14/20 on Borg scale).¹
Talk Test: You should be able to speak in full sentences.¹
These methods adapt better across trimesters and individual physiology.
Strength Training in Pregnancy
Resistance training is safe in uncomplicated pregnancies and improves strength, pain tolerance, and metabolic health.¹–³
Evidence-Based Prescription
General guidelines support:
2–3 days per week of strength training¹–³
8–12 repetitions per set
Moderate intensity (RPE 13–15)
1–3 sets per exercise
Reaching fatigue within the 8–12 repetition range — without breath-holding or straining — is consistent with current prenatal strength guidance.¹–³
Areas to Target
As pregnancy progresses, strength becomes protective. Focus on:
Gluteal muscles (hip stability)
Posterior chain (deadlift patterns)
Lateral hip stabilizers
Mid-back and scapular stabilizers
Deep abdominal wall coordination
Calves (circulatory support)
Pelvic floor timing and relaxation (not just contraction)
Examples of Well-Tolerated Movements
If they feel good and symptoms are absent:
Goblet squats
Supported split squats
Step-ups
Romanian or kettlebell deadlifts
Farmer carries
Seated or supported rows
Incline push-ups
Pallof press
Movements should feel steady, controlled, and breath-coordinated.
Coning (Doming) & Managing Intra-Abdominal Pressure
Coning is a visible ridge along the midline of the abdomen during exertion. It reflects elevated intra-abdominal pressure and suboptimal abdominal wall tensioning.⁴–⁶
Certain movements — sit-ups, aggressive planks, heavy overhead presses, or breath-holding during lifts — naturally increase intra-abdominal pressure. While coning is not inherently harmful, repeated unmanaged pressure may contribute to abdominal separation or pelvic floor symptoms.⁴–⁶
Strategies for safer pressure management:
Sense pressure vs. over-bracing: Notice pressure moving into the pelvic bowl or lower abdomen. Coordinating the pelvic floor and deep abdominal engagement can support, rather than restrict, the movement.
Coordinate breath: Exhale during effort to reduce upward pressure. Avoid breath-holding (Valsalva).
Adjust load and range: Reduce weight, limit depth, or shorten duration if pressure feels excessive.
Slow, controlled tempo: Gives the core and pelvic floor time to engage appropriately.
Monitor symptoms: Pain, heaviness, or bulging are cues to stop or modify.
Example adjustments:
Squats: Stop slightly above full depth if pressure is high; exhale on ascent.
Deadlifts: Maintain neutral spine; lightly engage pelvic floor; exhale on lift.
Planks or push-ups: Limit duration or use knee-supported variation if downward pressure is felt.
These approaches help manage natural intra-abdominal pressure safely, supporting both abdominal wall integrity and pelvic floor function. A pelvic physical therapist can provide individualized assessment and coaching, helping you identify how much pressure your body can safely handle and when to modify movements.
Dizziness & Pacing
Pregnancy alters vascular tone and venous return. Rapid transitions or prolonged supine positioning can provoke lightheadedness.¹
Strategies:
Change positions slowly
Use controlled tempos (2–3 seconds each direction)
Rest between sets
Avoid locking knees
Hydrate adequately
Roll to your side before sitting up
Persistent dizziness warrants medical evaluation.¹
Supine Positioning: Updated Evidence
After approximately 20 weeks, the uterus can compress the inferior vena cava in flat supine positioning, reducing venous return and cardiac output.¹
More recent evidence clarifies:
Prolonged supine rest in late pregnancy reduces maternal cardiac output and uteroplacental blood flow.⁷
Habitual supine sleep in late pregnancy has been associated with increased risk of stillbirth.⁸
Brief supine exercise produces transient hemodynamic changes but has not been shown to cause fetal harm in healthy pregnancies.⁹
Clinical guidance generally recommends:
Avoid prolonged flat supine positioning after mid-pregnancy
Modify to incline or side-lying positions
Stop if symptomatic
Brief exposure may be tolerated if asymptomatic, but modifications are typically preferred in second and third trimesters.¹,⁹
Heat & Overheating
Pregnancy increases metabolic heat production. Extreme elevations in core temperature in early pregnancy (such as high fever or prolonged hot tub exposure) have been associated with neural tube defects.¹⁰
General recommendations:
Avoid hot yoga or exercising in extreme heat
Hydrate consistently
Wear breathable clothing
Stop if feeling overheated
Moderate exercise in temperature-controlled environments is considered safe.¹
Activities With Fall or Impact Risk
ACOG recommends avoiding activities with high risk of abdominal trauma, falling, or decompression injury (e.g., contact sports, scuba diving, skydiving).¹
However, risk is not identical for every woman. Factors that influence safety include:
Prior experience with the activity
Skill level and body awareness
Ability to control environment
Symptom presentation
Trimester
For example, a highly experienced skier early in pregnancy may assess risk differently than someone new to the sport. As pregnancy progresses and balance shifts, fall risk increases.
Rather than blanket restriction, informed risk assessment and modification are appropriate in uncomplicated pregnancies.¹
How Exercise Changes by Trimester
First Trimester
Fatigue and nausea often limit intensity
Overheating precautions are especially important¹⁰
Continue prior exercise if tolerated¹
No automatic strength restrictions in uncomplicated pregnancies¹
Focus: energy management and hydration.
Second Trimester
Center of mass shifts
Balance changes become noticeable
Supine modifications begin (~20 weeks)¹
Pelvic girdle symptoms may emerge
Focus: stability, load control, posture.
Third Trimester
Greater ligamentous laxity
Increased cardiovascular demand
More positional dizziness¹
Reduced tolerance for prolonged supine positioning¹
Focus: controlled strength, circulation, pacing, recovery.
Benefits of Exercise for Mother and Baby
Systematic reviews show prenatal exercise is associated with:
Maternal Benefits
Reduced gestational diabetes²
Reduced hypertensive disorders²
Reduced excessive weight gain²
Reduced low back and pelvic girdle pain¹
Improved mood and decreased depressive symptoms²
Fetal Benefits
Reduced risk of macrosomia²
Reduced risk of preterm birth²
No increased risk of miscarriage in uncomplicated pregnancies¹–³
Exercise supports placental efficiency and maternal metabolic health.²
Why Seeing a Pelvic Physical Therapist Helps
A pelvic physical therapist can:
Assess pressure management
Individualize load progression
Address pelvic girdle pain early
Optimize pelvic floor timing
Modify programming across trimesters
While general recommendations suggest 2–3 strength sessions per week with 8–12 repetitions to moderate fatigue, exercise during pregnancy should always be individualized.¹–³
If you experience vaginal bleeding, persistent dizziness, chest pain, painful contractions, decreased fetal movement, or fluid leakage, stop exercising and contact your provider.¹
References
American College of Obstetricians and Gynecologists. Physical activity and exercise during pregnancy and the postpartum period. Committee Opinion No. 804. Obstet Gynecol. 2020;135(4):e178-e188.
Davenport MH, Ruchat SM, Sobierajski F, et al. Impact of prenatal exercise on maternal and neonatal outcomes: systematic review and meta-analysis. Br J Sports Med. 2018;52(21):1367-1375.
Mottola MF, Davenport MH, Ruchat SM, et al. 2019 Canadian guideline for physical activity throughout pregnancy. Br J Sports Med. 2018;52(21):1339-1346.
Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis recti: systematic review. Physiotherapy. 2014;100(1):1-8.
Spitznagle TM, Leong FC, van Dillen LR. Prevalence of diastasis recti. Int Urogynecol J. 2007;18(3):321-328.
Lee DG, Hodges PW. Behavior of the linea alba during curl-up in diastasis recti. J Orthop Sports Phys Ther. 2016;46(7):580-589.
Humphries A, Mirjalili SA, Tarr GP, Thompson JMD, Stone P. The effect of supine positioning on maternal hemodynamics in late pregnancy. J Physiol. 2019;597(3):743-753.
Cronin RS, Li M, Thompson JMD, et al. Maternal supine sleep position and late stillbirth: meta-analysis. EClinicalMedicine. 2019;10:49-57.
Meah VL, Davies GA, Davenport MH. Hemodynamic responses to supine exercise in pregnancy: systematic review. Appl Physiol Nutr Metab. 2018;43(6):539-547.
Ravanelli N, Casasola W, English T, et al. Heat stress and fetal risk: systematic review and meta-analysis. Br J Sports Med. 2019;53(13):799-805.
