Exercise in Pregnancy: Staying Healthy and Strong - Rachel Trotta  

Exercise in Pregnancy: Staying Healthy and Strong

Exercise in Pregnancy: Staying Healthy and Strong

This week, I’m six months pregnant, and I decided that it was time to summarize exercise in pregnancy for my first and second trimester! I’ve been fortunate to have an extremely healthy pregnancy, and – from a combination of personal experience and my pre-/post-natal certification – I have some nuggets that I think are worth sharing.

As a side note, even though I have that specialization, my business is focused on training women throughout the life span, not necessarily focusing on the pregnancy and postpartum period. So I am writing a few mega-posts rather than dripping out tons of pregnancy blog posts. In other words, buckle up, because this one’s a long one!

I will post a third trimester update as my pregnancy nears its end, so for now, this information is mainly applicable to the first 28 weeks of pregnancy.

Exercise in Pregnancy: The First Trimester

For the first 13 weeks of my pregnancy, there’s not much to say!

Morning Sickness

Up to 70% of women experience nausea and vomiting in the first trimester. While I wouldn’t call what I had “morning sickness” in the classical sense (I never actually got sick), I definitely experienced a lack of wellbeing. I was tired, often sleeping 9-11 hours a night with a lot of sleep disturbances, and still needing to lie down in the afternoon.

In other words, I felt like garbage.

My entire exercise plan for the first trimester consisted of going to the gym every morning for a 30-minute walk or elliptical… because that was literally all I could handle. Even if I went too fast and too long incline walking on the treadmill, I started to feel “off.”

Keep in mind that some women feel better than this, and some women feel worse. If you’ve never been pregnant before, you’ll only know when you’re in that position (and from what women tell me, even each woman can have very different experiences from pregnancy to pregnancy).

Do What You Can

The most traditional advice for exercise in the first trimester is to keep doing whatever you were doing before pregnancy. So if you were exercising five days a week with weightlifting and cardio, you can safely keep doing it in the first trimester.

But I think what these recommendations don’t distinguish between is “can” and “ready to.” What I mean is, there’s “safe”… and then there’s what you feel capable of doing.

In terms of strength and conditioning, I technically could have continued running and lifting weights in the first trimester, but I literally felt like I was not able to. My body was sending me strong malaise signals to treat myself like I was sick – there was no sense of readiness for or desire for exercise. The walking was a bare minimum that I disciplined myself to maintain for my own health and sanity – physically pushing myself would have been out of the question.

So I would expand that keep-doing-what-you-were-doing recommendation to include:

  • listen to your body
  • stay as active as you can (whatever that looks like)
  • do what doesn’t make you extremely anxious
The Fear of Miscarriage

To that last point from above…

For many women, exercise in the first trimester makes them extremely anxious, because the risk of miscarriage is also the highest in the first trimester. My point of view is that – while exercise is not associated with first trimester miscarriage – it doesn’t hurt to honor the mental space that you’re in and wait until you feel that sense of readiness. If you feel ready, go for it! If not (and it makes you very anxious), then switch up your routine so that you’re walking instead of running, or using light weights instead of heavy weights.

The mental and emotional part of health is significant! To quote personal trainer and pre-/post-natal specialist Rachel Livingstone on what she calls your “personal pregnancy journey”:

“If you’ve had three miscarriages or spent seven years trying to get pregnant, you may want to be more conservative, for your own sanity. Whether your doctor or trainer says to you ‘this is fine’, if you can’t feel that inside, don’t do the suggested exercise. Just keep active, find the level at which you feel comfortable at and focus on staying active there.”

I completely concur.

But don’t worry – the great likelihood is that, at some point, you will feel ready to start exercising again, both physically and mentally!

Exercise in Pregnancy: The Second Trimester

Fortunately, I had the stereotypical experience of feeling radically better with the advent of the second trimester. I described to people that it was “like a light switch flipped back on” – my energy came back, I no longer needed to lie down in the middle of the afternoon, and exercise became palatable again.

The ironic timing of my own personal pregnancy journey was that literally the week my second trimester started, the United States shut down because of COVID-19.

So… as it turned out, I didn’t go back to the gym at that time.

But I did find ways to stay active, and here were the keys to success for me:

Walking Breaks Every Day

Something I will discuss later on in this post is that I had terrible SI joint pain (which feels like lower back and hip pain) from almost the moment I got pregnant.

Walking is something that has helped significantly – I have almost no symptoms if I avoid sitting too long and walk frequently. A practice that gradually evolved throughout my second trimester was to go for a 15-20 minute walk for each meal of the day – before breakfast, after lunch, and after dinner. Sometimes, a fourth walk even snuck in pre-dinner.

Walking helped me enormously in pregnancy – it got me outside and helped my lower back and hips to relax.

Running Until 20 Weeks

Yes, I ran in pregnancy! I ran for about 6 weeks from the end of the first trimester to about 20 weeks.

Something that I am very keen on protecting in pregnancy is my pelvic floor health, so I made sure that my running was in short intervals (i.e. running for one minute, walking for one minute), and I also listened to my body and didn’t run if it didn’t feel “right” or good. Some women run all the way through pregnancy, but that didn’t feel right to me.

I followed the recommendations of pregnancy-specific physical therapists I follow online (Expecting and Empowered) and discontinued running by 20 weeks, with the reasoning that the increasing size/weight of the uterus and the increasing instability of the loosened-up pelvis are not a good match.

Strength Training Almost Every Day

Between changing hormones, relaxing ligaments, and the increasing forward weight of the uterus, there is almost no way to completely avoid aches and pains in pregnancy.

In fact, my back pain was so bad around week 12-13 that I was about to get a script from my Ob-Gyn for physical therapy. I was at my wit’s end, because even massage wasn’t helping.

But once I felt better with the end of the first trimester, I found that with regular strength training (almost every day), I could keep pain-related symptoms completely at bay.

In terms of aches and pains, I personally have had three main complaints that have been almost completely erased by sufficient strength training:

  • SI Joint Pain – this happens because your body releases hormones to make your ligaments and joints more flexible. The SI joints are the glue that hold the back of your pelvis together. In pregnancy, it’s common for this usually-stable area to become loosey-goosey. While “flexible” sounds good, it doesn’t feel good when it’s something that is supposed to feel stable (like your lower back!).
  • Round Ligament Pain – this happens because the round ligaments (two “cables” that support the sides of your uterus) get super stretched out as your uterus grows. Occasionally, these ligaments tighten up painfully if you make a sudden movement that involves your core (like standing or sitting up too fast). I have even had it from suddenly laughing or from jumping when startled. My Zoom class participants may notice that sometimes I’m a little grimace-y when going from one side plank to another – this is why.
  • Upper Back Pain – this is because of the center of gravity is shifting forward and putting strain on the back muscles to support posture. This is a low-level pain, but makes sleeping tricky. I have to be consistent to keep this particular symptom under control to protect my sleep.

Strength training, however, makes me feel like a completely different person! These symptoms go almost to zero if I’m consistent.

So what exercises do I do?

There’s a lot of outdated advice about exercise and pregnancy – like not lifting more than a certain weight, for example. The reality is that what you should do, as an individual, is largely dependent on what you were able to do before you got pregnant. If you are a super strong lifter, that mythical 40-lb. weight limit is going to feel feather light to you. But if you were not strength training at all prior to pregnancy, that weight may cause you to strain. Remember to always start where you are, pregnant or not!

I would definitely point out, though, that pregnancy has not been a time that I’ve been going for any personal records. I have focused far more on consistency than on intensity, and I advise pregnant clients to do the same.

In any case, while some women are going to be very, very strong from their pre-pregnancy workouts, I am confident that there is a range of exercises that pretty much any pregnant woman could do, especially if lower weights are used. To help out, I made this playlist on YouTube for your viewing convenience – I demonstrate 22 exercises and stretches individually with form tips, and I discuss pregnancy considerations for preventing diastasis recti.

Check out my YouTube playlist!

Oh, what is diastasis recti, you ask? Let’s talk about safety considerations for exercise in pregnancy!

Considerations for Exercise in Pregnancy

Something I have always told pregnant women (and I affirm for my own pregnancy) is that just because you are pregnant does not mean that you are made of glass. You will not break. You are not frail. In fact, you need to be really, really strong to have a good pregnancy and to maximize your power and endurance during labor. It’s in your best interests to stay or get in decently good shape while you’re pregnant.

But there are special considerations during pregnancy that – when not heeded – can cause unnecessary pain and issues down the road.

The Talk Test

In general, it’s a good idea in pregnancy to avoid being extremely overheated, or to get so out of breath that you can’t carry a conversation.

In general, this subjective test has replaced restrictions around heart rate because, when you think about it, heart rate is going to vary widely from individual to individual based on baseline fitness.

So I recommend exercising with a buddy, and making sure that you can carry on a spoken conversation!

It’s okay to get out of breath and heated, but what you want to avoid is being extremely hot or extremely out of breath.

Avoiding Excessive Abdominal Separation

“Diastasis Recti” is when the muscles of your front ab muscles (your six-pack, even if you can’t see them!) split down the middle. While this sounds absolutely horrifying, this is very, very common in pregnancy – but it’s still in your best interests to take steps to minimize it or possibly even prevent it.

The key to minimizing diastasis recti is not straining the front of your core. Light engagement and stability is fine, but avoid excessive planking and other core exercises.

It’s smart to replace planks with kneeling or all-fours exercises, to shorten the angle and reduce the load on the front of the core (also, hopefully obviously, crunches are out!).

It’s also a good idea to make a habit of rolling to your side and pushing yourself up with your hands anytime you need to get out of bed or get off the floor. Similarly, if you’re sitting back in a couch or chair, try to help yourself with your arms (either pushing or pulling) to get yourself out of the reclined position, instead of doing a sit-up to get out of the chair.

It’s not because you’re not capable of sitting up – it’s just that it’s in your best interests for a limited time to avoid putting load on those specific core muscles as much as possible.

So far, I haven’t seen any tell-tale signs of muscle separation, but I’ve also been pretty careful. We’ll see how the third trimester goes!

Deciding Whether Single-Leg/Split-Leg Exercises are for You

Something that a lot of people don’t realize is that in pregnancy, the aptly-named hormone relaxin is what causes your ligaments to loosen up, creating lots of extra aches and pains. It’s this hormone that causes your pelvis become unstable (i.e. go haywire), which means that for some people, split-leg exercises like lunges and split squats will end up being a no-go.

For me, these exercises have been fine – I have continued to cautiously include them in my workouts with no problem.

But for many people, the pelvic discomfort caused by relaxin means that they should really stick to squats, deadlifts, bridges, and other exercises where both feet are equally handling your body’s weight and your stance is symmetrical.

Stay Off Your Back

There is not a consensus on this safety “tip” anymore – but my attitude was “better safe than sorry.”

The theory is that the weight of the uterus after 20 weeks can put pressure on the inferior vena cava, an important source of blood and oxygen to you and the baby.

My personal experience is that being on my back feels terrible, so I don’t do it. I have played it safe even by training myself to sleep on my side, but my suspicion is that your body knows what it’s doing and will yell “Get off!” if you end up pressing down on a major blood vessel.

You Need to Drink So Much Water!

Drinking lots of water in pregnancy is way more important than I ever realized. I have learned over the last several months how much hydration contributes to both the amniotic fluid and your own blood pressure. I feel like I am drinking water constantly, but it does make me feel really good. I would hazard a guess that it makes the baby feel really good, too, because she moves a lot more when I drink water!

You need to be drinking at least half your bodyweight in ounces per day, and ideally you should be aiming much higher if you’re active. A smart way to stay hydrated is to keep a water bottle around and constantly sip from it. Try to empty it every hour or two hours.

A side benefit of hydration: I haven’t had a lot of low blood pressure or faint moments in pregnancy, and I think that staying hydrated is a big part of that.

Don’t Mess Around with Fueling Yourself

No, you’re not eating for two, but my experience during pregnancy is that I have pretty much zero leeway for being under-fueled, especially for exercise.

My blood sugar and my well-being tanks much faster than I’m used to pre-pregnancy (and I do not have GD). This affects everything from my mood to my performance to my sleep!

My best advice is to eat smaller meals more frequently, never letting more than 3 hours go by without eating. Plus, make sure you’re pairing up carbohydrates with protein/fat. Don’t eat things that will be easy to burn through quickly (like having only a banana for a snack). Pair it with peanut butter, and it’s a much stronger snack that will last longer!

Maybe Obvious? Avoid Contact Sports

I would think this one’s obvious, but maybe not?

The general advice in pregnancy is to play it safe and avoid activities where you’re likely to fall or be hit. For me, I have stopped some favorite summer activities like biking and tennis, just because I know that risk is there that I could fall or twist something. It’s just not worth it to me.

Everything in Moderation

Finally, one of the things I’ve learned in pregnancy is “everything in moderation.” Prior to pregnancy, I was definitely a person who liked to push myself (and I still am!). But pregnancy has made me realize the value of doing smaller helpings of activities and taking more breaks. I know that after I recover postpartum I can get back to exercising the way I really like to!

For me, there is definitely “too much of a good thing” in pregnancy. Walking helps me feel great, but there is a curve of diminishing returns where too much walking (i.e. more than 2-3 miles at a time) makes me feel pretty bad. Getting my heart rate up with strength training helps me feel great, but a too-intense circuit training session can leave me feeling worse, not better.

On the flip side, sitting feels good after a long walk or vigorous house work, but too much sitting makes me feel really, really bad.

For me, pregnancy is all about constantly mixing it up and varying my activities. I try to never do something for more than an hour, whether it’s a movement-oriented or sedentary activity!

One practical application of this is what I’ve started using multiple work stations for my studio office. I have three options: I can sit on my exercise ball, in my office chair, or stand at my standing desk. By rotating my positions, I feel so much better at the end of the day.

Weight Gain, GD, and Body Image

Finally, let’s talk weight!

For someone in a healthy BMI range, 25-35 pounds of weight gain is considered healthy in pregnancy. For someone underweight, 18-40 pounds is recommended. For someone overweight, the number is 15-25.

Obviously, these numbers can be a little off if you don’t take body composition into account – i.e., the amount of fat vs. lean body mass someone has.

As a petite person, I totally expected to be a tiny pregnant person. As in, “Oh, she looks normal except for the basketball-shaped bump strapped to the front of her body!” I was sure I would max out at 25 pounds.

Wrong.

I did not have this experience.

Instead, I unexpectedly gained weight very quickly in the first trimester. I had to make peace with this fast, because it really felt like my body took over and made these decisions for me. In the first trimester, you’re technically supposed to put on something like 0-4 pounds. I put on 11. For comparison, the baby weighs like six ounces at that point. Then in the second trimester, you’re supposed to put on 13-26 pounds. I put on another 11. Now, my baby weighs two pounds. I have gained 22.

It’s also worth pointing out that in the second trimester, some weeks, I put on four pounds, while other weeks, I gained nothing. It was not the linear experience I was expecting, and I am still “ahead” of where I should be for weight gain at 27 weeks even though my second trimester weight gain was slow.

But I have a hypothesis – and it’s exactly why I encourage clients to stay aware of weight, but not to make it everything. My theory is that even though I was a healthy BMI at the beginning of my pregnancy, I was probably lean for that BMI number (i.e. I had a lot of muscle and not a lot of fat so I “weighed in” heavier than I actually had stored in fat). I think that during the first trimester, my body aggressively back-filled with some extra fat storage, and then was able to slow down during the second trimester.

This is exactly why I encourage clients to look at body composition and not just weight, pregnant or not. The reality is that, all in all, I will probably end up being on track for weight gain by the end of the pregnancy (and ironically, I am still in the “healthy BMI range” for a non-pregnant person even after putting on 22 pounds… so go figure). Either way, I trust that my body is doing what it needs to do, since I am eating healthfully, exercising regularly, and not retaining excess water (i.e. my rings and shoes still fit).

I was also very concerned about the GD test – it wouldn’t have been the end of the world, but I really didn’t want to add a layer of managing gestational diabetes on top of managing pregnancy in general. I also thought that I was bound to have it because of how quickly I had put on weight (which is a risk factor for GD).

But… wrong again. I passed the one-hour test with flying colors despite my fast weight gain. And by the way, the dreaded test wasn’t terrible. The Glucola just tasted like drinking melted popsicles!

So… the moral of the story is: stay aware of your healthy habits and what’s happening with your weight, but keep it in context with the big picture. Don’t let numbers freak you out too much. And if your doctor is a good doctor, they will look at the big picture, too!

22 pounds later, have I felt like a pregnant goddess?

Let’s put it this way… Google “Venus of Willendorf” and you’ll get an idea of what kind of goddess I’ve felt like.

But have I absolutely felt confident in my appearance and like my self-worth didn’t hang on how defined my arm muscles were? 100%. And this surprised me. I thought that putting on weight and seeing myself get bigger would be distressing for me, but it was truly a blip on the radar.

There was a point around 20 weeks when I realized, “Oh wow, I’m going to get a lot bigger than I thought… Oh well.” And that was about it.

The main contributor to me feeling good about my body during pregnancy has been exercise. As long as I am active and feel strong and capable, I don’t “feel” the extra weight I’ve put on – I think because my body is doing exactly what it’s supposed to do.

Any Questions?

Currently, I have to go to the bathroom and there is either an elbow or a knee bulging through the front of my belly… so I gotta go!

But if you’re pregnant or trying to get pregnant, please feel free to leave questions in the comments section! I will do my best to answer them all or to point you in the right direction of a good answer!

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