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Safety Advice and Tips for Exercise During Pregnancy

By Dr. Brittany Masteller

Note: Before starting or changing an exercise routine during pregnancy, make sure you have clearance from your medical provider.

If you are a mom or mom-to-be, you may have heard conflicting information about the safety of exercise during pregnancy. According to the American College of Obstetrics and Gynecology (ACOG), exercise during pregnancy is associated with minimal risks and has been shown to benefit most women, even if you were previously inactive. Exercising during pregnancy is associated with a lower incidence of excessive gestational weight gain, gestational diabetes mellitus, gestational hypertension or preeclampsia, preterm birth, cesarean birth, and lower birth weight.

One common piece of exercise advice given to pregnant women is to “continue doing what you were doing pre-pregnancy.” Depending on what you were doing before pregnancy, that may not be sound advice. If you weren’t exercising pre-pregnancy, you can still begin exercising once pregnant. In contrast, certain activities are contraindicated during pregnancy, like sports that involve contact with the abdomen or increase the risk of falling.

In general, the biggest consideration will be modifying the intensity of your workouts. Rather than solely relying on your heart rate, you will also want to monitor your effort on a scale of 1-10, being mindful of staying in the range of 6-7 out of 10. This might indicate working at different effort levels on different days, and that is perfectly normal!

We believe that Orangetheory can be a great addition to your pregnancy journey! If you have been doing OTF since before pregnancy, it will be important to adjust your expectations to match the demands of pregnancy. It is okay to work up a sweat and feel like what you are doing is hard, but you should avoid feeling breathless.

There are a lot of changes happening during pregnancy that can affect exercising. These include changes in ventilation (breathing rate), body temperature, heart rate and blood pressure. Many of the guidelines surrounding exercise and pregnancy are based upon these changes, in addition to avoiding activities that are unsafe (such as any that involve direct contact with the abdomen). This is not to say exercise should be avoided by pregnant women, but the intensity and type of exercise and the environment where it takes place may need to be modified, especially in the latter half of pregnancy.

Let’s break it down by trimester:

First Trimester

Some physiological changes that may occur and affect exercise during the first trimester, weeks 0-13, include increased heart rate, fatigue, breast tenderness and headaches. Not all women will experience these symptoms. It is safe to exercise during the first trimester so long as there are no medical contraindications to performing exercise given by your medical provider. However, you may need to adjust your routine based on how you are feeling (due to symptoms such as fatigue, nausea, etc.). If you are new to exercising or haven't exercised in a while, exercising is still safe, but it is recommended that you start at a lower intensity, gradually increasing intensity as you become more comfortable. The goal is to be healthy and strong, not broken and exhausted!

Second Trimester

During the second trimester (weeks 14-27), women tend to feel more energy and less fatigue compared to the first trimester. As the baby continues to grow, physical changes in the mother will be more noticeable. Exercise is still safe and recommended, but more rest may be needed. The goals for exercise training during the second trimester include reducing the incidence of back and pelvic pain, strengthening/relaxing pelvic floor muscles, promoting good alignment and posture, and maintaining strength/fitness. At this point of your pregnancy, you should limit the time you spend lying flat on your back, even during exercise. Additionally, round ligament pain (pain in the lower abdomen and groin) may increase as you go through the second trimester and into the third trimester. If you experience this during exercise, try slowing down your transitions between movements. If certain movements are uncomfortable, finding an alternative exercise to target the same muscles could be helpful.

Third Trimester

As women enter the third trimester (weeks 28-birth), the baby will continue to grow, which will likely affect Mama's ability to perform certain exercises comfortably, safely and without pain. To modify movements that would normally be performed lying flat, use an inclined position or perform an alternate movement that uses the same muscle groups. You also want to avoid bulging of the form of the belly and downward pressure on the pelvic floor.

Are Orangetheory workouts safe during pregnancy?

Orangetheory workouts can certainly be safely incorporated as part of a healthy pregnancy! In fact, a group-based fitness class under the guidance of a qualified fitness professional may be a great option for many pregnant women.

Below are some considerations specific to the OTF workout on the tread, rower and floor:

TREAD: The paces you use will likely slow down beginning in the second trimester. Your “All Out” speed may become more like your “Push” or “Base Pace” speed, and that’s totally OK! Sprinting should be avoided during pregnancy. Additionally, many women will need to switch to power walking sometime during the second or third trimester as the baby grows and causes increases pressure downward on the pelvic floor — you will know when that time comes! There is not a set-in-stone week of pregnancy this occurs, and it will be different for all women. Monitor how you feel during and after the tread section of your OTF workouts and adjust accordingly.

ROWER: As pregnancy progresses, it will become more difficult to use proper rowing form due to the decreased range of motion at the hips. In the second and third trimesters, pregnant women may find it particularly difficult, or just uncomfortable, to strap their feet into the rowing machine. Once this happens, we suggest that you discontinue use of the rower, and modify by using another modality (such as the strider or bike) during rowing blocks.

FLOOR: Most movements on the floor can be modified to an alternative that will decrease the intra-abdominal pressure demand. If you aren’t sure how to modify a particular movement, you can ask your coach for ideas. Pregnant women want to avoid lying on their backs for long periods of time, so movements that require lying flat on a bench or on the floor can often be modified by using an incline bench or the TRX straps. Additionally, avoid movements that involve direct impact on the abdomen (such as lying on your stomach). It is a common misconception that you want to avoid direct core work during pregnancy, but this is false! There are several safe core movements that can (and should) be performed to improve core strength and stability during pregnancy (such as quadruped isometric holds and diagonal chops/lifts). You should avoid or modify any movements — core-focused or not — that create too much unmanaged intra-abdominal pressure.

What happens to your heart rate during pregnancy?

Pregnancy can alter your heart rate (HR). As such, it is recommended by the ACOG that you monitor your subjective effort using a 1-10 scale, rather than relying upon HR alone. There is an outdated recommendation still floating around that says pregnant women should not exercise above 140 beats per minute, but this is no longer the most updated recommendation. During pregnancy, HR can increase up to 20% by the end of the third trimester just due to being pregnant, which is why monitoring how you are feeling using a more subjective approach is also important (i.e., how hard you feel like you’re working on a scale of 1-10).

This means that as your pregnancy progresses your HR in the OTF studio may not necessarily match how you are feeling. It’s important to pay attention to how you feel during your workouts and not just what HR zone you are in. During pregnancy, your energy will fluctuate as you approach your due date.

Should I be worried about diastasis recti?

One common fear among pregnant exercisers is diastasis recti abdominis (commonly abbreviated as DR or DRA). DR is the separation of the rectus abdominis muscles, which are primarily responsible for flexing the spine into a crunch-like motion. During pregnancy, this separation makes room for the growing baby and is a necessary physiological change. As pregnancy progresses, the connective tissue between the rectus muscles — called the linea alba — stretches and thins. This is a completely normal (and necessary) adaptation to make room for the growing baby! It’s not something to fear, but it can be exacerbated by performing movements that create a lot of increased pressure in the core (such as sprinting, lifting heavy, etc.).

As the linea alba thins, you may observe what’s called “coning” when doing certain movements. When this happens, it will look like your stomach is coming to a point along your belly button area. Coning is not inherently harmful but serves as a warning sign that the pressure in the abdomen isn’t being managed well. Certain movements where the intra-abdominal pressure is high will increase the frequency of coning. These movements should be modified accordingly or avoided during your workouts.

How do I know if I should stop exercising at any point?

If you were an exerciser before you were pregnant, you might be used to pushing yourself through pain and discomfort in a workout. This is not something that is recommended during pregnancy, as there are a lot more considerations to think about! If you experience any of the following, discontinue your exercise session and consult your medical provider immediately: vaginal bleeding, abdominal pain, regular painful contractions, amniotic fluid leakage, dyspnea (shortness of breath) before exertion, dizziness, headache, chest pain, muscle weakness affecting balance, or calf pain/swelling.

Moms are superheroes. Moms are strong and capable of exercising while simultaneously growing life — how amazing! There are some factors to consider when it comes to exercising during pregnancy, and the key is listening to your body, modifying as needed and reminding yourself of all the amazing benefits exercise can provide for you and your child. Orangetheory Fitness can provide an excellent, well-rounded approach to help you stay physically active during your pregnancy.