Most pregnant women can benefit from continuing to exercise throughout their pregnancy. Regular physical activity can help improve a woman’s health and reduce symptoms associated with pregnancy and delivery. In addition, women who maintain high levels of fitness during pregnancy may more quickly return to their pre-pregnancy health, figure and weight after their babies are born.

The American College of Obstetricians and Gynecologists recommends that pregnant women engage in moderate exercise for at least 30 minutes on most days of the week. Women should consult with their physician before beginning an exercise routine. In some cases, health conditions or pregnancy complications may limit or prohibit the ability to exercise.

In addition, pregnant women need to adjust their exercise routine because of physiological changes associated with their condition. Failure to do so can leave a pregnant woman more vulnerable to injury. However, in most cases, a well-planned exercise routine can provide health benefits that far outweigh the risks associated with exercising during pregnancy.

Many gyms, hospitals or community centers offer specialized exercise programs for pregnant women. These programs are geared toward pregnant women and are often taught by instructors specially trained in this area. These programs may be more individualized and can be adjusted based on each woman’s condition. In addition, there are numerous exercise videos, DVDs and televised health programs for pregnant women. As with all exercise, women should consult with their physician, preferably an obstetrician, before beginning any programs.

Exercise has important health benefits for all women, including those who are pregnant. Most pregnant women can establish an exercise routine that will help improve their health and reduce symptoms or complications associated with pregnancy and labor and delivery. In addition, a woman who maintains a high level of fitness during pregnancy is more likely to quickly return to her pre-pregnancy health, figure and weight after her baby is born.

Women who are pregnant should engage in moderate exercise for at least 30 minutes on most days of the week, according to the American College of Obstetricians and Gynecologists (ACOG). However, the Centers for Disease Control and Prevention (CDC) has stated that several short bouts of activity that last at least 10 minutes can also be effective for women who have a difficult time fitting longer exercise routines into their schedules.

Exercise can help women ease many pregnancy-related symptoms or complications, including:

• Gestational diabetes (a temporary form of diabetes related to pregnancy)
• Bladder and bowel problems
• Backache
• Fatigue
• Varicose veins

In addition, exercise can provide long-term general health benefits unrelated to pregnancy. These include prevention of conditions such as:

• High blood pressure
• Heart disease and stroke
• Diabetes
• Osteoporosis
• Anxiety and depression
• Some forms of cancer

No woman, pregnant or otherwise, should begin an exercise program without first consulting her physician. Exercise may not be an option for some pregnant women who have various health issues. These may include:

• Obstetrical complications, including:
  
  
• Incompetent cervix
  
  
• Multiple pregnancy with increased risk of preterm labor
  
  
• Persistent vaginal bleeding in the second or third trimester
  
  
• Ruptured membranes
  
  
• Preeclampsia (pregnancy-related high blood pressure)
  
  
• Heart disease that restricts blood flow
  
  
• Restrictive lung disease
  
  
• Severe anemia
  
  
• Poorly controlled high blood pressure
  
  
• Diabetes
  
  
• Thyroid disease
  
  
• Seizure disorder

Women who have a history of other medical conditions may still be able to exercise with restrictions. A physician can help women design pregnancy exercise routines that are safe for those with a history of any of the following:

• Previous miscarriage
• Premature labor
• High blood pressure
• Mild anemia
• Vaginal bleeding
• Intrauterine growth retardation
• Placenta previa (occurs when the placenta obstructs the cervical opening to the vagina)
  

  

A growing body of research testifies to the benefits of exercise during pregnancy. However, certain forms of exercise are more appropriate during pregnancy than others. In addition, women will have to make certain adjustments to their workout routines as their body changes. 

As a woman’s uterus and breasts grow larger, her center of gravity will shift. This will affect her sense of balance and may make it more difficult to perform exercises that previously were easy. High hormone levels along with certain hormones produced during pregnancy can also make connective tissues more lax and loosened. Due to these changes, a woman’s ligaments and joints may become more susceptible to injuries such as sprains and strains.

Pregnant women should take steps to avoid overheating during exercise, particularly in the first trimester. If the mother’s body temperature reaches a sustained 102.5 degrees Fahrenheit (39 degrees Celsius), the fetus is placed at risk for certain birth defects of the brain and spine. Pregnant women should limit their exercise in hot, humid environments and should avoid hot tubs and saunas. During pregnancy, the body provides some natural protection against such overheating. Though the body of a nonpregnant woman tends to rise about 1.5 degrees Fahrenheit (1.5 degrees Celsius) following 20 minutes of exercise, the body heat of a pregnant woman actually dissipates slightly following exercise.

As a woman’s pregnancy progresses, she will need to adjust her workout routine to accommodate the changes to her body. Pregnant women require more oxygen than non-pregnant women, and women have to work harder to breathe as pregnancy progresses and the uterus grows larger and crowds the diaphragm (the large muscle that separates the chest and abdomen). As a result, pregnant women have to reduce the intensity of their workouts in the latter weeks of their pregnancy. Women who prefer non-weight-bearing activities – such as cycling or swimming – will probably be able to exercise at higher intensities later in pregnancy than women who engage in weight-bearing activities such as jogging or aerobics.

In addition, a woman’s cardiovascular system changes during pregnancy and responds differently to certain body positions. For example, a woman in her second or third trimester who lies flat on her back may cause her larger uterus to pinch the vena cava, the major vein that carries blood from the legs back to the heart. This can cause the heart to beat more slowly, triggering dizziness and preventing normal blood flow to the uterus. Standing motionless can also cause a woman’s heart to beat more slowly later in her pregnancy. For these reasons, pregnant women are urged not to exercise in these positions.

There are several types of exercise that offer excellent cardiovascular benefits for pregnant women. These include:

• Walking.
  
  
• Cycling. Stationary bikes are preferred, as there is less risk of falling.
  
  
• Low-impact aerobics.
  
  
• Water aerobics.
  
  
• Swimming. Diving and jumping should be avoided.
  
  
• Stretching and toning exercises.
  
  
• Yoga.
  
  
• Kegel exercises. These help strengthen the pelvic muscles.

Women who lift weights can continue to do so during pregnancy. However, they should avoid lifting heavier weights and avoid lifting while lying flat on their backs.

Though many forms of exercise are beneficial for women who are pregnant, other activities should be avoided during pregnancy. These include:

• Contact sports. Women should avoid any activities that can cause even mild trauma to the abdomen. These include basketball, hockey, soccer, football and kickboxing.
  
  
• Activities with a high risk of falling. These include gymnastics, horseback riding, downhill and water skiing, and intense racquet sports.
  
  
• Scuba diving. This activity places the fetus at risk of decompression sickness and may contribute to miscarriage, birth defects, poor fetal growth and premature labor.
  
  
• Jerky, high-impact sports. Activities such as high-impact aerobics may strain and injure the joints.
  
  
• Exercise at high altitudes. Strenuous activity at altitudes of more than 6,000 feet can lead to reduced amounts of oxygen reaching the baby.

There are many exercise programs offered specifically for pregnant women. They can include cardiovascular programs, weight-bearing exercises, yoga and stretching activities. Most of the programs are taught by instructors with knowledge of pregnancy and the limitations of exercise. The programs may be found through athletic facilities, hospitals, colleges and other classes in the community. These programs can be some of the most beneficial for women during pregnancy and after the birth of the baby.

Women who are pregnant should wear comfortable clothing during exercise, including bras that adequately support their breasts. They should drink plenty of water and stop exercising before they become overheated or exhausted. To prevent overexertion, women should abide by the “talk test” while exercising – if they are unable to easily hold a conversation while exercising, they are probably working out too intensely.

A woman who is exercising should immediately stop exercising and consult a physician if she experiences any of the following symptoms during activity:

• Pelvic pain
• Vaginal bleeding
• Dizziness or faintness
• Irregular heartbeat
• Shortness of breath
• Headache
• Chest pain
• Muscle weakness
• Calf pain or swelling
• Uterine contractions
• Leakage of amniotic fluid

Throughout pregnancy, a woman requires an additional 300 calories a day to provide adequate nutrition to herself and her fetus. Women who exercise regularly may require additional calories, particularly in the form of carbohydrates. The potential need for extra calories should be discussed with an obstetrician (OB).

At one time, it was believed that exercise could increase the risk of premature labor. However, studies have found that this is not the case in low-risk pregnancies, and that exercise may actually decrease this risk. In addition, earlier concerns that regular exercise might result in low birth weights has proved unfounded.

Meanwhile, a host of new research has revealed increasing numbers of benefits related to exercise. Potential benefits for the mother include:

• Improved general health
  
  
• Possible reduction in the risk of gestational diabetes
  
  
• Lower risk of excessive weight gain during pregnancy
  
  
• Fewer complications during labor and delivery
  
  
• Improved mood and reduced level of stress
  
  
• Better sleeping habits
  
  
• Increased energyy and stamina
  
  
• Relief from backaches, leg cramps and breathlessness
  
  
• Maintenance and strengthening of vaginal and abdominal muscle tone
  
  
• Prevention of urinary incontinence
  
  
• Reduction of constipation
  
  
• Faster loss of weight after pregnancy

Women who are pregnant can gain extra benefit from strengthening muscles in three areas of the body:

• Abdominal muscles. Makes it easier to support the fetus’ increasing weight.
  
  
• Pelvic muscles. Permits the vagina to widen more easily during childbirth (potentially eliminating the need for an episiotomy – surgical incision of the perineum during childbirth to facilitate delivery) and prevents urinary problems (such as leakage when coughing or sneezing) after delivery. 
  
  
• Back muscles. Exercises that strengthen these muscles and improve posture help minimize the strain of pregnancy on the lower back. In addition, strengthening these muscles will help reduce strain from bending and lifting after the birth of the baby.

In addition, exercise during pregnancy may have benefits for the fetus. Studies show that children of mothers who exercised during pregnancy tend to be leaner while maintaining growth in the normal range among their peers. These children also score significantly higher in tests that measure intelligence and language skills, although the reason for this remains unclear.

Women who exercise during pregnancy will maintain a level of stamina and muscle tone that will help them to return to their pre-pregnancy figure more quickly than women who do not exercise. This is especially true if new mothers resume exercise after an appropriate period following delivery. Many new mothers who exercise return to their pre-pregnancy weight by their baby’s first birthday.

Certain exercises can help prepare a woman’s body for labor and delivery. Kegel exercises – also known as pelvic floor exercises – help strengthen the muscles that are attached to the pelvic bone. These pelvic floor muscles act like a hammock and hold the pelvic organs in place. When these muscles are strong, a woman gains the following benefits:

• Less likely to tear the perineum (region between the vulva and the anus) during birth
  
  
• Less likely to need an episiotomy (surgical incision of the perineum during childbirth to facilitate delivery)
  
  
• Less likely to have urine leakage during sneezing and coughing (stress incontinence)
  
  
• More likely to have an easier birth and recovery

Kegel exercises are performed in two steps:

• Locate the pelvic floor muscles by stopping and starting urine flow while urinating.
  
  
• Tighten the muscles for five to 10 seconds before relaxing them. Repeat this process over and over throughout the day. 

Tailor exercises are a series of different types of exercises that help tighten and tone many of the muscles used during labor and delivery. The exercises should be performed every day in the following steps:

• Tailor sitting:
  
  
• Sit on the floor.
• Bring feet close to the body and cross the ankles.
• Maintain the position for as long as it feels comfortable.
  
  
• Tailor press:
  
  
• Sit on the floor.
  
  
• Bring bottoms of feet together and as close to the body as feels comfortable.
  
  
• Place hands under knees. Push down with knees while resisting pressure with hands.
  
  
• Count slowly to three before relaxing.
  
  
• Increase the number of presses up to 10 times. Perform exercise twice daily.
  
  
• Tailor sitting and stretching:
  
  
• Sit on floor with back straight.
  
  
• Stretch legs forward with feet about a foot apart.
  
  
• Allow feet to flop outward.
  
  
• Stretch hands forward toward left foot, then back.
  
  
• Stretch hands forward toward center, then back.
  
  
• Stretch hands forward toward right foot, then back.
  
  
• Increase the number of presses up to 10 times. Perform exercise twice daily.
  
  
• Pelvic tilt exercise:
  
  
• Lie on back on the floor with knees bent and feet flat.
  
  
• Tighten abdominal muscles.
  
  
• Tighten buttocks by squeezing and tucking under.
  
  
• Hold for several seconds then relax. Repeat up to 10 times.
  
  
• Can be done in standing position with knees relaxed.
  
  

• Pelvic rocking:
  
  
• Get on hands and knees. Place hands under shoulders, knees under hips.
  
  
• Inhale deeply.
  
  
• Slowly exhale. Pull abdomen in, tighten buttocks until spine curls into a “C.”
  
  
• Tighten pelvic floor muscles.
  
  
• Relax, but keep back straight.
  
  
• Repeat steps eight times.

Following delivery, it usually takes between four and six weeks before pregnancy-related changes in a woman’s body subside. For this reason, women are urged to return to their exercise routine at a gradual pace after consulting with their physician. In particular, women who have a Caesarean delivery should not exercise vigorously without their physician’s approval.

Exercise following pregnancy has several benefits, including:

• Helps women return to their pre-pregnancy figure and weight
  
  
• Increases energy and improves sleep patterns
  
   
• Helps women cope with postpartum depression
  
  
• Improves strength and reduces risk of injury from daily activities

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor or healthcare professional the following questions about exercise and pregnancy:

1. Can I safely exercise during pregnancy?
   
   
2. Are there limitations in the type of exercise I can do?
   
   
3. Which exercises can help me prepare for labor and delivery?
   
   
4. What are the signs of a medical emergency while I’m exercising?
   
   
5. Can I exercise up until my delivery?
   
   
6. How do Kegel exercises help during and after pregnancy?
   
   
7. Which exercises could cause harm to the fetus?
   
   
8. How long can I participate in running or aerobics?
   
   
9. Is there a way to monitor my heart rate during exercise?
   
   
10. Is there a heart or breathing rate that is considered too high for a pregnant woman?
    
    
11. When can I resume exercise after the birth of my baby?
    
    
12. Can you recommend exercise programs for pregnant women in the area?