The 4Ws of exercising during pregnancy

AndieM.Ed., RD, LDN, CLC, RYT-200

In your early pregnancy, when you may be experiencing fatigue and nausea, exercise may be the last thing on your mind; however, try to at least do some gentle stretching and strengthening exercises and some walking every day.

As your energy likely picks up in the second trimester, be sure to get up and move! You don’t need expensive equipment or a fancy facility to get a great workout. Daily walks with some strength training and stretching interspersed throughout the week are effective in supporting overall health and muscle tone.

As you approach your due date, you may find that your exercise routine needs to be modified even more to accommodate the growth and weight of your baby and the impact on, among other things, your balance, bladder, and energy.

Benefits of prenatal exercise

Exercise can enhance your mood, increase your energy, build endurance, improve posture, improve sleep quality, promote relaxation, and better prepare you for labor and birth. It can also help you maintain a healthy pregnancy weight gain.

Physical changes in the body to keep in mind when exercising

During pregnancy, your body goes through many musculo-skeletal changes. As your breasts and uterus enlarge, the weight in front of your body pulls the shoulders forward. To adjust for changes in your center of gravity, the lower back curves more deeply inward to keep you balanced. Pregnancy hormones cause the joints to loosen up due to the stretching of ligaments. These changes can cause strain, injury, and discomfort; however, stretching and strengthening exercises can aid in preventing and managing some of these changes.

Warm up and cool down stretches are helpful

You can help get your body ready for exercise and prevent injury by starting with dynamic stretching. Dynamic stretching, which is repeating a stretch multiple times for short durations, is recommended when your muscles are not yet warmed up as it’s less likely to overextend your muscles and joints and cause injury. Deeper stretching, with greater extension and longer duration per stretch, is safer to do after a workout.

With any exercise, and with stretching in particular, it’s important to listen to your body. Don’t take a “one size fits all” approach. Everyone has a different level of flexibility to start with and pushing yourself into a deeper stretch before you’re ready can lead to injuries that will sideline your efforts to exercise altogether.

Exercises to avoid during pregnancy

While there are many types of exercises that are safe during pregnancy, some are not recommended. Avoid jerky, high-impact exercise, deep knee bends, and double leg lifts. After your first trimester, refrain from exercises that involve lying flat on your back. Activities that should be discontinued during pregnancy because they involve excessive speed, impact, balance, or changes in pressure include downhill skiing, racquet sports, rollerblading, horseback riding, gymnastics, road biking, contact sports, surfing, diving and scuba diving.

Stop exercising and call your healthcare provider if you have any of these symptoms:

  • Vaginal bleeding
  • Dizziness or feeling faint
  • Increased shortness of breath
  • Chest pain
  • Headache
  • Muscle weakness
  • Calf pain or swelling
  • Uterine contractions
  • Decreased fetal movement
  • Fluid leaking from the vagina

What to Do

Engage in a variety of exercises that are safe for pregnancy and involve stretching, strengthening, and low-impact aerobics

  • Prenatal yoga and prenatal Pilates: Prenatal exercise classes offer modified positions for stretching and strengthening to accommodate your growing belly. Prenatal yoga and prenatal Pilates classes are safe and will help you stay flexible and toned throughout your pregnancy.
  • Walking: If you have not been exercising prior to pregnancy, then walking is an easy and effective way to be active, as are lower impact variations of hiking, snowshoeing, and cross-country skiing. Even if you were already exercising regularly or doing other types of exercise, consider setting a goal of walking for at least 30 minutes per day.
  • Stair climbing: Going up and down stairs, whether slowly or quickly and always with a hand on the railing, makes for an excellent workout. You can do it anywhere there are stairs with a railing and safe treads. By going up two stairs at a time (but always coming down one stair at a time), you can vary the exercise.
  • Swimming: Swimming works the whole body without stressing joints and ligaments. As an added bonus, the buoyancy of the water is comforting and relaxing.
  • Stationary cycling: Road biking requires good balance and is not recommended during pregnancy; however, stationary biking is a safe variation and equally beneficial. There are even recumbent bikes that have more comfortable seats in which you recline while cycling.
  • Jogging: If you were a runner prior to pregnancy, then you can continue jogging during pregnancy as long as your healthcare provider gives the OK.
  • Low-impact aerobics: Aerobic activity is generally safe during pregnancy, but stay away from exercise that involves jarring movement or jumping because these movements can cause joint strain and discomfort.
  • Light weight training: Strength training is generally safe if done with the guidance of an expert. Be sure to use slow and controlled movements, do short sets (less than 10 repetitions) and try not to hold your breath while bearing down as this may cause increased pressure on the uterus.

Consider doing exercises that can help promote back health

  • Isometric exercises: Engage/tighten the pelvic floor, abdominal, lower back, and gluteus muscles periodically while sitting, and always when lifting, to help strengthen your core and prevent lower back injury.
  • Arm and leg extensions: Start in an all-fours hands and knees position, then extend your right arm forward and left leg back as you inhale. Return to starting position as you exhale and repeat with your left arm and right leg. Do 6 sets on each side.
  • Back press: Stand with your back against the wall and feet about one foot away from the wall. Press your lower back into the wall and hold for 10 seconds. Repeat 10 times.
  • Pelvic tilts: Practicing pelvic tilts will help stretch the lower back muscles that may have tightened after performing the above strengthening exercises. . To do this, stand straight with your back against the wall, in the same position as you began in the back press. Then draw your belly button towards your spine and gently rock your hips towards your face so that your tailbone lifts – you will feel your lower back will press into the wall.
  • Child’s pose: Start in an all-fours hands and knees position with hands under shoulders and knees wider than your hips. Bring your hips back to your heels, arms still extended in front, and hold for 5 seconds. Come back up to your hands and knees. Repeat 5 times.
  • Sitting twist: Sit with legs crossed. Turn to your left, placing your left hand on the floor behind you and your right hand on your left knee as you move into a gentle stretch. Hold for a breath. Do the same on the other side. Repeat the set of twists 5 more times.

Warm-up before exercise by stretching

  • Toe flex and point: Alternate between flexing and pointing your toes on each foot to increase circulation and flexibility in the lower legs and feet.
  • Side stretch: Inhale and bring your right arm up and over to the left as you exhale. Repeat on the left side. Repeat several times.
  • Elbow bends: Extend your right arm straight up above your head and then bend the right elbow so that your bicep is next to your ear and your hand is behind you. With your left-hand press down and back on the right elbow to increase the stretch. Hold for 10 seconds and then repeat on other side.
  • Neck rolls: Gently roll the neck in each direction to release tension and maintain range of motion.
  • Shoulder rolls: Roll shoulders forward for 3 rotations and then back for 3 rotations to release muscle tightness.
  • Piriformis stretch: From a standing position, place your right ankle over your bent left knee and lean your torso forward toward your knee while balancing or holding onto a wall for 10 seconds. Do the same with the left ankle over the right knee.
  • Forward bend: Take a deep breath in a standing position as you reach your arms up above your head, then exhale and bend forward, reaching for your toes. Bend your knees slightly. Inhale and return to standing then exhale back down to a forward bend. Repeat several times.
  • Wrist and ankle rotations: Extend your right arm and left leg and rotate your right wrist and left ankle for 10 seconds to increase circulation. Repeat with left arm and right leg.
  • Quad stretch: Bend your right knee so your foot is behind you and grab your right ankle to stretch your right quads. Pull your ankle gently towards your gluteus. Hold for 10 seconds. Repeat with opposite leg.
  • Lunges: Stand with feet wider than hips. Step forward with your right foot and bend your right knee to lunge as you exhale, being careful to not extend your knee past your ankle. Inhale and step back to starting position. Exhale and lunge left. Repeat this dynamic stretch for 30 seconds.
  • Butterfly stretch: Sit on the floor with heels of your feet together while gently pressing your knees down toward the floor. Hold for 30 seconds.
  • Runner’s stretch: Place your hands against the wall about shoulder width apart. Keep your elbows straight. Left foot is about 18 inches from the wall with knee bent and the right leg is extended back with the knee straight. Lean forward for a great calf stretch. Hold for 10 seconds. Do the same with the right foot forward and left leg back. Repeat again on each side.
  • Pelvic tilt: From a standing position with your feet wider than your hips, place your hands on your thighs and curl your pelvis forward and chin down as you exhale. Inhale and tilt your head up and pelvis back while your hands remain on thighs. Continue this dynamic exercise for 30 seconds.
  • Chest opener: Clasp your fingers behind you, squeeze your shoulder blades together, and lift your arms up behind you as much as you comfortably can. Hold for 10 seconds.

When you cool down after exercise, include a recovery period followed by deeper and longer stretching

After more vigorous exercise, walk around until your heart rate comes back to normal, then take some time to stretch. Stretching after exercise is the perfect way to take advantage of your warmed-up muscles and increase your flexibility. Repeat the stretches you did during the warm up but this time hold the stretches for at least 30 seconds on each side.

Make strengthening your pelvic floor part of your daily exercise routine

Practice 30 perineal muscle squeezes (Kegels) per day. Try 10 squeezes 3 times per day, half of them at a rhythmic pulse and the other half with a longer squeeze and release. In other words, do 5 faster squeezes and 5 slower ones during each session. See Everything I need to know about pelvic floor exercises for more details.

Find creative ways to remind yourself to exercise your pelvic floor muscles – perhaps commit to doing your 10 squeezes with each meal or at certain landmarks during your commute to work and back.

One of the great things about Kegels is that you can do them discreetly, including in public or at work, so if it is easier for you to do 10 of them at spontaneous moments then go for it! Doing these exercises in small increments throughout the day may be more effective than just one long session and, for those who find the process overwhelming initially, more doable. For additional benefit, when you can, perform your pelvic floor exercises in a variety of positions such as hands and knees, sitting in butterfly pose, standing, or lying on your side.

Drink plenty of fluids

Providing your body with enough water helps prevent dehydration and the headaches, dizziness, and rapid pulse that go along with it. Keep a water bottle with you and drink before, during and after exercising. If you feel lightheaded or dizzy, then rest and make sure you replenish your fluids. Also, be sure to empty your bladder before you exercise–some women experience urinary incontinence with prenatal exercise.

Make sure you’re breathing at a comfortable rate

When you’re exercising you should be able to talk at a normal conversational pace. If you can’t carry on a conversation, you need to slow down the intensity of your exercise. Rapid, short, and shallow breaths, or hyperventilation, can cause lightheadedness and even fainting. Be cognizant of taking deep breaths with a slower exhale. Rest when and if you need to.

Be aware of warning signs that you need to stop exercising

Stop exercising and call your healthcare provider if you do find that exercise triggers hyperventilation or if you experience any of the following symptoms: chest pain, uneven heartbeat, pain or swelling, headache, uterine contractions that continue after rest, vaginal fluid leakage, vaginal spotting or bleeding, or decreased fetal movement.

Heed heat advisory warnings

Pay attention to the weather forecast during extremely hot and humid weather. Consider exercising indoors, preferably in air conditioning, so you can feel good after your workout rather than completely worn out. Swimming is a great option, and you may be able to find an “aquanatal” prenatal swim class at your local recreation center.

On your own or in a group, opt for whatever is most engaging for you

There are many ways to engage in effective prenatal exercise, whether in a group class, on your own, inside, or outdoors. Prenatal versions of yoga and Pilates classes modify exercises and positions for pregnant participants. If you enjoy working out in a group setting, these classes may be a great fit. If you prefer to do yoga or Pilates alone, you might consider taking a private class, or renting a DVD or trying an online class and exercising at home. Check out your local library or “on demand” cable for free rentals of these types of videos.

Research consistently shows the additional benefits to mood and mind when we move our bodies out of doors in more natural settings. So if you have access to safe outdoor trails, parks, and swimming holes, whether pools, lakes, or the ocean, then consider walking, hiking, swimming, snowshoeing or cross-country skiing for a breath of fresh air.