Yes, You Can Keep Moving:A Pregnancy Fitness Guide

Staying active while pregnant is linked to a wide range of benefits. Women who exercise are more likely to have a vaginal delivery and less likely to need a cesarean birth. Regular activity lowers the chances of gaining too much weight, developing gestational diabetes, and developing high blood pressure disorders like preeclampsia. It also improves mood, reduces the risk of depression after delivery, eases back and pelvic pain, and can speed up recovery after birth.

Long-standing worries that exercise causes miscarriage, poor fetal growth, injury, or early labor have not been shown to be true for women with healthy, uncomplicated pregnancies (American College of Obstetricians and Gynecologists, 2020).

Health guidelines recommend at least 150 minutes of moderate-intensity aerobic activity each week, spread across the week (U.S. Department of Health and Human Services, 2018). That works out to about 30 minutes on most days. A simple way to gauge "moderate intensity" is the talk test: if you can carry on a conversation while exercising, you are likely at a safe pace. If you are too breathless to talk, ease up.

If you already exercise, you can keep going at the same intensity. This is one of the most important and reassuring points to understand: women who were active before pregnancy, including those who did vigorous workouts like running, spinning, or high-intensity training, can generally continue those same activities at the same intensity through an uncomplicated pregnancy, with their provider's okay. You do not need to slow down or "take it easy" simply because you are pregnant. Over time you may naturally adjust as your body changes, but there is no need to dial back a routine you were already doing well. On the other hand, if you were mostly inactive before pregnancy, this is not the time to suddenly start intense workouts; begin slowly and build up gradually.

The reassuring news is that the activities shown to be safe in pregnancy are, for the most part, the everyday exercises people are already doing; nothing exotic or specialized is required. The following have been studied in pregnancy and are considered safe for most women:

• Walking
• Strength training with weights or resistance bands
• Yoga or Pilates
• Swimming and water aerobics
• Stationary cycling
• Low-impact aerobics and dancing
• Stretching

Some activities carry risks that outweigh their benefits during pregnancy and are best set aside until after delivery:

• Contact sports (soccer, basketball, ice hockey, boxing)
• Activities with a high risk of falling (downhill skiing, surfing, off-road cycling, horseback riding, gymnastics)
• Scuba diving and skydiving
• Hot yoga or hot Pilates
• Lying flat on your back for long periods, especially later in pregnancy

The core advice does not change from one trimester to the next: keep aiming for your weekly activity goal, keep up strength work and moving and pelvic floor exercises (if prescribed), and keep active as long as you feel well. What changes is how you apply those principles as your body changes:

• First trimester: For most women this is business as usual. If your pregnancy is uncomplicated, you can continue your usual routine and intensity; there is no need to slow down just because you are pregnant. Work around fatigue and nausea, stay well hydrated, and if you are new to exercise, ease in gradually.
• Second trimester: Keep up your aerobic and strength routine. As your uterus grows, avoid spending long stretches lying flat on your back. Because your heart rate becomes a less reliable gauge of effort in pregnancy, lean on the talk test to judge intensity.
• Third trimester: You can keep moving right up until delivery. As your balance and center of gravity shift, favor low-fall-risk, non-contact activities, and do not hesitate to shorten or lighten your sessions as you need to. Keep an eye out for the warning signs below that mean it is time to stop.

If there is one thing worth prioritizing in pregnancy, it is pelvic floor physical therapy. Working with a trained pelvic floor physical therapist to strengthen and coordinate these muscles has strong evidence behind it: it reduces urine leakage during late pregnancy and after delivery, and it lowers the risk of serious (third- and fourth-degree) tears during birth. An individualized, therapist-guided program tends to work better than simply being told to "do your Kegels," because a therapist can make sure you are engaging the right muscles correctly. If pelvic floor PT is available to you, it is well worth asking your provider for a referral.

Back pain and pelvic girdle pain are extremely common in pregnancy, especially in the later months, and they are not something you simply have to endure. Working with a chiropractor, physical therapist, or other musculoskeletal (MSK) specialist, you can use rehabilitative exercises to address these aches. These providers can guide you through individualized exercises, gentle manual therapy, stretching, and advice on posture and movement, all of which can ease discomfort and keep you mobile and active. Staying gently in motion, rather than resting and avoiding activity, is generally the better approach for pregnancy-related aches, and early referral for MSK care can make a real difference in how you feel day to day.

Exercise is safe for most pregnancies, but not all. For some women, certain conditions make exercise unsafe, and your provider may advise you to avoid it or to modify your activity. It is important to talk with your obstetric provider before starting or continuing a routine if any of the following apply to you:

• A significant heart or lung condition
• A cervix that opens too early (cervical insufficiency or a cerclage)
• Persistent bleeding in the second or third trimester
• A low-lying placenta (placenta previa) after 26 weeks
• Signs of preterm labor or ruptured membranes
• Preeclampsia or pregnancy-related high blood pressure
• Severe anemia
• Poorly controlled diabetes, thyroid disease, or seizures
• Being pregnant with twins or more with risk factors for early labor
• A baby that is not growing well

If your provider clears you but you develop any complication later in pregnancy, your exercise plan may need to change. And regardless of your history, use common sense on any given day: do not exercise in excessive heat or humidity, stay well hydrated, eat enough beforehand (long or intense sessions over 45 minutes can cause low blood sugar), wear supportive shoes and a supportive bra, warm up and cool down, and listen to your body. If something does not feel right, stop.

Stop and call your provider right away if you notice any of the following, as these can be reasons to cease exercise during pregnancy immediately:

• Vaginal bleeding or fluid leaking
• Regular painful contractions or belly pain
• Chest pain
• Feeling short of breath before you even start
• Dizziness or headache
• Calf pain or swelling
• Muscle weakness that affects your balance

If you want the essentials at a glance, the table below pulls together the weekly goal, how hard to work, which activities to favor and which to skip, everyday precautions, and the warning signs that mean it is time to stop.