Exercise in Pregnancy

Aka: Exercise in Pregnancy, Sports Participation in Pregnancy, Lifting Restrictions in Pregnancy, Activity Limitations in Pregnancy, Pregnancy Work Restrictions

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II. Physiology: Exercise benefits in pregnancy

  1. Improves mood and fitness during pregnancy
  2. Decreases postpartum pregnancy
  3. Decreases risk of Gestational Diabetes
  4. Decreases excessive Weight Gain in Pregnancy
  5. Decreases operative delivery and cesarean delivery risk
  6. Decreases Preeclampsia risk

III. Precautions: Activities to avoid

  1. Avoid more than light weight lifting
  2. Avoid hyperextension activities (e.g. gymnastics)
  3. Avoid raising Body Temperature >30 minutes (avoid Exercise in excessive heat and humidity)
    1. Avoid hot yoga or hot pilates
    2. Exercise in loose fitting clothing and in comfortable Temperatures
    3. Avoid excessive hot tub exposure
      1. Increased risk of Neural Tube Defects, esophageal atresia, Omphalocele
  4. Avoid starting strenuous Exercise in Pregnancy
  5. Avoid Scuba Diving
  6. Avoid travel to altitude >13,000 feet or 4000 meters (esp. for those living at low altitude)
  7. Avoid activities at high risk of injury
    1. Avoid Contact Sports (e.g. ice hockey, soccer, volleyball, basketball, martial arts, boxing)
    2. Avoid sports with high risk of fall (e.g. Downhill Skiing or snow boarding, water Skiing, mountain biking, gymnastics)

IV. Precautions: Contraindications to strenuous Exercise

  1. Pregnancy-related factors
    1. History of 3 or more Spontaneous Abortions
    2. History of Premature Rupture of Membranes (PROM)
    3. History of premature labor
    4. Multiple Gestation at risk for Preterm Labor (e.g. triplets, monoamniotic monochorionic twins)
    5. History of cervical incompetence
    6. History of Placenta Previa >26 to 28 weeks
    7. History of Intrauterine Growth Retardation (IUGR)
  2. Serious comorbidity
    1. Hemodynamically significant heart disease
    2. Restrictive Lung Disease
    3. Severe Anemia
    4. Uncontrolled Hypertension
    5. Uncontrolled Type 1 Diabetes Mellitus
    6. Uncontrolled Thyroid disease

V. Precautions: Lifting Restrictions in Pregnancy

  1. Very Frequent Lifting (>3 times per minute)
    1. Individualize restrictions and consider occupational health or obstetrics Consultation
  2. Repetitive Long Duration Lifting (>1 continuous hour of lifting more than once every 5 minutes)
    1. Lifting height from floor >52" (4' 4") or 132 cm (1.3 M) or above Shoulder height
      1. 15 lb (7 kg) if Lifting distance from body 15" or 38 cm (<20 weeks gestation)
      2. 10 lb (5 kg) if Lifting distance from body 20" or 51 cm
      3. 9 Lb (4 kg) if Lifting distance from body 25" or 64 cm
    2. Lifting height from floor >28" (2' 4") or 71 cm (0.7 M) or above knuckle height
      1. 18 lb (8 kg) if Lifting distance from body 15" or 38 cm (<20 weeks gestation)
      2. 13 lb (6 kg) if Lifting distance from body 20" or 51 cm
      3. 10 Lb (5 kg) if Lifting distance from body 25" or 64 cm
    3. Lifting height from floor >17" (1' 5") or 43 cm (0.4 M) or above Tibia height
      1. 16 lb (7 kg) if Lifting distance from body 15" or 38 cm (<20 weeks gestation)
      2. 11 lb (5 kg) if Lifting distance from body 20" or 51 cm
      3. 9 Lb (4 kg) if Lifting distance from body 25" or 64 cm
    4. Lifting height from floor <17" (1' 5") or 43 cm (0.4 M) or below Tibia height
      1. Lifting from this low height is not recommended
  3. Repetitive Short Duration Lifting (<1 continuous hour of lifting more than once every 5 minutes)
    1. Lifting height from floor >52" (4' 4") or 132 cm (1.3 M) or above Shoulder height
      1. 25 lb (11 kg) if Lifting distance from body 15" or 38 cm (<20 weeks gestation)
      2. 18 lb (8 kg) if Lifting distance from body 20" or 51 cm
      3. 14 Lb (6 kg) if Lifting distance from body 25" or 64 cm
    2. Lifting height from floor >28" (2' 4") or 71 cm (0.7 M) or above knuckle height
      1. 30 lb (14 kg) if Lifting distance from body 15" or 38 cm (<20 weeks gestation)
      2. 22 lb (10 kg) if Lifting distance from body 20" or 51 cm
      3. 17 Lb (8 kg) if Lifting distance from body 25" or 64 cm
    3. Lifting height from floor >17" (1' 5") or 43 cm (0.4 M) or above Tibia height
      1. 27 lb (12 kg) if Lifting distance from body 15" or 38 cm (<20 weeks gestation)
      2. 20 lb (9 kg) if Lifting distance from body 20" or 51 cm
      3. 16 Lb (7 kg) if Lifting distance from body 25" or 64 cm
    4. Lifting height from floor <17" (1' 5") or 43 cm (0.4 M) or below Tibia height
      1. Lifting from this low height is not recommended
  4. Infrequent Lifting (less than once every 5 minutes)
    1. Lifting height from floor >52" (4' 4") or 132 cm (1.3 M) or above Shoulder height
      1. 30 lb (14 kg) if Lifting distance from body 15" or 38 cm (<20 weeks gestation)
      2. 21 lb (10 kg) if Lifting distance from body 20" or 51 cm
      3. 17 Lb (8 kg) if Lifting distance from body 25" or 64 cm
    2. Lifting height from floor >28" (2' 4") or 71 cm (0.7 M) or above knuckle height
      1. 36 lb (16 kg) if Lifting distance from body 15" or 38 cm (<20 weeks gestation)
      2. 26 lb (12 kg) if Lifting distance from body 20" or 51 cm
      3. 20 Lb (9 kg) if Lifting distance from body 25" or 64 cm
    3. Lifting height from floor >17" (1' 5") or 43 cm (0.4 M) or above Tibia height
      1. 32 lb (15 kg) if Lifting distance from body 15" or 38 cm (<20 weeks gestation)
      2. 23 lb (10 kg) if Lifting distance from body 20" or 51 cm
      3. 18 Lb (8 kg) if Lifting distance from body 25" or 64 cm
    4. Lifting height from floor <17" (1' 5") or 43 cm (0.4 M) or below Tibia height
      1. Lifting from this low height is not recommended
  5. References
    1. MacDonald (2013) Am J Obstet Gynecol 209(2):80-8 +PMID: 23467051
      1. https://www.ajog.org/action/showPdf?pii=S0002-9378%2813%2900242-1

VI. Management

  1. General Recommendations
    1. Continue a regular Exercise program in pregnancy
    2. Maintain adequate hydration and Nutrition in Pregnancy to support activity
    3. Competitive athletes performing strenuous Exercise in Pregnancy should specifically discuss with provider
    4. Activity in pregnancy (including working) is typically beneficial in pregnancy
      1. Limit work week to 40 hours after 28 weeks gestation
      2. Prolonged standing and physically demanding work increases preterm delivery and Pregnancy Induced Hypertension
    5. Avoid Bed rest in pregnancy
      1. Does not reduce premature contractions
      2. Increased risk of DVT
    6. Lactation
      1. Breast feed before strenuous Exercise to reduce discomfort from Breast engorgement
      2. Moderate Exercise does not affect quantity or composition of Breast Milk
  2. Aerobic Exercise
    1. Perform for 20-30 minutes per day on most days of the week (150 minutes/week)
    2. Previously physically active women may continue their pre-pregnancy activity level
      1. Previously inactive women are encouraged to gradually increase activity to reach goals
    3. Expect maximum Heart Rate to be lower during pregnancy
      1. Avoid using Heart Rate in pregnancy to guide exertion level
    4. Swimming is an optimal Exercise in Pregnancy (however, unknown effect of pool chemicals on pregnancy)
    5. Running, Jogging or Walking
    6. Low-impact aerobics
    7. Racquet Sports
  3. Resistance Training
    1. Limit to lighter weights
    2. Avoid heavy lifting in pregnancy (see above)
  4. Stretching and Strengthening Exercises
    1. Yoga or Pilates (not hot yoga or hot pilates)
      1. Yoga improves well-being in second and third trimesters
        1. Holden (2019) Glob Adv Health Med +PMID: 31489259 [PubMed]
    2. Back
      1. While sitting, alternate straight and curved back
      2. Exercises for back pain in pregnancy (YouTube Bob and Brad)
        1. https://www.youtube.com/watch?v=ixJOwV1DijA
    3. Abdomen
      1. Alternate leg raises tones abdominal Muscles
      2. Isometric abdominal contraction
      3. Plank Exercises
      4. Posterior Pelvic Tilt Exercises
      5. Diaphragmatic Breathing
    4. Pelvic Floor Exercises
      1. Hip bridges (with and without resistance bands, or with weighted pullovers)
      2. Kegel Exercises
        1. Also perform with toe taps and squats

VII. References

  1. (2015) Obstet Gynecol 126(6):e135-42 [PubMed]
  2. Caro (2020) Am Fam Physician 102(7): 420-6 [PubMed]
  3. Wojnowich (2022) Am Fam Physician 106(1): 52-60 [PubMed]

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