Movement for Every Trimester: Adapting Your Routine as Your Body Changes

There have been so many fitness trends in my longish life. It’s hard to know what to believe sometimes. And when you’re thinking about pregnancy fitness, there are trends, but it also feels like a more high stakes situation that you probably want to get right. So what is the right thing to do?

In almost every pregnancy, there is general agreement that movement is good for you. Exercise can help you have a healthier pregnancy and feel better while you do. It’s a lot harder to figure out what type of exercise to do and how much is healthy. And there are different considerations depending on whether you’re already an athlete or are just starting to get into exercise.

A Brief History

A few decades ago and even more recently in the United States and in other cultures, pregnant women were treated with a lot of delicacy. It was thought that she should rest a lot and be taken care of. Manual labor might have been prohibited and exercise just wasn’t a thing. But a healthy pregnancy might have also included alcohol and cigarettes, so they may not have been getting everything right! I have a friend from eastern Europe who was horrified to see me using a tile saw during my first pregnancy. He was raised to believe that using electric and power tools was dangerous during pregnancy, so they were even discouraged from using appliances like a vacuum. Our children and future grandchildren are very lucky that we have learned more about how to be healthy during pregnancy.

But if you go back even further to biblical times, scholars were observing that women who were more active during pregnancy, such as people from the slave and servant classes, had easier deliveries. Those kinds of observations even led Aristotle to recommend exercise to ancient Greek aristocrats!

Benefits of Exercise

Besides being fun or the fact that it can make people feel better while they’re pregnant, research shows that a healthy amount of exercise can offer the following benefits:

• Decreased risk for high blood pressure and preeclampsia
• Decreased risk for gestational diabetes
• Better sleep. It can be hard to sleep well when pregnant, but when your body is strong and flexible, some of the pregnancy discomforts that might keep you awake will be gone. Good sleep during pregnancy lowers your risk for postpartum depression.
• Exercise during pregnancy also more directly lowers your risk for postpartum depression.
• As long as you are having an uncomplicated pregnancy, exercise can actually lower your risk for preterm birth.
• There may be a link to improved brain development for babies.
• Increased energy levels
• Improved mood
• Increases your chances for a complication free birth
• Exercising during pregnancy can help you maintain healthy levels of weight gain which can also assist in helping you return to or maintain a healthy weight after you give birth.
• Exercise in pregnancy can help you have a quicker and less complicated physical recovery postpartum, lowering your risks for pelvic floor disorders and diastasis recti.

How to do it

I interviewed Stacey Rikalo of femSTRONG for help with this article. She has been working as a fitness and strength trainer, specializing in the perinatal period. That means she works with folks who are pregnant or returning to exercise following birth. Based on her work, she knows that women can do a lot during pregnancy. They can maintain most of their routines and maintain a pretty high level of fitness. She usually works with athletes. These are people who were already doing a lot before becoming pregnant. They know a lot about fitness, what their bodies can handle, and are working with a trainer or coach to help them continue safely. Not everyone has that benefit. I highly recommend watching the recorded interview with Stacey below for a lot more detail, but here are some key takeaways that apply to most everyone:

• FIRST, talk to your health care provider. While it’s true that in general exercise is healthy and safe, there could be some risk factors that make it unsafe. Talk to your care provider about exercise to make sure you don’t have any risk factors that mean you need to be more careful.
• Walking counts! Walking is great exercise no matter your fitness level and is a safe entry level exercise for most everyone.
• Housework/yardwork count too! If you do a lot of physical activity for your job, or you’ve spent the day at home cleaning or doing yardwork and then don’t feel like doing exercise, DON’T! You already did. Exercise doesn’t have to be an organized routine. Moving your body while you clean or do home improvement projects is healthy and counts as exercise. Of course doing more is OK too, if you feel like it.
• Your aerobic and anaerobic capacity diminishes during pregnancy. This basically means that things that used to feel easy or manageable now feel more difficult. Maybe you used to be able to climb the stairs without feeling winded, but now you can’t. This is a normal part of being pregnant. So many of your energy resources are going to growing your baby and your placenta. You just don’t have as much fuel. It’s very reasonable not to push yourself to do the same amount you did before.
• You are TOO flexible. You have a hormone in your body during pregnancy that softens and loosens your connective tissues. That means you have a bigger range of motion in your joints. This is great for allowing your pelvis to shift and widen to accommodate your baby during pregnancy and for birth, but it also means that it’s easier to overdo it in other parts of your body too. When you’re stretching, try not to do the maximum that your joints are capable of. Stay a little below the edge so you don’t cause injury.
• You are less coordinated. This is not a judgment of you, and it’s not your fault. Your uterus is stretching to fit a larger and larger baby, so it has to expand forward and up out of its usual spot in your pelvis to fill your abdomen and then stick out in front! This means that your center of gravity changes dramatically. This is why most people do report feeling a lot more “clumsy” during pregnancy. This also means that you should be extra careful when exercising. For your safety, it might not be a good idea to do things that require a lot of coordination. For example, rock climbing without a pregnancy harness might not be an ideal choice.
• Body temperature is harder to regulate. Pregnancy causes a lot of strange physical changes, and one of them is a decreased ability to regulate your body temperature. This is especially useful information for my local area in Texas! It gets very hot here, and when you’re pregnant, it’s easier to overheat. Consider limiting the amount of time you spend outside in the heat, or do your workouts inside.
• Can you control your movements? If you can walk, run, lift, swim, etc. smoothly and with control, you’re probably doing ok. If your movements feel more choppy, forced, or out of control, you can consider backing off a little.
• Are you feeling heaviness “down there”? It can be a hard thing to understand until you feel it. Some people describe a feeling of fullness in the vagina. It might feel like swelling or bulging. However you describe it, you’ll probably be able to recognize it when you feel it….especially if you’re looking for it. This is the feeling of your pelvic floor organs being squished downward because of some pressure from your movement and probably because of the extra weight from the baby and the laxity in your connective tissues. So, pay attention when you’re exercising. If you notice that a particular movement causes this feeling of heaviness, you might consider doing less.
• Breathing well helps. Stacey talks a lot about breathing as a tool for helping you exercise safely. Your breathing muscle (diaphragm) can be useful for protecting your pelvic floor from injury. Breathing well itself can be a restorative and healthy movement that can also help prevent injury.

First Trimester

For safety, most types of exercise are fine! You don’t have too much going on yet related to your size or progress in pregnancy that can limit your mobility. However, you might not FEEL like doing much. Most people feel very tired and might have a lot of nausea and vomiting. These symptoms can definitely make it harder to exercise. That’s OK! I think you should give yourself permission to lie down if that’s what you need. Sleep if that’s what your body is asking for. Take it easy. Your reserves are being used right now. Your body is deciding what to do about the “invader” that has taken hold. It’s asking you to save your energy to fight off a potential threat OR save it up to give your baby the best start. If you feel up to it, you probably have the most freedom to do what you want for exercise during the first trimester. Move however you can, and remember that some gentle exercise might actually help you feel better.

Second Trimester

Most people feel better during the second trimester. I want to recognize that this is NOT true for everybody. Most people though are feeling less tired, more hungry, and starting to get that “pregnancy glow” that people talk about. You’re starting to see a bigger, rounder belly, and hormones are stabilizing a little. You’ll likely still have other symptoms that come up during the second trimester like heartburn or constipation or hip pain, but they just might not be the sorts of symptoms that make exercise impossible. So, you might start to feel more ready to exercise, AND THEN you might notice that it doesn’t feel the same or you have to modify things. That is normal. It’s a good idea to listen to your body when you notice these differences. Do less when you need to. Pay attention to the “HOW TO DO IT” section above. The second trimester is the point in pregnancy where it might be most important to follow some basic guidelines so you don’t overdo it. On top of all of the other things already covered, your abdominal muscles will begin to separate, and you want to make sure you’re guarding that area. That might mean changing the way you are doing core strengthening. Stacey loves to recommend “carries” during the second trimester.

I also want to recognize that many athletes out there aren’t so good at “listening to their bodies”. This is NOT a criticism! It just means that intense training often involves pushing past a threshold. Athletes have to work harder, push themselves, feel the burn. Most of the time, this is a great way to get stronger, but in pregnancy, your body might actually be trying to give you warning signs. If you are an athlete, try not to ignore those signals, or give yourself some great boundaries to stay within for safety.

Third Trimester

When you reach your third trimester, you might still be feeling great, but eventually most people start to feel more heavy and less energetic. A lot of people feel like winding down some and conserving energy in preparation for birth and early parenting. You might also be having some new pregnancy symptoms that make things harder. You are carrying a lot of extra weight. Your baby might weigh 4-7 pounds, your placenta probably weighs 1-2 pounds, you’re carrying about 2 pounds of amniotic fluid, a pound of extra breast tissue, 3 lbs of additional blood, a couple of extra pounds of uterine muscle, about 4 lbs of extra water, and about 8lbs of maternal fat stores. That basic gain alone is 20-30 extra pounds! For the fitness fanatics reading this, imagine carrying around a weight that size at all times. You are using energy that you weren’t using before.

You may also need to do more modification in your exercise related to the size of your belly. It’s pretty large in the third trimester, and can definitely be an obstacle to some of the things you might be used to doing. You also might be feeling more heaviness in the pelvis during the third trimester which is a good indication that you should do less.

Pelvic floor strengthening is recommended for many people, especially in the first and second trimesters, but the third trimester is a good time to focus on learning how to relax and soften in the pelvic floor.

I am most definitely not a fitness expert. In my own pregnancies I walked and did prenatal yoga. I can definitely recommend that program, although it’s definitely not the perfect program for everyone! Besides the morning sickness, I felt pretty good. I was strong and had a fair amount of energy. I did learn that my pelvic floor needed some guarding though! I had some injury to my pelvic floor after my second birth. I saw a pelvic floor physical therapist for help, but I sometimes wonder if I might have prevented some of the injury by seeking that help during pregnancy. Seeing a pelvic floor physical therapist is a great idea for anyone who wants to work on pelvic floor strengthening, control, AND softening. It’s also a good idea to talk to your pelvic floor physical therapist about your exercise program. They can help you ensure safety for your pelvic floor while getting the most from your workouts.

I was very happy to have guidance from Stacey in writing this article. Please watch the video to see more and find out about some of Stacey’s favorite resources related to exercise during pregnancy. You can also look for two more follow up articles and recordings discussing exercise AFTER birth!

References:

Physical Activity During Pregnancy – Past and Present – PMC

Breaking boundaries: A chronology with future directions of women in exercise physiology research, centred on pregnancy – ScienceDirect

A comparison of beliefs about exercise during pregnancy between Chinese and Australian pregnant women – PMC

Antenatal taboos among Chinese women in Hong Kong – ScienceDirect