Pregnancy is a difficult time for women, we are preparing for the most arduous and intense challenge, yet also told we are fragile and need protecting during pregnancy. I created this printable guide for women who are already physically active and need reassurance on how to maintain their strength and fitness in preparation for childbirth and motherhood.

The following essay contains the most up to date evidence-based advice on how to maintain your strength during pregnancy.

PROGRAMME OUTLINE – Physically Active Women During Pregnancy

Department of Health and Social Care (2020) guidance recommends at least 150 mins a week of moderate intensity physical activity (PA) during pregnancy.  For inactive women this may mean a gradual introduction to activities, but athletic women already exceeding this baseline it may mean making adaptations or reducing intensity of PA’s. Exercise is important to maternal and foetal health contributing to improved mood and sleep, reducing blood pressure, risk of gestational diabetes and can lead to positive labour outcomes.

Screening & Safety

According to ACOG (2020), women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength-conditioning exercises before during and after pregnancy.  Prior to each session it is best-practice to complete a PAR-Q (Active Pregnancy Foundation, 2024) and to encourage regular feedback on RPE (Rate of Perceived Exertion) during exercise.  Exercise should be stopped immediately is any of the following conditions are noticed; vaginal bleeding, abdominal pain, regular / painful contractions, leaking amniotic fluid, dyspnoea, dizziness, headache, chest pain / palpitations, muscle imbalance, calf pain / swelling or severe back of pelvic pain (ACOG, 2020 and POGP, 2013).  Competitive contact sports and high-risk activities should be ceased during the first trimester (NHS TIMS 2024). Due to increased blood volume and basic metabolic rate during the first trimester, core temperature rises so particular care must be taken to avoid dehydration. Mitigate risks by avoiding hot-yoga studios, saunas and other high humidity or altitude environments.  Drinking water before, during and after PA is essential during all trimesters to moderate temperature.

Programme & Trimester Guidance

TRIMESTER 1 (up to 12 weeks):  Maintenance of current fitness level, avoiding maximal effort high-intensity activity (Worska et al., 2024).  Elite athletes may continue to participate competitively up to the end of the first trimester (Aspetar, 2024 and NHS TIMS, 2024).

TRIMESTER 2  (13 -27 weeks):  Reduce intensity where needed, at 20 weeks exercises in prolonged supine position should be avoided due to risk of decreased venous return and uterine blood flow (ACOG, 2020).

TRIMESTER 3 (28- 40 weeks):  Continue to adapt exercises and activities as needed to work around growing bump and symptoms such as fatigue and sickness. Continue to avoid long periods of time in supine positions and prioritise rest and mental wellbeing.  It would be useful to include mobility exercises that mimic positions useful for labour i.e. all fours, squatting.

PHYSICAL ACTIVITY	Weekly frequency (Designed to be increased / decreased according to needs)	Sample exercises	RPE (Modified BORG scale 1-10)	NOTES
STRENGTH  (30-60m)	1 – 2	Warm up (5 – 10 mins)   Deadlift (3/10)   Leg Extension (3/10)   Lat pulldown (3/10)   Chest Press (3/10)   Farmer Carry (3/20s)   Cool Down (5 – 10 mins)   Warm up (5-10 mins)   Dumbell Split Squats (3/10 each leg)   Shoulder press (3/10)   Dumbell Rows (3/10)   Dumbbell Step ups (3/10 each leg)   Cool Down (5 – 10 mins)	5-8	Functional full body strength exercises to maintain strength that can be performed in the gym with free weights, machines or resistance bands, work to a moderate intensity i.e. no maximal intensity lifting (ACOG, 2020).
PA DAY (~ 60mins depending on intensity and RPE)	1 – 2	Existing sports / physical activity e.g. dancing, swimming, cycling, running, yoga, walking, weightlifting, crossfit	5-8	Contact sports should be ceased within the first 4 months of pregnancy (Bø et al., 2018 and NHS TIMS, 2024).
FUNCTIONAL STRENGTH (20 – 30 mins)	Can be done daily	90/90 Hip Mobility (2-3 mins)   Spine Balancing (1-2 mins)   Banded Step Backs (3/10 each leg)   Single Leg Deadlift (light weight) (3/10 each leg)   Bent-over Rows* (3/10 each arm)   Repeat Hip Mobility / Childs Pose to cool down   Other core exercises:   Stability ball pelvic tilts   Planks – not in 3rd trimester (up to 20s holds)   Kegals (up to 5s holds)   Medicine ball rotations – standing or seated	5-8	Keep daily training flexible, if your legs are tired, just do light core or mobility exercises, remember you can always reduce reps and times (Piper et al., 2011).     * Rows included to strengthen rhomboids and lower trapezius, to attempt to minimise risk of pain caused by hunched posture in breastfeeding (Ratajczak and Górnowicz, 2024)

Table 1:  Shows programme of suggested physical activities and how to tailor them for each trimester.

Monitoring & Feedback

During exercise, patient safety is monitored through self-reported RPE, keeping heart rate below 140bpm and ability to pass the ‘talk test’ (Bø et al., 2018 and Reed and Pipe, 2014).

Post-Partum Expectations

Following an uncomplicated labour initial exercises to introduce should prioritise pelvic floor strengthening, specialist pelvic health physiotherapists are an available NHS specialist team. Women are capable of returning to elite-level competitive sport post-partum, however the recovery from labour and biopsychosocial factors will dictate the speed of return to participation and play (Aspetar, 2024).

References

ACOG (2020) Physical activity and exercise during pregnancy and the postpartum period. Available at: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/04/physical-activity-and-exercise-during-pregnancy-and-the-postpartum-period (Accessed: 3 January 2025).

Active Pregnancy Foundation (2024) Get active questionnaire for pregnancy. Available at: https://www.activepregnancyfoundation.org/getactivequestionnaireforpregnancy (Accessed: January 9, 2025).

Aspetar Sports Medicine Journal (2024) ‘Back on track: Performing on the world stage after pregnancy.’ Available at: https://journal.aspetar.com/en/archive/volume-13-targeted-topic-sports-medicine-in-athletics/back-on-track-performing-on-the-world-stage-after-pregnancy (Accessed: 1 January 2025).

Bø, K., Artal, R., Barakat, R. and Owe, K.M. (2018) ‘Exercise and pregnancy in recreational and elite athletes: 2016/2017 evidence summary from the IOC expert group meeting, Lausanne. Part 5. Recommendations for health professionals and active women,’ British Journal of Sports Medicine, 52(17), pp. 1080–1085. Available at: https://doi.org/10.1136/bjsports-2018-099351.

Department of Health and Social Care (2020) Physical activity guidelines: UK Chief Medical Officers’ report. https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report (Accessed: 9 January 2025).

NHS TIMS (2024) Health & Fitness in Pregnancy. https://www.tims.nhs.uk/self-care/health-fitness-in-pregnancy/#:~:text=If%20you%20regularly%20participate%20in,to%20your%20GP%20before%20exercising.&text=Drink%20plenty%20of%20water%20to%20avoid%20dehydration  (Accessed: January 9, 2025).

Morales-Suárez-Varela, M. et al. (2020) ‘Maternal physical activity during pregnancy and the Effect on the mother and newborn: a systematic review,’ Journal of Physical Activity and Health, 18(1), pp. 130–147. https://doi.org/10.1123/jpah.2019-0348.

Piper, T.J. et al. (2011) ‘Core training exercise selection during pregnancy,’ Strength and Conditioning Journal, 34(1), pp. 55–62. https://doi.org/10.1519/ssc.0b013e318232c412.

Ratajczak, M. and Górnowicz, R. (2024) ‘The influence of breastfeeding factors on the prevalence of back and neck pain: data from an online survey,’ BMC Musculoskeletal Disorders, 25(1). https://doi.org/10.1186/s12891-024-07785-4.

Reed, J.L. and Pipe, A.L. (2014) 'The talk test,' Current Opinion in Cardiology, 29(5), pp. 475–480. https://doi.org/10.1097/hco.0000000000000097.

Worska, A. et al. (2024) ‘New Public Health and Sport Medicine Institutions Guidelines of Physical Activity Intensity for Pregnancy—A Scoping Review,’ Journal of Clinical Medicine, 13(6), p. 1738. https://doi.org/10.3390/jcm13061738.