Debunking Two Common Myths About Prenatal Exercise

If you’re pregnant and looking to stay physically active, you’ve probably come across a lot of information about exercise during pregnancy, some of which can be confusing or even misleading. In this article, we'll focus on two of the most common misconceptions that frequently appear in searches and provide you with accurate, up-to-date information based on guidelines from the American College of Sports Medicine (ACSM) and the American College of Obstetricians and Gynecologists (ACOG).

Misconception #1: "You shouldn't start exercising if you weren't active before pregnancy"

One of the most persistent myths about prenatal exercise is that if you weren't physically active before pregnancy, you shouldn't start during pregnancy. This misconception can prevent many moms-to-be from reaping the benefits of exercise during pregnancy. Back in the day guidelines were much more conservative out of caution and frankly because the research just hadn’t been done. However, both the American College of Obstetricians and Gynecologists and the American College of Sports Medicine encourage people with uncomplicated pregnancies to engage in regular physical activity, regardless of their pre-pregnancy fitness level. These expert obstetric and exercise organizations are very clear about the benefits of prenatal exercise which include preparing your body for the physical demands of pregnancy and childbirth, better weight management, reduced risk of gestational diabetes, and enhanced mental well-being.

You might find that pregnancy it’s an ideal time for you to start an exercise program. It’s a time in your life when you’re pausing to think about wellness, consider your health, and begin to adapt your habits and schedule. Exercise and physical activity can be incorporated into those thoughts and you can begin to prioritize physical activity as you make changes.

If you are new to exercise or haven’t been exercising consistently, the first step is shifting your mindset. Exercise should be used to support your pregnancy, so past exercise goals or routines may not apply to this stage of your life. Secondly, when you’re ready to get started, you should approach it as a gradual progression. This means little by little you’ll increase the duration of your workouts, the intensity, and the challenge level of exercises. You can begin with as few as 5 minutes of mobility each day and move toward being physically active for 30 minutes most days of the week. 

As always, your healthcare provider should be your resource if you’re concerned that you have complications or contraindications to exercise. However, if you have a healthy and uncomplicated pregnancy, I’d like you to get moving!

Misconception #2: "You should keep your heart rate below 140 bpm while exercising"

Another common misconception is the outdated guideline that pregnant women should keep their heart rate below 140 beats per minute (bpm) while exercising. This advice, once widely promoted, is no longer supported by ACOG or ACSM. No one "target" heart rate is appropriate for all pregnant moms.

Instead, both ACOG and ACSM recommend that pregnant women engage in moderate-intensity exercise, which can be gauged by the "talk test" – being able to carry on a conversation while exercising, but not being able to sing. This level of intensity typically corresponds to a heart rate of 60-80% of your maximum heart rate, which varies depending on your age and fitness level. However, this guidance is not a “maximum” and it is not to create fear of going over that moderate intensity. Many elite athletes work at higher intensities, and research shows that HIIT exercise is safe for moms and babies. So rather than focusing on or fearing the heart rate, or number, focus on getting your body moving at a moderate intensity.

Hopefully, these two misconceptions about prenatal exercise will continue to dissipate so more moms embrace physical activity during pregnancy. By understanding that it's safe and beneficial to start an exercise program during pregnancy, even if you weren't previously active, and by focusing on moderate-intensity exercise rather than a specific heart rate limit, you can confidently use exercise as a tool in your prenatal care plan. Use the power of exercise to feel strong and confident throughout each trimester!

If you’re looking for tips to get started, download 5 Tips to a Strong Core.

Have You Been Cleared for Exercise?

If you’re currently pregnant and have been consistent with exercise, you’re probably already planning your return to exercise postpartum, especially if exercise has always been a part of your life. I know most of my clients who have continued to stay active during pregnancy have goals to return to fitness as soon as their doctor gives the OK postpartum.

If you’ve recently had a baby, you may be awaiting your postpartum appointment to find out if you are “cleared for exercise”. Getting cleared for exercise can feel liberating if you’ve been missing that sense of control over your body. However, it’s important to understand what being cleared means as well as how to return to physical activity after pregnancy.

What Does "Cleared for Exercise" Mean?

Being cleared for exercise is your doctor’s medical opinion that you are physically ready to start increasing physical activity, or that it’s generally safe for you to exercise. This typically happens at your 6-week postpartum check-up, but if you’ve had complications like tearing or are recovering from a c-section, that may happen a bit later. 

In other words, your doctor will either tell you it’s safe, or that it’s not. Which, don’t get me wrong is important information. You shouldn’t begin to increase physical activity or exercise if you have contraindications. However, the trouble with the yay or nay approach is that it’s one size fits all. Postpartum exercise clearance usually comes with the advice that you should ease back into it and listen to your body. This is not inherently bad advice, but it’s pretty subjective and doesn’t educate you on what a proper progression looks like, or why easing back into it is essential. Fortunately for you, if you’re reading this, you probably already have an understanding that there are important considerations when returning to exercise after having a baby. In the rest of this article, I’ll provide you with tips and strategies to guide you in your return to fitness.

What do the postpartum exercise guidelines say?

At the time of this article (12/2023), postpartum exercise guidelines have not been published. BUT, there is encouraging news that they’re finally in the works and should be released soon. I’ll link to them when they come out, but in the meantime, I’m going to provide you with some tips inferred from the research that exists, my background in exercise science, as well as the practical experience I have working with pregnant and postpartum moms.

Do you need to see a pelvic floor physical therapist or postpartum exercise specialist?

The ideal answer is yes, it would be great if everyone was able to receive personal guidance from a professional after having a baby. The more realistic answer for most people is that it depends. If you have any concerning symptoms like incontinence, pelvic or back pain, abdominal separation, or others then I strongly encourage you to see a pelvic floor physical therapist as a starting point. If you live in a major city there are probably those that accept insurance, as well as cash-based, but you should be able to see someone. Additionally, if you are concerned about excessive fatigue, anxiety, or depression, I’d also recommend seeing a professional before beginning a structured exercise program beyond general physical activity. If you were not active during pregnancy or you’re new to strength training or core exercises, a postpartum exercise specialist can save you a lot of time and energy in the long run by helping you determine which exercises are best for you.

Time for the Tips

Aerobic

The general physical activity guidelines for adults recommend 150 minutes per week of moderate or moderate-vigorous physical activity, with activity occurring on most days. The postpartum guidelines may skew a bit, but will not be drastically different. In any case, that duration and intensity is what you’re working up to and not where you’re starting. For most moms that I’ve worked with, getting out and pushing the baby in the stroller for 10-20 minutes every day is a great starting point. Walking is great because you can still spend time with your baby, being outside may boost your mental health, it’s a low-impact activity ensuring you’re not stressing your healing pelvic floor too soon, and it’s a trackable activity that you can strategically progress to longer durations, distances, and intensities. 

Strength

Here’s where I plug the method I developed called the Core, Function & Fitness approach. The idea is that the core is the foundation of fitness and where you should prioritize your efforts. During the postpartum period, this most often means addressing any pelvic floor concerns and coordinating breath with your deep ab muscle activation. Initially, this could be through pelvic tilts or heel slides but can progress to exercises like the deadbug. After you’ve made some progress in core strength and function, you can add in functional strength training. So this might mean you’re spending 5-10 minutes on isolated core exercises and then doing a full body circuit focusing on muscles you need to move through your day pain-free, as well as the major movement patterns. For example, lengthening chest muscles and strengthening upper back muscles is usually a necessary focus for moms due to the feeding posture. 

After you’ve laid a solid foundation of core training and strength training you can continue to increase the duration, frequency, and intensity of your workouts, while also setting more specific goals like running.

Don’t Forget About Lifestyle Factors

To benefit from exercise, there are more factors than the workout or activity. Things like sleep, nutrition, hormones, childcare, the ability to be consistent, and the ability to recover all determine whether you’ll get the benefits you’re expecting from exercise. For this reason, not jumping back into structured workouts until you are more healed, getting a bit more sleep, and have found ways to stay hydrated and eat a balanced meal is a reasonable decision and it’s smart. Now this doesn’t mean you should do anything. You should begin to increase physical activity and address core strength at a minimum, but it means that rather than aiming for pre-pregnancy 60-minute workouts at the gym, your starting point might be daily walks and two minutes of isolated core work when the baby is doing tummy time.

On the flip side, if you have childcare help, you’re feeling healed and sleep deprivation isn’t an issue, you may be feeling like you’re ready to get back to your old routine. To that I’ll say, remember that your abdominal and pelvic floor muscles and tissues are still healing and your hormones are still fluctuating, so even if you’re feeling good, I’d suggest the same gradual core, function then fitness framework. You may move through the progression quicker than someone else but don’t skip the gradual transition.

The Takeaway

This article is just one piece of the postpartum exercise puzzle, but I hope it gave you some perspective on getting cleared for exercise. To summarize:

• Prioritize healing

• Remember that lifestyle factors should support the type of workouts you’re doing

• Core, then add functional strength then set fitness goals

Being an active mom is a lifestyle and will look different as you move through different stages of motherhood. The fourth trimester is not even the first chapter, we’ll call it the introduction.

Ready for more tips? Download 5 Tips for a Stronger Core After Pregnancy.

Is Some Exercise Really Better Than No Exercise?

Unfortunately for busy moms, when life gets chaotic we tend to prioritize things other than exercise. This may result in sporadic workouts and an inconsistent routine, or possibly skipping structured workouts altogether. This leads to the question, is something better than nothing??

Well, the short answer is yes…when it comes to the health benefits of exercise, then some physical activity is absolutely better than no activity. In fact, so much so that "make exercise a lifestyle" really needs to be a priority.

In a study of 35 healthy men and women, researchers found that many of the benefits they gained during a 13-week exercise program were lost over the course of one month of cessation of the program. This included strength gains, body fat percentage, and measures of heart health. However, the most important to note is that it only took one week for participants to lose the improvements in their blood pressure and cholesterol! This indicates that to keep your cardiovascular risk factors low, you need to maintain physical activity and make it a lifestyle. So returning to the answer to the question, yes some exercise is better than being sedentary when it comes to exercise and health. Upper and lower body strength gains also decreased progressively the month after completing the program. The good news is that the study did show us that 20-30 minute resistance training workouts just 2-3 times per week was enough to see fitness improve!

If staying consistent with exercise sounds easier said than done, here are some tips on how to make fitness work for you.

1. Be realistic with your time and identify ways that physical activity can naturally fit into your life. If you’re up several times per night, then setting a goal to do even a 10-minute HIIT workout before the baby wakes up in the morning is probably unrealistic and completely un-motivating. However, saying that you’re going to beat the afternoon energy slump by doing a 10-minute stroller walk with the baby, is probably more manageable and something you might look forward to.

2. Start with the minimum. If you can get benefits from just two days per week of strength training, start there. If you don’t have a gym membership, start with at-home bodyweight exercises. If you feel weak and experience pain with exercise, start with just a few core exercises.

3. Hire a professional. We invest in professionals for all sorts of things…cleaners to save time with housework, going to a nail salon instead of home pedicures, and therapists to improve our mental health. But for some reason when it comes to fitness, hiring a professional can be seen as a luxury. There is nothing wrong with seeking someone to hold you accountable. There is value in having an expert design a 30-minute program that will improve your strength.

I hope this post encourages you to adopt an active lifestyle!

Returning to Exercise After Covid

Are there dangers on returning to exercise post Covid? That is still something being studied, but we do know there are long term effects from Covid and because of possible complications there should be guidelines on how to return to physical activity. There is increasing evidence that “long Covid” symptoms can include cough, elevated resting heart rate, and extreme fatigue. Cardiac damage is also a concern, especially in athletes returning to sport post virus. The American College of Sports Medicine is one of the first organizations to provide guidelines based on your level of risk.

Low Risk: If you are under the age of 50 with asymptomatic or mild respiratory symptoms that resolved within seven days.

• When to return to activity: Rest for at least ten days after being diagnosed. Once asymptomatic for seven days then follow a gradual return to exercise without evaluation.

• How to return to activity: You should first return to normal daily routine and sleep patterns. You should be able to perform daily activities and be able to walk 500 m (.31 miles) on a flat surface without fatigue or shortness of breath. Your first workout should be light intensity for a duration of 15 minutes. If you feel your energy is as it was post covid, you can increase the duration during your next workout. It’s recommended you begin with bodyweight exercises and then progress to heavier resistance and sports. *Athletes should engage in at least two weeks of minimal exertion activity before resuming sport.

Intermediate risk: If you had symptoms or fatigue lasting for more than one week, or prolonged shortness of breath/chest pain that did not require hospitalization.

• When to return to activity: it is suggested that you be evaluated with an EKG and troponin test if you have an abnormal EKG. A personalized exercise prescription is recommended.

• How to return to exercise: a specialist team should create a personalized exercise prescription

High risk: if you were hospitalized or experienced shortness of breath or chest pain at rest or with basic daily activities.

• When to return to activity: it is suggested that you be evaluated with an EKG and troponin test if you have an abnormal EKG.

• How to return to exercise: a specialist team should create a personalized exercise prescription

A gradual return to exercise will help mitigate risk. Working with an exercise physiologist and care team is to your benefit as we continue to learn more about Covid-19 and exercise.

Below is an example of a low risk return to exercise progression. You should make sure you recover from each workout and that no new/returning symptoms occur. Contact your doctor if you experience any chest pain, irregular heartbeat or shortness of breath. This progression may take place over a 1-2 month period.

1. Stage 1: Mobility/Flexibility and light walking

2. Stage 2: Continue to build up walking intensity and duration

3. Stage 3: Moderate intensity aerobic exercise and bodyweight resistance training (one day of exercise interspersed with one day of recovery)

4. Stage 4: Moderate intensity aerobic activity and resistance training (moving up to two days of exercise and one day of recovery)

5. Stage 5: Attempting your baseline level of activity, ramping up intensity to moderate/vigorous.

This post is an interpretation of an article titled Safe Return to Physical Activity After Covid-19.

Advice on Prenatal Exercise: 3 Tips to Achieve 40 Weeks of Workouts

I’ve collaborated with two mamas-to-be to provide you with their advice on exercise during pregnancy. I’ve worked with both Shannon and Jen for 40 weeks of prenatal workouts. So consider these 3 tips you approach exercise each trimester.

Tip 1 from Shannon: Consistency is key. Consistent exercise feels better physically, but just as important, consistency will help you overcome that guilty pressure of needing to “get back on track”. Even if you can’t do much, do something to stay consistent. This could be a 40 minute workout, it could be a 5 minute walk. Either way check that box and get it done.

Jen and Shannon

Tip 2 from Jen: Build a relationship with your trainer. This is a great point. Any fitness professional experienced in prenatal exercise will do their due diligence to ask you about your experience, complications, history, etc. You don’t want to have to catch every new instructor up, or worse, not have them understand your strengths and weaknesses. You’ll receive better workouts and your trainer will feel more confident challenging you if you’ve built a relationship. Jen adds, “I have a constant connection with Ashley so I am more aware of how hard to push myself and/or to know what to look out for! Ashley keeps me updated as to what to watch out for if certain pains pop up. This enables me to continue my training with confidence.

Tip 3 from Shannon: Be kind to yourself. “You never know what kind of day you are going to have. Energy flow fluctuates so much throughout different trimesters and can change daily. At a certain point, your body just grows and changes and things you used to be able to do, you just can’t do. I’ve also cut back slightly on how frequently I workout as I get closer to the end, which is okay. I’m still making the time as my body feels it can. I agree with Shannon. For some the hardest part of prenatal exercise is mental. You want to challenge yourself, but you don’t want to be rigid in your goals. With hormones shifting and your body physically changing, your mentally have to be flexible and try to be OK with adapting as needed.

If you’re pregnant and ready to get started, check out 5 Tips for a Stronger Core During Pregnancy.

Ashley Reid is an exercise physiologist with the only strength-based studio for moms and moms-to-be in Philadelphia.