What exercise is safe for the first trimester of pregnancy?
First of all: congratulations on your pregnancy!
Whether this is your first or fourth pregnancy, it is an exciting journey that you are only at the beginning of!
Photo by Brass Tacks Photography
Disclaimer:
All of this information provided is based on my own opinion as a pelvic floor physical therapist, research I have done surrounding this topic, and my own personal experience going through pregnancy. This information is meant for a pregnant person that has no risk factors, and has been cleared by your OB/midwife for exercise. Any nutritional advise I give is based on personal experience and I recommend working with a dietician who specializes in prenatal care. You should always listen to your own body, and if any of my suggestions don’t feel right, don’t do it. I highly recommend working one-on-one with a pelvic floor physical therapist that works with pregnant women to get a more customized approach to your exercise plan (even if you only go for one session).
Battling First Trimester Symptoms:
Shortly after the excitement of being pregnant settles, many people get hit with the joys of first trimester symptoms (except for those lucky 20% that escape with minimal symptoms). So apologies to those struggling to get through the day, I feel your pain.
Nausea (they say morning sickness, but it can definitely be all day)
Extreme fatigue
Bloating and GI issues
Heartburn
Food cravings and dislikes
Frequent urination
Tender breasts
Depending on the severity of your symptoms, it can be really tough to add a workout into the mix. The most important thing is that you listen to your body. Rest when you need to. Eat enough food. Drink enough water. If you can add a little walk to your day, that’s great! Don’t beat yourself up over not “doing what you are supposed to do''. Every day and week of pregnancy is different. Every person is different, and every individual pregnancy is different. Try your best to not compare to other pregnant people, or other pregnancies you have had in the past. You will eventually get to the second trimester when a workout class sounds a lot more manageable.
My personal (not clinical) tips that helped me get through my first trimester:
Keep eating. When you don’t eat, blood sugars go haywire and nausea/fatigue gets worse.
Drink water. I was always worse when I didn’t get enough water in that day.
Momentum: get moving and stay moving the best you can. When I had the opportunity to lounge around all day, symptoms were worse.
Exercise is better than no exercise
Research has supported over and over again that exercise of any kind is better than no exercise at all in pregnancy. If you have never formally exercised before, I encourage you to start your movement practice now. It is safe and very beneficial to do so (1). Going for walks is a great way to start!
Photo by Brass Tacks Photography
Exercises you SHOULD NOT DO in the first trimester:
Bearing pressure down into your pelvic floor- you shouldn’t be doing this anyways, but now that you're pregnant, it is time to be extra mindful of how you manage pressure in your body, and what is going on with your pelvic floor
Video of bearing down:
Video of not bearing down:
“Dangerous” or contact sports: use your best judgment here. It is just a good idea to reduce the chance of you taking a hard fall rock climbing, snowboarding etc. But you know your skill level and ability.
Valsalva or breath holding when weight lifting: this changes the intra-abdominal pressure, potentially putting more pressure down on your pelvic floor and uterus. It can also cause a spike in blood pressure which may not be safe for some people. Again this could be safe with practiced weight-lifters. But in my opinion there are so many other ways to lift weight during pregnancy that this technique is just not necessary.
Photo by Brass Tacks Photography
Exercises you SHOULD DO in the first trimester:
Anything you want (within reason 🙂)
Daily walks are great!
Stick to what you normally do for exercise, and modify when you need to (more walking breaks on your run, less weight in the gym)
Pelvic floor lengthening exercises
Breath work: this gets more challenging to do when the baby grows and allows for less space for your diaphragm to move, getting some good deep breathing in during the first trimester is great!
Deep core activation: practicing pelvic floor and transverse abdominis muscle engagement to help stay connected during pregnancy, and help for an easier postpartum transition
Hip and glute strengthening: the hips and pelvis start to move a lot more in pregnancy as your body is preparing for birth (even in the first trimester!), the stronger and more stable your hips are, the less stress you will place on your back and the stronger you will be to lift that car seat up someday!
Thoracic mobility work: working on gentle rotation to get the mid back moving can help with the forward posture that can start to develop in late pregnancy
**For more clarification on some of these exercises, visit my pelvic floor blog.
Please note: there is nothing inherently bad about any exercise. Listen to your body, and do what feels good to you.
FAQs:
Can I keep running?
Yes! Many women run well up into their third trimester. Generally I tell people, you will know when it is time to hang your hat. If things feel good while you are running, keep it up! Your pace will start to slow, and your form may start to change, and that is okay. If you start getting different aches and pains due to running, it may be time to stop (or see a PT who can help guide you). If you have never run before, it is not an exercise I prefer as a new thing to start when pregnant.
Can I do hot yoga?
Yes. Again this wouldn’t be my favorite thing to do in pregnancy, as heat tolerance can be a lot lower in pregnancy. Increasing your body temperature too high can also be potentially harmful to the baby. You will likely have to modify a lot in these classes. If you feel lightheaded, or something feels off, its time to rest. This would not be something I would recommend to someone who has never done it before.
Can I do core work?
Yes and you should! You want to make sure you are doing correct form, however. Depending on your experience level with core work, my answer will be different. In general you want to make sure you aren’t doming in the middle of your abdominal area (see picture below) when doing abdominal exercises. You should think about engaging your lower abs and pelvic floor muscles first, which will help with this doming effect. I recommend everyone work with a pelvic PT in order to review form so you know what to look for.
www.thepelvicstudio.com
Can I lift heavy weight?
Yes! Again, I would not do any breath holding when lifting weight, but if you are experienced in heavy lifting, continue as you are and modify when your belly gets in the way. Listen to your body and you may need to slow down later in pregnancy. If you have no experience in lifting weight, I encourage you to start doing body weight training to work on functional movement that will only benefit you later in pregnancy and postpartum. Again, working with a pelvic PT or strength coach who is knowledgeable about prenatal/postpartum strength training is a great idea.
Can I do rotational movements?
Yes! Rotation is something that is sometimes feared in the fitness world for pregnant people. I will say when you rotate, focus on engaging your core, and rotating through your hips or upper back as the primary movement. You don’t want to twist excessively through the abdominal area. Not because it’s not safe, but because you are already getting stretched through there and the rotation you need is more in your mid back region.
What are signs and symptoms I should be concerned about?
When to not exercise:
Pain or vaginal bleeding.
Dizziness/lightheadedness.
Extreme Nausea or fatigue.
Prenatal complication that makes exercise unsafe or you are advised by your provider to not exercise.
When to call your provider (please note that this list is not inclusive, there are plenty of other reasons to call your provider.)
Vaginal Bleeding
Your water breaks, and there is a foul smell or it is any color other than clear. This could be a sign of infection.
If your water breaks, and you are earlier than 37 weeks.
Pre-term Labor
Decreased fetal movement
Headaches and/or blurred vision
You are concerned about your pregnancy
If you have any concerns or are looking for safe exercise guidance during your pregnancy, the first trimester is a great opportunity to connect with a pelvic floor physical therapist.
The reality of miscarriage
I also want to address the elephant in the room and a topic many try to avoid. This is a time that can be an unsettling time for many people. The chance of miscarriage in the first trimester is 1 in every 4 pregnancies (and the number is much higher than that in my opinion).
I say this not to scare anyone or take the joy away of the news of your pregnancy, but to normalize the reality that many people suffer pregnancy and baby loss. Should this happen to you, the chances that there are people in your life who have also experienced the same thing. There are many resources available out there as well (see my resource section below). Know you are not alone.
My husband and I suffered a pregnancy loss in 2020 (prior to having my son). I didn’t know many people at the time who could relate to my experience, and was in a friend group who was conceiving left and right. I understand how lonely and confusing this time can be. I am always happy to be a resource if you need someone to talk to about your experience.
Unfortunately there is not much in your control to reduce your chance of miscarriage. It can give more peace of mind to talk to your OB and midwife about ways you can stay as healthy as you can during your pregnancy. It can also be helpful to work with a prenatal dietician to work on how you can use your nutrition for optimal baby health. Never underestimate the power of mental health. High stress and anxiety is not good for your body as a whole, and reaching out to a licensed professional can help get you through this exciting and stressful time.
Author: Lauren LePage, PT, DPT
Next on your reading list:
Resources:
Pregnancy Book Recommendations:
Exercising Through Your Pregnancy
by James F. Clapp III and Catherine Cram
This is a great resource to learn more about what has been researched about exercising during pregnancy to help you feel more comfortable about being safe during your pregnancy. It was written a long time ago but the information is still relevant.
by Lily Nichols
I am not a nutrition expert or dietician. This was a book recommended to be by multiple clinicians to learn more about how to utilize food for optimal nutrition during your pregnancy. There was a lot of helpful information that changed the way I ate during my pregnancy. I recommend reading prior to pregnancy (when you don’t have symptoms).
Miscarriage/Infant loss Resources:
I primarily used the podcast referenced below in the first few months after my miscarriage. Everyone’s journey is different, but the podcast helped me feel a lot less alone. There was a certain point in time for me that it felt like it was too much and it was making it more challenging to move onto the next chapter (especially when you get pregnant again). Use some of these resources, or none at all. Do what is best for you.
19 Helpful Books to Read after a Miscarriage
I want to make note, I did not read any of these books but there is a little bit of everything in this resource list. If you are more of a book person than a podcast listener, check it out!
The Unexpected: brand new book I have not read but I love Emily Oster!
Resolve New England - offers free, virtual peer support groups each month
Articles:
1. Maconochie N, Doyle P, Prior S, Simmons R. Risk factors for first trimester miscarriage-results from a UK-population-based case-control study. BJOG: An International Journal of Obstetrics & Gynaecology. 2007;114(2):170-186. doi:https://doi.org/10.1111/j.1471-0528.2006.01193.x
2. Cohain JS, Buxbaum RE, Mankuta D. Spontaneous first trimester miscarriage rates per woman among parous women with 1 or more pregnancies of 24 weeks or more. BMC Pregnancy and Childbirth. 2017;17(1). doi:https://doi.org/10.1186/s12884-017-1620-1
