Pregnancy Exercise Program with a Physiotherapist

Exercise is part of antenatal care

The World Health Organization advises at least 150 minutes of moderate activity a week during pregnancy for women without complications, plus some muscle strengthening. That's a long way from the advice many of our patients' mothers were given, which was mostly to rest.

The reasons are practical. Regular exercise in pregnancy is linked with a lower risk of gestational diabetes and excessive weight gain, better sleep and mood, and fewer back and pelvic aches. It won't guarantee an easy labour, but it gives you a fitter body to go through it with.

What goes into the program

Trimester by trimester

• First trimester

  Nausea and tiredness often run the show. Keep some activity going, even short walks. It's not the time to start high-intensity training you've never done before.

• Second trimester

  Usually the best stretch for exercise. We build strength and fitness, and start limiting long periods lying flat on your back.

• Third trimester

  Maintain rather than build. Impact comes down, labour positions and pelvic floor relaxation come in, and sessions adapt around any pain.

How hard is hard enough?

Heart rate targets for pregnancy have largely been dropped because they vary so much between women. We use the talk test instead: you should be able to hold a conversation, even if you couldn't sing. On a scale of 0 to 10, most of your exercise should feel like a 5 or 6. Women who were already running or lifting before pregnancy can often continue at a higher level with sensible changes, and we help plan those changes rather than telling you to stop.

What we change or avoid

• Contact sports and anything with a real risk of falling, such as horse riding, skating or mountain biking
• Hot yoga and exercising in very hot, humid conditions
• Scuba diving
• Holding your breath while lifting heavy weights
• Exercises that make the midline of the tummy bulge or dome, which we swap for alternatives
• Long spells lying flat on your back later in pregnancy

Who needs a doctor's go-ahead first

Most women can exercise safely in pregnancy. Some conditions mean your obstetrician needs to decide what's appropriate before we start, including:

• Persistent bleeding in the second or third trimester
• Placenta previa after 26 weeks
• Ruptured membranes or signs of preterm labour
• Pre-eclampsia or pregnancy-induced high blood pressure
• Cervical insufficiency or a cervical stitch
• Significant heart or lung disease, or severe anaemia

Stop and seek advice if you notice

• Vaginal bleeding or a leak of fluid
• Regular, painful contractions
• Dizziness, faintness, chest pain or breathlessness before you start exercising
• A severe headache
• Calf pain or swelling
• Your baby moving less than usual

How the sessions work

The first session is one-to-one: history, a check of posture, strength and any pain, then a program you can do at home or at the gym. Follow-ups adjust it as you move through the trimesters. If you already have back pain or pelvic girdle pain, the program is built around it rather than on top of it. Some women like to combine this with our therapeutic yoga classes once we've checked what suits them.

Frequently asked questions