Exercise in High-Risk Pregnancy

Practical counseling for patients with medical/obstetric risk factors: screen first, then prescribe a safe, sustainable routine—and individualize for athletes.

Goal: move most days
Prefer low-fall-risk modes
Use “talk test” / RPE
Clinical bottom line: In the absence of contraindications, prenatal physical activity (aerobic + resistance training) is associated with meaningful reductions in several pregnancy complications and is generally safe. Previously active women often can continue, with modifications as pregnancy progresses. [1]
Print note: Use this page as a counseling aid; defer to the patient’s obstetric provider for individualized restrictions.
High-risk pregnancy requires clearance. This page is for education and shared decision-making. If a patient has bleeding, contractions, ruptured membranes, placenta/vasa previa, significant cardiopulmonary disease, severe-range hypertension, or other serious complications, exercise may be restricted or contraindicated—follow the treating obstetric team’s plan.

1) Safety Screen

A. “Stop now & call your obstetric team” warning signs

  • Vaginal bleeding
  • Leakage of fluid (possible rupture of membranes)
  • Regular painful uterine contractions
  • Severe chest pain or persistent shortness of breath not resolving with rest
  • Persistent dizziness/faintness not resolving with rest

These “stop” reasons are emphasized in the Canadian guideline safety boxes. [1]

B. Choose safe modes of exercise in pregnancy

Preferred (low fall/contact risk)
  • Brisk walking
  • Stationary cycling
  • Swimming / aqua fitness
  • Elliptical
  • Light-to-moderate resistance training
Avoid
  • Contact sports
  • Activities with high fall risk (e.g., downhill skiing, horseback riding)
  • Scuba diving
  • “Olympic lifts” / gymnastics-style lifting (fall/impact risk)
  • Avoid physical activity in excessive heat, especially with high humidity
  • Women who live below 2500 m altitude should avoid physical activity at high altitude ( greater than 2500m).

Canadian guideline lists gymnastics/Olympic lifts among higher-risk activities. [1]

C. Intensity guide (practical)

  • Talk test: moderate = “talk but not sing.” [1]
    • Moderate intensity (goal for most workouts): you can talk in full sentences, but you can’t sing. Breathing is faster but controlled.
    • Vigorous intensity: you can say only a few words at a time before needing to breathe.
    • Too hard / back off: you can’t speak more than 1–2 words, feel breathless, dizzy, or unwell—slow down/stop.
  • Heart rate zones (optional): for vigorous training, pregnancy-specific ranges were derived from screened low-risk pregnant women; women aiming for the upper end (heart rate range greater than 160 beats/min) should consult an obstetric provider. [1]
  • High intensity: chronic high-intensity training above guideline levels has limited evidence; consider only in a monitored/closely supervised context. [1]
Quick prescription template (FITT) Frequency • Intensity • Time • Type
  • Frequency: aim for activity on most days; start lower if deconditioned.
  • Intensity: moderate by talk test/ rate of perceived exertion (RPE) ; avoid “all-out.”
  • Time: 10–30 min bouts; build weekly minutes gradually.
  • Type: mix aerobic + resistance; add gentle mobility/yoga if helpful. [1]

2) Practical Routines (examples after obstetric clearance)

These are “starter templates” designed for common higher-risk contexts (e.g., diabetes, hypertension, prior preeclampsia, obesity). If the patient has restrictions (bleeding, previa, preterm labor risk), follow the treating team’s plan.

A. Low-impact aerobic base (most patients) Walking • stationary bike • swimming
  • 3–5 days/week
  • 20–30 minutes (can be split: 10 + 10 + 10)
  • Intensity: “talk but not sing” (moderate) [1]
  • Progression: add 5 minutes/session each week as tolerated
B. Gestational diabetes / glucose-focused week Post-meal walks • resistance circuits
  • After meals: 10–20 min easy-moderate walk (especially after dinner)
  • 2 days/week resistance: 20–25 min circuit (see Routine C)
  • Safety: hydrate and carry quick carbs if on insulin/agents that can cause hypoglycemia

Prenatal activity is associated with improved maternal glucose and reduced odds of several complications in guideline reviews. [1]

C. Prenatal strength (safe default) Bands • dumbbells • machines

2–3 nonconsecutive days/week

Exercise Prescription Notes
Supported squat or sit-to-stand 2–3 sets × 8–12 reps Exhale on effort; avoid breath-holding/straining.
Hip hinge (light RDL) or glute bridge 2–3 × 8–12 Bridge if comfortable; modify if supine symptoms occur. [1]
Row (band/cable) + chest press (machine) 2–3 × 8–12 each Prefer stable positions as balance changes.
Step-up (low box) or split squat (supported) 2 × 8–10/side Hold rail/wall for balance.
Overhead press (light) or lateral raise 2 × 8–12 Stop if dizziness or headache.
Core: side plank (knees) / bird-dog 2 × 20–30 sec Avoid aggressive “bracing” that increases intra-abdominal pressure.
Pelvic floor muscle training (PFMT) Daily short sets May reduce odds of urinary incontinence. [1]
Strength training is encouraged as part of prenatal activity (with appropriate technique and modifications). [1]
D. Hypertension, controlled / prior preeclampsia (conservative) Lower peaks • steady pacing
  • 4–6 days/week easy-moderate aerobic (walk/bike/swim)
  • Avoid “all-out” intervals unless specifically cleared and monitored
  • Emphasize cool-down, hydration, and avoiding overheating
  • If symptoms (headache, visual changes, RUQ pain, chest pain) occur → stop and seek care

3) Elite Athletes: Running & Weight Training

Direct evidence for elite and competitive amateur athletes (≥10 hours/week) is limited, so recommendations are typically individualized and based on close observation of maternal and fetal well-being. [2]

A. Long-distance runners (how to keep running safely) Maintain fitness • reduce risk
  • Intensity ceiling: avoid maximal efforts; fetal HR decelerations have been reported when maternal effort exceeds ~90% max HR in performance tests. [2,4]
  • Vigorous training: vigorous exercise into the 3rd trimester appears safe for most low-risk pregnancies, but avoid ≥90% max HR until better evidence exists and individualize if fetal growth is borderline. [3]
  • Practical pacing: use talk test/RPE; consider “tempo becomes steady moderate” and replace VO₂max sessions with controlled intervals or hills at submaximal effort.
  • Volume: reduce weekly mileage as symptoms, heat intolerance, pelvic girdle pain, or urinary symptoms arise; cross-train (bike/swim) to keep aerobic load.
  • Environment: prioritize cooler settings; hydrate and fuel (avoid low energy availability).
  • Stop triggers: contractions, bleeding, fluid leakage, dizziness, chest pain, severe SOB—stop and call. [1]
B. Weight training (how to modify strength work) Technique • breathing • stability
  • Default approach: shift from maximal strength to “strength-endurance”: moderate loads, 6–12 reps, 2–4 sets, longer rest, pristine form.
  • Avoid breath-holding/Valsalva (exhale on effort) to reduce spikes in pressure and dizziness.
  • Stability first: prefer machines, cables, supported dumbbell lifts as balance changes.
  • Avoid high fall/impact lifting: activities with danger of falling are discouraged; Canadian guidance explicitly lists gymnastics/Olympic lifts among higher-risk activities. [1]
  • Supine modification: if lightheaded or unwell lying flat, avoid/modify supine positions. [1]
  • “All-out” testing: postpone 1RM testing and maximal conditioning tests until postpartum; keep hard efforts below the >90% max HR zone described in athlete reviews. [2–4]
Monitoring suggestion (athletes): If continuing vigorous training, consider periodic check-ins with obstetric care. Athlete-focused evidence reviews highlight fetal HR decelerations primarily with very high intensity (>90% max HR). [2,4]

SEE ALSO

Nutritional Supplements

Nutrition


Updated 1/3/2026
References
  1. Mottola MF, et al. 2019 Canadian guideline for physical activity throughout pregnancy. Br J Sports Med (Consensus statement PDF). Safety precautions, stop criteria, resistance training, and notes on high-intensity/monitored environments. Open PDF
  2. Wieloch N, et al. Sport and exercise recommendations for pregnant athletes: a systematic scoping review. BMJ Open Sport & Exercise Medicine. Notes fetal HR decelerations reported during performance tests >90% max HR. Open full text (PMC)
  3. Beetham KS, et al. The effects of vigorous intensity exercise in the third trimester of pregnancy: systematic review and meta-analysis. BMC Pregnancy and Childbirth (PMC). Concludes vigorous exercise into 3rd trimester appears safe for most low-risk pregnancies; advises avoiding ≥90% max HR pending further evidence. Open full text (PMC)
  4. Wowdzia JB, et al. Elite Athletes and Pregnancy Outcomes: A Systematic Review and Meta-analysis. Med Sci Sports Exerc. Summarizes limited evidence; reports rare fetal bradycardia episodes after high-intensity exercise resolving quickly. Open on PubMed
  5. ACOG News Release (2020). ACOG releases updated guidance on exercise in pregnancy and postpartum. Open
  6. ACOG Committee Opinion Number 804 (Replaces Committee Opinion Number 650, December 2015.) ACCESSED 1/3/2026
  7. ACOG Committee Opinion No. 650: Physical Activity and Exercise During Pregnancy and the Postpartum Period. Obstet Gynecol. 2015 Dec;126(6):e135-e142.  PMID: 26595585.

Disclaimer: This OBRx page is for educational use and does not replace individualized medical advice. For high-risk pregnancies, follow the treating obstetric team’s restrictions and monitoring plan.