What sort of exercise is best in pregnancy?

For most healthy pregnancies, major organizations (ACOG, SMFM, WHO, Canadian, and U.S. guidelines) generally recommend:

• At least 150 minutes per week of moderate intensity aerobic activity
  (for example, 30 minutes on 5 days per week), plus
• Muscle strengthening activities on 2 or more days per week that work major muscle groups, plus
• Regular pelvic floor (Kegel) exercises

The Top 3 “MFM-Approved” Exercises

While every patient is different, as a maternal-fetal medicine physician these three categories are generally the safest and most effective for the pregnant body.

1. Swimming and Water Aerobics

• Why it’s the best: Water supports your weight, relieving the strain on your lower back and pelvic floor. It also helps redistribute fluid, which can reduce that nagging swelling (edema) in your legs and feet.
• The Benefit: It provides cardiovascular conditioning without the risk of falling or joint impact.

2. Walking

• Why it’s the best: It requires no equipment, can be done anywhere, and is easy to modify.
• The Benefit: Regular walking is excellent for blood sugar control. I often recommend my patients with gestational diabetes take a 15-minute walk after meals to help blunt glucose spikes.

3. Prenatal Yoga or Pilates

• Why it’s the best: These focus on core stability and breathing—two things you will desperately need during labor and delivery.
• The Caveat: You must be careful with relaxin. This is a hormone your body produces to loosen ligaments for birth. It makes you more flexible, but also more prone to injury and overstretching. Stick to “prenatal” specific classes that avoid deep twists or lying flat on your back (which can compress the vena cava and reduce blood flow to the baby).

What to Avoid

While we encourage movement, there is physical activity you should avoid during pregnancy.

• Contact sports: Soccer, basketball, or boxing carry a risk of abdominal trauma.
• Fall risks: Horseback riding, downhill skiing, or road cycling (where balance is compromised).
• Hot Yoga/Hot Pilates: Overheating (hyperthermia) is a risk, particularly in the first trimester, as it can affect neural tube development.

The High-Risk Exception: When Not to Exercise

This is where my role as an MFM comes in. While exercise is healthy for most, there are specific conditions where I may ask you to limit activity or stop entirely. These are some  contraindications:

• Emergency cerclage placement (a stitch in the cervix).
• Placenta previa (placenta covering the cervix).
• Ruptured membranes (water breaking).
• Preeclampsia or pregnancy-induced hypertension.
• Persistent vaginal bleeding.
• Risk of preterm labor (regular, painful contractions).