Co-authored by Nicole Golden and Jennifer Rought, Pre/Post Natal Corrective Exercise Specialist.
Exercise during pregnancy can be quite beneficial though there are many myths and concerns surrounding safe exercise practices during this time.
A well-planned training program can provide benefits such as reduction in the risk of gestational diabetes, improved strength for labor and delivery, improved movement mechanics, which can reduce pregnancy-related discomfort, and enhancements in flexibility, balance, strength, and cardiovascular health (Hammer et al., 2000).
Despite the health benefits of exercise during this period, there is much questionable information regarding exercise and pregnancy circulating through social media channels. Often, women feel pressure to maintain a particular physique, and this extends into pregnancy.
Similarly, well-meaning bloggers may provide health recommendations with little
evidence to support the claims (i.e., the pregnancy squat challenge). There are critical physiologic factors to consider when participating in a pre and peri-natal exercise program, depending on which trimester. Let us dive into some evidence-based recommendations.
If you are a Women's Fitness Specialist, the information within this blog can be applied to how you approach training clients.
Are Squats Safe During Pregnancy?
It is vital that a pregnant woman get a complete medical evaluation from her doctor and medical clearance to exercise.
In the case of an uncomplicated pregnancy with physician clearance, squats are safe to perform during all three trimesters of the pregnancy.
See also, progressive exercises for post pregnancy for options after pregnancy as well.
The benefits of squats during pregnancy
Doing squats during pregnancy can have some great benefits for the mother-to-be in preparation for the changes to her body, labor, and delivery (Artal, 2003).
Physiologically speaking, a pregnant woman will have the hormone relaxin surging in her body, making her ligaments and joints looser and less stable. This, along with a change in center of gravity, can cause low back pain, hip, and pelvic pain, and cause posture problems.
Squatting promotes stronger gluteals, and a person's gluteal muscles are a central part of stabilizing and mobilizing the hips and pelvic region. Squats can therefore assist with alleviating pain, promoting stability, and optimal movement patterns (Evenson et al., 2013)
Squatting and Pelvic Floor Muscles
As the fetus continues to grow in utero, it can put a lot of pressure on the mother's pelvic floor musculature, thereby weakening it.
A weak pelvic floor musculature can cause incontinence during pregnancy and even continue into the post-natal stage. A balanced exercise program focused on transverse abdominis (TVA) activation, Kegel exercises, and squats in tandem can help strengthen a women's pelvic floor (Pires et al., 2020).
Overall, in an otherwise uncomplicated pregnancy, squats are not only safe but can be incredibly beneficial for the expectant mother.
Exercise (and Squat) Considerations in the First Trimester
The first trimester of pregnancy can leave an expectant mother (even an athlete) feeling nauseous and exhausted. However, the pregnancy is well-protected by the mother's pelvic bones and is relatively small.
At this point, the cardiac system begins to gear up to support the growth and development of the fetus by increasing cardiac output by 20 percent: body temperature and metabolic rate increase. The expectant mother may find it difficult to exercise in hot and/or humid conditions (Soma-Pillay et al., 2016).
Performing squats during this period is not necessarily a problem. However, there is limited research on specific volumes and intensity for exercise prescription in the general population. Therefore, guidelines for strength training during this period involve lighter loads (or bodyweight) and more repetitions (Evenson et al., 2013).
Pregnant athletes who are already well-trained can often continue their same training regimen during this period as their bodies allow (Kardel, 2005).
Generally, participating in routines that include very deep squats with heavy loads is not recommended due to lack of evidence supporting their safety.
This is especially true if the expectant mother was not used to heavy squatting before her pregnancy. Incorporating squats that can help reinforce good movement patterns with lighter loads is likely safe and incredibly beneficial during this period (Kehler & Heinrich, 2015).
Exercise (and Squat) Considerations in the Second Trimester
The second trimester of pregnancy often comes with some relief in that fatigue and nausea will usually start to subside. Yet, more changes to the body can alter a pregnant woman's exercise routine during this period. You can alter the balance and stability during this trimester as spinal alignment may shift to accommodate the growing belly.
Round ligament pain and increased laxity in the joints can lead to an increased injury risk when it comes to higher impact plyometric movements such as squat jumps, box jumps, or depth jumps (Evenson et al., 2013)
Foundational movements like squats and lunges are still perfectly safe during this period and can be quite beneficial for reinforcing good spinal alignment and lower body strength. It is important to focus training efforts on maintaining good posture, core stability, and overall balance.
Again, there are different considerations for female athletes who have been training before pregnancy. Still, any exercises that cause significant pain and discomfort (including heavy squats) should be avoided (Sims, 2016).
Stabilization Endurance Training and PRegnancy Squats in 2nd trimester
These movement skills can be maximized by training in the Stabilization Endurance (Phase 1) and Strength Endurance (Phase 2) phases of the OPT Model with lighter loading for the strength exercises.
Repetition and sets should range from 12-20 reps with an intensity of 50-70 % of the 1RM in the Stabilization Endurance Phase and 8-12 reps with an intensity of 70-80% of the 1RM in the Strength Endurance Phase (Clark et al., 2014).
It may be wise to stick with the lower ranges of intensity for resistance training unless you are a trained athlete before pregnancy (Kardel, 2005). This is true of squat exercises.
Exercise (and Squat) Considerations in the Third Trimester
The third trimester can make an exercise routine a bit more challenging, even for seasoned athletes. The cardiac system is under more strain during this time as blood volume and cardiac output increase substantially. The pregnant woman's center of gravity will continue to shift in this phase, and the range of motion on some activities (such as putting on running shoes) can be limited.
It is also common for the expectant mother to have a lower tolerance for exercise in hot/humid conditions or at high intensities (Cooper & Yang, 2020). However, if tolerated, moderate and even vigorous exercise is still considered safe during this period, especially in women who have been training throughout their pregnancies (Beetham et al., 2019).
Exercise in this period should focus on preparation for delivery, overall flexibility, and mobility. Exercises to strengthen the pelvic floor (including squats) are generally safe and beneficial until delivery (Sims, 2016).
Still, it is important for the expectant mother to listen to her body and avoid any exercises that cause significant pain and discomfort.
Benefits of Exercise During Pregnancy and Preparing for Delivery
Although it used to be thought that pregnant women should not engage in any type of exercise and instead become more sedentary or risk the health of themselves or babies, exercise is now recommended and encouraged throughout a pregnancy (Chan et al., 2019). This can include women with some medical risks during pregnancy if they have a thorough medical evaluation and clearance from their doctor (Artal, 2003).
In fact, Baena-García et al. (2020) conducted a study demonstrating that increased physical fitness during pregnancy can lower the possibility of a woman needing a cesarean section and improve neonatal outcomes.
Although there are many benefits of maintaining an exercise routine throughout pregnancy, one of the most important benefits of exercising during pregnancy is increasing a woman's endurance for labor.
Gradually and safely increasing a woman's overall cardiorespiratory and muscular endurance throughout her pregnancy via cardio and strength training is key to helping her have an easier labor and delivery (Kehler & Heinrich, 2015).
A balanced exercise plan will incorporate things like squats into the routine to give the woman a well-rounded and healthy way to exercise. Squats are only one of many ways to build strength and endurance in the lower body, though, and should only be incorporated as a part of a balanced program.
Pregnancy Squat Challenge: Is it a Good Idea?
The "Pregnancy Squat Challenge" is currently being circulated on social media platforms. This challenge stems from a blog post that has women performing squats two weeks prior to their delivery date and increasing the number of squats they do every day until they reach 350 squats a day just a day before their due date.
The claim being suggested by this challenge is that it will speed up labor and make giving birth easier How to Speed Up Labor: Do Squats During Pregnancy! - Diary of a Fit Mommy (Cooper, 2016)
There is no substantial scientific evidence to support these claims, nor is it a good idea to do these types of challenges for several reasons:
1. This challenge recommends that a pregnant woman begin performing squats two weeks before her due date. Two weeks prior to giving birth is not the time to start new exercises or add this type of intensity level to existing prenatal fitness routines. At this point in a pregnancy, a woman's body is preparing for delivery which can increase fatigue and discomfort (Sims, 2016). Performing hundreds of squats at a time may exacerbate these symptoms with little benefit.
2. Working the same muscle or muscles every single day does not allow adequate muscle recovery. The point of working any muscle is to build strength and muscle endurance. A balanced exercise program will allow for recovery time between exercise sessions to allow for recovery of the muscle group as opposed to stressing the same muscle group with very high frequency (daily) high volume (may repetitions) of the same exercise (Clark et al., 2014).
3. Performing a high number of squats in an otherwise untrained person can trigger significant muscle soreness. The later part of pregnancy going into delivery already comes with discomfort, pain, and fatigue. Additional muscle soreness is not beneficial for improving the speed or outcome of labor and delivery. In fact, if a woman is under physiologic stress, it can increase the pain of labor and sometimes prolong it (Slade et al., 2021).
4. The National Academy of Sports Medicine stabilization endurance phase recommends a repetition range of 12-20 per exercise set. There is no evidence to suggest that increasing repetitions beyond 20 per set is necessarily beneficial to a pregnant woman training in the stabilization endurance phase, and those ranges are lower in the strength endurance phase (Clark et al., 2014). The number of squats this challenge requires a woman to perform in each set is far outside guidelines and not recommended for any population, especially pregnant women two weeks from giving birth.
Learn more about common squat misconceptions here.
Conclusions
Squats can be an extremely safe and effective exercise to include as part of a balanced exercise program throughout a woman's pregnancy. This is true of all three trimesters.
However, beginning a program heavy in one type of exercise (i.e., the Pregnancy Squat Challenge) is not necessarily effective or supported by evidence. Rather, incorporating squats as part of a comprehensive exercise program and remaining active during the prenatal period can lead to an easier overall pregnancy and delivery experience.
References
- Artal, R. (2003). Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. British Journal of Sports Medicine, 37(1), 6–12. https://doi.org/10.1136/bjsm.37.1.6
- Baena-García, L., Coll-Risco, I., Ocón-Hernández, O., Romero-Gallardo, L., Acosta-Manzano, P., May, L., & Aparicio, V. A. (2020). Correction: Association of objectively measured physical fitness during pregnancy with maternal and neonatal outcomes. The GESTAFIT Project. PLOS ONE, 15(4), e0231230. https://doi.org/10.1371/journal.pone.0231230
- Beetham, K. S., Giles, C., Noetel, M., Clifton, V., Jones, J. C., & Naughton, G. (2019). The effects of vigorous-intensity exercise in the third trimester of pregnancy: a systematic review and meta-analysis. BMC Pregnancy and Childbirth, 19(1). https://doi.org/10.1186/s12884-019-2441-1
- Chan, C. W. H., Au Yeung, E., & Law, B. M. H. (2019). Effectiveness of Physical Activity Interventions on Pregnancy-Related Outcomes among Pregnant Women: A Systematic Review. International Journal of Environmental Research and Public Health, 16(10), 1840. https://doi.org/10.3390/ijerph16101840
- Cooper, D. B., & Yang, L. (2020). Pregnancy And Exercise. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430821/
- Cooper, S. (2016, April 15). How to Speed Up Labor: Do Squats During Pregnancy! Diary of a Fit Mommy. https://diaryofafitmommy.com/how-to-speed-up-labor-do-squats-during- pregnancy/
- Evenson, K. R., Barakat, R., Brown, W. J., Dargent-Molina, P., Haruna, M., Mikkelsen, E. M., Mottola, M. F., Owe, K. M., Rousham, E. K., & Yeo, S. (2013). Guidelines for Physical Activity During Pregnancy. American Journal of Lifestyle Medicine, 8(2), 102–121. https://doi.org/10.1177/1559827613498204
- Hammer, R. L., Perkins, J., & Parr, R. (2000). Exercise During the Childbearing Year. Journal of Perinatal Education, 9(1), 1–13. https://doi.org/10.1624/105812400x87455
- Kardel, K. R. (2005). Effects of intense training during and after pregnancy in top-level athletes. Scandinavian Journal of Medicine and Science in Sports, 15(2), 79–86. https://doi.org/10.1111/j.1600-0838.2004.00426.x
- Kehler, A. K., & Heinrich, K. M. (2015). A selective review of prenatal exercise guidelines since the 1950s until present: Written for women, health care professionals, and female athletes. Women and Birth, 28(4), e93–e98. https://doi.org/10.1016/j.wombi.2015.07.004
- Pires, T. F., Pires, P. M., Costa, R., & Viana, R. (2020). Effects of pelvic floor muscle training in pregnant women. Porto Biomedical Journal, 5(5), e077. https://doi.org/10.1097/j.pbj.0000000000000077
- Slade, P., Sheen, K., Weeks, A., Wray, S., De Pascalis, L., Lunt, K., Bedwell, C., Thompson, B., Hill, J., & Sharp, H. (2021). Do stress and anxiety in early pregnancy affect the progress of labor: Evidence from the Wirral Child Health and Development Study. Acta Obstetricia et Gynecologica Scandinavica. https://doi.org/10.1111/aogs.14063
- Soma-Pillay, P., Nelson-Piercy, C., Tolppanen, H., & Mebazaa, A. (2016). Physiological changes in pregnancy. Cardiovascular Journal of Africa, 27(2), 89–94.Your blog post content here…
