The Barbell Mamas Podcast | Pregnancy, Postpartum, Pelvic Health
The times are changing and moms have athletic goals, want to exercise at high-intensity or lift heavy weights, and want to be able to continue with their exercise routines during pregnancy, after baby and with healthcare providers that support them along the way.
In this podcast, we are going to bring you up-to-date health and fitness information about all topics in women's health with a special lens of exercise. With standalone episodes and special guests, we hope to help you feel prepared and supported in your motherhood or pelvic health journey.
The Barbell Mamas Podcast | Pregnancy, Postpartum, Pelvic Health
The Evolution of Prenatal Exercise: Breaking Down Barriers
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Pregnancy fitness has undergone a revolution. What was once a landscape of caution and restriction has transformed into one of empowerment and evidence-based freedom. In this candid exploration, pelvic floor physical therapist Christina Previtt shares both personal experience and cutting-edge research showing just how dramatically prenatal exercise recommendations have evolved.
Remember when lifting anything over 20 pounds during pregnancy was considered dangerous? When heart rate limits were gospel? When certain sports were absolutely off-limits? Those days are rapidly disappearing as research consistently demonstrates that pregnant bodies are far more capable than previously believed. Christina walks us through the mountain of evidence now supporting strength training during pregnancy, including studies showing that previously feared practices like lifting heavy weights, exercising on your back, and holding your breath during lifts pose no threat to mother or baby. Similarly, intensity restrictions for cardio have been largely debunked, with studies of ultramarathoners and other endurance athletes challenging our assumptions about exercise limits.
Perhaps most fascinating is the shift in how we approach sports participation during pregnancy. From soccer players to equestrians to even bull riders, athletes are pushing back against blanket restrictions in favor of individualized risk assessment based on their intimate knowledge of their sports and bodies. The trend is clear: pregnancy exercise is moving away from one-size-fits-all prescriptions toward personalized approaches that respect each individual's unique pregnancy journey.
Christina also candidly addresses where research gaps remain, particularly around the pelvic floor, and shares exciting developments from her current research that may soon provide answers to these lingering questions. Whether you're an athlete, fitness enthusiast, or health professional, this episode offers valuable perspective on how far we've come and where we're headed in the world of pregnancy fitness.
Have questions about exercise during pregnancy or postpartum that you'd like to see addressed by future research? Christina would love to hear from you as she continues her work in this rapidly evolving field.
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Hello everyone and welcome to the Barbell Mamas podcast. My name is Christina Previtt. I'm a pelvic floor physical therapist, researcher in exercise and pregnancy, and a mom of two who has competed in CrossFit, powerlifting or weightlifting, pregnant, postpartum or both. In this podcast, we want to talk about the realities of being a mom who loves to exercise, whether you're a recreational exerciser or an athlete. We want to talk about all of the things that we go through as females, going into this motherhood journey. We're going to talk about fertility, pregnancy and postpartum topics that are relevant to the active individual. While I am a pelvic floor physical therapist, I am not your pelvic floor physical therapist and know that this podcast does not substitute medical advice. All right, come along for this journey with us while we navigate motherhood together. Hello everybody and welcome to the Barb Alvama podcast.
Speaker 1:Christina Previtt here and first of all, thank you all so much for your congratulations and your kind messages about my pregnancy announcement. It has been super exciting to kind of get past what I consider my tentative time. I know that things can still happen, but I did breathe a lot easier getting past the time when I had my previous loss and hopefully I'll be able to see baby soon, and I am just that person that just loves to share when I'm expecting because it's such a joyful moment, even though you know I've had some sad stories along that journey. So thank you all so much for reaching out to me Today. What I wanted to talk about is kind of this acknowledgement of truly how far we have come in the research around exercise in pregnancy and postpartum. I wanna go through actually quite a few examples that we have seen some really positive change. We have really moved the needle on what we thought and just kind of acknowledge that, because I know for me I can get really in my head or I can really be discouraged that it feels like, oh my gosh, there's just so far for us to go. There's still so many studies that are needed, there's so much uncertainty in certain areas of pregnant and postpartum exercise. But despite the fact that there are still all these unanswered questions I have to step back and reflect on. You know, there is a lot that has changed in the last little while and the whole point of science and research and discovery is that we're continuing to ask more questions as this data continues to accumulate, which is kind of cool. So let's start first with pardon me, where we've gone, like let's talk about what has really changed in the space of exercise and pregnancy.
Speaker 1:So today I got tagged by Jacinta Carroll. She is pregnant with her second child. She was a national, international level water skier, olympic weightlifter, has been lifting heavy in her first pregnancy, lifting heavy in her second, and she sent a message while she was lifting heavy and she's right towards the end of her pregnancy and said how it's so cool that she's in this space where she is surrounded by research that's being done to allow her to continue doing what she's loving in pregnancy. And that's kind of what prompted me to be thinking about this episode. So the first thing I'm going to talk about is just the truly astronomical flip in the idea around lifting in pregnancy. Flip in the idea around lifting in pregnancy, deciding to lift heavy and by heavy I'm meaning legit anything over like a 15 or 20 pound dumbbell.
Speaker 1:You know, 10 years ago was one extremely rare and two met with a lot of criticism, and my first pregnancy was about seven years ago. My daughter is six now and I had a lot of people not necessarily telling me I had some people say your baby's going to die, but I also had a lot of really well-meaning pelvic providers who was telling me that what I was doing was unsafe and it was because that was the idea that we had at the time. And so fast forward now to where we're at in 2025. And it is just so cool to see that it is not rare anymore. It is actually pretty common, and in some cases, people are saying you should prioritize strength training over aerobic training when it comes to building capacity and helping your body stay pain free or pain managed in pregnancy, and that is a massive switch. And so some of that is on the mom side of the spectrum, where there's a lot more moms who want to engage in strength training, who love strength training and want to keep at it, and so that exposure effect has made it so that when you have a person ripping a heavy deadlift up off the ground and they're noticeably pregnant, the comment section doesn't turn into a complete dumpster fire, which it used to. I felt like I would go into the comment sections fighting for my life, fighting for the client's life or for the poster's life, rather, because, oh my gosh, all the comments were so aggressive saying that this was something that was bad. So that kind of exposure effect I think has really changed public perception of lifting in pregnancy.
Speaker 1:And then we've also had a lot of really cool studies that have come out. Some of mine are contributing to this growing body of literature a lot that have come out of my lab and we're now starting to get a density of research studies right. It's not just one study that has shown maybe it's okay. There is now studies that are looking at acute blood flow to mom and baby, looking at changes in breath when you're holding your breath while lifting and exhaling while you're lifting, and showing that it's safe for mom and baby.
Speaker 1:I just posted about another study that was being consistent with the findings from our lab, showing that lifting on your back is not causing harm to mom or baby and acknowledging that one of the things that used to freak us out and now we're starting to realize is normal is transient heart rate variability with exercise. What I mean by that is when we're doing checks with baby is transient heart rate variability with exercise. What I mean by that is when we're doing checks with baby we are often doing checks on mom when she has been sitting at rest for a certain amount of time. What we really hadn't studied, acknowledged or kind of pulled together is that baby's heart rate at rest, when mom is at rest, may be different than baby's heart rate when mom is exercising. And so having some of these changes and dips in heart rate up or down when they are transient in response to mom's physiology, may not be bad, and we're actually seeing that if mom is exercising and heart rate is up, that in some cases baby's heart rate goes up, and when we look at what that means for mom and baby, we're seeing positive metabolic adaptation to baby. It's like she's taking on or he is taking on some of mom's fitness adaptation, which is so freaking cool right, it's so cool which has been a very big change in the strength training space.
Speaker 1:Another thing that we've started to have more density of research in that has allowed us to remove some of these ideas around how to scale or how to modify includes these studies around how we're breathing while we're lifting and in what position we are in. Having more than one study and showing consistent findings increases our sense of safety as healthcare providers to say, hey, that modification that you can't lift on your back anymore, or that modification that you have to exhale on exertion or you can't hold your breath while you're lifting. We can kind of put those recommendations to bed now and instead of saying safe versus unsafe, we can kind of go from a performance and feel perspective and say, hey, if you're not feeling good lying on your back, just prop those shoulders up. If you feel really nauseous and if you're bracing really hard, it makes that nausea really worse. In your first trimester, try exhaling on exertion so that you get rid of some of that intensity of that brace which might feel like you're up chucking and that you want to throw up right, like what we're doing is we're moving away from this prescriptive this is what is safe and this is what isn't and moving to this individualization, this creation of exercise programming that fits the human that is exercising, which I think is really neat, flipping from the aerobic space to the or from the resistance space to the aerobic space.
Speaker 1:We have seen in the last little while more and more research that has come out that gives us a ton of really cool insight around running and high intensity aerobic training while pregnant. My lab group, margie, just published a couple of months ago a case study of a ultra marathon runner who ran throughout multiple pregnancies returned to elite level competition and was a very intense example, in a good way, of somebody who was used to having super high levels of physical activity levels of physical activity and what that has done is shown where the limit is, or asking does the limit exist? This was followed up by a research study that was looking at individuals who are endurance athletes or recreational training athletes that they exercise more than 300 minutes. Our guidelines in exercise talk about accumulating 150 minutes of exercise in pregnancy, and we have to acknowledge that there's going to be some people who are blowing past those numbers. If I look at my Garmin, if I'm exercising resistance training at intensity plus my running, it's very easy for me to hit over 275 to 300 minutes of moderate to various physical activity, because also parenting accumulates some of that time.
Speaker 1:If we're looking at accelerometer-based data and heart rate-based data, and so what we are starting to see is this accumulation of evidence that heart rate targets don't seem to have any credibility. We're starting to kind of debunk the need for heart rate zones. We used to say you have to pass the talk test and if you can't talk, you're exercising too intensely. In pregnancy that we can move away from. In pregnancy that we can move away from. We are now seeing that people can work out at 300 plus minutes. When you're doing a lot of that aerobic activity, your rate for something like diastasis recti may be a little bit higher, but strength training is going to be able to mitigate some of those changes and it's likely just a lot of up and down sheer force, especially if you're a runner on your stretched tissue, so something that you want to be aware of. But none of that is a concern from a safety and well-being perspective in your pregnancy and in that postpartum period or for your baby. And so we're starting to see that those recommendations are being knocked down.
Speaker 1:And thank goodness, if you saw my garment for my running in my first trimester, I'm so thankful I'm still able to run at almost 10 weeks. But I'm high, like I'm averaging probably 160. I'm not a very good runner. I don't care about zones. I know people talk about zones. I'm not good enough to care about zones. I just go out and run with my dog and I freaking love it. And if my heart rate is 150, cool. If it's 180, that's probably a rough day for me, but I'm okay and I don't worry about it as a pregnant individual, which is very cool, because we used to get to this point where we would worry about it or you would have this target of 140 or 150, and that's kind of been debunked, and so those are big recommendations that we used to have and kind of nuances in these recommendations that we used to have that we have given a lot more freedom to the person that's pregnant and I think that's super exciting.
Speaker 1:Another area that, especially in the last I would say six to 12 months, we have seen push back around is the different types of sports that individuals can participate in and what their obstetrical team thinks about participating in those sports. Now, the evidence or the recommendation was never that soccer isn't safe when you are pregnant. It was that anything that causes you to have a higher than acceptable risk and I'm kind of putting air quotes around this should be discouraged in pregnancy. That created a lot of blanket statements and caused individuals to say you should, after X amount of weeks or as soon as you find out you're pregnant, you should avoid these exercises. Don't horseback ride, don't do any type of contact sport, and that was kind of that recommendation.
Speaker 1:But what we're starting to see in the FIFA group again, margie's involved in that and what we're starting to see is that these group again, margie's involved in that what we're starting to see is that these athletes aren't accepting that recommendation because they have such a detailed understanding of what happens to their body in sport that they are choosing differently, and that is maybe sometimes against medical advice, but ideally, and where we hope that this is going to go, is coming alongside their obstetrical team and making very conscious decisions about exercise in the sports-related space, and so that's really exciting. And so we're starting to see more of these athletes who understand their bodies, understand their sports, say okay instead of no, let's say it depends, and modify and adapt as necessary. And you know, when you step back, this makes so much sense, right. And you know when you step back, this makes so much sense, right. Like you could be doing skills and drills on a soccer pitch and not be playing in high contact games where the relative risk is higher, for example and even some athletes may disagree with me around those contact hits, and that they have been playing for years and never hit the floor right. So we have this change in idea.
Speaker 1:We're seeing a similar trend happen in equestrian, where again, the thought of being bucked off a horse or falling off of a horse was the concern, not the act of riding that horse, which has meant that equestrian riders have pushed back on this recommendation and said I trust my horse with my life and I feel okay. There is a person on TikTok right now who is going mega viral because she is a bull rider and 33 weeks pregnant and still doing some rodeo competitions this is not my space I'm going to embarrass myself if I try to talk about which ones but is still participating in her rodeo activities and the internet again is starting to like lose their mind, be like, what do you mean? And you know there's been some obstetricians who have stitched it and said you know, every person is going to have a different risk, tolerance and understanding of what they think their body can and cannot do. Where we have to be concerned is again around the relative risk of a person having a fall and then some considerations. She mentioned considerations around accelerations and decelerations, but that is a longer conversation and I have a little bit more kind of. I think there's a little bit more nuance to that discussion as well, considering I know of Army pilots who are pregnant and going up against G-forces in the military. So I think there's still a lot that we need to know on that side. But definitely the falls-related factor is relevant.
Speaker 1:And all of this to say, these are huge pieces of advice that have systematically and, thankfully, very fundamentally been debunked, and this is really exciting because what I truly believe and where I think we need to go, is that exercise recommendations in pregnancy don't have to be that complicated. We can give buoys and adapt and adjust when symptoms come up. But this thought process around giving blanket recommendations because you are pregnant was sound from a hypothesis perspective, but when we tested those hypotheses it just hasn't panned out. And it's helpful when we start taking an individualized approach, because you may not feel comfortable doing Toast-A-Bar at 12 weeks but someone else may feel comfortable up until 32 weeks, and it wasn't that one person was right and the other was wrong. It's that every pregnancy is different and how you feel in pregnancy is different.
Speaker 1:This is my third pregnancy. I've lifted all the way up until delivery in baby one and baby two. I haven't run in a pregnancy I wasn't running, I was just lifting, and so it's going to be interesting for me to see if I can keep running or how long I can keep running, for I'm thankful every time I can run because I really love it and I love hanging out with my dog and my daughter comes with me sometimes now and I love all of that, and so I'm thankful every time I can run and I recognize that there may be a time where I need to say goodbye to that activity and continue lifting or doing some sort of other modality for aerobic activity. So that is going to be an individualized choice and it's not going to be based on anything from a blanket statement perspective, which is still really cool. So when I sit back and I think about all of those changes and recommendations, I just think, gosh, like how cool that is that we have learned so much in relatively a short amount of time, especially, you know, someone who is in research right now and knows how, fundamentally, how long it takes to do a lot of these research studies and how important it is to build this level of evidence and do these studies well. So where do we need to go from here? Where do we need to go? Where am I passionate about trying to see change in the next? I'm going to say five years, five years, okay. So I think number one, talking about these blanket statements, we need to link all of these things. We've done a lot of work to make sure that we've done our due diligence on the safety profile piece. What I mean by that is that no increase in complications, no increase in fetal distress, no increase in stillborn birth, no increase in pregnancy-related complications, no increase in delivery complications, et cetera. We've kind of started to accumulate this evidence that has done their due diligence on that side of the continuum where we can now say with absolute not absolute, but higher certainty that these things seem to be okay, great, fantastic, love this.
Speaker 1:Now, where people come in and say to me is okay, but what about the pelvic floor? And this is where a lot of my research is coming in and I'm so excited. I have a couple of manuscripts that are right now either in submission or about to be submitted. I'm in data analysis for another one. This is where I'm really passionate is, what about the pelvic floor? Because that's where pelvic PTs will come back at me and say but Christina, what about the pelvic floor? Because that's where pelvic PTs will come back at me and say but Christina, what about the pelvic floor?
Speaker 1:And you're correct in some ways that we don't have a ton of research density that is linked exercise in pregnancy to pelvic floor dysfunction postpartum. Some of my cross-sectional work has looked at this but again, there's no it's correlation, it's not causative, so we can't say there was a protective effect or a net negative effect. For example, we do know that individuals who are exercising, especially under high speed, high fatigue and high load, have higher rates of pelvic floor dysfunction before they even get pregnant. And so understanding not just about pelvic floor dysfunction from how you exercise in pregnancy, how does that influence pelvic floor dysfunction postpartum? But where I think we haven't even begun to have a discussion is what about if you had pelvic floor dysfunction before pregnancy? How does that influence your relationship with exercise during pregnancy and postpartum pelvic floor dysfunction? Similarly, with injuries right, especially if you've had a history of low back or hip pain, what does the added changes to your physiology in pregnancy do to maybe a flare up in symptoms there? How does that influence your exercise during pregnancy? How does that expression translate into how you're feeling from a postpartum recovery perspective?
Speaker 1:So we really haven't done enough yet and totally working on it to tie in the pelvic floor piece. However, because we do not have anything right now. The recommendations cannot be to protect your pelvic floor Because, just like you can challenge me and say, hey, christina, we don't know a ton about if this is okay, yes, and we also don't know if it isn't. So you cannot confidently say either that, hey, this is going to strain the pelvic floor, like, for example, my cross-sectional studies show that when we subgrouped those who kept doing Valsalva in pregnancy and looked at pelvic floor dysfunction postpartum, there was no difference between those that continue to hold their breath while lifting versus those that shifted to an exhale on exertion strategy. That is the only study that has investigated that relationship and so, based on the highest quality of data we have, acknowledging that it is low on the evidence-informed pyramid.
Speaker 1:We cannot say that changing your breast strategy is protective of the pelvic floor in postpartum recovery, and so I am totally acknowledging that we need more evidence here. That is literally why I'm doing my postdoc. Right, but it takes time to accumulate data and collect data from all you wonderful people who have taken part in my research studies. But that means we also can't say it in the opposite direction, and so this is still a big gap. I am working on data analysis for my retrospective study on functional fitness, and we have looked at all of the associations and I am just so excited to tell you the findings Teaser for that, which is probably going to drive you guys crazy because it takes forever for those things to get published but we are starting to look at those relationships, which is really cool.
Speaker 1:We are starting to look at those relationships, which is really cool. So the next piece of this that I am hoping, in the next five years, to really truly have clear understanding of is are all these cues and corrections, modifications and scales truly changing anything? And, on the flip side, are they just creating more confusion or are they creating an unnecessary barrier to physical activity in pregnancy and postpartum? And I know that's a hot take and I know that's a big statement, but even looking at myself from five years ago like Christina of 2020, I kind of cringe at how much nuance I was creating that now Christina of 2025 just knows so much different, and so it's going to be so interesting to see if any of these changes actually do anything. And then the third thing that I'm going to be really excited about hopefully having more data in the next five years, because I know that it's a big interest in my lab group and we're really trying to target this in a very specific way and trying to think about this really strategically in terms of how do we apply research.
Speaker 1:Here is really early exercise and our international Delphi and Margie's 2025 Exercise Guideline for Postpartum and Exercise in the First Year Postpartum really highlighted how when individuals return to exercise is highly individualized and our International Delphi talked about how medical clearance shouldn't be and isn't really necessary with respect to returning to exercise and some people may feel confident starting at two weeks, some might be eight weeks, some might be 16 weeks and it's totally up to them based on their circumstances. But the physiology of delivery itself. There is no contraindications to exercise and there is no necessity for medical clearance and oftentimes medical clearance is done insufficiently anyway, which is exciting, is done insufficiently anyway, which was exciting. But now we need to do some nuance around that, around what dose of exercise are we talking about? Early exercise is only kind of rehabilitation focused exercise, or is it early rehabilitation plus low intensity exercise? When does impact come in? How does impact tolerance talk up to pelvic floor dysfunction with return to activity? What does that look like for return to sport, because returning to recreational activity versus trying to get back to elite competition are two very different demographics and so there's still a lot that we need to know.
Speaker 1:When we start to do research on the elite level athlete, it trickles into releasing the reins in recreational exercise for life individuals as well, like me, and that is kind of exciting. So pushing some of our exercise on the elite, really intense side, what that does is it allows for an adjustable and very flexible amount of risk tolerance in terms of how much you're exercising, at what intensity you're exercising and what you're choosing to do while pregnant and into postpartum. And so again, just it's going to be really exciting to see groups from all over the world. Obviously I center around our lab group because that is the data that I know the best over the world. Obviously I center around our lab group because that is the data that I know the best. But it's going to be really exciting to see if those recommendations and maybe like that, medical management, postpartum and when check-ins happen.
Speaker 1:I'm a big advocate for the two-week check-in with pelvic if that's at all possible, but kind of looking at that activity, that early activity and what that means. So I'm super excited for where we have come from. I am frustrated with how slow it goes, partly because the research process that is what it is, but that's how we do our due diligence and that's how we make sure our data is accurate and complete. And then I also have so much motivation and so much excitement for where we're going to go. I know that we are not the only lab group who is working on this.
Speaker 1:There's a lot of questions to be answered, there's a lot of ways to tackle those conversations and it's just, it's really cool. So I'm really excited for that coming up. I'm really excited to share some of the stuff that I have been working on. Hopefully, let the peer review. Gods be in my favor and I can share it with you sooner rather than later. If you have any other questions or if you have any other goals that you think it would be very cool if research gave me a little bit more clarity on this, let me know, because it's always exciting to hear other people's perspectives. I hope you all have a wonderful week and we will see you all next time.
