Pregnancy Exercise Modifications

If you’ve ever been told to “just walk” the moment you get pregnant, you already know how discouraging that can feel when training is part of your identity. We’re digging into a smarter, more flexible approach to exercise during pregnancy that respects both safety and the very real desire to keep moving in ways that feel like you. The goal isn’t to chase perfect rules, it’s to understand how to adjust a movement while keeping the training effect you’re actually after.

We walk through what “modifying” a pregnancy workout really means (and how it’s different from swapping an exercise entirely). From there, we lay out four clear reasons to change what you’re doing: pain that doesn’t settle, pelvic floor symptoms like heaviness or leaking, dizziness or feeling unwell (including concerns with lying on your back), and the simple category of “it just doesn’t feel good.” Then we give you an organized framework you can use with almost any movement: check your mechanics and points of performance first, then consider breath strategy, load, and range of motion before jumping to a totally different exercise.

You’ll hear practical examples from prenatal strength training and running while pregnant, including deadlift tweaks for pelvic girdle or SI joint pain, and cardio options that keep aerobic intensity when walking won’t cut it. If you want more freedom and less fear around pregnancy exercise modifications, this one will give you a plan. Subscribe, share with a fellow active mom, and leave a review so more listeners can find the show.

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Transcript

Welcome And Podcast Purpose

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Hello everyone and welcome to the Farbell Mamas Podcast. My name is Christina Farvin. I'm a public school physical therapist, researcher, and exercise in pregnancy, and a mom of two who have competed in classic, powerlifting, or weightless being, pregnant, post-partum, 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 gonna talk about fertility, pregnancy, and postpartum topics that are relevant to the active individual. While I am a public floor physical therapist, I am not your public 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. And I can't wait to get to it. Hello everyone and welcome to the Barbell Mamas Podcast. Christina Previtt here, and today I want to talk about modification of exercise in pregnancy. If you have been following the podcast for any length of time, you know that I am not a blanket statement gorilly, where I have a list of exercises that I consider pregnancy safe and a lift list of exercises I consider unsafe outside of a direct blow to the abdomen. So I'm not doing jujitsu where I'm doing kicks to the belly or whatever in pregnancy. But outside of that one caveat, there really is a lot of wiggle room. And our new kind of perspectives and exercise in pregnancy is that how, when, or if we modify is going to be a personalized and individualized decision based on your fitness and experience, training volume going into pregnancy, your considerations and situation of your pregnancy, what your supports and environment looks like, what your goals during pregnancy and postpartum look like. All of these things are going to factor into our decision. I was probably just doom scrolling on the internet, and I saw a person who was saying, okay, here's modifications for these different exercises. And one of them, for example, was a sit-up. And the modification was like a side plank on knees with a clamshell. And while the intention was good, my first thought was, well, that's not a modification, that's a substitution or an option. Why? Because the stimulus, a sit-up is working rectus, and that side plank was looking at our uh hip or glute rotators and our obliques, which is still a wonderful exercise, but it wasn't the intended stimulus of the exercise that she was modifying around, which got me into this whole kind of thought process of what does it mean to modify exercise and what should be some of the goals to choosing or selecting what modifications to have. In my mind, a modification happens when there is a reason why we want to modify, not just I'm pregnant. And I'll go through what those reasons are in a second. And the goal is to maintain the intended stimulus of the exercise. We can also do substitutions where one cluster of exercises doesn't feel good. So we just kind of ditch it and do something different. But if I'm looking at exercise modification, I am trying to maintain the stimulus, whether that is the aerobic intensity or the muscle group, I'm trying to strengthen, if I'm thinking cardio versus strength training as much as possible. When do we think about modifying in pregnancy, right? Don't have trimester-specific modification. We are modifying when there is pain with the movement. And this is true whether you're pregnant or not, right? If something hurts, especially if it's over a four to 10, has a sharp quality and doesn't go away after you stop doing that exercise, those are our signs and signals that our body may not be ready for that exercise variation at that intensity. And or our body just isn't loving that movement variation right now. We might also modify around pelvic floor dysfunction. If we are feeling heaviness, if we are leaking, if we are feeling like we are going to have a not trust a fart type of moment, anything like that, pelvic floor dysfunction-wise, we may be thinking about modifying in pregnancy. If you are feeling nauseous, dizzy, or unwell, particularly when you are doing exercises that have you on your back. That is a sign of something called clinical supine hypotensive syndrome. It is your body's way of telling you that baby doesn't like that position. This is especially common for individuals over week 20. It is not everyone. Some people are going to feel totally fine on their back, others are not. It depends on you and your anatomy, but is another reason to modify. And my fourth kind of bucket of reasons to modify is I call them vibes. Like if it really just doesn't feel good, you don't like it, it doesn't feel good for your body. You do not have to keep exercising in one way versus another. There's a lot of freedom there, particularly in pregnancy. I always say it's really important to listen to your body, but I really need to give you what to listen for. And that's often the piece of that puzzle that we are missing. Now we have those four buckets: pain, pelvic floor dysfunction, dizziness, feelings of unwell or vibes. It just doesn't feel good. And you're thinking, okay, maybe I'm far enough in this pregnancy or in my pregnancy, this isn't something that feels good. I might think that maybe I'll want to modify this week from this movement. So when we are thinking about exercise modification, I'm gonna go through an example with resistance training. I'm gonna go through an example with uh aerobic training. When we are thinking about modifying, before I start adjusting anything, the first thing I do is look at how that person is performing that movement. When individuals get further into their pregnancy, because they're compensating for baby bump, they can sometimes have movement drift, meaning that they are not in their strongest position anymore and they are maybe arching their back too much, or their feet are too wide and it's causing their knees to come in and it's making their knees feel a bit cranky. Um, we can see that points of performance can change or people can stop hitting their points of performance from a movement mechanic perspective because of the way that their body has adapted in pregnancy. So before you try modifying anything or feel the need to modify anything, the first thing we want to do is watch how you are performing that movement and see if you have unintentionally gotten yourself into a tougher position. And if we change that position or we coach the movement, maybe that will start to feel better. Pain will go down, pelvic floor dysfunction will go away, et cetera. An example that we see is like in running, because of baby in front, people can get into more extension through their back, which can put their pelvis into more anterior pelvic tilt. That is not bad, but if you're feeling leakage or you don't feel strong in that anterior pelvic tilt position, maybe I can get your ribs over your pelvis just a little bit more, become a little bit more aware of that position, and it can help with your symptom sensation. So before we're doing anything, this our top thing to do before we go down a checklist of modification ways or or methods at which to modify is to check your movement mechanics and make sure you're hitting points of performance. Then what I look for before I change the movement is modifying breath, modifying load, and modifying range. So when we are thinking about, let's talk about in resistance training. Like, so let's talk about a deadlift. If mom is having problems and feeling kind of like pelvic girdle pain, posterior or glute around the glute si joint pain with a deadlift later in her pregnancy. I take a look at her points of performance. And because baby bellet is touching her thighs, she's starting her deadlift in a bit of a rounded pelvis position, right? Because she can't really get into neutral because the baby bump is hitting the thighs. So she, first of all, I'm seeing, okay, she is not hitting her points of performance. And because of that, she's her brace is off the floor and she's getting pain off the floor. Ways for us before we remove the deadlift, is I'm gonna get her legs to get a little bit wider to get her baby bump out of the way. And I'm gonna really try and get her into that neutral pelvis position. Let's see if that changes it. Yes? Great. Then we're just gonna do that little tiny tweak to her points of performance to get her into a neutral, stronger brace position. She can go ahead and keep up whatever she's doing. That's number one. That doesn't change anything. And she's having pelvic symptoms. Maybe then I modify her breath. Valsalva maneuver or holding your breath while lifting. My data is showing that it's not bad for pelvic floor, especially when bracing mechanics are coordinated in the right way. You're doing the right brace for your pelvic floor. Valsalva isn't bad, but maybe her body isn't ready for a Valsalva because of the pressure of baby on her pelvic floor, and she's starting to have some heaviness. Then maybe instead, I'm not removing the deadlift, but I'm telling her, hey, instead of holding your breath, try to exhale off the floor and see if that gives you a bit of help and you feel a little bit more supported off the ground. Cool. We can try that. That doesn't really help. Next thing I can try and do is I'm gonna again keep the deadlift. And if babybump is touching the thigh, moving the feet out a little bit didn't really help, then let's modify her range. So let's put 45-pound plates, those big stack plates, plates or risers underneath her barbell. And then I can get her range to be a little bit less, especially if it's at pull first two or three inches off the floor. Then I can try a modified range and she's doing an elevated deadlift. Great. Maybe that helps. Maybe right now it's just when she's in her top loads, and we have to bring the weight down at least temporarily before or to get her pain threshold underneath that four out of 10 in that low pain, one, two, three. I don't need pain to be zero, especially around the rehab process. I often tell my clients, hey, we are going to be strengthening muscles around a site that is sore and injured. Uh, pain is not a signal that you are doing damage or that something is wrong. Um, but we don't want to have you do exercise and then you be flared up the rest of the day. If your pain is a one, two, three and it goes away as soon as we stop, that is all right. We are strengthening muscles around that sore spot. But if it's higher than that, we're gonna need to modify or change something. And so maybe we're modifying load. So with that deadlift, we did points of performance. We tried modifying breath, we modified range, we modified load. And then if it's just not feeling good in any of those variations, then we can try something different. So we're gonna try and keep the stimulus, which is a hinge movement for strength building, and try a different movement variation. So that might be a sumo deadlift, slightly different than a conventional deadlift, a bit more on the adductor, a bit more squatty, but because your chest is up a little bit, oftentimes doesn't have the same bend forward as much hip flexion. Um, some people with low back pain or uh SI joint pain can find the sumo deadlift to be better tolerated than the conventional deadlift. The exact opposite is true. If your pain is in that pubic symphysis joint, where the sumo deadlift because of the pull of the adductors may be tougher. So my modification or swap goes to a conventional deadlift. So we're we're still doing a uh full expression of a hinge movement with a barbell. Our feet position change and our variation is slightly different. We can try uh dumbbells and see if having a bit more freedom of movement and not locking into the barbell helps. We can try a staggered stance hip hinge. Um, and so all of these are our movement variations that maintain a hinge position. We can try a good morning with lightweight hugging the weight in front or having the weight behind, see how that feels. Like we have a bunch of different movement variations, and there is not one, like if you have a SI joint pain in pregnancy with a deadlift, you move to this. There's all of these different, nuanced, different types of activities that we can leverage to be able to help. We can put a band around the knees and see if we facilitate the butt muscles, if that helps you hinge a little bit easier. Another way for us to modify the movement, but maintain the stimulus. Having that freedom to have a few different options in your back pocket makes it much easier for you to find or not completely move from a heavy deadlift to something like a single-leg glute bridge, right? Technically, both are working on the butt muscles, but a hinge with the need for spinal stabilization, inner abdominal pressure, like the goal of that is different. Neither though, like both of those movements are excellent. I love single-leg glute bridges. I love deadlifts. Um, but when I'm trying to modify exercise, I try to maintain the stimulus as much as possible. Um, if people don't really care and they are want that substitution to something uh different, that's totally fine. But when I'm thinking modification and exercise, I'm trying to keep the stimulus as much as possible. Another uh variation or example that I see a lot is uh modifying around running. So we're gonna go down that same checklist of points of performance, breath, load, range of motion, but we're gonna express express this in a cardio capacity. So, uh, as I mentioned, with running and pregnancy, we see individuals end up in a bit more lumbar extension. They're arching their back because baby is in front. And that can change some of our butt muscle activation, that can change how much pressure people are feeling on their belly button, et cetera. And it can cause pain and discomfort with running while pregnant. So first we're gonna see can we tweak some of those movements? And if I get you a little bit more rib over pelvis, or maybe leaning a little bit forward, or I slow um down, or sorry, if I increase your cadence, does that change how you're feeling within your pelvis, how you are feeling uh within your pelvic girdle and bring down pain or pelvic floor symptoms? Okay, that doesn't do anything. Um one with breath, I'm not really manipulating as much, but intensity, so how heavy you are breathing, might be something that I modify. So maybe you're having pain as you hit fatigue. And so I'm getting you to be in a different zone, or I get your heart rate down a little bit, or I give you a hey, don't let your heart rate go over this rate, not because it's bad for baby, but if I am pushing you into higher amounts of fatigue, is that exacerbating or making some of your pelvic symptoms or pelvic girdle symptoms worse? Managing load is instead of removing running, maybe I am changing from your distance to something a little bit less. If you're starting to feel uh pelvic girdle pain after three miles, then maybe I get you to do a couple of weeks while we're managing that pain so that your top end run is three miles. That may not work for some people who are trying to train for a half marathon. And so maybe in my kind of range is that we do work run or walk run intervals where you run for a mile and you walk for 0.2 miles, and then you go back and forth doing that so that you never hit that critical threshold where pain hits a uh a variable or pain hits a level rather that feels really uncomfortable and that's gonna cause you to stop. And so here we have all of these different options for um for running. When we are thinking about the stimulus here, most people are running for moderate to high intensity aerobic training. And so the modification of fast walking may not hit the intended stimulus. And so I would rather move to something like a bike or an elliptical or a rower that I can push the aerobic heart rate piece. If that is the goal, to stay in moderate intensity or higher zones. I would prefer changing modalities to something lower impact but higher intensity than moving to walking, where a lot of people have trouble getting into those high intensity zones, especially those who do a lot of cardio exercise and are used to uh higher volumes at higher intensities. And so this conversation around modification of exercise in pregnancy, I think is an important one because when we're thinking about goals in pregnancy, a lot of people want to continue moving in the way that they enjoy. And so when we kind of dismiss, like, oh, this doesn't feel good, then like just do yoga or just walk or just stop exercising that intensely. Um, what it's not taking into account is the wants and desires of mom, right? And there is often for many, especially those who are really active, a sense of loss or fear when they do get pregnant, particularly for the first time, and they are so afraid they're gonna lose fitness, they're gonna, they've worked so hard for different skills or different endurance or different paces or splits or whatever is the important metric for you and the exercise that you enjoy. And so trying to maintain that activity for as long as possible in pregnancy is a very real goal and one that I really try to come alongside moms with so that they feel really supported and hopefully they're able to do as much as they can for as long as they desire. And then when stuff starts to come up or stuff starts to feel bad, we have this list of options that we go through on the movement itself. And then we also have a list of options that's gonna allow individuals to keep fitness, maybe not in the same way, but maintain fitness for as long as they can. I hope you all found that framework helpful. As you know, I do not like blanket statements very much, but I do like to have an organized framework of how we approach things like modification of exercise, because then I think that gives you a lot of freedom and a lot of empowerment to move and wiggle your exercise in different ways. And now it applies to almost any exercise that we have, especially if you have a lot of knowledge of different variations of that movement, those movement patterns. If you have any other questions, please let me know. Otherwise, enjoy the rest of your week. We are already approaching Easter, which is crazy, and we will see you all next time.