The number of people who run is continuing to climb, so more and more we find our clients are asking if it is ok to continue to run during pregnancy. The answer to that is twofold. As a pregnancy fitness educator, personal trainer, running coach and birth professional the basic answer is yes; however…
In general, running during pregnancy is safe and has benefits specific to pregnancy. There are certain medical conditions that would prohibit running during pregnancy. Therefore, it is recommended that any client who is pregnant and wanting to run should get the ok from a care provider first and in the case of any medical changes.
Exercise during pregnancy has been associated with reduction in some of the common complaints and complications of pregnancy including digestive issues, fatigue, leg cramps and swelling, all the way up to preeclampsia and gestational diabetes.
We also know that regular exercise during pregnancy helps to prepare the baby for the stress of labor because they have adapted to changes in heart rate and blood pressure during exercise. It is also associated with more stamina and endurance for the birthing parent during labor.
Some of the main concerns for continued running throughout pregnancy are related to the pelvic floor and abdominal muscles, which are interconnected in function. There are a few different causes to pelvic weakness directly related to pregnancy.
One is the hormone relaxin. Relaxin helps to loosen the pelvic floor so it has more freedom of movement during labor allowing it to open wider for delivery. However, relaxin affects all joints, muscles, and connective tissues in the body, including the pelvic floor. Because the pelvic floor is also weighed down from the growing uterus and baby, as well as increasing volume of amniotic fluid, this can cause these muscles to grow weaker. Running can increase the intraabdominal pressure up to 2.5 times more than normal, so this increased pressure can make those muscles even weaker.
However, most physical therapists and others who focus their work on the core find that many athletes, including runners, have tighter than normal pelvic floors and have difficulty relaxing their pelvic floors. Both situations can lead to weak pelvic floors, which in turn can cause dysfunction in pregnancy, labor, and postpartum.
How does a tight pelvic floor equal weakness in the pelvic floor? Try this experiment – tighten your bicep and keep it tightened for 1 minute, 2 minutes, 3 minutes; how long can you keep it tight? Then try to activate the bicep to lift something. Notice how keeping it tight for all that time actually made it weaker. When a person continually tightens their pelvic floor and abdominal muscles, it causes these muscles to become weakened. These muscles cannot relax and expand to allow the baby to descend during labor.
Both the tight and overly stretched pelvic floor muscles can lead to incontinence, low back pain, and sexual dysfunction. The good news is that the same focus on core recruitment and synchrony can help prevent and restore both a tight and/or overly stretched pelvic floor.
So, how can a runner continue to run safely throughout pregnancy to reap the benefits while at the same time keep the pelvic floor muscles strong and flexible? Here are some tips:
- Base intensity on effort rather than pace or even heart rate; the runner should be able to carry on a conversation while running.
- Pregnancy is not the time to increase mileage or work on new personal records for time and pace.
- Because of the shift in center of gravity and the joint looseness due to the Relaxin, it is best to stick to running routes that are flat and obstacle free.
- Keep hydrated and cool during all runs and any other exercise.
- Running during the first trimester can sometimes be easier because of increased heart rate and stroke volume and there is generally no need to reduce the amount of running during this time. It can help keep morning sickness abated as well.
- The first trimester is a good time to work on recruitment and synchrony in the core muscles, this includes learning to let the pelvic floor drop and release tension as well as allowing the abdominal muscles to expand when breathing. This is called the “core breath”.
- During the second trimester it is typically ok to continue with the same moderate intensity as the first trimester. Keeping the focus on the intensity based on effort also has the benefit of limiting the feeling of discouragement because distance and pace will begin to decrease.
- During the second trimester keeping control of lifting and letting go of the pelvic floor and abdominal muscles together can become more difficult. It takes focus both outside of running and during running. However, it is essential to pelvic floor health.
- During the third trimester it is best to scale back the amount and intensity of running dramatically, perhaps even quitting all together. Since exercise it still important, other forms of exercise should replace the running.
- Continuing to practice the core breath as well as other core strengthening exercises throughout pregnancy is beneficial for anyone, not just runners. Core focused exercise can help with more effective pushing as well as postpartum recovery and continued pelvic function and health.
- A good core restoring postpartum exercise program can begin with the core breath immediately after birth and adding additional exercises progressively beginning at 2 weeks.
- It is best to wait for a minimum of 6-8 weeks after the birth before resuming running. In many cases, it may be best to wait even longer for the pelvic floor and abdominal muscles to regain their strength.
- An assessment by a pelvic floor therapist should be standard care, but especially is important before resuming running.
CPD, CLD, CLE®, CCCE, CPFE, Faculty, Senior Program Advisor
Laura Nance is the CAPPA senior program advisor for the postpartum doula and new parent educator programs. She also trains for the lactation educator program. She is a CAPPA certified postpartum doula, new parent educator, labor doula, lactation educator, childbirth educator and pregnancy fitness educator. She is also a personal trainer and a running coach with additional training in women’s running and core health especially as it relates to pregnancy and postpartum. She has been working with families during the perinatal period for 18 years. She lives in NC with her husband of 27 years and her adult children where she owns a doula and educator collective. She loves running, traveling, concerts, cats, and inspiring new families and professionals.