This question is asked frequently by women who are pregnant and fear doing harm to themselves or their baby. Many women enjoy running and find the thought of having to stop — for pregnancy, injury or other reasons — distressful to consider.
While many people believe that high impact or more intense levels of exercise should not be performed during pregnancy, most international guidelines concur that running is safe in uncomplicated pregnancies.
Sports Medicine Australia, in their recent position statement on exercise in pregnancy and the postpartum period, state that exercise such as jogging or running is “considered to be generally safe for pregnant women with an uncomplicated pregnancy” .
The American Congress of Obstetricians and Gynecologists also state that pregnant women who habitually engage in vigorous-intensity aerobic activity (i.e., the equivalent of running or jogging) or who are highly active “can continue physical activity during pregnancy and the postpartum period, provided that they remain healthy and discuss with their health care provider how and when activity should be adjusted over time” .
A recent survey performed in conjunction with ParkRun on 1293 female runners found that there was no difference in birth weight or gestational age at delivery between those who continued to run, versus those who stopped running . However, they did find that the rate of assisted vaginal deliveries was higher in the running group (27 percent versus 22 percent). The authors suggest that pelvic floor muscle muscles may provide more resistance to the birth process.
So now that we have ascertained that running is not contraindicated, let’s look at the question as to whether women should run while pregnant. I believe that this is never a simple yes or no answer as there are so many things to consider.
If you were my client, there are 4 things that I want to enquire about before giving my reply:
- Are you a regular runner?
- Has your doctor cleared you for exercise?
- Do you have any pelvic floor or musculoskeletal issues?
- Are you aware of signs and symptoms that you need to watch out for if you do decide to run while pregnant?
Let’s take a look at each of these questions one by one.
1. Are You a Regular Runner?
Why is this important? If you are not someone who regularly runs, then I would make the suggestion that it is not the best time to start a jogging habit. We know that even in the first trimester the blood volume increases by as much as 40 percent (more than 50 percent by the final trimester). The resting cardiac output increases by up to 50 percent during pregnancy therefore increasing the load on your cardiovascular and respiratory systems .
If you were already running prior to pregnancy, you are more likely to be able to accommodate for these changes more easily. If you are someone who is not used to more intense levels of cardiovascular exercise, then the adaptation to demand may just be too much and you may find yourself too breathless and fatigued.
From a musculoskeletal point of view, someone whose muscles and joints are used to frequent jogging may also cope better with the increase in load on the pelvic floor and abdominal musculature as the weight of the baby, placenta, fluid and breasts increase.
The bottom line is that we don’t have any studies that take women who have been previously sedentary and made them run through their pregnancy to see what happens, so we don’t really know what the effect of that would be. However, it seems prudent to not put such a high physiological demand on a system that is already dealing with marked changes.
2. Has Your Doctor Cleared You for Exercise (in Particular Running)?
There are a few obstetric and medical conditions for which running would contraindicated or considered to be high risk . Your obstetrician or GP should screen you for medical and obstetric conditions that could put you at risk during exercise.
If you have any pre-existing medical conditions, it is very important that you discuss these with your doctor to make sure that you are safe to continue running. This would include any cardiovascular, respiratory, metabolic or neurological conditions.
An example of an obstetric condition would be an incompetent cervix (cervical insufficiency) which puts women at a high risk of miscarriage. Running involved high loads onto the cervix and would be considered contraindicated. A low lying placenta, especially one that covers the cervix, would also be a contraindication for running.
Do not be afraid to ask direct questions during your obstetric appointments. A simple question to ask of your medical professionals is “I love to run; is there any medical reason why I should stop?”
3. Do You Have Any Pelvic Floor or Musculoskeletal Issues?
So this may be a large question and I would certainly tackle it with a few follow up questions, but essentially I want to know if you have any musculoskeletal conditions that might be made worse with running. If so, I may suggest that you find a more low impact alternative (eg static cycling, swimming, weight training) or I may take a look at your running and see where adjustments can be made to your load or running style.
Some of the pelvic floor questions I would be asking you are:
- Do you leak when you cough, sneeze, laugh or run?
- Do you have any heaviness or dragging around the perineum (especially after exercise or if you have spent a long time on your feet?)
- Have you been through a pregnancy and birth before — was there any trauma or issues with your recovery?
If you had a history of pelvic floor problems, then I would strongly suggest that you see a pelvic health physical therapist for assessment and guidance. It may be recommended that you reduce or remove running from your program for the pregnancy if the risk to your pelvic floor is high. However, this is your choice.
Some of the common musculoskeletal conditions that we (physical therapists) see in pregnancy include:
- Pelvic girdle pain
- Low back pain
- Carpal tunnel syndrome
- Knee pain
But really, any joint can be affected through pregnancy (we go through this in a lot more detail in the Coaching & Training Women Academy Pre- and Postnatal Coaching Certification!)
The role of relaxin in joint pain is currently unknown. Although there does seem to be some increase in laxity of the joints around the pelvis, the level of relaxin in the blood does not seem to correlate with levels of pain. However, some women do find that musculoskeletal issues crop up during pregnancy and they may be related to:
- Increased weight
- Changes in centre of gravity
- Changes in the muscular system (e.g., abdominal wall stretched, more load on pelvic floor muscles)
- Balance changes
- Stress, sleep problems, etc.
If you do have joint pain, there may be some treatment options that help settle the pain so that can continue to run. This may involve specific exercises, pelvic belts, taping, massage or load modification (e.g., reducing run speed, distance, frequency, etc.) If the pain does not settle, then ultimately you will have a choice to make.
For some women, running is everything. They must run — for their social outlet, the endorphins it gives them, and for their mental health. If this is you, then you may choose to continue running despite the fact that you have pain.
In my experience, the vast majority of pregnant women that I work with choose to stop running in their second trimester as it “just doesn’t feel right anymore.” They make the choice that the risk of doing injury or creating more pain is not worth it for the sake of continuing to run.
4. Are You Aware of Signs and Symptoms That You Need to Watch Out For?
If you are a regular runner, have doctors’ clearance and have no pelvic floor or other musculoskeletal issues, you may well choose to continue running through your pregnancy. Here are some tips to help you.
Don’t be afraid to reduce your speed or distance as the pregnancy progresses. Remember that it is a not a failure to slow things down! By the third trimester, most recreational and competitive runners have reduced or ceased running voluntarily. In fact, one study showed that only 31 percent of runners continued into their final trimester , and the ParkRun study found only 16 percent ran in their final trimester .
So the reality is that most women stop running when it just doesn’t feel good anymore. This means that you need to check in with your body and really ask yourself: How does it feel when I run? Some of the signs and symptoms that you’ll want to be aware of are:
- Pain (pelvis, low back, knees)
- Incontinence (leaking of urine and feces)
- Leaking of blood or clear fluid (this requires immediate assessment with your medical team)
- Bulging or strain along the linea alba (the connective tissue that connects the two sides of the rectus abdominis)
- Chest pain, headaches, dizziness, calf pain or swelling, shortness of breath prior to exertion (these all require medical follow up)
There has been research to show that when women are exercising at around 90 percent of their maximum heart rate, there does seem to be a transient reduction in the baby’s heart rate . Although for most women, using a rate of perceived exertion (RPE) is recommended in pregnancy, elite athletes should consider using a heart rate monitor of they are exercising at higher intensities and consider keeping their heart rate below 90 percent of their maximum.
Most women self-limit running during pregnancy, with fewer than one-third of athletes continuing to run in their final trimester. Running is believed to be a safe exercise for pregnant women, providing they have no medical or obstetric conditions that may put mother or baby at risk. In any case, women should be aware of signs and symptoms on when they should cease exercise and seek medical attention.
- Sports Medicine Australia (SMA), Exercise in pregnancy and the postpartum period Position Statement, 2016, https://www.researchgate.net/publication/308106170_Sports_Medicine_Australia_SMA_’Exercise_in_pregnancy_and_the_postpartum_period’_Position_Statement
- American Congress of Obstetricians and Gynaecologists, Physical Activity and Exercise During Pregnancy and the Postpartum Period, https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Physical-Activity-and-Exercise-During-Pregnancy-and-the-Postpartum-Period
- Kuhrt K, Harmon M, Hezelgrave N L, Seed P T, Shennan A H, Is recreational running associated with earlier delivery and lower birth weight in women who continue to run during pregnancy? An international retrospective cohort study of running habits of 1293 female runners during pregnancy, BMJ Open Sport Exerc Med, April 2018, https://www.ncbi.nlm.nih.gov/pubmed/29644086
- Bø K, et al. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1-exercise in women planning pregnancy and those who are pregnant, British Journal of Sports Medicine, 2016, https://www.ncbi.nlm.nih.gov/pubmed/27127296
- Tenforde A S, Toth K E S, Langen E, Fredericson M, Sainani K L, Running habits of competitive runners during pregnancy and breastfeeding, Sports Health, March 2015, https://www.ncbi.nlm.nih.gov/pubmed/25984264
- Salvesen K Å, Hem E, Sundgot-Borgen J, Fetal wellbeing may be compromised during strenuous exercise among pregnant elite athletes, British Journal of Sports Medicine, 2012, https://www.ncbi.nlm.nih.gov/pubmed/21393257