Pregnancy workouts: a weekly routine built on the guidelines

Most pregnancy workouts online are built backwards: a pastel thumbnail first, the guidelines never. This one goes the other way. Everything below comes from three sources: the American College of Obstetricians and Gynecologists (ACOG), the World Health Organization (WHO) and the NHS. Where they're silent, so is this post.

The short version: if your pregnancy is uncomplicated and your care provider agrees, a sensible prenatal workout week is about 150 minutes of moderate activity plus a couple of strength sessions, built from exercises with a long safety record, at an effort where you can still talk. Whether you plan it by hand or use an app that plans the whole week, the rules are the same.

Before anything else: check with your doctor, midwife or a pelvic health physiotherapist before you start, continue or change any workout plan during pregnancy. Everything here assumes an uncomplicated pregnancy and a care provider who has said yes. Nothing here is medical advice.

What pregnancy workouts need to include, according to the guidelines

The three bodies agree on the basics.

• ›WHO 2020: all pregnant and postpartum women without contraindication should do regular physical activity throughout pregnancy and postpartum, do at least 150 minutes of moderate-intensity aerobic activity through the week, and incorporate a variety of aerobic and muscle-strengthening activities (Bull et al., 2020).
• ›ACOG Committee Opinion 804: women with uncomplicated pregnancies should be encouraged to do aerobic and strength-conditioning exercises before, during and after pregnancy. The program should build toward moderate-intensity exercise for at least 20–30 minutes a day on most or all days of the week, developed with the patient and adjusted as medically indicated (ACOG, 2020).
• ›NHS: aim for 150 minutes of moderate activity a week, including muscle strengthening, and try to include 2 sessions of muscle-strengthening exercises each week (NHS).

ACOG also says a thorough clinical evaluation should come before an exercise program, to make sure there's no medical reason to avoid exercise. That's the "check with your care provider" step, and it's in the guideline, not just the disclaimer.

If you were already following a women's program you can follow before pregnancy, the job now is adapting it, not binning it. And if you're thinking about where this fits in a longer training life, there's more on strength training for women over 40, which covers the decades on either side.

How hard a prenatal workout should feel

Moderate, judged by feel.

ACOG says that because both blunted and normal heart-rate responses to exercise have been reported in pregnancy, ratings of perceived exertion may be a better way to monitor intensity than heart-rate targets. For moderate intensity, that's 13–14 ("somewhat hard") on the 6–20 Borg scale. The talk test is the backup: as long as you can carry on a conversation while exercising, you're likely not overexerting yourself (ACOG, 2020). The NHS version is shorter: you should be able to talk but not sing.

Harder training isn't automatically banned. ACOG says an upper level of safe exercise intensity hasn't been established, and that regular exercisers with uncomplicated, healthy pregnancies should be able to do high-intensity programs such as jogging and aerobics with no adverse effects. It also warns that high-intensity or prolonged exercise beyond 45 minutes can lead to low blood sugar, so eat enough beforehand or cap the intensity or length. Anything above moderate is a conversation with your care provider, not a decision you make because a class leader yelled "push".

Best pregnancy workouts: what the evidence has actually tested

ACOG's Box 1 lists examples of exercises that have been extensively studied in pregnancy and found to be safe and beneficial (ACOG, 2020):

• ›Walking
• ›Stationary cycling
• ›Aerobic exercises
• ›Dancing
• ›Resistance exercises (for example, weights and elastic bands)
• ›Stretching exercises
• ›Hydrotherapy and water aerobics

That's the menu. The "best" pregnancy workout is whichever of these you'll actually do most weeks.

The NHS adds that swimming can be good exercise in pregnancy because the water can relieve pressure on your muscles and joints, and that muscle strengthening can include yoga, carrying shopping and children, or strength training at a gym if you already do it. ACOG mentions exercise in water as an alternative for women who get low-back pain.

The guidance goes into far more detail on volume, intensity and what to avoid in exercise during pregnancy explained. This post is about turning it into a week.

Prenatal workout exercises for strength days

Lifting is in. What the guidance doesn't give you is a rep scheme. ACOG notes that early pregnancy guidelines didn't consider heavy resistance training safe, because of potential injury and possible fetal heart decelerations from the Valsalva maneuver (breath-holding while straining), so the research is sparse. For elite athletes who want to keep training hard, it advises getting approval from their health care providers and considering lighter resistance loads than before pregnancy (ACOG, 2020).

So the practical version:

• ›Familiar movements. The NHS says it's usually fine to keep doing activities you already do, and to start anything new gently. Pregnancy is not the moment to learn a snatch.
• ›Lighter, not heavier. Lower loads than before pregnancy is the documented direction. Your care provider sets the limits.
• ›Moderate effort. Same RPE 13–14 and talk test as your cardio. Grinding reps you can barely finish aren't moderate.
• ›Not flat on your back for long. ACOG says lying on your back during exercise after 20 weeks can reduce blood return to the heart and cause low blood pressure, and advises avoiding long periods lying flat. The NHS says to avoid lying flat on your back for more than a few minutes in later pregnancy. Flat bench press becomes incline, floor work becomes side-lying or seated.

ACOG also notes that pregnancy shifts your center of gravity and that more than 60% of pregnant women experience low back pain, and says strengthening abdominal and back muscles could minimize this risk (ACOG, 2020). "Could" is the word. It's a reason to keep training your back and trunk, not a promise.

A sample pregnancy workout program

This is an illustration, not a prescription; agree it with your care provider. It's the guidance laid onto a calendar for someone who was already active before pregnancy and has been told to carry on.

ACOG says the program should build toward moderate-intensity exercise for at least 20–30 minutes a day on most or all days of the week, and that prolonged exercise belongs in a thermoneutral or air-conditioned environment (ACOG, 2020). The week below sits inside that.

That's comfortably over the WHO and NHS 150 minutes and includes the NHS's 2 strength sessions. Every strength exercise is upright, seated, inclined or side-lying, so nothing keeps you flat on your back.

How to use it:

• ›Effort: moderate across the board. A few sets per exercise, stopping well short of failure, is coaching convention rather than something the guidelines specify.
• ›Fuel and water: the NHS says don't exercise on an empty stomach as it could make you faint, and to drink water and keep cool.
• ›Tell the instructor. The NHS says to tell your trainer or instructor you're pregnant.
• ›Bad day, shorter session. The NHS says to listen to your body and not push yourself too hard. Skipping one session doesn't break the week.

Pregnancy workout program for beginners

If you weren't active before, the guidance is gentler, not absent. The NHS suggests starting with a smaller amount, like 10 minutes a day, and slowly building toward 150 minutes a week, and says that if you can't reach 150, any activity is better than none. It also says starting a new vigorous activity such as running isn't recommended in pregnancy (NHS). ACOG says women who were sedentary before pregnancy should follow a more gradual progression.

In practice: walking, stationary cycling, swimming or a pregnancy class, a few minutes longer each week, plus two short sessions of light bodyweight or band work.

What to leave out

The avoid list is short and specific.

• ›Contact and fall-risk sports. ACOG says to avoid contact activities with a high risk of abdominal trauma or imbalance. The NHS names hockey, rugby and mountain biking.
• ›Scuba diving. ACOG and the NHS both say avoid it.
• ›Heat. ACOG advises staying well hydrated, wearing loose clothing and avoiding high heat and humidity, particularly in the first trimester. The WHO says to avoid physical activity in excessive heat, especially with high humidity (Bull et al., 2020).
• ›Long stretches lying flat on your back, as above.

Some of these matter more at some points than others, which is the subject of exercise by trimester.

Warning signs: stop the workout

ACOG's Box 3, "Warning Signs to Discontinue Exercise While Pregnant", word for word (ACOG, 2020):

• ›"Vaginal bleeding"
• ›"Abdominal pain"
• ›"Regular painful contractions"
• ›"Amniotic fluid leakage"
• ›"Dyspnea before exertion" (dyspnea means shortness of breath)
• ›"Dizziness"
• ›"Headache"
• ›"Chest pain"
• ›"Muscle weakness affecting balance"
• ›"Calf pain or swelling"

The NHS rule: "stop if you feel uncomfortable, too hot or unwell."

If any of these happen, stop, and contact your doctor or midwife. That isn't a training decision, and no sample week overrides it.

After the birth, and later

Pregnancy workouts end at delivery. Training doesn't, but it restarts from a different place, whatever kind of birth you had. ACOG says exercise routines may be resumed gradually after pregnancy as soon as medically safe, depending on the mode of delivery and any complications, and that pelvic floor exercises can start in the immediate postpartum period (ACOG, 2020). Rebuilding your core after birth is usually the first block, with a pelvic health physiotherapist's input.

Much further down the road, lifting keeps paying off, and strength training for perimenopause picks up the same principles for a different stage.

How exrsz handles this

exrsz builds a periodized plan from your goal, schedule, level and equipment, balances running and lifting in one plan, adapts each week to how you actually trained, and reshuffles missed sessions instead of stacking them up. It doesn't give medical advice and doesn't replace the person managing your pregnancy. Check with your doctor, midwife or a pelvic health physiotherapist first, then train inside what they've agreed.

FAQ

How many pregnancy workouts should I do a week?

The WHO recommends at least 150 minutes of moderate-intensity aerobic activity a week plus muscle-strengthening activity (Bull et al., 2020), and the NHS suggests 2 strength sessions a week (NHS). Agree the details with your care provider.

What are the best pregnancy workouts?

ACOG lists walking, stationary cycling, aerobic exercise, dancing, resistance exercise with weights or bands, stretching, and water exercise as extensively studied in pregnancy and found safe and beneficial (ACOG, 2020). The best one is the one you'll do consistently.

Can I follow a strength workout plan during pregnancy?

Yes, if your care provider agrees. ACOG encourages strength-conditioning exercise before, during and after pregnancy, and suggests elite athletes consider lighter loads than before pregnancy (ACOG, 2020). Avoid long periods lying flat on your back.

How hard should a prenatal workout be?

Moderate: 13–14 ("somewhat hard") on the Borg scale, or able to hold a conversation, per ACOG (ACOG, 2020). The NHS puts it as able to talk but not sing.

When should I stop a pregnancy workout?

Stop and contact your doctor or midwife if you have any ACOG warning sign, including vaginal bleeding, abdominal pain, regular painful contractions, amniotic fluid leakage, dizziness or chest pain (ACOG, 2020). The NHS also says to stop if you feel uncomfortable, too hot or unwell.