Exercising (and Elite Sports) During your Pregnancy: Scientific & Practical

You enjoy physical activity — perhaps you love running, cycling, strength training, or even (ultra) elite sports. Good news: in an uncomplicated pregnancy, continuing to exercise is safe and healthy, provided you listen carefully to your body and adapt intelligently. In this article, you will find an ‘evidence-based’ guide per trimester, plus specific tips for avid athletes and elite sportspeople.

Would you like to discuss this personally with us? Feel free to contact our team in The Hague: call us.

The essence in 30 seconds

• Engage in at least 150 minutes of moderate-intensity activity weekly (e.g., 20 minutes of walking per day) and add 1-2 strength training sessions per week if possible; this is the international standard (also during pregnancy).
• Were you already (very) active before your pregnancy? You can generally continue training, paying attention to temperature, hydration, nutrition, and recovery. However, please discuss this with your midwife.
• Avoid sports with a risk of falls or abdominal trauma, and diving; be cautious with heat (hot yoga) and prolonged supine positions after 20 weeks.
• Elite and (ultra) endurance sports are possible, but require a tailored approach (shorter blocks, cool conditions, good nutrition, close medical/coach supervision).

Regular physical activity during pregnancy is associated with a reduced risk of gestational diabetes, fewer hypertensive disorders, a lower risk of C-sections, and improved well-being. The ACOG guideline (2020) and the WHO guideline (2020) emphasize that physical activity during pregnancy is safe and desirable for almost all pregnant individuals without complications.

It is important to exercise at the correct intensity. How can you practically measure that? Use the talk test: you should still be able to hold a conversation during the activity. Heart rate zones often read from your sports watch are less reliable due to physiological changes in the body.

Current literature shows that vigorous training is generally well-tolerated up to the third trimester in uncomplicated pregnancies.

For extreme intensities (>~90% HRmax), the evidence is scarcer; individual adjustment remains important, especially for (elite) female athletes. The IOC expert group advises continuing training with temperature and hydration management, sufficient energy intake, and frequent monitoring. However, it is again important to discuss this thoroughly with your medical specialist and to follow the advice carefully.

• Plan shorter (moderately) intensive blocks with ample rest and cool/ventilated conditions.
• Extra attention to nutrition: for exercise >45 min or higher intensity, ensure timely carbohydrates and sufficient electrolytes/hydration; prevent hypoglycemia and weight loss.
• Listen to your body; if something doesn’t feel right, stop immediately. Your intuition and recovery (sleep, fatigue) are paramount.

Are you working towards a competition? Discuss this with your sports physician and midwife regarding the possibilities.

• Exercise with prolonged supine positions after 20 weeks (aortocaval compression) → opt for side-lying or inclined variations.
• Avoid higher ambient temperatures (hot yoga/heat); exercise at a neutral temperature and hydrate well.
• Diving: discouraged due to fetal risks (gas bubble formation).
• High altitude: up to ~1,800 m is well-tolerated in studies by sea-level residents (such as in the Netherlands); higher altitudes only with experience/acclimatization and consultation.
• Sports with contact/fall risk (boxing, football, horse riding, mountain biking downhill, skiing): refrain from these for now.

Stop your activity immediately and call us if you experience:

Vaginal bleeding, abdominal pain, painful regular uterine contractions, loss of amniotic fluid, shortness of breath before exertion, dizziness, headache, chest pain, muscle weakness with loss of balance, calf pain/swelling.

Do not take any risks and listen to your body and your medical specialist.

Useful background information per pregnancy phase can also be found in our Pregnancy Overviews (from 0–5 weeks up to 37–42 weeks).

During pregnancy, your posture, hormones, and abdominal pressure change—therefore, it pays to train specifically and also be able to relax. Below you will find a complete, practical program that you can apply immediately.

How to Feel your Pelvic Floor (Check your Technique)

• Cues: imagine gently lifting a tampon upwards or wanting to stop your urine stream and fart simultaneously—gently lift and draw inwards, not push downwards.

• What you do not do: tightly clench your glutes, thighs, and abdomen, or hold your breath.

• Breath test: during a gentle contraction, you should be able to continue speaking calmly.

• Release: after each contraction, consciously fully release. Relaxing is just as important as contracting.

Also check out our Margriet Library for practical handouts and preparation.

Pregnancy changes your thermoregulation; avoid heat peaks, dress lightly, drink on time, and train in a cool environment. With self-controlled exertion in conditioned spaces, core temperatures generally remain within safe margins, but be careful not to overheat.

It is becoming more common each year in the Netherlands for the National Heat Plan to be in effect during persistent warm weather. In such cases, it is important to pay extra attention to your routine. Plan your workouts for cooler times, take extra rest, and drink plenty.

• Do not ‘diet’ during pregnancy; prevent unintentional weight loss. Healthy nutrition is the basis for proper fetal growth.
• Eat sufficiently before and during longer training sessions; the risk of hypoglycemia increases with >45 min of high intensity.
• In case of persistent fatigue/loss of capacity: have your hemoglobin/ferritin checked in consultation.

We are happy to assist you — from the first trimester to recovery after delivery.

• Call or email us to discuss your sports plan.
• Are you newly pregnant or want to register? Look here for more information: 0–5 weeks (with registration info).
• More practical articles? Check out our blog and Margriet’s Library.