By our midwife Katia Ciccarella

Too often, expectant mothers still believe that pregnancy necessarily means limiting—or even stopping—physical activity. Unless prescribed for specific medical reasons, absolute rest during pregnancy can lead to excessive weight gain, reduced awareness of bodily changes, physical discomfort (such as back pain, swelling in the legs and ankles), and even emotional distress.

In this post, we aim to clarify current guidelines and debunk some common myths.

Benefits and Features of Physical Activity During Pregnancy

For low-risk pregnancies, international guidelines (RCOG, ACOG, SIGO, and Italy’s Istituto Superiore di Sanità) recommend at least 150 minutes of moderate physical activity per week—around 30 minutes a day, which can be divided into 10-minute sessions.

The benefits are numerous:

  • Improved cardiorespiratory fitness, enhancing oxygen exchange between mother and baby
  • Better weight management
  • Reduced nausea and fatigue
  • Enhanced muscle endurance, helpful during labor and postpartum recovery
  • Prevention of back pain and other muscular discomforts
  • Lower risk of preeclampsia, gestational diabetes, hypertension, and cesarean birth
  • Decreased and prevented depressive symptoms

Contraindications

Pregnancy is not, by itself, a contraindication to exercise. However, it’s always best to consult with your obstetrician or gynecologist.

There are absolute and relative contraindications:

Absolute Contraindications (Exercise not advised):

  • Significant heart disease
  • Restrictive lung disease
  • Incompetent cervix (with or without cerclage)
  • High-risk multiple pregnancy
  • Persistent vaginal bleeding in the second or third trimester
  • Placenta previa after 26 weeks
  • Preterm labor in current or past pregnancies
  • Preeclampsia or pregnancy-induced hypertension
  • Ruptured membranes
  • Severe anemia

Relative Contraindications (Case-by-case):

  • Mild anemia
  • Mild cardiac arrhythmias
  • Chronic bronchitis
  • Poorly controlled type 1 diabetes, hypertension, epilepsy, hyperthyroidism
  • Morbid obesity (BMI > 40)
  • Severe underweight (BMI < 15)
  • Extremely sedentary lifestyle
  • Intrauterine growth restriction in current pregnancy
  • Orthopedic limitations
  • Heavy smoking

Which Activities Are Safe During Pregnancy?

Most sports and forms of exercise are suitable for pregnancy (across all trimesters), including:

  • Running
  • Cycling (especially indoor)
  • Swimming
  • Aerobics
  • Strength training
  • Yoga
  • Pilates

However, keep in mind:

  1. The goal is to maintain overall fitness and health, not to improve performance. As pregnancy progresses, you may need to reduce intensity and movement range.
  2. It’s never too late to start. Even sedentary women are now encouraged to begin gradually, e.g., brisk walking.

Always seek guidance from qualified fitness professionals, ideally with pre/postnatal certifications, and make sure your midwife has approved your plan.

Importantly, moderate physical activity does not increase the risk of miscarriage in the first trimester. Fatigue is normal in early and late pregnancy—listen to your body, but don’t stop exercising completely, especially if you were active before.

Which Activities to Avoid?

Avoid high-risk and contact sports, including:

  • Football, rugby, martial arts, basketball, boxing
  • Horseback riding, climbing, artistic gymnastics, off-road cycling, skiing
  • Scuba diving
  • Skydiving
  • High-altitude sports (above 2000 m)
  • Hot yoga or hot pilates

After the first trimester:

  • Any sport involving risk of abdominal impact (e.g., tennis, squash)
  • Exercises lying on your back (supine position) after 16 weeks, especially if you experience dizziness or nausea in this position

When to Stop and See a Specialist?

Immediately consult your doctor or midwife if you experience:

  • Vaginal bleeding
  • Painful or regular contractions
  • Leakage of amniotic fluid
  • Shortness of breath after activity
  • Chest pain
  • Severe headaches unrelieved by paracetamol
  • Muscle weakness affecting balance
  • Sudden calf pain or swelling (unrelated to exercise)