Pregnant, Not Fragile: What Exercise Physiologists Need to Know About Lifting During Pregnancy

This article was written in collaboration with Accredited Exercise Physiologist Samuel Padarcic, General Manager of  The Biomechanics in Melbourne, Victoria. 

My wife was training up until 40+1 weeks of her pregnancy before giving birth to our gorgeous son. She was lifting, going to the gym, and exercising right throughout her pregnancy. I think that is awesome; I say that as her husband, but also as an Accredited Exercise Physiologist.

However, the fear-based messaging around pregnancy and lifting is something I hear about constantly, and it's important we address this head on if we want the best health outcomes for our pregnant clients seeking exercise advice. This fear doesn't arise from nowhere; it's often inherited from guidance or beliefs stemming from old paternalistic obstetric attitudes that treat pregnancy as a state of vulnerability rather than capability, then projected by well-meaning health professionals who may not be up to date with the latest literature or who share the view that the human body is inherently fragile. For us, as exercise physiologists working in the antenatal and postnatal space, addressing this directly with our clients isn't optional, it's core to our job. A client who is anxious about resistance training won't stay adherent to a program, let alone even consider commencing, no matter how well it's programmed or how great the benefits are.

We will walk through some recent peer-reviewed studies relevant to resistance training in pregnancy and discuss how they translate into practical guidance for client education and programming.

Is lifting safe?

Most restrictions around exercise in pregnancy were never built on direct evidence. They were built on conservative expert opinion that was rarely tested against outcome data. A 2020 systematic review examined the evidence behind each commonly cited contraindication to prenatal exercise (Meah et al., 2020). Across 44 studies, the review found that most of these restrictions lacked meaningful support, and that inactivity itself carries real, measurable risk.

The following are no longer considered barriers to exercise participation:

• Chronic or gestational hypertension

• Obesity (BMI ≥30)

• Recurrent miscarriage

• Short cervix

• Multiple pregnancies (twins or more)

• Epilepsy (treated, no recent seizures)

• Anaemia

• Orthopaedic limitations

• History of extremely sedentary lifestyle

• History of spontaneous preterm labour

• History of intrauterine growth restriction

This matters clinically because it's exactly the list a lot of clients arrive with as reasons they've been told to stop or avoid exercise. Knowing this evidence base gives you a defensible clinical position when a client asks “but my doctor said...” Genuine reasons to modify or avoid exercise still exist, and every client still needs an individual risk assessment to identify relative and absolute contraindications. The point is the list of valid restrictions is considerably shorter than most clinicians and clients assume. The Meah et al. paper is free access and worth familiarising yourself with directly, including its breakdown of evidence-informed contraindications.

General safety principles still apply regardless of training background: activities with a high risk of falling or collision, significant pressure changes such as scuba diving or high altitude, or anything that provokes pain still warrant caution or modification, and hydration and heat management become more important as pregnancy progresses. The Australian Government's physical activity guidelines for pregnancy are a useful reference point to sit alongside your own individualised programming.

Where this usually gets murky is when guidelines say avoid “heavy lifting.” It's a term thrown around in public guidelines and medical appointments without any real context, since “heavy” is always relative to the person doing the lifting.

What does resistance training actually do for outcomes?

A 2025 systematic review and meta-analysis (Prevett et al., 2025) pooled data from 50 studies and 47,619 participants across 14 countries, the largest analysis of its kind to date. Resistance training, whether performed alone or as part of a multicomponent program, was associated with lower odds of gestational hypertension (OR 0.42), gestational diabetes (OR 0.62), perinatal mood disorders (OR 0.48) and macrosomia (OR 0.67), compared with control groups.

It is important to be accurate about what this does and doesn't show. Ninety per cent of the included studies used multicomponent programmes combining resistance training with aerobic work, resistance training dosage was generally low-to-moderate, and reporting on load selection and progression was poor across the field. This isn't a dataset built on specific lifting protocols, it's evidence of resistance training participation broadly, most of it conservative in intensity. Even dosed modestly, resistance training moves the needle on major pregnancy complications.

What about heavy compound lifting?

Until 2025, high-intensity resistance training in pregnancy was discouraged automatically, not because it had been shown to cause harm, but because no one had directly studied it. That gap has now been addressed (Moolyk et al., 2025).

This was the first study to directly assess heavy compound lifting in pregnancy: barbell squat, bench press, and deadlift performed at 70-90% of a 10-rep max, including with the Valsalva manoeuvre. Ten healthy, experienced lifters (average 26 weeks gestation, minimum two years lifting experience and able to back squat, deadlift and bench more than 50lbs/22.7kg for 10 reps) were monitored for fetal heart rate and umbilical blood flow before and after each set.

Findings:

• Zero cases of fetal bradycardia at any load

• Umbilical blood flow remained within normal ranges across all sets

• All infants born healthy at term

• The Valsalva manoeuvre, long assumed unsafe in this context, showed no adverse effect

For clinical application, this data applies specifically to experienced lifters in the late second trimester performing near-maximal compound lifts. It is not a green light to introduce a novice to heavy barbell training mid-pregnancy, but it does remove a major evidence gap for clients who were already resistance training pre-pregnancy and want to continue training near their established capacity.

What about the pelvic floor?

Pelvic floor concerns come up constantly in conversations about lifting. A 2023 survey of 679 people who lifted at least 80% of their one-rep max during pregnancy (Prevett et al., 2023) found gestational hypertension (3%), preeclampsia (3%) and gestational diabetes (1%) below expected population values. Prolapse itself was low (3% during pregnancy, 14% postpartum), though not compared by lifting technique. Urinary incontinence was compared directly: postpartum rates were higher than the general population (57% vs ~32%), which the authors attribute to this being a high-impact-training population generally, not to pregnancy or any specific technique, and rates didn't differ between those who did or avoided Olympic lifting, Valsalva, or supine lifting.

A larger study answers the prolapse question more directly. A survey of 3,934 women, not pregnancy-specific (Forner et al., 2020), found prolapse symptoms were lowest in women lifting over 50kg (7.1%), versus light lifters under 15kg (19.4%) and inactive women (21.3%), holding after adjusting for vaginal parity, age, family history and history of constipation or hemorrhoids. It's not directly a pregnancy sample, so it sits alongside the Prevett data rather than replacing it, but it directly tests the heavy-lifting-causes-prolapse assumption and finds the opposite.

Worth being upfront about design limitations: both are cross-sectional surveys with self-reported outcomes, so causation can't be confirmed, and heavy lifting was self-selected rather than randomly assigned in either. Prevett's comparisons are within a population of lifters, not against a sedentary group, so it can't speak to lifting versus inactivity specifically. Forner's study does include an inactive comparison group, but in a non-pregnant population. Between the two, this is the most direct data available on lifting and pelvic floor symptoms, and neither supports the assumption that heavy lifting during pregnancy or otherwise elevates prolapse risk.

Key takeaway: it's likely urinary stress incontinence will come up when working with pregnant and postpartum clients, so being comfortable discussing this topic openly in a safe space, understanding symptoms and triggers, and knowing what modifications and advice you can offer to best support your client - including referring on when indicated.

Is it safe for baby?

Fetal heart rate changes during maternal exercise are one of the most common sources of client anxiety, and one of the easiest to misinterpret without current evidence. A 2024 overview addresses this directly (Duchette et al., 2024): changes in fetal heart rate during resistance training reflect increased fetal wakefulness and activity, not distress, and are not associated with fetal hypoxia.

This is a useful reframe to have ready in session, particularly for clients who've been told to “watch for” heart rate changes as a warning sign. The same overview found resistance training during pregnancy is associated with reduced risk of gestational diabetes, preeclampsia, and macrosomia, better labour and delivery outcomes, and reduced postpartum anxiety, depression, and incontinence.

So many benefits, so little adherence

Adherence isn't just a safety issue, it's an outcome in itself. A 2025 systematic review of nine RCTs (n=1,581) examined the effect of strength training on quality of life during pregnancy (Redondo-Delgado et al., 2025). Findings included significant reductions in low back pain, sciatica and total pain, improvements in energy, vitality and sleep quality, reductions in anxiety, sadness and fatigue, improved strength, physical function and general health, and reduced excessive gestational weight gain.

And yet, despite all of this, adherence remains poor. Only 3 in 10 pregnant women in Australia meet the physical activity guideline; 54% are insufficiently active and 16% are inactive altogether (AIHW, 2019).

The benefits are well established. The gap isn't a lack of evidence, it's a lack of confidence, and that's exactly where our role sits. Pregnancy isn't a state of fragility to be managed around, I would argue the entire process is the most incredible and physiologically demanding things the human body can do. The appropriate response to that shouldn’t caution for its own sake, it's preparation. The least we can do to support a body doing something this remarkable is help it move, adapt, and build the capacity it needs for what's ahead. Framing resistance training purely as “safe” tends to land as permission-seeking. Framing it as part of how we prepare the body for one of its most demanding tasks gives clients a reason to stay engaged, which is where adherence is actually won or lost.

A starting structure for healthy pregnancies

Guess what, you've heard it before: pretty much follow physical activity guidelines. No need to reinvent the wheel.

Based on the current evidence, a reasonable baseline structure for most healthy pregnancies (Redondo-Delgado et al., 2025):

• Frequency: 1-2 sessions per week

• Intensity: moderate to vigorous, roughly RPE 12-16/20

• Duration: approximately 60 minutes per session

• Focus: full-body, with specific attention to core and pelvic floor function

This is a framework for overarching programming decisions, not a substitute for individual assessment. Let's use common sense too: midway through pregnancy is not the time to force a 60-minute session. Break it up, use movement snacks, program based on presentation, because adherence and consistency is what matters most. Load progression, exercise selection and Valsalva use should still be matched to training history, gestational stage, and individual presentation. There are plenty of options to meet someone where they're at and focus on participation over any specific movement. This is a recommended structure, but the best exercise is still the exercise that gets done, so get creative and make it meaningful.

The true intervention is empowerment

The practical value of this evidence for us as exercise physiologists isn't just clinical, it's communicative. Clients frequently arrive with instructions from other health professionals that don't reflect current evidence, and pushing back on that without a clear evidence base risks damaging trust in both directions. Being able to point to specific, recent, peer-reviewed data, rather than general reassurance, changes that conversation. It gives clients permission to trust their own body and their program, and gives you a defensible clinical position when scope-of-practice questions come up with referring practitioners.

Real reasons to modify or avoid exercise in pregnancy still exist, and shared decision-making with the client and their care team remains essential. But the default should be individual assessment against current evidence, not inherited caution.

References

AIHW (Australian Institute of Health and Welfare) (2019). Physical activity during pregnancy 2011-12. AIHW, Australian Government.

Duchette, C., Perera, M., Arnett, S., White, E., Belcher, E., & Tinius, R. (2024). Benefits of resistance training during pregnancy for maternal and fetal health: A brief overview. International Journal of Women's Health, 16, 1137-1147. PMID: 38912201

Forner, L. B., Beckman, E. M., & Smith, M. D. (2020). Symptoms of pelvic organ prolapse in women who lift heavy weights for exercise: A cross-sectional survey. International Urogynecology Journal, 31(8), 1551–1558. PMID: 31813038

Meah, V. L., Davies, G. A., & Davenport, M. H. (2020). Why can't I exercise during pregnancy? Time to revisit medical 'absolute' and 'relative' contraindications. British Journal of Sports Medicine, 54(23), 1395-1404. PMID: 32513676

Moolyk, A. N., Wilson, M. K., Matenchuk, B. A., Bains, G., Gervais, M. J., Wowdzia, J. B., & Davenport, M. H. (2025). Maternal and fetal responses to acute high-intensity resistance exercise during pregnancy. British Journal of Sports Medicine, 59(3), 159-166. PMID: 39694629

Prevett, C., Gingerich, J., Sivak, A., & Davenport, M. H. (2025). Resistance training in pregnancy: Systematic review and meta-analysis of pregnancy, delivery, fetal and pelvic floor outcomes and call to action. British Journal of Sports Medicine, 59(16), 1173-1182. PMID: 40610191

Prevett, C., Kimber, M. L., Forner, L., de Vivo, M., & Davenport, M. H. (2023). Impact of heavy resistance training on pregnancy and postpartum health outcomes. International Urogynecology Journal, 34(2), 405-411. PMID: 36331580

Redondo-Delgado, P., Blanco-Giménez, P., López-Ortiz, S., García-Chico, C., Vicente-Mampel, J., & Maroto-Izquierdo, S. (2025). Effects of strength training on quality of life in pregnant women: A systematic review. Acta Obstetricia et Gynecologica Scandinavica, 104(7), 1231-1243. PMID: 40230063