Running in Pregnancy

by Kat Suchet, Women's Health Physio and founder of Hatch Athletic

Can you run in pregnancy? How hard can you go? And for how long? What do you need to look out for and when should you stop? You've asked for it, we've been eagerly awaiting it and it's finally here. 

Running in Pregnancy

We know that there are many benefits to running: getting outside, it's great for for mental health, it's easy to make it happen, it's cheap and fits easily around your life.

It's also not news that exercise in pregnancy is encouraged. Most of us are also aware of the generic running in pregnancy advice: that if you are a regular runner before pregnancy, you should be able to continue this throughout your pregnancy as long as it feels ok.

But is this advice really the truth? Are there limits if you're a marathon runner? Or a 100m sprinter? And what is really at stake? 

Exertion: how much is too much?

Running is probably one of the quickest exercise modalities out there to spike your heart rate. 

Pregnant women have a higher basal resting heart rate, so now you're pregnant, if you're running it might spike to a higher heart rate quicker than you're used to.

The latest recommendations (at of the time of publishing this blog) suggest keeping your running workouts to under 90% max heart rate with short periods over this being absolutely fine (Wowdzia et al, 2023 & Beetham et al, 2019). 

Pair this advice with using the Talk Test - being able to comfortably hold a conversation during workouts - which is sound advice through your whole pregnancy. 

What this means though, is if you're a 100m sprinter, you're good to go in terms of exertion as far as the research is concerned. Vigorous exercise in short bursts has been deemed as safe for mum and bub. But if you like the longer runs or you tend to hang out in the red for long periods, you might want to invest in a heart rate monitor and keep it below 90% HRM. Garmin, MyZone, Polar, and now even FitBit and Apple Watch have all been clinically validated as accurate HR monitors. 

Your body will always make sure it protects your baby's homeostatic environment before it protects you (blood supply and nourishment) so a long, intense run in pregnancy might leave you feeling rubbish and depleted for the rest of the day. Not a great idea in our books. 

Heat and Hydration

Hydrate. If you're pregnant and running, drink plenty. Aim for 3 litres every day if you can. Try a little pinch of salt in there to help with the absorption if you're training hard. Dehydration can feel awful if you're pregnant and also you don't want to get constipated (which is super common in early pregnancy). You'll likely be sweating more so losing more water than normal, so do whatever you can to replenish your lost fluids, keep your bowel movements regular and avoid headaches. 

A pregnant woman's basal temperature is a little warmer as you've actually got more blood flowing through your veins! Take rest periods if you feel like you're overheating. Remember for some women it's hard to give themselves permission to slow down a bit but really - it's ok to take the tempo down a notch so you can remain comfortable - just for this short season. 

So can I go running now?

It is safe to say, pregnancy is not the time to take up running if you haven’t previously been a runner. For those who have a healthy lifestyle prior to pregnancy and have a low-risk pregnancy, the guideline is that you may be able to safely continue running during your pregnancy as long as you have considered the following:

1. Do you have a history of pelvic floor dysfunction?

Do you have a history of leaking on cough, sneeze, run, jump, laugh or lift? Do you have irregular bowel habits? Do you have a long history of very heavy or painful periods (i.e. endometriosis)? Are you currently working through any bodily aches/pains or injuries?

If you answer yes to any of the above it might be worth checking in with your women's health physiotherapist. They will be able to address some of your concerns and might be able to help you address any pelvic floor dysfunction. 

Hatch recommends NOT running during your pregnancy if you have any of the above concerns until you've been assessed by a women's health physiotherapist. 

If you're symptom-free, we also recommend (as a gold standard) to get a Pregnancy MOT with a physio to be sure your pelvic floor is in top shape to run in pregnancy. Ask them to take a measurement called a GH+PB. This is a measurement of your pelvic floor which should, ideally, be under 7cm if you want to run without increasing any risk of pelvic organ prolapse. 

This measurement typically elongates/lengthens throughout your pregnancy, to allow for vaginal delivery, so just be mindful that your pelvic floor in later pregnancy is going to be more mobile and potentially a bit more vulnerable in later pregnancy. More on this later. 

Understandably, women's health physio assessments aren't easily accessed by all. So as a rule of thumb - if you have experienced, or do experience any leaking, dragging, bulging, or heaviness in your bladder or vaginal areas when you run this is your cue to take it to low impact for now.

2. Do you have any jointy or muscular aches, pains or tweaks? 

During pregnancy the pelvic floor tissues soften to prepare for childbirth. The cumulative distance between the openings in your pelvic floor (the distances between your urethra, vagina and anus) increases. The pelvic floor is now not only relaxing, but it has the increased load of their growing baby. 

Large hormonal changes mean that the ligaments and other support structures around the pelvis, including your fascia, also stretch.

Then you have to consider that women will put on anywhere from 10-30kg by their third trimester

All of this means your pelvic floor muscles, your pelvis and low back, knees and ankles - in general - can be a bit more vulnerable to sprains, strains and tweaks in pregnancy. 

Add to this mix repetitive high impact activities such as running and you have, what we would call, a more challenging exercise modality in pregnancy. 

The pelvic floor is connected to the pelvis, other muscles and the pelvic organs by non-muscular fascia. This is connective tissue so it cannot be repaired like a muscle can. Any compromise or injury to the pelvic floor fascia - prior to running, or during repetitive activities on an already compromised pelvic floor - cannot be undone. This is something to note if you have a history of pelvic floor damage or injury, or if you suspect this in your pregnancy. Damage to the fascia rarely hurts - it would present itself as dragging or bulging sensations, or potentially pelvic pain. 

Hatch recommends NOT running during your pregnancy if you have any concerns about your pelvic floor or your connective tissue, until you've been assessed by a women's health physiotherapist. 

This does NOT mean you must not run - it just means you need to be armed with all the correct information in order to make an education decision about running. 

So what if I decide to run in pregnancy?

Running can be great in pregnancy and if you're symptom-free and you're enjoying gentle runs and keeping your exertion, heat and hydration under control then there's no reason to stop. 

If you do choose to run in your pregnancy don't forget these 4 all-important points to keep running safely:

1. Manage your exertion - stay under 90% HRM if you're running long-distance. Short periods above this is fine if you're interval training;

2. Ensure you're symptom-free, i.e. not leaking or experiencing symptoms of bulging, dragging, heaviness or pain at any point during your run. If you do - please stop and seek the advice of a women's health physiotherapist;

3. Work on your strength, i.e. strong pelvic floor, core, glute and lower limbs will maximise pelvic stability and reduce risk of injury;

4. Reduce the impact where you can. Wear well-cushioned shoes, avoid downhill running (or walk the downhills) and choose softer terrains where you can, in order to minimise the jarring ground-reaction-forces delivered by road-running.

4. What's the alternative? 

Towards later pregnancy there will be some women who can still manage to run, but for most it will likely get a bit more uncomfortable (or perhaps way sooner than that). Or perhaps you've identified your pelvic floor needs a bit more TLC in pregnancy, or you simply don't like the feeling of running in pregnancy. That's ok. Wanting that cardio high without the high-impact? We've got you.

Here are some suggestions for low-impact options that gets the heart rate pumping. 

1. Carries (Farmers, Front Rack, Suitcase)
2. Static Bike (Erg, Echo, Assault, Turbo Trainer)
3. Sled/Box Push
4. Stair Climb/Incline Power Walk
5. Swim
6. Kettlebell Swings
7. Wall Ball Shots

Remember, our guidelines are exactly that. They can’t account for every case scenario, so with all of this considered, it’s important to know the signs of when your body is ‘doing it tough’, and ultimately – when do you need to stop running? This includes;

• Leaking urine during running
• A feeling of heaviness or dragging in the pelvis 
• Feeling uncomfortable during or after running 
• Chest pain, headaches, dizziness or severe shortness of breath. 

If you experience any of these symptoms, it's important to stop running and seek specific medical advice from your health care professional. 

Want to know more or have a consult about your own personal pregnancy circumstances? Book a 1-to-1 consult with Women's Health Physio and Hatch Founder, Kat here https://www.hatchathletic.com/1-to-1 

Images with kind permission from athletes Ellie from @Ellie_Living_Healthy and Ankita Gaur from @thecookie_runner.