CrossFit & Pregnancy

When I decided to explore this particular topic, I figured it would be a controversial one. Our team at 5 Point PT recently attended APTA CSM, where we sat in on a lecture on CrossFit during pregnancy that really got my wheels turning. The presenters made a point that a lot of CrossFit movements are functional, and therefore will help afterwards with lifting a car seat, carrying the baby, and performing all kinds of motherly duties. But I failed to hear any evidence to support or negate this – I’ve spent some time researching, and I’m excited to share my findings.

I also want to state that we are neither for nor against CrossFit, but I’m merely looking to present objective facts.

I began my search with the American College of Gynecology and Obstetrics (ACOG). A 2015 committee opinion on physical activity and exercise during pregnancy and postpartum period lists these as reasons not to engage in exercise (contraindications) : hemodynamically significant heart disease, restrictive lung disease, incompetent cervix or cerclage, multiple gestation at risk of premature labor, persistent second or third trimester bleeding, placenta previa after 26 weeks of gestation, premature labor during current pregnancy, ruptured membranes, preeclampsia or pregnancy-induced hypertension, and severe anemia.

Relative Contraindications to exercise during pregnancy (meaning, you might be able to exercise but you should ask your doctor, and monitor how you respond to exercise): anemia, unevaluated maternal cardiac arrhythmia, chronic bronchitis, poorly controlled type 1 diabetes, extreme morbid obesity, extreme underweight (BMI less than 12), history of extremely sedentary lifestyle, intrauterine growth restriction in current pregnancy, poorly controlled hypertension, orthopedic limitations, poorly controlled seizure disorder, poorly controlled hyperthyroidism, or heavy smoking.

Activities to consider avoiding during pregnancy (as recommended by the ACOG):

  • Contact sports like ice hockey, boxing, soccer, and basketball
  • Activities with high risk of falling like downhill skiing, water skiing, surfing, off-road cycling, gymnastics and horseback riding
  • Scuba diving
  • Sky diving
  • Hot yoga or Pilates

Since heart rate changes rapidly, it is recommended to use the Borg Scale of Perceived Exertion (6-20) and pregnant women should be between a 13-14.  The paper notes that studies have not found negative effects to the fetus, and actually show a lower rate of GDM (gestational diabetes), lower rate of preeclampsia, improved recovery after delivery and during the post-partum.

Recommendations for lifting

Though most OB’s seem to use lifting guidelines from a paper published in 1984, I was able to find a more recent study that summarizes all the studies to date about lifting, but mainly in an occupational setting. This fantastic diagram provides very specific recommendations for lifting – it notes that if you are under 20 weeks gestation, the max lift you should be doing is 36 pounds, and after 20 weeks is 26 pounds.  It makes me think about how this works in real life.  Let’s say that you already have a child – a baby or toddler for example – that weighs more than 26 pounds. Or you have a young baby and they are in a car seat (which weighs 10 pounds) – you’d already be surpassing this weight limit. The Royal College of  Physicians would say that there’s minimal risk, finding that only  .1 of cases of pre-term delivery per 100 pregnancies amongst women undertaking heavy lifting at work.

In the end, I didn’t come up with much substance on heavy lifting while pregnant, and absolutely nothing specifically geared towards CrossFit and pregnancy beyond blog posts and online articles.

This 2008 article in the CrossFit journal provides a few valid points; its author advises against lying flat, and suggests avoiding inversions (this depends on the person). It also stresses the importance of keeping heart rate at the perceived exertion level of being able to talk. Here are some exercises they suggest avoiding during pregnancy:

  • Rope climbs and handstand pushups
  • Heavy or max lifts
  • Back or hip extensions are OK for a few months, but stay away from GHD sit ups
  • Box jumps (because these can cause loss of balance)

You should also avoid rushing during workouts or working to exhaustion. For example, don’t run or row until you can’t anymore. Listen to your body and scale down things you want to do – if squats are too difficult, try to sit and then stand up; if pull ups are impossible, do ring rows; instead of sit-ups do knees to elbows; if push ups are too hard, try against the wall or on a box; if your belly gets too big, substitute dumbbells for barbells.

I finally found a resource directly related to CrossFit and Pregnancy. It lists guidelines for each trimester and notes some common post-partum issues including: joint laxity, rectus diastasis, urinary incontinence, pelvic floor muscle injury, and pelvic organ prolapse.  One of the recommendations to deal with prolapse is to perform Kegels, which I disagree with as a pelvic floor PT.

I would strongly recommend that all women, regardless of if you have had a C-section or vaginal delivery, should be fully evaluated by a physical therapist that specializes in women’s health. During this session, we can look at the pelvic floor muscles and vaginal canal to check for strength, scarring and function.  We will fully evaluate for any prolapse, diastasis of the abdominals, as well as your strength and functional movements.  Unfortunately, Kegels alone might not “fix” the dysfunction that might have occurred from childbirth –  and depending on what the patients presents like they could actually make it worse.

In conclusion, there is not enough research to definitively say that CrossFit is beneficial or harmful during pregnancy.  I hope that the articles that I reviewed can give you some insight and help guide your decisions.