There is a trimester nobody talks about, the one before pregnancy even starts. In this episode I am breaking down what the research actually says about muscle mass, cardio, and overall fitness on fertility, pregnancy, neuromuscular control, and postpartum recovery, plus what your fitness does for your baby and where dad fits into all of it. As a board certified orthopedic Dr. of PT and women's health PT, this is the episode I wish more people had before they started trying to conceive. We get into the real numbers on gestational diabetes, labor duration, postpartum depression, diastasis recti, and the brand new research on paternal exercise and sperm. If you like conversations like this, come join the Mavens over at The Smart Girl Newspaper, my free weekly newsletter, link in the show notes.

LINKS:

Youtube Trimester 0 Mobility Flow: https://youtu.be/PNM2B5MdG2U

Male Fertility Episode: https://wellness-big-sis-the-pod.captivate.fm/episode/mamapalooza-/

Creatine for mom & baby: https://wellness-big-sis-the-pod.captivate.fm/episode/mamapalooza-creatine-for-women-mama-and-baby-from-conception-to-postpartum-with-dr-stacey-ellery-phd/

My own pregnancy prep guidebook: https://player.captivate.fm/episode/d87cd44e-cfb5-4113-a294-00281f65aaf4/

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Research articles and links

Preconception and fertility Physical Activity, BMI, and Ovulatory Disorder Infertility: https://www.researchgate.net/publication/11481782_Physical_Activity_Body_Mass_Index_and_Ovulatory_Disorder_Infertility Association between physical activity and infertility, systematic review and meta analysis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9125843/ Maternal physical and sedentary activities in relation to reproductive outcomes following IVF: https://pmc.ncbi.nlm.nih.gov/articles/PMC5053884/ Effect of exercise as an intervention for women with PCOS, systematic review and meta analysis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220722/ The effect of physical activity on fertility, a mini review: https://www.fertstertreports.org/article/S2666-3341(23)00044-2/fulltext

Pregnancy Effects of exercise on blood glucose and pregnancy outcomes in GDM, meta analysis and meta regression: https://pmc.ncbi.nlm.nih.gov/articles/PMC12465038/ Effects of physical exercise in overweight and obese pregnant women, meta analysis: https://pubmed.ncbi.nlm.nih.gov/30240042/ Effect of exercise on adverse neonatal outcomes in GDM, systematic review and meta analysis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11997568/ Effects of exercise on GDM, preeclampsia, and spontaneous abortion in healthy women: https://pmc.ncbi.nlm.nih.gov/articles/PMC10298745/ Effect of exercise on GDM in normal weight women: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233372/ Effects of physical exercise during pregnancy on delivery outcomes: https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0326868 Impact of prenatal exercise on maternal harms, labor and delivery outcomes: https://pubmed.ncbi.nlm.nih.gov/30337349/ Exercise during pregnancy associated with shorter labor duration, RCT: https://www.sciencedirect.com/science/article/abs/pii/S0301211518300964 Optimizing labor duration with Pilates, systematic review and meta analysis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365214/ Benefits of resistance training during pregnancy for maternal and fetal health: https://www.dovepress.com/benefits-of-resistance-training-during-pregnancy-for-maternal-and-feta-peer-reviewed-fulltext-article-IJWH

Neuromuscular control Postural balance and the risk of falling during pregnancy: https://pubmed.ncbi.nlm.nih.gov/26212584/ Retrospective analysis of balance parameters in pregnant women: https://doi.org/10.3390/jcm14061892 Pelvic floor adaptation to a prenatal exercise program, RCT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12346635/ Cochrane review, PFMT for preventing and treating incontinence antenatal and postnatal: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007471.pub4/full Influence of PFMT on urinary incontinence, episiotomy, and perineal tear: https://obgyn.onlinelibrary.wiley.com/doi/10.1111/aogs.14744

Postpartum Impact of postpartum physical activity on maternal depression and anxiety: https://pubmed.ncbi.nlm.nih.gov/39500542/ Overview of systematic reviews on physical activity and postpartum depression: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12192973/ Evidence for abdominal and pelvic floor muscle training for diastasis recti postpartum: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8721086/

Benefits to baby Exercise benefits for mother and offspring, molecular mechanisms and advances: https://link.springer.com/chapter/10.1007/978-3-032-08045-5_3 Exercise benefits yourself and your offspring, mini review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162635/ The metabolic implications of maternal exercise: https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2026.1741714/full Maternal obesity and offspring cardiovascular remodeling: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11281905/ Physical activity during pregnancy and gestational weight gain, epigenetic programming: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12564381/ Maternal exercise during pregnancy prevents neurocognitive impairments in offspring from prenatal stress: https://www.sciencedirect.com/science/article/abs/pii/S0941950019300892

Dad's role Physical activity and male fertility, finding the sweet spot: https://www.fertstert.org/article/S0015-0282(24)02317-3/fulltext Physical activity is not related to semen quality in young healthy men: https://pmc.ncbi.nlm.nih.gov/articles/PMC4393647/ Moderate intensity physical activity and semen parameter changes in men with impaired semen quality: https://www.urotoday.com/recent-abstracts/men-s-health/male-infertility/170348-moderate-intensity-physical-activity-is-associated-with-favorable-semen-parameter-changes-and-normalization-of-selected-abnormalities-in-men-with-impaired-semen-quality.html Paternal exercise confers endurance capacity to offspring through sperm microRNAs: https://www.cell.com/cell-metabolism/fulltext/S1550-4131(25)00388-2 Paternal preconception exercise and sperm epigenetic mechanisms, systematic review: https://pubmed.ncbi.nlm.nih.gov/41572846/ How dad's fitness may be packaged and passed down in sperm RNA, Quanta Magazine: https://www.quantamagazine.org/how-dads-fitness-may-be-packaged-and-passed-down-in-sperm-rna-20251222/ Couples based interventions for perinatal depression and anxiety: https://www.sciencedirect.com/science/article/pii/S2666560326000204 Perceived partner support in pregnancy predicts lower maternal and infant distress: https://journalofattachmentparenting.org/PerceivedPartnerSupport Association between perceived partner support and lifestyle in mother father dyads: https://pubmed.ncbi.nlm.nih.gov/36148362/

So we talk about pregnancy

fitness all the time.

2

We talk about postpartum recovery, but

what no one is talking about is the

3

preconception phase, the trimester zero

phase that comes before all of that

4

So today we're getting

into what your muscle mass

5

your cardio, and yes, even

your partner's gym habits

6

are actually doing for your

fertility, your pregnancy

7

your postpartum experience, and your baby

8

Welcome back to Wellness Fixes the Pod.

9

I'm your host, Dr.

10

Kelsey Vick, a board-certified

orthopedic doctor of physical therapy

11

and a pelvic floor physical therapist

12

And this episode is personal for

me because I myself am in this

13

trimester zero phase of just trying

to prepare my body in the best way.

14

I call it my hottest version era,

where how can I best prepare my

15

body physically and mentally for the

next potential stage of pregnancy?

16

So I figured we'd kick off this sort of

month-long celebration by having a little

17

bit of a wellness girl chat on trimester

zero from my lens as a pelvic floor PT.

18

I've done one of these

for women in pregnancy.

19

I had so many friends get pregnant

around the same time, Which inspired

20

an episode about a year and a half

ago, I believe it was like February

21

2025 or so, that I released an episode

talking about how to prepare your body

22

for birth during pregnancy, and it was

really an episode dedicated to all of

23

my friends who are pregnant and sort

of this best friend chat that I would

24

have with them, given my expertise

as a pelvic floor physical therapist.

25

But not necessarily coming from a

professional setting, more of just

26

what I would tell my best friends,

knowing that I have this expertise

27

that a lot of them have questions on.

28

So I wanted to approach today's

episode in that same way.

29

Both of us just sitting down, chatting.

30

"Kelsey, what are you

doing in trimester zero?

31

How can I best support my body?

32

What is the research surrounding exercise

and fertility in this preconception phase?

33

And how can I use this phase right

now, getting ready for pregnancy,

34

to prepare myself for when I become

pregnant and my postpartum experience?"

35

So I wanna just treat this as a little

bit of a best friend chat on trimester

36

zero, and what I would tell you to help

your body in this preconception phase

37

before that next potential future stage

of pregnancy before we dive in, I'm

38

going to link a tool that I'm gonna

release in association with this episode

39

based on actually one of the guests

that we've had on this pod, Claire.

40

She is a mom herself, and she was

saying how helpful it would be to have

41

visuals of things to go through during

this trimester zero preconception, and

42

even those early stages of pregnancy

to help prepare her body for pregnancy,

43

labor, and delivery, and postpartum.

44

So I'll leave the link

to that resource below.

45

I'm not…

46

I haven't quite filmed it yet, but

my thought is it's going to be sort

47

of a workout mobility flow with

descriptors as why I chose each exercise

48

to include in that video, and the

sort of pillars that I look at when

49

I'm programming for someone in this

trimester zero preconception or those

50

very early stages of pregnancy phases.

51

So it'll be a little bit of a workout,

But it'll also be me talking through

52

what some of the pillars are that I

look at from a physical standpoint as

53

a pelvic floor physical therapist when

it comes to helping someone in this

54

trimester zero and preconception phase.

55

So thank you, Claire, for that

recommendation and that suggestion.

56

I think it's great.

57

I'm think I'm gonna upload it to YouTube,

so I'll still leave that link below

58

And I'll also include it in our Smart Girl

Newspaper that releases every Wednesday.

59

So if you are a maven and signed

up for the Smart Girl Newspaper

60

completely free, it just releases every

Wednesday, and it expands outside of

61

health and wellness to include other

industries outside of what my own

62

expertise is in so that we can learn

63

about a wide range of subjects.

64

But I always make sure to include the

week's podcast episodes in that, and then

65

I'll also include the tool and resource

that I'm going to film that goes along

66

with this episode, and I'll send that

out in the Smart Girl Newspaper as well.

67

So I'll leave the link for all of those

things below if you wanna sign up for the

68

Smart Girl Newspaper or if you just want

to take a look and follow that video that

69

I will film for this trimester zero phase

70

So before we dive into the meat of it,

I definitely wanna cover some of the

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research surrounding trimester zero

preconception and fertility So fertility

72

and fitness is not a straight line.

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It's actually a curve.

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There are consequences to your fertility

at either end of the spectrum, so too

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low a fitness, but also too high a

fitness or too vigorous of activity

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There were a few studies that found

this sort of U-shaped curve when it came

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to a woman's fitness and her fertility

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Specifically

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In a 2022 meta-analysis of nearly

700,000, a little over 700,000 people

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They found that high activity had a

slightly higher infertility risk than

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moderate activity showing that more

exercise is not actually better when

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it comes to trying to get pregnant

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In women going through IVF, low

muscle mass and high body fat were

84

each tied to higher infertility

odds, but sedentary time mattered

85

more than the activity level itself.

86

So you're at a disadvantage when you

eventually are trying to get pregnant

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if you have too high of activity, too

vigorous of an activity level for your

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body, but also if you're too sedentary

for your body So that's that U shape that

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the research was talking about So very

low body fat and very high trained volume

90

can both disrupt the signaling

between your brain and your ovaries

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The same pathway that shows

up in competitive athletes

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who lose their menstrual cycle

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moderate, consistent movement

94

supports that communication a little bit

better than stressing it out to the max

95

Although a little caveat that I have to

mention, there was no standardized way

96

between a lot of these research studies.

97

Like, all of these research studies that

have studied the effects of vigorous

98

and moderate and sedentary lifestyles

and levels of activity on fertility

99

have used a variety of outcome measures.

100

So some people use

self-reported questionnaires.

101

So the woman herself is saying whether

or not she is partaking in vigorous

102

exercise or how sedentary she is.

103

There's just no standardization

across what is considered vigorous

104

and what is considered sedentary.

105

So that alone can cause a lot

of discrepancies in how we apply

106

that research to our own lives

107

Vigorous for you might look a lot

different than vigorous for me.

108

So I created sort of this playbook,

a few guidelines that I would look at

109

to know is the exercise you're doing

too vigorous if you are in a phase

110

where you are trying to get pregnant.

111

I'm in trimester zero, not necessarily

trying to get pregnant right now, but

112

starting to look at my body and look

at how it responds to different inputs.

113

But if you are actively trying to get

pregnant right now, these might be

114

some guidelines to look at to know

where you fall On those activity level

115

guidelines for trying to get pregnant

116

So take into account your

previous level of fitness.

117

If you are someone who would

classify yourself as sedentary,

118

don't go, balls to the wall trying

to exercise in a super drastic way.

119

Start with a few daily walks.

120

Increase that strength training,

muscle mass, cardiovascular fitness.

121

All of that is great for your

long-term health, but there is

122

no need to go from sedentary to

extremely vigorous for your body.

123

Exercising five to six times a week,

heavy strength training, running

124

five days a week, there is no need

to make that drastic of a change.

125

If you're someone who falls on either

end of that spectrum and you're looking

126

to get more into that moderate zone,

my recommendation is gradual changes

127

So the same thing applies if you're

doing heavy strength training,

128

heavy cardiovascular training.

129

Start to make those gradual changes

to more of that moderate intensity

130

I also don't want you to

automatically assume that the

131

vigorous activity that you're doing

is too vigorous for your body.

132

That's where I think analyzing your cycle

and really reflecting on how your cycle

133

and your own sort of hormonal rhythm is

affected by the exercise you're doing.

134

If you are training for a marathon but you

have a pretty good body fat percentage,

135

you can get that tested with a DEXA.

136

We've done an episode on that, on how

to get the actual metrics for that.

137

But if you have a regular cycle, if you

have a good body fat percentage, and

138

you're able to maintain that training

intensity, I'd be less likely to classify

139

you as vigorous activity because it

seems to be working for your body.

140

Although, if it is something that you are

concerned about and you're really in this

141

trying to conceive phase, maybe backing

it down a little bit, still monitoring

142

what's happening to your menstrual

cycle and that overall hormonal rhythm.

143

On the flip side, if you have a little

bit more body fat than what you would

144

like or what is recommended for your

height and you're trying to shift,

145

going into this extreme caloric deficit

to get to that ideal body weight

146

or that ideal BMI that you are told

147

can also affect that hormonal signaling

So gradual changes are best, and I

148

really do feel like the menstrual cycle

and understanding your current state

149

of your menstrual cycle right now and

then monitoring it as you make these

150

changes if you deem and your healthcare

provider deems that some of these

151

changes might be necessary for you So if

you're trying to conceive and maybe in

152

that later part of trimester zero where

you're really hoping to go into that

153

trimester one, I'd maybe start looking

at making your routine more moderate

154

for you, whatever that means for your

exercise capacity and for your own body.

155

If you already feel pretty moderate

at it, if you already feel like you're

156

at a good level, you have this good

balance of strength training, of

157

cardiovascular fitness, then great.

158

You don't have to change.

159

But if you feel like you're on either

side of those extremes, that's where I'd

160

start to look at that playbook a little

bit more, some of those guidelines,

161

some of those actual numbers and data

points that you can get from lab work

162

and DEXA scans that will help figure out

163

where your body is and then how your body

is responding to some of those changes.

164

So exercise during pregnancy

is tied to 30 to 40% lower risk

165

of gestational diabetes across a

lot of different research studies.

166

So building a routine in trimester

zero, especially if you're on that

167

more sedentary side of the spectrum,

can really help during pregnancy

168

and postpartum for the health of

you and the health of your baby

169

Multiple trials also found a shorter

first stage of labor in women who

170

exercise often an hour to an hour

and a half shorter on average

171

Exercise raises the odds

of a vaginal delivery

172

and lowers the odds of needing

forceps or vacuum assistance

173

Exercise can also help as

your body starts to change.

174

There are a lot of things that

start to work against us as our

175

belly starts to grow, our center

of gravity starts to shift.

176

Some of those neuromuscular

control, mind-muscle control

177

mechanisms start to shift.

178

Our balance, our weight shift,

our posture, how we're having to

179

compensate for certain motions, a

lot of that changes during pregnancy.

180

So exercising in trimester zero,

helping to build that strength up,

181

build that cardiovascular endurance

up, can help during pregnancy to help

182

offset some of the challenges that we

might experience due to the things that

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our body naturally has to go through

184

Exercise also helps to improve insulin

sensitivity and placental function

185

Which is mostly why we have those

186

favorable results from exercise when it

comes to things like gestational diabetes

187

on the neuromuscular side, it targeted

core, pelvic floor, and balance exercises

188

in addition to some of the postural stuff

189

gives your nervous system and your

body practice trying to coordinate

190

A body that is changing shape

week to week, month to month

191

Which is very different than just being

generally fit This is why I thought

192

Claire's suggestion of the tool to

go along with this episode was super

193

beneficial because I will walk you

through exactly the pillars that I

194

think of when it comes to preparing our

bodies in trimester zero for how our

195

bodies are going to change throughout

the next nine, 10, 12 months, Depending

196

on when you'd like to get pregnant,

when you actually get pregnant, and the

197

pregnancy postpartum experience itself

198

So some of the things I focus on, a lot of

hip mobility really helps with birth prep.

199

Thoracic mobility, breathing mechanics

really helps with the pelvic floor work.

200

I focus a lot on core strength

in a lot of different directions.

201

Postural strength, especially

when it comes to the changing

202

shape of our bodies, but then even

postpartum with breastfeeding.

203

A lot of the time, exercise beforehand

can help you better access some

204

of those muscles, especially if

you're not used to using them

205

during pregnancy and postpartum.

206

And during pregnancy, some of the

efficiency of those muscles change.

207

As your belly expands, the efficiency of

those core muscles decreases temporarily.

208

We will be able to get it back

postpartum with the right sort of inputs.

209

But having that pre-established

connection point, neuromuscular control,

210

mind-muscle connection between your

brain and different muscles in your

211

body can really help when it comes

to helping to reduce some of the

212

challenges, the physical challenges

during pregnancy, but then also the

213

recovery postpartum, things like diastasis

recti, leaking, all of the challenges

214

that your pelvic floor goes through.

215

A lot of the stuff we do now can really

help our bodies relearn it better and

216

get back to a more sort of normal,

optimal functioning after our body

217

goes through a lot of those changes

218

So of course, exercise and helping our

bodies get as fit as they possibly can in

219

a healthy way is great throughout life,

but especially before pregnancy and this

220

trimester zero preconception phase, both

to help us prepare for pregnancy and

221

postpartum physically, but then there's

also this mental health component as well

222

Postpartum exercise specifically lowers

the odds of postpartum depression by 45%.

223

When they looked at about 4,000 women,

they found that about 80 minutes

224

a week I have moderate activity.

225

Things like brisk walking, water aerobics,

cycling, or resistance training can help

226

lower the odds of postpartum depression

227

Movement affects mood through a lot

of different overlapping pathways

228

Better sleep, better stress regulation

And a sense of self-efficacy that is

229

especially important postpartum when your

body has already gone through so much

230

And I'm mentioning this postpartum fact

now in a trimester zero preconception

231

exercise because how much better will

we also be able to go through all of

232

the phases and challenges that we go

through during pregnancy and postpartum

233

if we build a solid routine now that

really works for our body and favors our

234

bodies now so that we can pick back up

235

And start to activate things

a little bit quicker and have

236

that sort of primed pathways.

237

What's the phrase?

238

If you don't use it, you lose it.

239

This is a way to use it, knowing we

might lose a little bit of its efficiency

240

throughout pregnancy, but to eventually

gain it back again in postpartum

241

So prioritize getting movement in first

for your mental health But then also the

242

physical benefits will come with it So

let's talk a little bit about dad and

243

baby too because they both matter when

we talk about trimester zero and fitness

244

So dad's fertility follows the same curve

as mom's, where too little negatively

245

impacts their fertility, but too much

also negatively impacts their fertility

246

Moderate activity tracks with better sperm

quality An elite level training volume

247

tracks with worse However, more than all

of that, that's more the physical side of

248

things, but on the mental side of things

249

Couples interventions

that actively include

250

Partners cut postpartum

depression significantly more

251

often than ones that don't.

252

So including your partner in

your communication and how

253

you're feeling can significantly

help with postpartum depression

254

And then on the baby's side,

Maternal exercise is tied to improved

255

neo-neonatal health, especially in

pregnancies with gestational diabetes

256

There have also been a few mouse studies

to look at sperm quality and what

257

transfers into the baby, and they found

that sperm carry more than just DNA

258

They carry small RNAs that can influence

259

how genes switch on in the

earliest days of an embryo

260

There was also a very striking recent

finding that's very exciting, but in a

261

twenty twenty-five Cell Metabolism paper,

they found that trained male mice pass on

262

improved endurance capacity and metabolic

health to their offspring via small

263

RNAs carried in sperm that can reprogram

264

gene expression in a very early

embryo The researchers also

265

found the same RNAs elevated in

the sperm of exercised human men

266

hinting that the mechanism they found

in mice could also transfer to humans

267

There was also a broader

systematic review done

268

of paternal preconception exercise

269

in animal studies and they found

270

Consistent associations between paternal

training and offspring having better

271

metabolic function, glucose control

272

and physical endurance.

273

So treat dad's fitness and maybe more

importantly, his actual presence and

274

support throughout the whole process

275

as a part of the trimester

zero preconception plan

276

rather than an afterthought

277

We've done a male fertility episode

before, so I'll leave that link below.

278

I'll leave a lot of the relevant episodes

that you guys might find interesting

279

if you find this episode interesting

below as well, in addition to that tool

280

and resource for you guys if you're

interested in learning how I sort

281

of coach and teach patients in this

trimester zero preconception and early

282

stages of pregnancy phases on things

to start to think about to optimize

283

how their body moves for these later

stages of pregnancy and postpartum

284

So today we covered the curve,

not necessarily the straight line

285

that connects fitness to fertility

286

The training effect

287

that exercise has on labor itself

288

The fourth trimester postpartum

exercise glow up that has meaningful

289

impacts on your mental health

290

And the importance of not just thinking

about Trimester Zero when it comes to

291

our bodies as women, but also when it

comes to the baby's health and happiness,

292

and the involvement of the partner

293

So I hope you enjoyed this little

intro to this Trimester Zero

294

podcast festival that we're doing.

295

We have exciting episodes coming

throughout the rest of the month.

296

So I was excited to kick it off, but I'm

also excited to pass the mic to some of

297

the top women involved in a wide range

of realms to chat about trimester zero

298

through the lens of their own expertise.

299

So I hope you guys enjoyed this episode,

and I'll see you guys again on the

300

next episode of Wellness Fixes the Pod.