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.

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We talk about postpartum recovery, but

what no one is talking about is the

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preconception phase, the trimester zero

phase that comes before all of that

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So today we're getting

into what your muscle mass

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your cardio, and yes, even

your partner's gym habits

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are actually doing for your

fertility, your pregnancy

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your postpartum experience, and your baby

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Welcome back to Wellness Fixes the Pod.

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I'm your host, Dr.

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Kelsey Vick, a board-certified

orthopedic doctor of physical therapy

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and a pelvic floor physical therapist

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And this episode is personal for

me because I myself am in this

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trimester zero phase of just trying

to prepare my body in the best way.

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I call it my hottest version era,

where how can I best prepare my

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body physically and mentally for the

next potential stage of pregnancy?

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So I figured we'd kick off this sort of

month-long celebration by having a little

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bit of a wellness girl chat on trimester

zero from my lens as a pelvic floor PT.

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I've done one of these

for women in pregnancy.

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I had so many friends get pregnant

around the same time, Which inspired

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an episode about a year and a half

ago, I believe it was like February

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2025 or so, that I released an episode

talking about how to prepare your body

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for birth during pregnancy, and it was

really an episode dedicated to all of

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my friends who are pregnant and sort

of this best friend chat that I would

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have with them, given my expertise

as a pelvic floor physical therapist.

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But not necessarily coming from a

professional setting, more of just

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what I would tell my best friends,

knowing that I have this expertise

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that a lot of them have questions on.

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So I wanted to approach today's

episode in that same way.

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Both of us just sitting down, chatting.

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"Kelsey, what are you

doing in trimester zero?

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How can I best support my body?

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What is the research surrounding exercise

and fertility in this preconception phase?

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And how can I use this phase right

now, getting ready for pregnancy,

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to prepare myself for when I become

pregnant and my postpartum experience?"

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So I wanna just treat this as a little

bit of a best friend chat on trimester

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zero, and what I would tell you to help

your body in this preconception phase

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before that next potential future stage

of pregnancy before we dive in, I'm

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going to link a tool that I'm gonna

release in association with this episode

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based on actually one of the guests

that we've had on this pod, Claire.

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She is a mom herself, and she was

saying how helpful it would be to have

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visuals of things to go through during

this trimester zero preconception, and

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even those early stages of pregnancy

to help prepare her body for pregnancy,

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labor, and delivery, and postpartum.

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So I'll leave the link

to that resource below.

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I'm not…

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I haven't quite filmed it yet, but

my thought is it's going to be sort

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of a workout mobility flow with

descriptors as why I chose each exercise

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to include in that video, and the

sort of pillars that I look at when

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I'm programming for someone in this

trimester zero preconception or those

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very early stages of pregnancy phases.

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

But it'll also be me talking through

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what some of the pillars are that I

look at from a physical standpoint as

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a pelvic floor physical therapist when

it comes to helping someone in this

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trimester zero and preconception phase.

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So thank you, Claire, for that

recommendation and that suggestion.

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I think it's great.

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

so I'll still leave that link below

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And I'll also include it in our Smart Girl

Newspaper that releases every Wednesday.

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So if you are a maven and signed

up for the Smart Girl Newspaper

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completely free, it just releases every

Wednesday, and it expands outside of

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health and wellness to include other

industries outside of what my own

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expertise is in so that we can learn

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about a wide range of subjects.

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But I always make sure to include the

week's podcast episodes in that, and then

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I'll also include the tool and resource

that I'm going to film that goes along

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with this episode, and I'll send that

out in the Smart Girl Newspaper as well.

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So I'll leave the link for all of those

things below if you wanna sign up for the

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Smart Girl Newspaper or if you just want

to take a look and follow that video that

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I will film for this trimester zero phase

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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

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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

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each tied to higher infertility

odds, but sedentary time mattered

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more than the activity level itself.

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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

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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

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supports that communication a little bit

better than stressing it out to the max

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Although a little caveat that I have to

mention, there was no standardized way

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between a lot of these research studies.

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Like, all of these research studies that

have studied the effects of vigorous

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and moderate and sedentary lifestyles

and levels of activity on fertility

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have used a variety of outcome measures.

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So some people use

self-reported questionnaires.

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So the woman herself is saying whether

or not she is partaking in vigorous

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exercise or how sedentary she is.

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There's just no standardization

across what is considered vigorous

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and what is considered sedentary.

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So that alone can cause a lot

of discrepancies in how we apply

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that research to our own lives

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Vigorous for you might look a lot

different than vigorous for me.

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So I created sort of this playbook,

a few guidelines that I would look at

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to know is the exercise you're doing

too vigorous if you are in a phase

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where you are trying to get pregnant.

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I'm in trimester zero, not necessarily

trying to get pregnant right now, but

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starting to look at my body and look

at how it responds to different inputs.

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But if you are actively trying to get

pregnant right now, these might be

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some guidelines to look at to know

where you fall On those activity level

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guidelines for trying to get pregnant

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So take into account your

previous level of fitness.

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If you are someone who would

classify yourself as sedentary,

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don't go, balls to the wall trying

to exercise in a super drastic way.

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Start with a few daily walks.

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Increase that strength training,

muscle mass, cardiovascular fitness.

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All of that is great for your

long-term health, but there is

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no need to go from sedentary to

extremely vigorous for your body.

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Exercising five to six times a week,

heavy strength training, running

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five days a week, there is no need

to make that drastic of a change.

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If you're someone who falls on either

end of that spectrum and you're looking

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to get more into that moderate zone,

my recommendation is gradual changes

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So the same thing applies if you're

doing heavy strength training,

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heavy cardiovascular training.

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Start to make those gradual changes

to more of that moderate intensity

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I also don't want you to

automatically assume that the

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vigorous activity that you're doing

is too vigorous for your body.

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That's where I think analyzing your cycle

and really reflecting on how your cycle

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and your own sort of hormonal rhythm is

affected by the exercise you're doing.

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If you are training for a marathon but you

have a pretty good body fat percentage,

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you can get that tested with a DEXA.

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We've done an episode on that, on how

to get the actual metrics for that.

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But if you have a regular cycle, if you

have a good body fat percentage, and

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you're able to maintain that training

intensity, I'd be less likely to classify

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you as vigorous activity because it

seems to be working for your body.

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Although, if it is something that you are

concerned about and you're really in this

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trying to conceive phase, maybe backing

it down a little bit, still monitoring

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what's happening to your menstrual

cycle and that overall hormonal rhythm.

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On the flip side, if you have a little

bit more body fat than what you would

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like or what is recommended for your

height and you're trying to shift,

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going into this extreme caloric deficit

to get to that ideal body weight

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or that ideal BMI that you are told

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can also affect that hormonal signaling

So gradual changes are best, and I

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really do feel like the menstrual cycle

and understanding your current state

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of your menstrual cycle right now and

then monitoring it as you make these

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changes if you deem and your healthcare

provider deems that some of these

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changes might be necessary for you So if

you're trying to conceive and maybe in

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that later part of trimester zero where

you're really hoping to go into that

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trimester one, I'd maybe start looking

at making your routine more moderate

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for you, whatever that means for your

exercise capacity and for your own body.

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If you already feel pretty moderate

at it, if you already feel like you're

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at a good level, you have this good

balance of strength training, of

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cardiovascular fitness, then great.

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You don't have to change.

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But if you feel like you're on either

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

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start to look at that playbook a little

bit more, some of those guidelines,

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some of those actual numbers and data

points that you can get from lab work

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and DEXA scans that will help figure out

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where your body is and then how your body

is responding to some of those changes.

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So exercise during pregnancy

is tied to 30 to 40% lower risk

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of gestational diabetes across a

lot of different research studies.

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So building a routine in trimester

zero, especially if you're on that

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more sedentary side of the spectrum,

can really help during pregnancy

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and postpartum for the health of

you and the health of your baby

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Multiple trials also found a shorter

first stage of labor in women who

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exercise often an hour to an hour

and a half shorter on average

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Exercise raises the odds

of a vaginal delivery

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and lowers the odds of needing

forceps or vacuum assistance

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Exercise can also help as

your body starts to change.

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There are a lot of things that

start to work against us as our

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belly starts to grow, our center

of gravity starts to shift.

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Some of those neuromuscular

control, mind-muscle control

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mechanisms start to shift.

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Our balance, our weight shift,

our posture, how we're having to

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compensate for certain motions, a

lot of that changes during pregnancy.

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So exercising in trimester zero,

helping to build that strength up,

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build that cardiovascular endurance

up, can help during pregnancy to help

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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

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Exercise also helps to improve insulin

sensitivity and placental function

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Which is mostly why we have those

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favorable results from exercise when it

comes to things like gestational diabetes

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on the neuromuscular side, it targeted

core, pelvic floor, and balance exercises

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in addition to some of the postural stuff

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gives your nervous system and your

body practice trying to coordinate

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A body that is changing shape

week to week, month to month

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Which is very different than just being

generally fit This is why I thought

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Claire's suggestion of the tool to

go along with this episode was super

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beneficial because I will walk you

through exactly the pillars that I

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think of when it comes to preparing our

bodies in trimester zero for how our

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bodies are going to change throughout

the next nine, 10, 12 months, Depending

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on when you'd like to get pregnant,

when you actually get pregnant, and the

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pregnancy postpartum experience itself

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

hip mobility really helps with birth prep.

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Thoracic mobility, breathing mechanics

really helps with the pelvic floor work.

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I focus a lot on core strength

in a lot of different directions.

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Postural strength, especially

when it comes to the changing

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shape of our bodies, but then even

postpartum with breastfeeding.

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A lot of the time, exercise beforehand

can help you better access some

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of those muscles, especially if

you're not used to using them

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during pregnancy and postpartum.

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And during pregnancy, some of the

efficiency of those muscles change.

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As your belly expands, the efficiency of

those core muscles decreases temporarily.

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We will be able to get it back

postpartum with the right sort of inputs.

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But having that pre-established

connection point, neuromuscular control,

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mind-muscle connection between your

brain and different muscles in your

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body can really help when it comes

to helping to reduce some of the

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challenges, the physical challenges

during pregnancy, but then also the

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recovery postpartum, things like diastasis

recti, leaking, all of the challenges

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that your pelvic floor goes through.

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A lot of the stuff we do now can really

help our bodies relearn it better and

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get back to a more sort of normal,

optimal functioning after our body

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goes through a lot of those changes

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So of course, exercise and helping our

bodies get as fit as they possibly can in

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a healthy way is great throughout life,

but especially before pregnancy and this

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trimester zero preconception phase, both

to help us prepare for pregnancy and

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postpartum physically, but then there's

also this mental health component as well

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Postpartum exercise specifically lowers

the odds of postpartum depression by 45%.

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When they looked at about 4,000 women,

they found that about 80 minutes

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a week I have moderate activity.

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Things like brisk walking, water aerobics,

cycling, or resistance training can help

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lower the odds of postpartum depression

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Movement affects mood through a lot

of different overlapping pathways

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Better sleep, better stress regulation

And a sense of self-efficacy that is

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especially important postpartum when your

body has already gone through so much

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And I'm mentioning this postpartum fact

now in a trimester zero preconception

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exercise because how much better will

we also be able to go through all of

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the phases and challenges that we go

through during pregnancy and postpartum

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if we build a solid routine now that

really works for our body and favors our

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bodies now so that we can pick back up

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And start to activate things

a little bit quicker and have

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that sort of primed pathways.

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What's the phrase?

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

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This is a way to use it, knowing we

might lose a little bit of its efficiency

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throughout pregnancy, but to eventually

gain it back again in postpartum

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So prioritize getting movement in first

for your mental health But then also the

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physical benefits will come with it So

let's talk a little bit about dad and

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baby too because they both matter when

we talk about trimester zero and fitness

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So dad's fertility follows the same curve

as mom's, where too little negatively

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impacts their fertility, but too much

also negatively impacts their fertility

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Moderate activity tracks with better sperm

quality An elite level training volume

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tracks with worse However, more than all

of that, that's more the physical side of

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things, but on the mental side of things

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Couples interventions

that actively include

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Partners cut postpartum

depression significantly more

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often than ones that don't.

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So including your partner in

your communication and how

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you're feeling can significantly

help with postpartum depression

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And then on the baby's side,

Maternal exercise is tied to improved

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neo-neonatal health, especially in

pregnancies with gestational diabetes

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There have also been a few mouse studies

to look at sperm quality and what

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transfers into the baby, and they found

that sperm carry more than just DNA

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They carry small RNAs that can influence

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how genes switch on in the

earliest days of an embryo

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There was also a very striking recent

finding that's very exciting, but in a

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twenty twenty-five Cell Metabolism paper,

they found that trained male mice pass on

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improved endurance capacity and metabolic

health to their offspring via small

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RNAs carried in sperm that can reprogram

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gene expression in a very early

embryo The researchers also

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found the same RNAs elevated in

the sperm of exercised human men

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hinting that the mechanism they found

in mice could also transfer to humans

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There was also a broader

systematic review done

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of paternal preconception exercise

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in animal studies and they found

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Consistent associations between paternal

training and offspring having better

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metabolic function, glucose control

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and physical endurance.

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So treat dad's fitness and maybe more

importantly, his actual presence and

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support throughout the whole process

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as a part of the trimester

zero preconception plan

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rather than an afterthought

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We've done a male fertility episode

before, so I'll leave that link below.

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I'll leave a lot of the relevant episodes

that you guys might find interesting

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if you find this episode interesting

below as well, in addition to that tool

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and resource for you guys if you're

interested in learning how I sort

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of coach and teach patients in this

trimester zero preconception and early

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stages of pregnancy phases on things

to start to think about to optimize

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how their body moves for these later

stages of pregnancy and postpartum

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So today we covered the curve,

not necessarily the straight line

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that connects fitness to fertility

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The training effect

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that exercise has on labor itself

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The fourth trimester postpartum

exercise glow up that has meaningful

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impacts on your mental health

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And the importance of not just thinking

about Trimester Zero when it comes to

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our bodies as women, but also when it

comes to the baby's health and happiness,

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and the involvement of the partner

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So I hope you enjoyed this little

intro to this Trimester Zero

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podcast festival that we're doing.

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We have exciting episodes coming

throughout the rest of the month.

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

also excited to pass the mic to some of

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the top women involved in a wide range

of realms to chat about trimester zero

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through the lens of their own expertise.

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So I hope you guys enjoyed this episode,

and I'll see you guys again on the

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next episode of Wellness Fixes the Pod.