REVIEW PAPER
From caution to guidance: a narrative review of CrossFit during pregnancy
 
 
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Department of Physical Education and Sport, University of Hradec Králové, Hradec Králové, Czech Republic
 
 
Submission date: 2023-11-20
 
 
Acceptance date: 2024-04-02
 
 
Publication date: 2024-06-28
 
 
Corresponding author
Petr Schlegel   

University of Hradec Králové
 
 
Hum Mov. 2024;25(2):1-11
 
KEYWORDS
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ABSTRACT
Public opinion on engaging in vigorous activity during pregnancy remains divided. While numerous examples exist of pregnant women competing at high levels in sports, concerns persist regarding potential adverse effects on maternal and foetal health. CrossFit, known for fostering community and social connection, often remains a continued practice for female athletes during pregnancy, despite its association with high-intensity exercise, Olympic weightlifting, and dynamic movements. This article aims to synthesise current evidence-based information on CrossFit training during pregnancy, objectively outline potential risks, and provide practical recommendations. A narrative review was conducted, sourcing data from PubMed, Scopus, and Semantic Scholar. Articles were categorised into relevant sections: exercise during pregnancy, high-intensity exercise, resistance training, injuries in CrossFit, and practical applications. In the absence of studies directly assessing CrossFit’s impact on pregnant women, available sources allow us to endorse this form of exercise as safe and beneficial for both maternal and foetal health. Certain exercises, such as jumping and burpees, should be adapted to the specific trimester, while others might be best avoided (such as box jumps and bar muscle-ups). Nonetheless, adherence to professional guidance and medical directives is crucial. The recommendations herein are intended for healthy, physically active pregnant women.
 
REFERENCES (79)
1.
Physical activity and exercise during pregnancy and the postpartum period: ACOG Committee Opinion, Number 804. Obstet Gynecol. 2020; 135(4):178–88; doi: 10.1097/AOG.0000000000 003772.
 
2.
Evenson KR, Moos M-K, Carrier K, Siega-Riz AM. Perceived barriers to physical activity among pregnant women. Matern Child Health J. 2009;13(3): 364–75; doi: 10.1007/s10995-008-0359-8.
 
3.
McKeough R, Blanchard C, Piccinini-Vallis H. Pregnant and postpartum women’s perceptions of barriers to and enablers of physical activity during pregnancy: a qualitative systematic review. J Midwifery Womens Health. 2022;67(4):448– 62; doi: 10.1111/jmwh.13375.
 
4.
Dowling C. The Frailty Myth: Women Approaching Physical Equality. 1st ed. New York: Random House; 2000.
 
5.
Weaving C. Prenatal paranoia: an analysis of the bumpy landscape for the pregnant athlete. Sport Ethics Philos. 2020;14(2):176–91; doi: 10.1080/175 11321.2019.1593233.
 
6.
Shum KW, Ang MQ, Shorey S. Perceptions of physical activity during pregnancy among women: a descriptive qualitative study. Midwifery. 2022; 107:103264; doi: 10.1016/j.midw.2022.103264.
 
7.
Nagpal TS, Everest C, Goudreau AD, Manicks M, Adamo KB. To HIIT or not to HIIT? The question pregnant women may be searching for online: a descriptive observational study. Perspect Public Health. 2021;141(2):81–8; doi: 10.1177/175791 3920985898.
 
8.
Tiidenberg K, Baym NK. Learn it, buy it, work it: intensive pregnancy on Instagram. Soc Media Soc. 2017;3(1); doi: 10.1177/2056305116685108.
 
9.
Davenport MH, Steinback CD, Borle KJ, Matenchuk BA, Vanden Berg ER, de Freitas EM, Linares AM, O’Halloran KD, Sherpa MT, Day TA. Extreme pregnancy: maternal physical activity at Everest Base Camp. J Appl Physiol (1985). 2018; 125(2):580–85; doi: 10.1152/japplphysiol.00146. 2018.
 
10.
Kubler JM, Clifton VL, Moholdt T, Beetham KS. The effects of exercise during pregnancy on placental composition: a systematic review and metaanalysis. Placenta. 2022;117:39–46; doi: 10.1016/ j.placenta.2021.10.008.
 
11.
Dominski FH, Serafim TT , Siqueira TC, Andrade A. Psychological variables of CrossFit participants: a systematic review. Sport Sci Health. 2021; 17(1):21–41; doi: 10.1007/s11332-020-00685-9.
 
12.
Prewitt-White T, Connolly CP, Feito Y, Bladek A, Forsythe S, Hamel L, McChesney M. Breaking barriers: women’s experiences of crossfit training during pregnancy. WSPAJ. 2018;26(1):33–42; doi: 10.1123/wspaj.2017-0024.
 
13.
Fernández-Fernández J, Sabido-Solana R, Moya D, Sarabia Marín JM, Moya M. Acute physiological responses during Crossfit® workouts. Eur J Hum Mov. 2015;35:114–24.
 
14.
Tibana RA, de Sousa NMF, Cunha GV, Prestes J, Fett C, Gabbett TJ, Voltarelli FA. Validity of session rating perceived exertion method for quantifying internal training load during high-intensity functional training. Sports. 2018;6(3):68; doi: 10.3390/sports6030068.
 
15.
Perkins C, Dewalt H. CrossFit training during pregnancy and motherhood: a new scientific frontier. CrossFit J. 2011;1:1–9.
 
16.
Machado L da S, Marques Cerentini T, Laganà AS, Viana da Rosa P, Fichera M, Telles da Rosa LH. Pelvic floor evaluation in CrossFit® athletes and urinary incontinence: a cross-sectional observational study. Women Health. 2021;61(5):490–9; doi: 10.1080/03630242.2021.1927288.
 
17.
Khowailed IA, Pinjuv-Turney J, Lu C, Lee H. Stress incontinence during different high-impact exercises in women: a pilot survey. Int J Environ Res Public Health. 2020;17(22):8372; doi: 10.3390/ ijerph17228372.
 
18.
Pisani GK, de Oliveira Sato T, Carvalho C. Pelvic floor dysfunctions and associated factors in female CrossFit practitioners: a cross-sectional study. Int Urogynecol J. 2021;32(11):2975–84; doi: 10.1007/s00192-020-04581-1.
 
19.
Sigurdardottir T, Steingrimsdottir T, Geirsson RT, Halldorsson TI, Aspelund T, Bø K. Do female elite athletes experience more complicated childbirth than non-athletes? A case–control study. Br J Sports Med. 2019;53(6):354–8; doi: 10.1136/ bjsports-2018-099447.
 
20.
Feito Y, Burrows EK, Tabb LP. A 4-Year analysis of the incidence of injuries among crossfit-trained participants. Orthop J Sports Med. 2018;6(10): 2325967118803100; doi: 10.1177/2325967118 803100.
 
21.
Everhart JS, Poland S, Vajapey SP, Kirven JC, France TJ, Vasileff WK. CrossFit-related hip and groin injuries: a case series. J Hip Preserv Surg. 2020;7(1):109–15; doi: 10.1093/jhps/hnz072.
 
22.
Owe KM, Nystad W, Stigum H, Vangen S, Bø K. Exercise during pregnancy and risk of cesarean delivery in nulliparous women: a large populationbased cohort study. Am J Obstet Gynecol. 2016; 215(6):791.e1–791.e13; doi: 10.1016/j.ajog.2016. 08.014.
 
23.
CrossFit, LLC. About Affiliation 2022. Available from: https://www.crossfit.com/affil... (accessed November 23, 2022).
 
24.
Anderson J, Pudwell J, McAuslan C, Barr L, Kehoe J, Davies GA. Acute fetal response to highintensity interval training in the second and third trimesters of pregnancy. Appl Physiol Nutr Metab. 2021;46(12):1552–8; doi: 10.1139/apnm-2020- 1086.
 
25.
Avery ND, Stocking KD, Tranmer JE, Davies GA, Wolfe LA. Fetal responses to maternal strength conditioning exercises in late gestation. Can J Appl Physiol. 1999;24(4):362–76; doi: 10.1139/ h99-028.
 
26.
Clapp JF. The course of labor after endurance exercise during pregnancy. Am J Obstet Gynecol. 1990;163(6 Pt 1):1799–1805; doi: 10.1016/0002- 9378(90)90753-t.
 
27.
Kardel KR. Effects of intense training during and after pregnancy in top-level athletes. Scand J Med Sci Sports. 2005;15(2):79–86; doi: 10.1111/j.1600- 0838.2004.00426.x.
 
28.
Szymanski LM, Satin AJ. Strenuous exercise during pregnancy: is there a limit?. Am J Obstet Gynecol. 2012;207(3):179.e1–6; doi: 10.1016/j. ajog.2012.07.021.
 
29.
Baethge C, Goldbeck-Wood S, Mertens S. SANRA – a scale for the quality assessment of narrative review articles. Res Integr Peer Rev. 2019;4:5; doi: 10.1186/s41073-019-0064-8.
 
30.
Costantine MM. Physiologic and pharmacokinetic changes in pregnancy. Front Pharmacol. 2014;5: 65; doi: 10.3389/fphar.2014.00065.
 
31.
Barakat R, Perales M, Garatachea N, Ruiz JR, Lucia A. Exercise during pregnancy. A narrative review asking: what do we know?. Br J Sports Med. 2015;49(21):1377–81; doi: 10.1136/bjsports- 2015-094756.
 
32.
Gregg VH, Ferguson JE. Exercise in pregnancy. Clin Sports Med. 2017;36(4):741–52; doi: 10.1016/ j.csm.2017.05.005.
 
33.
Melzer K, Schutz Y, Boulvain M, Kayser B. Physical activity and pregnancy: cardiovascular adaptations, recommendations and pregnancy outcomes. Sports Med. 2010;40(6):493–507; doi: 10.2165/11532290-000000000-00000.
 
34.
Grattan DR, Ladyman SR. Neurophysiological and cognitive changes in pregnancy. Handb Clin Neurol. 2020;171:25–55; doi: 10.1016/B978-0- 444-64239-4.00002-3.
 
35.
Santos-Rocha R, Gutiérrez IC, Szumilewicz A, Pajaujiene S. Exercise Testing and Prescription for Pregnant Women. In: Santos-Rocha R (ed.) Exercise and Sporting Activity During Pregnancy. Springer; 2019, pp. 183–231.
 
36.
Tinloy J, Chuang CH, Zhu J, Pauli J, Kraschnewski JL, Kjerulff KH. Exercise during pregnancy and risk of late preterm birth, cesarean delivery, and hospitalizations. Womens Health Issues. 2014; 24(1):99–104; doi: 10.1016/j.whi.2013.11.003.
 
37.
Di Biase N, Balducci S, Lencioni C, Bertolotto A, Tumminia A, Dodesini AR, Pintaudi B, Marcone T, Vitacolonna E, Napoli A. Review of general suggestions on physical activity to prevent and treat gestational and pre-existing diabetes during pregnancy and in postpartum. Nutr Metab Cardiovasc Dis. 2019;29(2):115–26; doi: 10.1016/j. numecd.2018.10.013.
 
38.
B ø K, Artal R, Barakat R, Brown W, Dooley M, Evenson KR, Haakstad LAH, Larsen K, Kayser B, Kinnunen TI, Mottola MF, Nygaard I, van Poppel M, Stuge B, Davies GAL; IOC Medical Commission. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 2 – the effect of exercise on the fetus, labour and birth. Br J Sports Med. 2016;50(21):1297–1305; doi: 10.1136/bjsports-2016-096810.
 
39.
Liddle SD, Pennick V. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database Syst Rev. 2015; 2015(9):CD001139; doi: 10.1002/14651858.CD 001139.pub4.
 
40.
Bauer I, Hartkopf J, Kullmann S, Schleger F, Hallschmid M, Pauluschke-Fröhlich J, Fritsche A, Preissl H. Spotlight on the fetus: how physical activity during pregnancy influences fetal health: a narrative review. BMJ Open Sport Exerc Med. 2020;6(1):e000658; doi: 10.1136/bmjsem-2019- 000658.
 
41.
Schlegel P, Hiblbauer J, Agricola A. Near infrared spectroscopy and spiroergometry testing in Cross- Fit. Studia Sportiva. 2020;14(1):6–14; doi: 10.5817/ StS2020-1-1.
 
42.
Glassman G. What is CrossFit? CrossFit J. 2004; 19:1–7.
 
43.
Beetham KS, Giles C, Noetel M, Clifton V, Jones JC, Naughton G. The effects of vigorous intensity exercise in the third trimester of pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2019;19(1):281; doi: 10.1186/ s12884-019-2441-1.
 
44.
Feito Y, Heinrich KM, Butcher SJ, Poston WSC. High-Intensity Functional Training (HIFT): Definition and research implications for improved fitness. Sports. 2018;6(3):76; doi: 10.3390/sports 6030076.
 
45.
Asplund CA, Bright JM. Pregnancy and the endurance athlete. In: Miller TL (ed.) Endurance Sports Medicine. Springer; 2016, pp. 43–54.
 
46.
Di Mascio D, Magro-Malosso ER, Saccone G, Marhefka GD, Berghella V. Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol. 2016;215(5):561–71; doi: 10.1016/j.ajog. 2016.06.014.
 
47.
Mottola MF, Davenport MH, Brun CR, Inglis SD, Charlesworth S, Sopper MM. VO2peak prediction and exercise prescription for pregnant women. Med Sci Sports Exerc. 2006;38(8):1389–95; doi: 10.1249/01.mss.0000228940.09411.9c.
 
48.
Salvesen KÅ, Hem E, Sundgot-Borgen J. Fetal wellbeing may be compromised during strenuous exercise among pregnant elite athletes. Br J Sports Med. 2012;46(4):279–83; doi: 10.1136/bjsm.2010. 080259.
 
49.
Schlegel P. High-intensity functional training in pregnancy: a case study. Studia Sportiva. 2022; 16(2):64–72; doi: 10.5817/StS2022-2-8.
 
50.
O’Connor PJ, Poudevigne MS, Cress ME, Motl RW, Clapp JF. Safety and efficacy of supervised strength training adopted in pregnancy. J Phys Act Health. 2011;8(3):309–20; doi: 10.1123/jpah.8.3.309.
 
51.
Prevett C, Kimber ML, Forner L, de Vivo M, Davenport MH. Impact of heavy resistance training on pregnancy and postpartum health outcomes. Int Urogynecol J. 2023;34(2):405–11; doi: 10.1007/ s00192-022-05393-1.
 
52.
B arakat R, Stirling JR, Lucia A. Does exercise training during pregnancy affect gestational age? A randomised controlled trial. Br J Sports Med. 2008;42(8):674–78; doi: 10.1136/bjsm.2008.04 7837.
 
53.
Garshasbi A, Faghih Zadeh S. The effect of exercise on the intensity of low back pain in pregnant women. Int J Gynaecol Obstet. 2005;88(3):271– 75; doi: 10.1016/j.ijgo.2004.12.001.
 
54.
Schoenfeld B. Resistance training during pregnancy: safe and effective program design. Strength Cond J. 2011;33:67–75; doi: 10.1519/SSC.0b01 3e31822ec2d8.
 
55.
Garnæs KK, Nyrnes SA, Salvesen KÅ, Salvesen Ø, Mørkved S, Moholdt T. Effect of supervised exercise training during pregnancy on neonatal and maternal outcomes among overweight and obese women. Secondary analyses of the ETIP trial: a randomised controlled trial. PLoS One. 2017; 12(3):e0173937; doi: 10.1371/journal.pone.0173 937.
 
56.
Hall DC, Kaufmann DA. Effects of aerobic and strength conditioning on pregnancy outcomes. Am J Obstet Gynecol. 1987;157(5):1199–203; doi: 10.1016/s0002-9378(87)80294-6.
 
57.
Ramírez-Vélez R, Tordecilla-Sanders A, Correa- Bautista JE, Peterson MD, Garcia-Hermoso A. Handgrip strength and ideal cardiovascular health among colombian children and adolescents. J Pediatr. 2016;179:82–89.e1; doi: 10.1016/j.jpeds. 2016.08.099.
 
58.
Petrov Fieril K, Glantz A, Fagevik Olsen M. The efficacy of moderate-to-vigorous resistance exercise during pregnancy: a randomized controlled trial. Acta Obstet Gynecol Scand. 2015;94(1):35– 42; doi: 10.1111/aogs.12525.
 
59.
B geginski R, Almada BP, Kruel LFM. Fetal heart rate responses during maternal resistance exercise: a pilot study. Rev Bras Ginecol Obstet. 2015; 37(3):133–9; doi: 10.1590/SO100-72032015000 5132.
 
60.
Meah VL, Strynadka MC, Steinback CD, Davenport MH. Cardiac responses to prenatal resistance exercise with and without the Valsalva maneuver. Med Sci Sports Exerc. 2021;53(6):1260–9; doi: 10.1249/MSS.0000000000002577.
 
61.
Gould S, Cawyer C, Dell’Italia L, Harper L, McGwin G, Bamman M. Resistance Training does not decrease placental blood flow during Valsalva maneuver: a novel use of 3d Doppler power flow ultrasonography. Sports Health. 2021;13(5):476– 81; doi: 10.1177/19417381211000717.
 
62.
Gephart LF, Doersch KM, Reyes M, Kuehl TJ, Danford JM. Intraabdominal pressure in women during CrossFit exercises and the effect of age and parity. Proc (Bayl Univ Med Cent). 2018;31(3): 289–93; doi: 10.1080/08998280.2018.1446888.
 
63.
Dietze-Hermosa M, Hitchcock R, Nygaard IE, Shaw JM. Intra-abdominal pressure and pelvic floor health: should we be thinking about this relationship differently?. Female Pelvic Med Reconstr Surg. 2020;26(7):409–14; doi: 10.1097/ SPV.0000000000000799.
 
64.
Coleman TJ, Hamad NM, Shaw JM, Egger MJ, Hsu Y, Hitchcock R, Huifeng J, Choi CK, Nygaard IE. Effects of walking speeds and carrying techniques on intra-abdominal pressure in women. Int Urogynecol J. 2015;26(7):967–74; doi: 10.1007/ s00192-014-2593-5.
 
65.
Hsu Y, Hitchcock R, Niederauer S, Nygaard IE, Shaw JM, Sheng X. Variables affecting intra-abdominal pressure during lifting in the early postpartum period. Female Pelvic Med Reconstr Surg. 2018;24(4):287–91; doi: 10.1097/SPV.0000000 000000462.
 
66.
Vladutiu CJ, Evenson KR, Marshall SW. Physical activity and injuries during pregnancy. J Phys Act Health. 2010;7(6):761–69; doi: 10.1123/jpah. 7.6.761.
 
67.
Stracciolini A, Quinn B, Zwicker RL, Howell DR, Sugimoto D. Part I: crossfit-related injury char acteristics presenting to sports medicine clinic. Clin J Sport Med. 2020;30(2):102–7; doi: 10.1097/ JSM.0000000000000805.
 
68.
Hopkins BS, Cloney MB, Kesavabhotla K, Yamaguchi J, Smith ZA, Koski TR, Hsu WK, Dahdaleh NS. Impact of crossfit-related spinal injuries. Clin J Sport Med. 2019;29(6):482–5; doi: 10.1097/ JSM.0000000000000553.
 
69.
Mehrab M, de Vos R-J, Kraan GA, Mathijssen NMC. Injury incidence and patterns among dutch Cross- Fit athletes. Orthop J Sports Med. 2017;5(12): 2325967117745263; doi: 10.1177/23259671177 45263.
 
70.
Aasa U, Svartholm I, Andersson F, Berglund L. Injuries among weightlifters and powerlifters: a systematic review. Br J Sports Med. 2017;51(4): 211–9; doi: 10.1136/bjsports-2016-096037.
 
71.
Klimek C, Ashbeck C, Brook AJ, Durall C. Are Injuries more common with CrossFit training than other forms of exercise?. J Sport Rehabil. 2018; 27(3):295–9; doi: 10.1123/jsr.2016-0040.
 
72.
Ángel Rodríguez M, García-Calleja P, Terrados N, Crespo I, Del Valle M, Olmedillas H. Injury in CrossFit®: a systematic review of epidemiology and risk factors. Phys Sportsmed. 2022;50(1):3– 10; doi: 10.1080/00913847.2020.1864675.
 
73.
Feito Y, Burrows E, Tabb L, Ciesielka K-A. Breaking the myths of competition: a cross-sectional analysis of injuries among CrossFit trained participants. BMJ Open Sport Exerc Med. 2020;6(1): e000750; doi: 10.1136/bmjsem-2020-000750.
 
74.
Ludviksdottir I, Hardardottir H, Sigurdardottir T, Ulfarsson GF. Comparison of pelvic floor muscle strength in competition-level athletes and untrained women. Laeknabladid. 2018;104(3):133–8; doi: 10.17992/lbl.2018.03.177.
 
75.
Yang J, Cheng JW, Wagner H, Lohman E, Yang SH, Krishingner GA, Trofimova A, Alsyouf M, Staack A. The effect of high impact crossfit exercises on stress urinary incontinence in physically active women. Neurourol Urodyn. 2019;38(2):749–56; doi: 10.1002/nau.23912.
 
76.
Sangsawang B. Risk factors for the development of stress urinary incontinence during pregnancy in primigravidae: a review of the literature. Eur J Obstet Gynecol Reprod Biol. 2014;178:27–34; doi: 10.1016/j.ejogrb.2014.04.010.
 
77.
Ramírez-Vélez R, Bustamante J, Czerniczyniec A, Aguilar de Plata AC, Lores-Arnaiz S. Effect of exercise training on eNOS expression, NO production and oxygen metabolism in human placenta. PLoS One. 2013;8(11):e80225; doi: 10.1371/ journal.pone.0080225.
 
78.
Szumilewicz A. Who and how should prescribe and conduct exercise programs for pregnant women? Recommendation based on the European educational standards for pregnancy and postnatal exercise specialists. Dev Period Med. 2018;22(2): 107–12; doi: 10.34763/devperiodmed.20182202. 107112.
 
79.
Rudin LR, Dunn L, Lyons K, Livingston J, Waring ME, Pescatello LS. Professional exercise recommendations for healthy women who are pregnant: a systematic review. Womens Health Rep. 2021;2(1):400–12; doi: 10.1089/whr.2021.0077.
 
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