Programming considerations for clients in the first trimester of pregnancy | Fit Futures

With over 85% of women having children at some point in their life, if you work with female clients, training your first pregnant client isn’t a matter of if – but when! Training clients during pregnancy can be daunting, but it doesn’t need to be. Instead of needing to refer onto other trainers, why not educate yourself about how to train this target market?


Today’s article will delve into the first trimester, the physiological and psychological changes that occur, and how we can train our clients to give them more energy in what can be a very exhausting time.


Firstly, let’s recap the benefits of exercise during pregnancy. It’s important to remind our clients of their “why” when first trimester symptoms such as morning sickness, mood swings, and fatigue can make exercise seem like a daunting task.


Benefits of exercise during pregnancy:

  • Reduces back pain
  • Eases constipation
  • May decrease the risk of gestational diabetes, preeclampsia, and cesarean delivery
  • Promotes healthy weight gain during pregnancy
  • Improves overall general fitness and strengthens the heart and blood vessels
  • Prepares the client for labor and birth
  • Decreases postpartum recovery time
  • Prevents/ improves depression, anxiety, and other mental health illnesses
  • Decreases the risk of postnatal depression
  • Decreases risk of urinary incontinence
  • Prevents postpartum weight retention
  • Increases energy levels
  • Increase in lean muscle mass
  • Reduces pregnancy-related bone density loss


Physiological changes:


To understand how to create safe pregnancy programs, it helps to understand the physiological changes that occur during the first trimester (weeks 1-13). During weeks 1-8 the placenta, spinal cord and brain begin to form. Eyes, ears, nose and genitalia begin to develop, although the eyes remain closed. The tissues of the heart and major organs begin to develop, and small buds that form the limbs appear.

From weeks 9-13 fingers, toes and soft nails start to form; at this stage the hands are more developed than the feet and the arms are longer than the legs. The spine is soft and can already flex! Intestines, bones and muscles begin to develop while the skin is still so thin it is transparent. It’s no wonder women are so fatigued, it’s a lot for the body to do in just 13 weeks!

By the time your client gets their 12-week scan they will be able to see what looks like a fully formed baby, hear the heartbeat, and see the blood flowing through the baby’s body. This scan also marks a point of relief for many clients as this is (usually) the first time they get to see and hear their baby, and the risk of miscarriage is significantly reduced.


Physiological changes for the mother;

Even if your client has been very active before falling pregnant, the first trimester can bring some or all of the following physiological changes and symptoms:

  • Increased blood volume and heart rate
  • Increase in hCG, hCS and hPL, estrogen and progesterone hormone levels
  • Fatigue
  • Morning sickness – which can affect some women in the afternoon or throughout the day
  • Breast tenderness, feeling fuller or heavier
  • Headaches
  • Increased urination
  • Insomnia
  • Vivid dreams
  • Dizzy spells


Not all pregnant women will experience these symptoms but many will experience multiple. If your client is one of these women, her goal for the first trimester should be to take care of herself and rest where possible.


Psychological changes


During the first trimester women experience changes in their memory, moods, mental health, energy levels, and appetite. It’s important to understand how a pregnant woman may be feeling; if her pregnancy is planned she may be excited, anxious or overwhelmed. Unplanned pregnancies can also bring joy and happiness but for some women, this may be stressful or sad news. With these feelings, along with extra hormonal changes that can cause unpredictable moods and thoughts, it is important for the trainer to give positive reinforcement to each client.


Each and every woman will have an individual pregnancy experience so it is paramount that we always ask open-ended questions to check in with our clients and see how they are feeling each time they train. Some days they may feel great and want to train hard, and others they may be exhausted, feeling nauseous, and overwhelmed (so a gentler session may be more appropriate).


Program considerations


Before beginning any exercise program with a pregnant client, or when a client advises you they are pregnant, it is best practice to have your client answer a pregnancy-specific pre-exercise questionnaire. The Canadian Society for Exercise Physiology has an excellent one on their website (link at the bottom of the page). The American College of Sports Medicine recommends women should accumulate 150 minutes of moderate Physical Activity each week. Exercise is encouraged daily but should be completed at least 3 times per week.


Goals for the first trimester should include:

  • Focus on posture and alignment
  • Increase strength and muscle mass
  • Pelvic floor
  • Developing a solid aerobic foundation
  • Promote healthy weight gain


We need to know when to stop exercise with a pregnant client. If your client exhibits any of the following signs you should stop exercise immediately and get in touch with their lead maternity carer:

  • Bleeding from the vagina
  • Feeling dizzy or faint
  • Shortness of breath before beginning exercise
  • Chest pain
  • Headache
  • Muscle weakness
  • Calf pain or swelling
  • Regular, painful contractions of the uterus
  • Fluid gushing or leaking from the vagina


The volume and intensity of your program will vary depending on your client’s previous experience, fitness level, any complications they may have. It’ll also vary depending on her current pregnancy symptoms, her goals, and the amount of time she has to dedicate to training. These may change throughout her pregnancy, so it’s best to keep frequent and open communication.


Things to avoid during the first trimester include:

  • Getting too hot – avoid activity done in high temperatures
  • High impact activities, such as contact sports or anything with a high risk of falling


Strength training

When it comes to strength training very few modifications need to be made during the first trimester as your client’s belly will not yet be in the way, but there are a few things to consider:

  • Building a strong upper back will help support a women’s growing breasts and belly
  • A strong core will help her carry the weight of the growing baby
  • A strong posterior chain can help keep the spine aligned and reduce back pain
  • It is not recommended to lift in the 1-5 rep range as this increases abdominal and pelvic floor pressure
  • Your clients may feel breathless so you may need to lower the intensity as necessary


Cardiovascular training

Building or maintaining a good cardiovascular base can help clients sleep better, reduce stress and recover from strength sessions. For women who are overweight, it can also reduce the risk of developing gestational diabetes. For most clients and those who are new to exercise, working at a level of 4-6 out of 10 is ideal; HIIT training may not be appropriate. For those who are more conditioned, you can work at a 6-8 out of 10 and include HIIT training if the client is feeling up to it. If they are suffering from extreme fatigue or nausea it would be best to leave the HIIT and higher intensity sessions to another time.


Putting it all together;


Just like any client, when creating a program for the first trimester you need to factor in your client’s goals, the duration and frequency of sessions, what your client enjoys, any complications or symptoms they may have, training load/ volume/ range of motion/ exercise choice and a balance of pushing v.s pulling movements. Each program should be tailored to the individual, but the most important thing to remember is exercise during pregnancy should increase energy levels, not leave your clients fatigued and nauseous. Learn to adapt a program for your client’s fluctuating mood, energy level, and level of nausea and you will play a big part in keeping them active through their entire pregnancy so they can reap the benefits.


References – Prenatal exercise questionnaire

Girls Gone strong – Pre and PostNatal Certification textbook

Bureau USC. FFF: Women’s history month: March 2017

Wesnes SL, Rortveit, Bo K, Hunskaar. Urinary incontinence during pregnancy. Obstet Gynecol. 2007


LibbyTutor Bibliography

As a teenager, Libby was unfit, smoked, drank and thought the gym was for “fit people”. At the age of 19 she fell in love with strength training. The gym changed Libby’s life forever, but it was not without some struggles – she has had multiple major hip surgeries, and through these developed a drive and determination to not let injuries stop her from training. This drive led her to fall in love with powerlifting and she’s been competing ever since.

Libby became a personal trainer to help anyone who felt like being fit was out of their capabilities, and show them the positive impacts exercise can have on all aspects of their life. She has been a group fitness instructor for seven years and a qualified personal trainer for six. Libby has worked in commercial gyms, had her own home studio, and after having her daughter Rose in 2018 now works from a strength gym in Christchurch. She specialises in training female beginners, pre/postnatal women, and small group personal training.

Libby won ‘Small Group Trainer of the Year’ at the NZ Exercise Industry Awards in 2017 and continues to seek professional development through local and international ongoing education courses such as Kettlebell and pre/postnatal training certifications.


Disclaimer: The exercises and information provided by Fit Futures Learning Institute (T/A Fit Futures Academy) ( are for educational and entertainment purposes only, and are not to be interpreted as a recommendation for a specific treatment plan, product or course of action. Read the full content disclaimer.