Over 85% of women will have children at some point in their lives, exercise during pregnancy has so many benefits for both the mother and child and can help women to navigate what can be an emotionally and physically exhausting experience, reduce common aches and pains during pregnancy and help prepare your client for labor and birth. Pregnancy can be an exciting, happy experience for some, and for others, it can be physically and emotionally demanding. Pregnant women are going through constant changes and may not feel like themselves, one woman's pregnancy will be different from someone else’s and may even be different from previous pregnancies they have had. Many women are overly precautious during pregnancy due to misconceptions from friends, family, or the media but then on the flip side are too quick to jump into intense exercise postnatally, although postnatal fitness is an article on its own! This is where you, the personal trainer, can step in and help women safely and effectively exercise and help to break through many of these misconceptions.
BENEFITS OF EXERCISE DURING PREGANACY
Is it safe?
Generally speaking, exercise is not only safe during pregnancy but it is recommended. 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.
The rule of thumb is, if your client was exercising before pregnancy, they can continue to exercise during pregnancy. However, this does not mean a client can not start a fitness regime during pregnancy, if they were not exercising before you must ensure they start with lower intensities for shorter periods of time then gradually increase the intensity and duration of sessions until they reach the recommended weekly guidelines.
With most clients who were active previous to falling pregnant, there are a few simple guidelines you can follow
- Make sure they have clearance from their lead maternity career, in NZ this is likely to either be their midwife or obstetrician
- Work at any intensity of 7/10 but adapt training to your client’s energy levels that day as these will fluctuate throughout pregnancy. The goal is to give them more energy, not zap them of any energy they have.
- During the first trimester, avoid your client getting too hot, this can have serious repercussions to the fetus during these early stages. If you are training in the Summer, set them up in front of a fan or get them to bring a wet flannel in a snap-lock bag to cool themself off with. Hot yoga/ pilates, saunas and spas are all dangerous and should be avoided.
- After 16 weeks avoid your client lying in a supine position for long periods of time - you can avoid this by using the bench on an angle, having their shoulders/ hands elevated on a bench.
- If a client is showing or tells you that they are having any signs or urinary or fecal incontinence refer them to a pelvic health physiotherapist
- Never allow a client to continue exercise that causes her pain and call her LMC immediately if she experiences vaginal bleeding, regular painful contractions, amniotic fluid leakage, shortness of breath before exertion, dizziness, headaches, chest pain, calf pain or swelling or muscle weakness that affects her balance.
So what are the benefits of exercise during pregnancy?
- Reduces back pain
- Eases constipation
- May decrease your risk of gestational diabetes, preeclampsia, and cesarean delivery
- Promotes healthy weight gain during pregnancy
- Improves your overall general fitness and strengthens your 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
- Less pregnancy related bone density loss
Needless to say, with all of these benefits why wouldn’t you want to exercise during pregnancy?
Pregnancy is very taxing on the body and some days your client will simply not have the energy to train, may have aches and pains or be struggling with “morning sickness”, which is not always in the morning. Some clients will have morning sickness all day long or be worse in the afternoon. This can be debilitating and also stop them from consuming enough food and water throughout the day which can make training difficult and getting enough nutrients even harder.
It’s important to be flexible with your pregnant clients and try and find a time of day to train where they feel their best, again, every client is different so it may be in the afternoon or lunchtime instead of in the evening. This will be crucial to helping them to maintain healthy habits during pregnancy.
How, when, and what your client does for exercise will vary spending on your client’s goals, their pregnancy journey so far (including any complications they may have), how much time they have, their energy levels and what the client enjoys.
Your clients goals during pregnancy should be
● Maintain good posture and alignment
● Maintain or increase strength
● Maintain lean muscle mass
● Strengthen core and balance the tone of pelvic floor
● Develop a solid aerobic foundation
● Promote a healthy weight gain
● Increase/ maintain energy levels
● Yield health improvements without over stressing her body
A variety of activities can be utilized including swimming, resistance training, walking or yoga. Programs should always include breathing, core, and pelvic floor exercises specific to the trimester of each client and it is a good idea to have a pelvic floor physiotherapist within your referral network. It is important to note that pelvic floor dysfunction is common but is not normal, you should refer out to a pelvic floor physiotherapist as there may be a wide range of issues from scarring, nerve damage to pelvic organ prolapse or pelvic floor dysfunction and prescribing kegels simply won’t cut it for some of these clients. One out of 2 women who walk onto the gym floor have symptoms of urinary leakage. Around 48% of pregnant women who haven’t given birth before have signs of incontinence by week 30 and this increases to 67% for women who have given birth before. Another study done in the U.S found that 94% of women who had given birth had some degree of pelvic organ prolapse, with 51% of this population being grade 2 or higher.
These are pretty alarming numbers! Both urinary incontinence and pelvic organ prolapse can be embarrassing for clients to speak about so many women never speak up or seek professional help, this is where we can step in and refer out to a pelvic floor physiotherapist.
Exercises/ things to avoid during pregnancy
● Pressure on the abdomen - this can exacerbate or cause diastasis recti, where the linea alba (midline of the abdominals) separates. This can include planks, push ups and using the valsalva maneuver (holding your breath whilst lifting)
● After 16 weeks avoid prolonged periods lying on their back
● High risk of falling exercises including jumping, horse riding, skiing, surfing, off road cycling and gymnastics
● Contact sports including hockey, boxing, soccer, rugby, football and basketball/ netball
● Becoming too hot, this can rule out crowded group fitness rooms and hot yoga should be avoided
● As pregnancy progresses be careful when programming unilateral exercises. Your clients center of balance changes as the baby grows, this can increase the risk of a fall. It can be helpful to use a form of support such as TRX or box or stick to bilateral exercises
● Unilateral leg work can also put extra pressure through the pelvis and aggravate clients who may have pelvic girdle pain, for these clients stick with bilateral exercises and refer to a pelvic physiotherapist
● Avoid overstretching, heavy loading or pushing past the normal range of motion. As pregnancy progresses the hormone relaxin which helps the pelvis to open during birth starts to increase. This causes joint laxity and a higher risk for injury
● Isometric holds
● Valsalva maneuver (holding of breath whilst lifting). Instead, ensure clients breath out on exertion
● Running- if the client has not been a regular runner before, pregnancy is not the time to start. It can put a lot of pressure on the pelvic floor and pelvis and cause long term damage. However, if the client is an avid runner and they want to continue to run as long as they are not getting any hip discomfort or pelvic floor dysfunction it is safe to run if the intensity is kept at a 7/10. Let them decide when to stop, most clients will feel too heavy or uncomfortable to run beyond a certain point and will stop themselves.
● Past the second trimester leg press and deep squats may be impossible or cause discomfort
Best exercises to include during pregnancy
● An adequate warm up
● Breathing and pelvic floor exercises
● Restorative activities and or active recovery
● Walking, swimming or yoga
● Resistance exercises
When designing a strength training program for your client you should focus on what helps the client feel strong, maintains or boosts her energy levels and keeps her healthy in and out of the gym. Like any client, aim to keep the program well balanced and take into account the training level and time the client has to train each week. Every session does not need to include the following but these should be included over the training week. Depending on your client it can be useful to program 3 full body days or 2 upper body and 2 lower body days.
● Focus on the posterior chain as this helps to offset the heavier load growing on the anterior side of the body
● More pulling than pushing. Pulling movements strengthen the upper back - this again helps with the extra load at the front of the body but also after the baby arrives as holding and feeding a baby for long periods of time is very harsh on the upper back.
● As your client’s belly gets larger using a rope cable attachment can be helpful for rows as it can move around her body
● Glute work with bands
● Exercises that work larger muscle groups such as squats, deadlifts (scale the weight and height as needed) rows, pull-downs
● Tempo movements can be used to create a challenge without adding extra load
● Bilateral exercises for the lower body in the last trimester or use a support such as a TRX to create more stability
● During the second and third trimester, a barbel may become difficult to use. If you notice the client changing their technique to maneuver the bar around their belly it is a good time to switch to Dumbbells or Kettlebells.
● Push-ups can still be done with clients hand on the wall, a bench or on a TRX
● A bench can be used for upper body exercises if at a 45▫ angle
With all the benefits exercise has to offer to a pregnant woman and her baby, if she has clearance from her LMC it is a no brainer for her to be exercising regularly. Exercise can be a daunting task at the best of times so it is important for us to support our pregnant clients and do our best to keep them moving. One golden rule applies here - if in doubt, refer out.
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