Baby Onboard: Modifying Exercises For Effective Prenatal Workouts

“My husband and I are expecting our first baby!”

These words are exciting for any friend or relative to hear. As a Personal Trainer, however, you may feel a sense of trepidation creeping into your soul upon learning your client’s blessed news. Questions may begin to flood your brain:

• Should I allow her to continue her current workouts?
• Is she / are we being prudent and safe?
• How can I help her remain healthy and active while still protecting the unborn child?

 

Keep Moving, But Carefully

These are all valid concerns, especially if you have never had the opportunity to work with pregnant women. I have trained many expectant mothers through the years, and helped them achieve healthy pregnancies and uncomplicated deliveries. These clients’ bodies also tend to return more easily to their pre-pregnancy status when compared to their sedentary counterparts. If you plan to continue training an expectant mom, a little advance planning on your part can make all the difference to your client as she journeys through the next 7 or 8 months.

Over the last 5 decades, theories on pregnancy and activity have come a long way. When our moms were expecting, the prevailing notion was to stay off of one’s feet and get as much rest as possible. Today’s women are remaining much more active further into their pregnancies than ever before. Still, there always remains a lingering thought as to just how safe this practice might be for the developing fetus.

Preemie Risk Addressed

A recent study examined the controversy surrounding the possibility that exercise during the course of a woman’s pregnancy might increase the risk of preterm delivery. Was there in fact a potential cause-and-effect relationship between exercise engaged in during the 2^nd and 3^rd trimesters and the birth of a premature baby?

Scientists separated their female subjects into categories. In the first group, expectant women engaged in a supervised training regimen consisting of half an hour of toning and very light resistance exercises 3 times a week. Training was implemented at 13 weeks’ gestation and continued through week 39. The second group of women served as a control and did not engage in any exercise. The data points revealed no significant differences between the 2 groups of subjects in terms of the mean gestational age of the child at birth.

Stress Awareness Above All

While this may alleviate some of the worry associated with training a pregnant client, it is important to remember that every woman is unique. There are those who successfully continue the workouts they enjoyed prior to becoming pregnant, including participation in boot-camp-type classes, step aerobics, strength training, and running marathons. Others find a need, either due to their own levels of comfort or at the urging of a medical professional, to significantly modify their pre-pregnancy fitness programs.

It is always a good idea to frequently urge your clients to pay attention…not only to how they feel during and after a training session, but also to more overt signs that require promptly discontinuing the exercise and consulting their medical professional.

Among these potential warning signs are vaginal bleeding, dizziness or fainting, chest pain or heart palpitations, abdominal pain unrelated to core-strengthening exercises, calf pain, and leaking of amniotic fluid. As the months go on and the pregnancy progresses, complete with the obvious physical changes, it becomes increasingly important for a trainer to assess the client regularly so that any necessary modifications to the workout can be made before a problem presents itself. Always ensure that she is maintaining a safe level of hydration, and use prudent caution while training during periods of extreme heat and humidity.

The Balancing Act

There are many aspects of a pregnancy that will effect women who adhere to their favorite exercise and training programs. The first change most women report is an altered sense of balance. As your client’s center of gravity shifts with the growth of the fetus, her balance will shift as well, rendering certain exercises unsafe. If your client expresses unease due to her balance being off-kilter, you might consider discontinuing activities such as downhill skiing, skating, horseback riding, and hiking in the woods over potentially uneven terrain. Instead, she may wish to substitute swimming or water aerobics as a way to maintain her level of cardiovascular endurance.

Because the baby is growing and becoming more vulnerable if a fall or a blow to the abdomen should occur, a healthcare provider may recommend stopping ball sports (soccer, basketball, racquetball etc.), contact sports, and outdoor biking. (Note that because of an expanding abdomen, a recumbent bike might be more comfortable than a traditional stationary bike).

Position Transitions

After your client’s first trimester has passed (along with the accompanying fatigue and morning sickness!), lying on her back during exercise should be avoided. This position has the potential to decrease the flow of oxygen to the baby. While this may put a damper on performing traditional crunches or sit-up’s there are many other alternatives for helping a pregnant woman continue strengthening her ever-expanding midsection. Remind her that beneath all of the extra fluid and tissue in that area, which are necessary for a growing fetus, abdominal and core muscles are in fact still there.

Suggest training on a stability ball or an inclined workout bench. Remaining in a supine position for extended periods of time can affect not only the baby but the mom as well. The additional weight of the uterus, particularly during the second and third trimesters, adds undue pressure to the inferior vena cava. This often leads to lightheadedness and dizziness, brought on by a decrease in venous return to the client’s heart. Some researchers still question the idea that lying on the back might lead to a decrease in fetal blood supply. Until further studies can be performed and a accurate assessment confirmed, it will be safer to keep in mind that supine exercises should be approached with extreme caution, and only performed in very short bouts, if at all.

Take any opportunity possible to have the client share her “awareness” of how she is feeling and if she is experiencing any unusual symptoms. Your communication skills need to be highly cultivated, starting in the first trimester, so that you and the client are completely at ease sharing these details as the pregnancy progresses.

Bracing For The Load

Planks have become a pregnant woman’s greatest ally in terms of core strengthening throughout these exciting 9 months. As additional midsection load becomes cumbersome, try having your client perform a modified plank with her toes on the floor and her chest and forearms resting on a stability ball. Another option is to place the client on hands and knees while holding a position where the left arm and right leg are off the floor, extended in opposite directions. This position activates the abdominal muscles, and forces the core to work at stabilizing balance. Switch to the right arm and left leg after holding the first position for 5-10 seconds.Towards the latter stages of pregnancy, abdominal bracing can be accomplished by performing the “cat stretch”: from a hands-and-knees position, the expectant mother rounds her back while drawing her abdominals toward the ribcage. Holding that pose for 5-10 seconds, she then releases and relaxes into an arched back.

Less Obvious Changes Are still Important To Address

As the growth of a pregnant woman’s belly continues, she often displays an increased anterior pelvic tilt. This is brought about due to the fact that her glutes and hips are becoming weakened, which in turn is a result of excessively tight hip flexors. By strengthening the client’s gluteus medius and minimus, you can facilitate the stabilization of her the sacroiliac joint, which can become loosened and unstable during pregnancy. The side-lying clamshell exercise is both safe and easy to perform throughout the remaining months of her pregnancy. With her pelvis perpendicular to the floor and a knee bend of 45-90 degrees, instruct the client to brace her core and keep her feet together. As she engages her glutes, the top knee is lifted off the bottom knee, moving this top knee toward the ceiling, as her comfort allows. Keep a careful eye on the woman’s pelvis: if it begins to move, or if her hips roll back, stop the progression of the lift. Have the client hold the position for 5-10 seconds, lower the knee, and repeat. This exercise may be performed on both sides of her body.

 

The Role Of Relaxin

Such loosening of joints is a commonality shared by virtually all expectant moms at some point during the pregnancy. A hormone appropriately called relaxin becomes elevated in the woman’s bloodstream, which helps prepare her for the work of childbirth by relaxing all of the joints and ligaments throughout the body. While at first it may seem advantageous to possess increased flexibility, caution your client that she is also at a greater risk of injury due to unintentional overextension. Keep this in mind as you have the client engage in cool-down stretches.

How Safe Are Yoga And Strength Training?

Prenatal yoga classes are often touted as wonderful alternatives to traditional exercise during a woman’s pregnancy. If your client should inquire about the safety and efficacy of beginning such a program, be ready with an answer. Yoga does indeed offer many prenatal benefits, but some poses are contraindicated during pregnancy. If your client was already enmeshed and comfortable in a regimen of yoga before conceiving, she may safely continue, as long as she is aware of a few caveats. Explain to her that it is advisable to avoid performing downward facing dog (in her third trimester), as well as crane pose, cobra pose and upward facing dog at any point during her pregnancy. Although it may seem intuitive to you as a Personal Trainer, always mention to your client that she avoid inverted poses, backbends, and lying on her stomach once she has passed the first trimester.

Strength training is safe and beneficial during pregnancy, as long as your client adheres to the aforementioned refraining of supine position and awareness of compromised balance issues. Vigilance on your part requires paying closer attention to her posture and spinal positioning. The heavier load currently being placed upon a pregnant woman’s midsection stresses her spine, potentially leading to an arching of the back and rounding of the shoulders. Even with you spotting your client, during this time in her life it is safest to avoid lifting heavy weights that may cause her to facilitate the lift by leaning. Always make sure that her spine is in neutral alignment and her posture remains upright.

 

Safer Support While Running

I have read articles about marathon runners who continue to exercise throughout their pregnancies. Most medical professionals will endorse this practice as long as the pregnancy is progressing without any health complications to either mother or baby. While this is great news, the limiting factor for many pregnant women is the growing degree of discomfort as the months go on. If your client is such a running enthusiast, suggest she take some simple strides toward support. A high-quality sports bra is a must as her breast develop and begin to prepare for lactation. In addition, a support belt placed directly under her abdomen can help stave off lower back pain. If running simply becomes too awkward or causes unwelcome fatigue, you may suggest running/walking intervals, or simply brisk walking. Swimming and rowing, too, are safe and effective cardiovascular alternatives to running.

 

Spreading The Information, Dispelling The Myth

While fitness professionals and their clients are highly tuned in to the necessity of fitness at almost any stage of life, this message unfortunately is not always delivered to the entire population. It has been found that prenatal exercise may decline during pregnancy for several reasons. Sedentary women are not likely to begin an exercise program upon receiving confirmation of a positive pregnancy test, often due simply to the physical changes of pregnancy. There is also the unfortunate case of women shying away from exercise due to a combination of social and psychological factors. It is sometimes awkward being the only expectant mom in a group exercise class. If a woman perceives herself as “under-performing” due to limitations imposed by her condition, she may feel inferior to her fellow aerobics participants and begin to cultivate a lack of self-efficacy, which leads to abandonment of her fitness program.

Is it possible that some of the readily available health education information (the Internet, for example) may be failing to correct outdated perceptions of the risks associated with physical exercise in pregnancy?

As Personal Trainers, we must naturally respect the boundaries of our scope of practice. However, without dispensing direct medical advice, we do possess the ability to improve both the quantity and quality of information dispensed to the public with regard to prenatal exercise. Your gym or fitness center may consider offering seminars on the topic, to correct inaccurate perceptions and elucidate the benefits of fitness to both maternal and fetal health. Inviting a medical or other guest speaker to your gym can also alleviate fears and generate interest in personal training among expectant moms.

 

Participation in a carefully planned, moderate physical activity program during the first, second, and third trimester of a woman’s pregnancy can go a long way toward improving her “maternal perception” of health. If the focus is kept on safety, both the mom’s and that of the baby, we have the potential to enhance this already magical time in the life of our female clients.

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References

https://www.acefitness.org/blog/5558/prenatal-fitness-modifications-for-safety-and/?authorScope=6

http://bjsm.bmj.com/content/42/8/674.short

http://www.midwiferyjournal.com/article/S0266-6138(03)00088-3/abstract?cc=y=

http://www.ajog.org/article/S0002-9378(11)00082-2/abstract

http://www.dummies.com/health/pregnancy/modifying-your-exercise-routine-for-a-healthy-pregnancy/

http://www.sparkpeople.com/resource/pregnancy_articles.asp?id=758

https://breakingmuscle.com/womens-fitness/training-during-pregnancy-how-to-modify-your-workout-without-losing-your-workout