Despite what your mom and grandma were told, exercising while pregnant is a good idea and it should involve some effort.
There are two ultimate goals with your programming for prenatal clients.
- To help make women strong and fit in order to support the changes/challenges during pregnancy.
- To train for a safe labour and delivery for mom and baby.
Male or female, if the trainer has not gone through a pregnancy they may feel that the client may not trust their guidance. Likewise, the trainer might not be able to relate to anything the client is going through and doesn’t know what the most important qualities to train are or what to avoid. This article lays out what you need to know when training prenatal women.
Exercising While Pregnant Step 1
Read. Read as much as you can about pregnancy. Good places to start for general information are here and here. Find out everything you can on what typical pregnancy symptoms are, what happens in the first, second, and third trimesters, and what the phases of labour are. Talk to your mom about her experiences of pregnancy and delivery, that is what she hasn’t tried to forget.
Exercising While Pregnant Step 2
Understand. There are going to be many changes that are going to happen over the next few months. You may have to adjust your whole session on the fly if they show up to the session with a nasty case of nausea. They may show up exhausted when they’ve been up to go to the bathroom 6 times the previous night. And, they will likely get quite uncomfortable near the end of pregnancy and you will have to get pretty creative.
Exercising While Pregnant Step 3
Plan. Plan out how many weeks of pregnancy the client has remaining (typical pregnancy being 37-42 weeks), and design their program accordingly. The main things you should try to develop or maintain during pregnancy are posterior chain strength, posture, and the ability to contract the abdominals.
Typical exercise rep ranges can be from 5-15. While this might not be the time to try for 1 rep max PRs, you can certainly build muscle mass (especially in the second trimester), lift heavy, perform properly planned interval work, and do soft tissue work.
Girl, look at that body.
Many changes are occurring in the body during pregnancy. Hormonal, musculoskeletal, cardiovascular, the list goes on. Below are some of the biggest changes you need to be aware of.
There is A LOT of hormonal ‘stuff’ going on in pregnancy. One that will be important for you to know is called “relaxin”. Relaxin increases during pregnancy and remains in the body for up to a year or more postpartum. As the name implies, it relaxes the body’s muscles, tendons, ligaments, and cervix. The pelvis stretches and expands, making the hip and lumbar joints quite unstable.
Your client might be cursing relaxin for their aching hips and lower back, but they’ll certainly be thanking it when they’re pushing out that baby’s impossibly big head. This also means that mobility can improve significantly during pregnancy, but keep in mind that hypermobility can be a concern. All the more reason to strength train and create stability!
Of course, women have to carry a lot of additional weight during pregnancy. What’s not so comfortable is the force placed on the body anteriorly — namely a lot more belly and boobs than one woman could hope for. Imagine the work it takes to keep the body in reasonable posture as your client nears months 8 and 9+.
The pelvis will be pulled into a more anterior tilt, the posture becomes kyphotic, the abdominal muscles overstretched, and the hip flexors tight with potentially weakened glutes. Get these ladies on the deadlift train STAT! [Note from Jon: I've trained a lot of pregnant women and, after a lot of studying and testing, found that the sumo deadlift with either a kettlebell or single dumbbell was my exercise of choice. Here's a video of my friend Marianne Kane demonstrating it]
The resting heart rate will automatically rise 10-20 beats per minute to account for the additional supply to the fetus. As a result, cardiovascular output will double. It was long regarded to not allow the heart rate to rise over 140bpm during exercise, however this restriction has been dropped. Although we don’t have any current, specific heart rate guidelines we know that women can exercise without harm to themselves and baby at a much higher intensity, with higher heart rates.
Keep in mind how easily shortness of breath will occur. How would you like a uterus shoved into your diaphragm?! Seriously though, that’s what she’s dealing with near the end of pregnancy.
Do this, not that
1) DO check for Diastasis Recti. Dia-what?
It’s important to check your prenatal clients for Diastasis Recti (DR), especially as the pregnancy gets into the second and third trimesters. A diastasis is a two finger or more separation of the rectus abdominis muscle sideways. The muscle gets over-stretched and the abdominal contents exert pressure anteriorly, so the muscle begins to separate and the connective tissue becomes weakened.
Get your client lying on their back, knees bent and feet flat. Press your two or three middle fingers into their belly button and have them lift their head and shoulders off the floor. Feel if there is a distinct separation between the two sides of the rectus abdominis and measure with the number of fingers needed to fill the gap. If there is, you can also gently press downwards into the separation to tell how weak that connective tissue appears. The weaker it is, the softer it will feel. Repeat this, with a three finger spacing above and below the belly button.
2) DO have purposeful programming.
Lots of foam roller work and trigger point release for pecs, upper back, glutes and hip flexors. Make sure they are breathing properly with diaphragmatic breathing techniques. Be sure to read up on Mike Robertson’s excellent work on breathing here.
Make sure they are properly engaging the abdominals always, in and out of the gym. Work core stability, rotation (depending, see below) and anti-rotation. Oh, and if you want your ladies to be able to have a glimmer of abdominal contraction postpartum, you will coach the elevators and contractions. While they might seem simple for the non- pregnant client, these babies get tough and will keep that DR from being too large and causing debilitating back pain.
Place a strong emphasis on pelvic floor work and encourage them to kegel like it’s their job! In all seriousness, no one wants reoccurring “accidents” from a sneeze, or worse a pro-lapsed uterus postpartum.
Your exercise selection should include the main patterns of hinging, squatting, lunging, single leg stance, gait/movement, tons of pulling, with some pushing and pressing. Double the pulling to pushing movements to facilitate a strong back and reduce the likelihood of the pecs becoming over-active.
3) DON’T do any of this.
Now you know what to do, here’s what not to do.
One typical “don’t” you’ve probably heard is to not have your client lie supine after the first trimester because the blood supply to the fetus might be compromised. This is not so strict anymore, and generally you can follow the principle that if the client feels ok on their back and is not in that position for more than a couple minutes, it is probably alright to have them there. If they do feel a bit light headed, just sit them up and have them breathe normally.
Next, back to the diastasis. If your client does have a DR you need to keep them out of any supine crunching or spinal flexion, all fours positions or front loaded planks. These movements will put undue stress on the recti. Be careful of trunk rotation work if there is a DR, as that can worsen it too.
Be cautious of impact work, mainly because it will be highly uncomfortable as the pregnancy progresses and because of those hypermobility concerns talked about previously.
Get them to D-day…and beyond
Your exercising while pregnant training prepares them for D-day, that is, delivery day. You can truly help them reach the end of their pregnancy feeling strong, mobile, and physically up for the effort that labour will require. The next best part to that healthy baby being born, is when your clients come back to you recently postpartum already to get a solid abdominal and pelvic floor contraction, with minimal diastastis. Get ready for referrals coming at you from all angles once those ladies start talking to their mommy friends!