Exercise and Pregnancy: Women Taking the Lead in Their Workouts
Exercise and Pregnancy? Yes! See the benefits of why they go together so well and exercise programming ideas for each trimester.
Remaining physically active during pregnancy can help improve posture, decrease back pain, swelling, constipation, and incontinence, and significantly reduce the risk of many other pregnancy-related ailments. Women who exercise throughout their pregnancy tend to have shorter, less difficult labors with fewer complications. They also have a decreased need for medical intervention with quicker, easier recoveries once the baby is born. Research has repeatedly shown that active women even have healthier, happier, smarter babies. Unfortunately, the majority of pregnant women do not exercise consistently, if at all, and those who do tend to reduce activity in the later months (Garland, 2017). Exercising during pregnancy is often mistakenly viewed as an unnecessary risk to a woman’s unborn child. Expectant mothers are encouraged to “play it safe” and “take it easy” by misinformed loved ones, well-meaning strangers, and inaccurate websites. Outdated medical advice is still circulating, telling pregnant women to avoid elevating their heart rate, abstain from many types of exercise and spend their pregnancy resting instead of staying physically active. But, this could not be further from the truth!
The American Congress of Obstetricians and Gynecologists (ACOG) is the organization that releases the official guidelines regarding exercise during pregnancy. Their early recommendations were much more conservative and alarmist than necessary because they were based on assumptions and limited animal studies. However, the last few decades of extensive research have shown numerous incredible benefits to exercise, with no risk to mother or child. As a result, ACOG now encourages pregnant women to get at least 20-30 minutes of exercise each day in the absence of medical or obstetric complications (ACOG, 2015). Prenatal exercise is no longer just acceptable; it is a necessary component to achieving optimal health of both mother and child (Harris, Baer & Stanford, 2018). Staying active and avoiding excess weight gain during pregnancy offers lifelong health benefits for women and their children.
In a singleton pregnancy, without complications, women can typically maintain their pre-pregnancy routine, regardless of intensity, as long as it still feels comfortable. The number one rule for prenatal exercise is that women need to listen to their body and adjust workouts accordingly. When creating a program for a pregnant client, it is important to consider that the frequency, intensity, time, and type (FITT) of exercises will vary with each workout depending on prenatal symptoms. Working around fatigue, nausea, “growing pains,” etc. means that trainers may need to adjust the routine at any given moment. Using the rate of perceived exertion (RPE) scale or “talk test” to measure intensity will help facilitate ongoing communication and keep workouts within a manageable range. Heart rate is typically not a reliable indicator during pregnancy. The NASM Optimum Performance Training™ (OPT™) with Phases 1 and 2 provide the structure for creating a safe and effective program throughout pregnancy and postpartum. While a client’s fitness before pregnancy is typically a good starting point, the focus of prenatal workouts is to help manage changes in the body, prepare for labor and delivery, and build a solid foundation of balance, endurance, and strength to meet the demands of motherhood.
A personal trainer’s responsibility is to guide expectant mothers through a safe fitness program by encouraging them to exercise while consistently checking in to make sure everything feels okay. Women should not push through any discomfort as they may have in the past. Pregnancy is the perfect time to strengthen a mind-body connection and allow women to take the lead in their workouts, with the trainer in a much-needed supportive role.
Exercises for Each Trimester
It is important for women to drink plenty of water and breathe deeply during exercise to avoid feeling dizzy or faint since these are common side effects of the added blood volume and hormone shifts. If any discomfort or dizziness occurs, make adjustments or take a break before trying again. Remember that the number one concern is always listening to the client’s body cues. While there is no “one-size-fits-all” approach, the following circuits can help the typical pregnant client to improve balance, strength, and endurance. Most women should aim for about 2-3 sets of 15 repetitions, or 60 seconds each, and then do a bit more or less depending on how she feels during that particular workout. Do not be afraid to use some creativity and a unique training style when creating a prenatal program following the OPT™ model and FITT principle to vary workouts as needed.
First Trimester – 1 through 12 weeks
The first trimester is notorious for intense nausea and exhaustion as well as strong emotions including fear of doing anything that may harm the baby. There is a common misconception that physical activity is unsafe in the early months of pregnancy, but rest assured that research has proven otherwise. It is essential that trainers are confident that prenatal exercise is safe and empower women to dictate the pace and intensity of their workouts. Always default to the recommendations of a woman’s doctor and guidance of ACOG when faced with any doubt.
• Reverse Lunge:
Works core, glutes and quads. Gentle on joints while challenging stabilization and endurance. Be sure to perform near something sturdy for safety.
• Single Leg Deadlift:
Works core, glutes and hamstrings. Improves stabilization and requires mental focus which improves mind-body communication. Perform with one hand gently placed on a wall or bench to prevent falling. Instruct clients to fix their gaze several feet in front if balance is a challenge.
• Crunch on Ball:
Strengthens abdominals and improves balance. Ensure ball is properly inflated for lower back support. Bracing abdominals, slowly exhale during contraction with a small range of motion. Crunches, performed correctly, are safe and effective for maintaining core muscles during pregnancy and postpartum.
Cardio – Stair climber at slow to moderate pace or high knees, quickly march in place elevating knees to waist at a pace that feels comfortable. Just 1-3 minutes as part of the circuit or at the end of a workout is often enough.
Second Trimester Workouts – 13 through 26 weeks
In the second trimester, the extreme fatigue, dizziness, and nausea of the preceding weeks will hopefully subside, and women will begin feeling more like themselves. This is a good opportunity to get the most out of workouts in preparation for the next trimester when exercise starts slowing down prior to labor.
• Lat Pulldown:
Draw shoulders down and back to counterbalance added weight from the growing chest and belly. A strong back will also help maintain good posture and prevent pain. Be sure that clients are not shrugging as they pull down toward the chest. Consistently remind women to keep abs tight and exhale as they pull down.
• Wide Stance Squat with Kegel:
Strengthens the inner-thighs, quads, core, glutes, and pelvic floor along with balance and endurance. Squat to bench for added safety and feedback that hips are back and low. Cue women to “zip up” through inner thighs, pelvic floor, and lower abs.
• Opposite arm and leg extension:
A full-body exercise that challenges a woman’s balance, core strength, and coordination. Complete one set with an opposite arm and leg before switching. Bring the knee and elbow in, around the belly, during the exhale and round the back for added core work and back stretch. Return to a neutral spine, avoiding hyperextension of the lower back.
Cardio – Modified Burpee (perform slowly): Squat down to the floor. Place hands flat on the mat and step the feet out behind one at a time into the push-up position. Return to the squatted position and press body up while reaching hands overhead.
Third Trimester Workouts – 27 through 40 weeks
Exercises may feel more challenging during the third trimester. Pregnant women are at their heaviest which makes just getting around an act of endurance and power. The majority of a woman’s weight is in front which will throw off her center of gravity, pull shoulders forward, increase the risk of falling, and strain the core, which makes even simple tasks more difficult. Women will also become out of breath and fatigued more easily. Do not rush through the workout, and modify wherever necessary.
• Seated Pelvic Tilt and Hip Circles on Ball:
A pelvic tilt helps women stretch a tight lower back while engaging the overstretched lower abdominals. Adding hip circles can relieve tension while also gently contracting core muscles.
• Back Row:
Like the lat pulldown, a row strengthens the back and improves posture, which is very important for pregnant women. Be sure clients do not raise their shoulders up as they pull, but draw them back and down toward the spine with chest raised and core engaged.
• Ball Squat (with Bicep Curl):
Strengthens lower body while supporting lower back and improving balance and coordination. With the ball placed between the wall and the client’s lower back, her body should move straight up and down with the feet far enough in front that the legs make a 90-degree angle at the lowest point of the squat.
Cardio – Walk or swim.
Regardless of a woman’s BMI or previous activity level, physical activity during pregnancy offers many lifelong benefits for mother and child. Doing something, no matter how small, is always better than doing nothing. With so many obstacles and misguided messages, supporting expectant and new moms is critical. Working with pregnant clients is a uniquely challenging and rewarding experience that quite literally helps to reshape a family’s genetics and have a positive impact on multiple generations.
ACOG. (2015) Committee opinion no. 650: Physical activity and exercise during pregnancy and the postpartum period. Obstetrics & Gynecology, 126, e135–e142.
Garland, M. (2017). Physical activity during pregnancy: A Prescription for improved perinatal outcomes. Journal for Nurse Practitioners, 13(1), 54-58. doi://doi.org/10.1016/j.nurpra.2016.07.005
Harris, J. E., Baer, L. A., & Stanford, K. I. (2018). Review: Maternal exercise improves the metabolic health of adult offspring. Trends in Endocrinology & Metabolism, 29, 164-177.