A detailed guide that covers in the ins and outs of training during pregnancy.
Pregnancy can bring a mixed bag of feelings; love, excitement and warmth, combined with fear, anxiety and confusion.
New mothers are given the incredible yet seemingly overwhelming responsibility to grow, nurture and bring a new life into this world.
With the intention to be the best possible walking incubator for their new baby it can seem like an impossible task with the piles of conflicting information out there for us to sift through.
If you’re pregnant or coach someone who is and feel a little bit uncertain on how to program your training – don’t worry you are not alone. With a lot of the guidelines surrounding training being based on hypotheticals it can can difficult to get real, reliable information.
Some questions that may be racing through your mind could be:
· Can I continue my regular exercise routine?
· How much and when do I need to modify training?
· Do my goals need to change?
When I first discovered I was pregnant I very quickly realised that my life was about to change.
Apart from the obvious, it occurred to me that a whole lot of new little changes needed to be made. One in particular was my training.
As a trainer myself I thought that this would be a piece of cake but I soon realised that I needed to learn a lot more.
There was so much conflicting information out there, that I found myself very confused.
I turned to peers and colleagues for advice and they seemed just as confused as I was.
In the fitness industry, we are plagued with misinformation; especially surrounding pre and post natal training. It is little wonder why everyone is so confused.
Following endless amounts of reading and study into pre and post natal training I eventually discovered where I was going wrong. I was searching for a “one size fits all” approach, some clean cut guidelines handed to me on a platter– when in fact; we need to take the circumstances of each individual into account, just as we would with any other programming.
THE BACKGROUND:
While pregnancy has been studied extensively, there is minimal research out there that depicts the long term effects of training during pregnancy.
Even though the condition of each pregnancy and pregnant woman is unique, we are given very generalised information that is mostly based on hypotheticals.
While there may be a point that could be considered ‘overdoing it’ when pregnant, common misconceptions about pregnancy and training can often lead to many women to be overly cautious— sometimes to the point of stopping exercise altogether.
However, in light of recent research in this field, there is no arguing that appropriate exercise during pregnancy can be beneficial for both mum and bub.
“The research when summarised, suggests that moderate exercise in a low risk pregnancy does not lead to adverse outcomes for the foetus or mother and in fact improves overall fitness and well being.” (Nascimento, 2012)
A recent research review in Current Opinion in Obstetrics and Gynaecology (Nascimento, 2012) revealed that women who exercise during pregnancy have higher cardiorespiratory fitness, less urinary incontinence and low back pain, reduced symptoms of depression and gestational weight gain control.
SHIFTING YOUR TRAINING MINDSET:
Some of the most misleading and confusing advice I was given at the beginning of my pregnancy was:
“Just keep doing what you’re doing”
I heard this from friends, family and even a GP. Although they were just trying to be supportive, it is clear that they had very little idea about the training I was doing pre-pregnancy and the implications this could have on my recovery post natal (I will elaborate on this a little later on).
Since falling pregnant I have indeed altered my approach/mindset towards my training.
Pre-pregnancy my training was centred around PROGRESSING my performance goals and challenging what my body could do.
However, the biggest focus of my training during pregnancy is MAINTENANCE; working on light, strict work and accessories to build a strong base and reduce recovery time post natal. I like to think of it as a 9 month long ‘de-load’.
Over the past few years I have been a BIG advocate of listening to your body… but in recent times I feel like I would like to amend that a little.
I’ve recently realised, particularly during pregnancy that it is not longer just about LISTENING to your body but UNDERSTANDING it.
Taking it from just merely responding to what your body wants to being able to give your body what it needs.
There will be days where you feel great (I promise that second trimester is much more forgiving) and feel like you can really ‘push the boundaries’. The question you should be asking yourself is no longer ‘CAN you still do this?’ but whether you NEED to. If in doubt over a particular exercise choice or load, I suggest looking for an alternative.
CHANGES IN THE BODY AND TRAINING IMPLICATIONS:
As stated above; you will likely need to modify your training during your pregnancy in some way, shape or form.
As much as some coaches may like to believe; not all exercises are appropriate during pregnancy.
As every body and EVERY pregnancy is different, programming and exercises must be individualised to suit each pregnant woman. Additionally, pregnancy is not a static process. It involves stages (trimesters) that require specific modifications to suit that stage (ACOG, 2015).
Now before we get into the nitty gritty of it all, lets have a quick look at the physiological changes that occur during pregnancy outlined in Physiologic changes during normal pregnancy (Katz VL, 91) and how they can impact training:
Cardiovascular/ Respiratory:
Increased blood volume, cardiac output and resting heart rate means the body is working harder at rest and may fatigue quicker when exercising.
An altered shape of the rib and decreased thoracic space in later stages of pregnancy can also increase breath rate and decrease Thoracic mobility.
Hormonal:
A spike in relaxin hormones and progesterone affects joints, blood vessels and ligaments. When joint laxity is increased, joint stability is decreased meaning high impact exercise can pose a greater risk of injury.
Weight Gain:
Carrying around extra weight through increased blood volume, fluid retention and not to mention the little human growing inside your expanding uterus – will also mean increased stress on joints, less space for other organs and a possibility to interrupt blood flow.
For your training this will mean that your joints will need a little more TLC during this period and it may be a good idea to start including those stability / pre-hab exercises you have been neglecting.
Lying supine for long periods of time after the 16-week point is also deemed inappropriate due to decreased placental blood flow.
Postural Change:
A shifting centre of gravity due to increased load of uterus can result in an excessive lumbar curve – minimising abdominal control and tightening lower back and hip flexors.
When training it is important that we can maintain neutral spine throughout your movement. It would also be wise to work on activating and strengthening the posterior chain to help support the new load.
Abdominals:
Throughout pregnancy the abdominals become stretched and weakened to make room for the growing baby.
Whilst a varying degree of abdominal separation seems to be unavoidable it is advised to modify exercises that excessively load this area –specifically any exercise that causes a doming appearance, excessive flexion and extension through the spine, breath holds/ intra abdominal pressure and heavy loads.
A good way to minimise separation during pregnancy is to include deep abdominal conditioning into your program and learning to activate your transverse abdominis. If you are struggling to make the connection with your deep abdominal muscles I recommend consulting with a Women’s Health Physiotherapist, Exercise Physiologist or qualified Pilates professional who can guide and assess proper engagement.
Pelvic Floor:
Another muscle that becomes stretched and weakened during this time is the pelvic floor.
This is another reason why we need to reduce load and impact during this time. To prevent long term damage being done to this thin little muscle it is recommended to include control exercises that both activate and RELAX the pelvic floor. I always recommend getting a Pelvic floor assessment from a Women’s Health Professional so you know where you are at with Pelvic Floor (if you are over-active the last thing you want to be doing is perform routine kegels).
Overheating:
Your body’s core temperature is slightly higher when your pregnant. With the added stress of growing a human, your body has a higher chance of overheating. Overheating is shown to pose increase risk to mother and baby and precautions need to be taken to avoid it.
Some signs of overheating may include; cramps, nausea and faintness. If you experience any of the above cease activity and speak to your health professional immediately.
Sweating is not a sign of overheating but a good indication that your body is working to keep your core temperature down (it need not be feared but should be monitored).
Some of the following modifications are good strategies to avoid overheating;
Keeping hydrated, wearing light loose clothing and minimising activity during the hottest parts of the day.
Whilst exercise is deemed safe during a low risk pregnancy there are definitely instances where exercise is inadvisable.
Here is a list of some contraindications to exercise during pregnancy. If you or your client presents any of these conditions guidance from the appropriate health professional is a MUST! Sourced from ACOG Guidelines for exercise and pregnancy (ACOG, 2009).
· Ruptured membranes
· Risk of premature labor
· Unexplained persistent vaginal bleeding
· Placenta previa after 28 weeks of gestation
· Pre-eclampsia
· Incompetent cervix
· Intrauterine growth restriction
· High-order multiple pregnancy (e.g., triplets)
· Uncontrolled Type I diabetes
· Uncontrolled hypertension
· Uncontrolled thyroid disease
· Other serious cardiovascular, respiratory or systemic disorder
· Recurrent pregnancy loss
· Gestational hypertension
· History of spontaneous preterm birth
· Mild or moderate cardiovascular or respiratory disease
· Symptomatic anemia
· Malnutrition
· Eating disorder
· Twin pregnancy after the 28th week
· Other significant medical conditions
EXERCISE PRESCRIPTION AND MODIFICATIONS:
The precautions we take with our training are not only about keeping mum and bub safe but ensuring our movement and health is with us long term. As you probably realised above there are some specific areas in the body that become a little "sensitive" in this time, possibly making them more susceptible to some long term (but not irreparable) conditions.
It is for this reason that training during these 9 months needs to make a shift to be less towards “Progress” and more towards “Maintenance”. If training is a big part of your identity (like it is for myself) this can be a difficult shift to make but I assure you that being adaptable and learning to surrender your ego will only benefit you in the long run.
How you structure your training during your pregnancy is entirely up to you and your doctor or Women’s Health professional. If maintenance is your goal I would suggest keeping up a balance between your cardiovascular and strength training. The main purpose of your strength training during this time will be to maintain that mind muscle connection and improve postural awareness, which as mentioned above can be affected by the shift in weight pulling you forward.
Similarly, the purpose of our cardio sessions will be to maintain or build a strong base level of fitness and help keep that heart healthy.
Please keep in mind that a workout is just an hour of your day. Try to keep movement into your routine as much as you can; aiming for
10 000 steps a day is a great goal. If racking up steps; going for a little walk down the street, walking to your car or going for a shop is all you can muster for that day, then that is fine. Do what you can and stay realistic with the goals you set for yourself.
Below I have created two lists of exercises that may be deemed inappropriate during pregnancy as they toe the line of the "risk vs reward" scale. Keep in mind that every women's "risk vs reward" will be different based on their occupations and current physical condition.
The choice to continue these exercises lies with you and your guiding health professional. Remember form and function are key!
Exercises it is recommended to avoid:
Movements that place a great demand on the abdominals: sit-ups, planks, crunches, hanging knee raises -where doming or coning occurs.
Movements that create intra-abdominal pressure: heavy lifting or explosive movements such as ball slams.
Kipping movements- pull ups, toes to bar.
Lying Prone Positions: lying on belly- supermans, chest to floor burpees, hand release push-ups, lying hamstring curls.
Olympic lifting with barbell.
Contact sports: Football, soccer, hockey.
Movements/ Sports that involve a sudden change in direction; tennis, netball, trail running.
Water sports with high impact: water skiing, diving, surfing
High risk sports; road biking, rock climbing, skiing, gymnastics.
Exercises to be mindful of:
Overhead movements: Shoulder press, Lat Pull down, Strict pull ups, overhead squat.
Split stance and single leg exercises: Lunges, Bulgarian Split Squats, Single Leg RDL.
Wide stance: Sumo Squats, Cossack squats
Prone Positions: Push-ups, bear crawls, table top.
Lying Supine: Bench Press, Glute Bridge, Hollow body
High impact: running, sprints, box jumps, skipping
Barbell movements.
Suggested Modifications:
Reduce range of motion:
It is common to experience joint and ligament pain particularly around the hips and pelvis. If you experience any of symptoms, it is important to discuss them with your doctor or women’s health physiotherapist. Modify your squat, split stance or lunge variations by narrowing your stance. You may even need to reduce your range of motion when squatting by placing a box beneath you.
Elevate supine positions:
As mentioned above, lying supine can decrease placental blood flow. If you experience light headedness, tingles, breathlessness or any discomfort cease the exercise inform your doctor. To be safe I recommend opting for the following modifications: Incline your bench for bench press, keep shoulders elevated for hip thrusts and choose a horizontal leg press over the vertical leg press.
Elevate prone positions:
Is usually more difficult to keep a neutral spine in these positions. If you can no longer keep your core engaged without doming or feel a significant amount of pressure (bearing down) through your mid-section, consider the following modifications. Prop your hands on a box, bench or counter top to modify push-ups and burpees.
Reduce load:
Heavy loads which cause you to hold your breath or create intra-abdominal pressure may increase abdominal separation – lighten loads, increase rep count and challenge tempo to keep those muscles you’ve worked so hard for firing.
Reduce impact:
It is recommended to cease or reduce your volume of high impact exercise during pregnancy mainly to look after the mother’s health and function in the long term. There are plenty of options to help get that heart rate up and keep your conditioning in check whilst keeping the impact to a minimum; stationary bike, rower, assault bike, swimming, hill walks, stair climbs (just be wary if you suffer from SPD).
Switch the barbell to dumbbells or kettlebells:
The positioning of the barbell can at times exacerbate the postural imbalances that occur during pregnancy. Loading barbell back squats on an already extended lower back could heighten symptoms of pain and discomfort. Instead make accessories your focus for this training block- working tempo, front loaded goblet squats to assist and maintain the movement patterns.
If you wish to continue Olympic lifting it may be wise to switch to a dumbbell or kettlebell. Bar path is likely to be affected to accommodate for your growing belly- letting the bar travel too far away from the body will overload the spine and may reinforce unsafe movement patterns.
Intensity:
It was once suggested that you shouldn’t elevate your heart rate above 140 during pregnancy but that recommendation has now been thrown out the window. Whilst it is true that you should not “over” exert yourself when pregnant, it is no longer recommended to stick to a set heart rate. With everybody’s physiology being unique the level of exertion is going to differ dependent on how conditioned the individual was prior to falling pregnant and how conditioned they are now. Some professionals like to use the ‘talk test’ and suggest that you should still be able to string a sentence together whilst still moving, others use the RPE (Rate of Perceived Exertion) Scale and ask you to rate your effort level out of 10. It is usually suggested to stick to an RPE of 8 or below for short interval/circuit work and 6 or below for long continuous efforts.
I still believe it to be wise to monitor your heart rate as it can be a good indication of how hard your body is working and if you may be over doing it. Keep an eye out for sudden spikes and monitor how long it takes your heart rate to recover after a workout. A little bit of intensity is fine if that is what your body is used to and your body is able to quickly recover from it. Just stay in tune with your body and hold back when you need to.
Finally, it is important to highlight that conditions are always changing during pregnancy. Make sure you are aware of your current condition and legitimacy to train. Always confirm with your health professional that it is ok to keep exercising every time you visit and if you can seek advise from a Women’s Health Physiotherapist that specialises in Pre and Post Natal Training.
Note whilst there is a lot of information in this article, it is not to be taken as gospel and is not intended to override medical advice. The true intention here is to give you the ‘WHY’ behind modifications recommended in prenatal training and hopefully empower you to make your own choices regarding your exercise routine during pregnancy.
If you are still left confused about your exercise during pregnancy the one thing I would like you to take away from this post is to seek support and guidance from a specialist in pre-natal and post natal training.
Remember there is no such thing as a one-size fits all approach, use the resources you have to find what works best for you and your body.
You are not in this alone. Even as a Qualified Personal Trainer I have sought advice and guidance from a number of professionals to help make informed decisions about my training during pregnancy. A part from my doctor and midwife, I have had regular appointments with a Women’s Health Physiotherapist and a Pilates Instructor who specialises in Pre and Post Natal Training.
Resources:
American College of Obstetrics and Gynaecology (ACOG), Updated opinion and Exercise during pregnancy guidelines 2015:
https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Physical-Activity-and-Exercise-During-Pregnancy-and-the-Postpartum-Period?IsMobileSet=false
Katz VL, Physiological changes during normal pregnancy, Current Opinion in Obstetrics and Gynaecology, 1991.
Nascimento, Simony L., Fernanda G. Surita, and Jose G. Cecatti. "Physical exercise during pregnancy: a systematic review." Current Opinion in Obstetrics and Gynaecology 24.6 (2012): 387-394
Mentors:
Claire Norgate - Pre and Post Natal Training Certification
Michelle Barnes - Shellharbour Pilates
Other Good Resources:
The Pre-Natal and Post-Partum Athlete (Brianna Battles)