Yes you should start exercising when you fall pregnant – the idea that you shouldn’t start anything new is a MYTH. The health risks of a sedentary lifestyle on your pregnancy is in line with smoking – and I don’t say that to shame or scare you – I say it to emphasise how important it is that we keep working out if we can.
So, if you’re not qualified in training women throughout their pregnancy, then perhaps you should consider getting a qualification – there’s an untapped potential in the hundreds of sedentary women who are not training right now, they’ll certainly be advised to start when they fall pregnant!
However, as discussed, it is also not true that we can continue doing everything we always have done – the mother’s risks change. Her body is also going through a massive metamorphosis that it’s important that we support, not necessarily challenge, at this time.
So this month we are going to cover some key points in exercise during pregnancy, including where to start, what to prioritise, and how to support the breastfeeding – but please do not confuse these sessions with formal training. Watching these sessions does not qualify you to train pregnant women if you do not have a pregnancy training qualification.
There are exceptions to the “training is good for you” rule during pregnancy, and that is for those women undergoing IVF treatment (link in comments to mini course), and if your pregnant client has any of the following conditions (so screen for them):
Where to start.
If your client is sedentary – start with pelvic floor exercise and 15min walking.
Your pelvic floor exercise should be performed in partnership with a women’s health physio, which you can look up your closest one here: http://whta.com.au/, and will essentially be a combination of lifting and dropping and breathing. You’ll start on your back, because that’s gravity assisted, but ultimately you need to get them sitting, then standing, and then moving with a pelvic floor that lifts, drops, relaxes, co-ordinates with other muscles and movements, and does all these things at the right time. We have an excellent pelvic floor and core course available here: https://intoyou.teachable.com/p/13cec-core-masterclass
Walking should start with 15min, but ultimately we are aiming to build to 150m per week (30min x 5), providing the client remains symptom-free and healthy. Strength training sessions should be introduced slowly, and build to a moderate intensity through her pregnancy, twice a week. For example, you might start with 1 set of 15-20 reps chest, back, legs, pelvic floor. Then build to two-3 sets, 2-3 exercises, and increase weight gradually until she’s doing 8-12 reps.
Light to moderate exercise (use RPE) has been shown to be better for her pregnancy than no exercise at all, unless she has one of those contraindications that we discussed last week.
So we have an example from a trainer who has a newly pregnant client (she’s at 8wks). She hasn’t been training, and she lives a sedentary lifestyle, so we know right away that we need to start walking with her for 15min a day, and get qualified in pelvic floor training so that we can fill the rest of the 30min session out with that.
We might also look at what mobilisors and stretches will help with her posture, so that her advancing pregnancy means she stays as aligned as possible for as long as possible. I’m thinking about lengthening the muscles that commonly shorten due to upper and lower cross syndrome..
Now this client is also Vit D deficient, and while it’s out of scope to prescribe supplements, Vit D also comes from the sun, so we can guide to walking OUTSIDE rather than on a treadmill, then refer to a naturopath for supplementation.
We also know that she’s at a high risk of miscarriage until 12wks, so if we choose to do strength training with her, it has to be extremely conservative – not because strength training causes miscarriage, but because you don’t want to be anywhere near any gray zone that could mean being blamed for it. Guidance from their obstetrician or midwife in the first trimester is ideal.
So you can see how integrated training during pregnancy is with healthcare, developing a strong network of health professionals will be fantastic for your business, and also for your peace of mind as you progress your client throughout her pregnancy.
Training a high volume, high intensity, or high loaded client…
The opposite end of the sedentary client spectrum are those client who train extremely hard, who train often, who train everyday, or all of the above. These clients are the ones that will say that their doctor told them to continue doing what they’ve always done, and to “listen to their body”.
But what does that even mean? Are we waiting for pain? Injury? Fatigue? Moodiness? Unusual aches?
Here’s my take, as a pregnancy and post natal master trainer with over 20 years of experience, study, and training under my belt… These populations aren’t great at listening to their bodies, and will need specific instructions regarding what is appropriate at what stage. Furthermore, these populations, depending on what activities they’re engaging in, are often more than twice as likely to develop pelvic dysfunctions such as stress incontinence.
So, here’s my advice. Your pregnancy is time to begin gradually down training your intensity, volume, complexity, and loads (especially if they’re generating a lot of intra-abdominal pressure – how can you tell? Doming! Pain! Stress incontinence! Other pelvic sensations!).
This may mean she continues training as she’s always done during her first trimester – however the risk of miscarriage is between 30-66% depending on where you get your stats, and I am not sure I’d love a miscarriage to happen in my gym, even if it’s impossible that the exercise caused it. As her body changes, her intensity, volume, complexity and load should be reduced at the same rate, with special considerations around what we are preparing her body for.
Not the birth. We are preparing for motherhood.
So if your deadlift looked like a regular deadlift before, it now looks like putting a baby on a change table. If your squat was technically perfect before, it’s now more about getting the pram out of the back of a car, or putting a baby capsule in… We have to start diversifying her body’s capabilities and training for the purpose for which her body will be used.
Her training doesn’t necessarily have to be gentle and easy, but it does need to be modified, monitored, and specific to her purpose.
What WONT harm your baby? Moderation.
This week we need to talk about exercise and risk management. There is a lot of scaremongering, which means many of us go the conservative route, but this essentially holds women back from their potential. Conversely, training them to their potential without a understanding of the risks is also less than ideal.
The goal is the middle. Moderate volume, intensity, complexity, and loads have the best bang for buck when it comes to health outcomes than anything else. What this means is:
Moderate volume: not training once a week, nor training 7 times a week. Your client now trains 3-5 times a week, for more than 30min, but less than 60min (depending on where they started).
Moderate intensity: means that they neither workout at 50%RPE, nor do do they hit 90% RPE, rather, they sit in the aerobic zone of 60-80%.
Moderate complexity means simplifying the movements, even as you make them more diverse and specific to the tasks they’re training for. A burpee becomes a press and squat. A clean and press becomes an upright row, and a deadlift as a completely different exercise.
In this category, you also need to consider what positions they’re in as their body changes, and jumping adds extra loads to the PF and prone positions put pressure against the abdominal wall (do you really want to stretch that further right now?). Think about going gently on those structures as they’re already under extra pressure from the pregnancy alone.
In addition, thinking about direction changes and balance work conservatively as she enters her third trimester, when her centre of gravity rises and her risk of falls and soft tissue injury also rise.
Moderate loads means instead of doing 20 reps, or just 1-3 reps, you’re now doing 12-15 reps of whatever weight is hard but possible, twice a week instead of 3-5 times.
This is generic, non-specific to circumstance advice that maximises safety without compromising fitness and health. Moderate exercise also means the least amount of harm to the developing foetus as well, and has in fact been shown to be healthier for the foetus.
Other things to think about
Other things to think about when training pregnant women include the importance of weights during pregnancy and breastfeeding and her lifestyle.
Breastfeeding women lose up to 6% of their bone mineral density in the first 6mths of breastfeeding.
How can we mitigate that loss? Heavy weights.
Risks of heavy weights? Prolapse and pelvic dysfunctions.
So – working with a women’s health physio will monitor her pelvic condition, and teaching her the kegal will inoculate her somewhat to it getting worse. Both conscious and unconscious PF work needs to be included in her program.
Deliberate lifting work
Deliberate PF relaxation
Deliberately timing the lift and/or drop with movement
Unconscious work includes:
Pelvic mobility work
Movements that include the arms AND the legs in 3 dimensions
You also need to consider your pregnant client’s current lifestyle, is she still working full time or is she at home with other children? How many? How old? What are her stress levels? How are her physical requirements in her other “jobs” (including stay at home mothering)?
As a basic rule of thumb, the harder/more stressful her lifestyle, the easier/less stressful your sessions.
In addition, the movements have to help her live her life better. If it’s her first pregnancy, then we need to train for the physical role of mothering – she’s literally never held 3.5kg all day before! However, if she has a 3YO and 5YO at home, then perhaps your training has to be less, and include the things she’s missing; lying down, deep core, deep breathing, posture and mobility for example.
As per usual, feel free to message me with your questions! Hopefully this has cleared some things up for you!