Programming for Pregnant Clients

Research and medical guidelines have long demonstrated the value of exercise during pregnancy – not only for the sustained health and well-being of the mom, but for the baby as well. Further, regular physical activity during pregnancy offers many benefits, among which are:

• Reduced rates of preeclampsia
• Reduced risk of gestational diabetes
• Reduced pain and discomfort throughout pregnancy
• Reduced heart burn
• Reduced risk of excessive weight gain
• Reduced risk of insomnia, nausea, and anxiety
• Reduced likelihood of needing a Caesarean section

Regular exercise is not harmful to the fetus and does not contribute to the risk of miscarriage. That said, there are precautions health and exercise professionals should take to ensure their pregnant clients are safe and secure during their exercise sessions. 

Guidelines

According to the Australian Government Department of Health and Aged Care, pregnant women should be active on most days, preferably every day, to a weekly total of either:

• 2.5 to 5 hours of moderate intensity physical activity
• 1.25 to 2.5 hours of vigorous intensity physical activity
• An equivalent combination of moderate to vigorous physical activity
• Include 2 days a week of muscle strengthening activities.

Doing any physical activity is better than doing none. If a pregnant client is new to physical activity, start by doing some, then slowly build up to the recommended amount as she can tolerate based on energy levels, stamina, fatigue, and presence of nausea. 

Activities that are well-tolerated include brisk walking, stationary cycling, swimming, dancing, prenatal yoga, and light resistance training – including body weight, resistance bands, machines, or dumbbells. 

Precautions

Be sure your client has medical clearance and no contraindications to beginning an exercise regimen (or continuing a current one) by adhering to the standard prescreening guidelines. If your client is newly pregnant and has been working with you previously, ask that she speak with her primary care provider to ensure she is cleared to continue forth. 

For exercise programming, be sure to avoid any activity that has a fall or collision risk, includes jarring or jumping exercises, requires heavy lifting, or promotes pain or discomfort. Further, avoid any activity that promotes a change in pressure such as scuba diving. Hot yoga should also be avoided. 

Pregnant clients should remain well hydrated and avoid exercising in extreme temperatures. Any activity in the supine position should be avoided from the second trimester on. 

Warning Signs

As with any client, health and exercise professionals should be aware of the warning signs that require exercise to stop immediately. Those signs include:

• Any pain – specifically in the abdomen
• Vaginal bleeding
• Contractions
• Dyspnea before exertion
• Headache or chest pain
• Calf pain or swelling
• Amniotic fluid leakage
• Dizziness
• Muscle weakness affecting balance

Exercises to Include

It is advisable to include the following exercises in a program

• Gradual warm-ups and cool-downs to support prenatal circulation and avoid blood pooling.
• General strengthening exercises with a particular focus on pregnancy-specific muscles, such as the pelvic floor, core, and postural muscles.
• Modified strength training .
• Modifications for exercises in supine or stationary standing positions, such as four-point kneeling, sitting on a fit ball, and side-lying.
• Flexibility training limited to a comfortable range of movement. Incorporation of relaxation techniques. Labor preparation exercises.
• Use of appropriate low-impact exercise styles.
• Modified exercise programs when the risk of overheating is elevated.
• If a pregnancy-related musculoskeletal condition is present, include exercises that either do not exacerbate or help alleviate the condition.

Exercises to Avoid

It is advisable to avoid or minimise the following exercises

• High-impact, jerky, or ballistic movements.
• Exercise intensities or durations that cause the client to feel overheated, excessively fatigued, or overly sweaty.
• Sudden changes in exercise intensity or position.
• Exercises that involve breath holding or the Valsalva maneuver.
• Exercises that place significant load on the abdominals or pelvic floor, such as abdominal curls, sit-ups, planks, and hovers.
• Stretching beyond a comfortable range of movement to avoid overstretching due to increased joint and ligament flexibility.
• Weight-bearing activities beyond a comfortable range of movement. Exercises involving lying supine from 16 weeks onward.
• Exercises in stationary standing (especially upper body strengthening) that could increase the risk of fainting. Contact activities, to minimize the risk of falls or blows to the abdomen.
• Any exercise that may cause discomfort or risk to the pregnancy.

FIIT for Exercise During Pregnancy 

The following guidelines for frequency, intensity, time, and type have been established by the American College of Obstetricians and Gynecologists, and the US Department of Health and Human Services. 

Example workout 

There’s no formulaic approach to programming for any pregnant client as it will depend on their previous physical activity experiences, current health status, and presence of pregnancy-related symptoms, but here are two examples of what a weekly program might look like.

Example 1

Example 2

It’s important for health and exercise professionals to closely monitor their pregnant clients, and check-in with them about how they are feeling related to fatigue, hunger, energy, sleep, and nausea. A woman’s energy levels, and pregnancy symptoms can fluctuate throughout the day and day to day. Take care in amending the program as needed and in a way that aligns with the client’s needs on that particular day or week. 

Resources

•       Australian Government Department of Health and Aged Care

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