Prenatal Training Guidelines

Exercise during pregnancy provides significant benefits for both mother and baby when performed appropriately. This chapter covers evidence-based guidelines for training pregnant clients safely and effectively.

Remember: All pregnant clients should have medical clearance before beginning or continuing exercise. Your role is to implement appropriate programming, not provide medical advice.

Benefits of Prenatal Exercise

Maternal Benefits

Physical benefits:

• Improved cardiovascular fitness
• Better weight management
• Reduced back pain and discomfort
• Improved posture and body mechanics
• Better sleep quality
• Maintained muscle strength
• Improved energy levels

Mental health benefits:

• Reduced anxiety and depression symptoms
• Better stress management
• Improved body image
• Enhanced sense of control
• Social support (group exercise)

Pregnancy-related benefits:

• Reduced risk of gestational diabetes
• Reduced risk of pre-eclampsia
• Shorter labor duration (some studies)
• Reduced likelihood of cesarean delivery
• Faster postpartum recovery

Benefits for Baby

Research suggests prenatal exercise may:

• Support healthy fetal heart development
• Not increase risk of preterm birth or low birth weight
• Possibly improve stress tolerance
• Support healthy birth weight

Current Exercise Guidelines

Official Recommendations

Major health organizations (ACOG, ACSM, SOGC) recommend:

Frequency: Most or all days of the week Duration: Accumulate 150 minutes of moderate-intensity activity per week Type: Aerobic and strength training activities Intensity: Moderate (can talk but not sing)

Practical Implementation

For previously active women:

• Can generally continue pre-pregnancy activities
• Modify as pregnancy progresses
• Listen to body signals
• Avoid high-risk activities

For previously sedentary women:

• Begin gradually
• Start with 15-20 minute sessions
• Build up slowly over weeks
• Focus on low-impact activities

Exercise Selection Guidelines

Recommended Exercises

Cardiovascular:

• Walking
• Swimming and water aerobics
• Stationary cycling
• Low-impact aerobics
• Modified hiking (flat terrain)

Resistance training:

• Bodyweight exercises (modified as needed)
• Resistance band exercises
• Light to moderate weights
• Functional movements

Flexibility and mobility:

• Gentle stretching
• Prenatal yoga (modified)
• Mobility work for common tight areas

Exercises to Modify or Avoid

Avoid completely:

• Contact sports
• Activities with high fall risk (skiing, horseback riding)
• Scuba diving
• Hot yoga/hot Pilates
• Exercises at altitude (if unacclimatized)
• Heavy lifting with breath holding

Modify or avoid as pregnancy progresses:

• Supine exercises (after ~16-20 weeks)
• Prone exercises (when uncomfortable)
• Exercises requiring significant balance
• High-impact movements
• Deep squats if uncomfortable
• Exercises that cause abdominal doming

Calisthenics Modifications by Trimester

First Trimester Modifications

General approach:

• Maintain fitness rather than build
• Listen to energy and nausea levels
• Stay hydrated
• Avoid overheating

Specific modifications:

• Push-ups: Standard variations usually fine
• Squats: Regular depth typically acceptable
• Planks: Standard or modified based on comfort
• Pull variations: Continue as normal if comfortable

Second Trimester Modifications

General approach:

• Begin modifying exercises
• Avoid supine positions
• Increase stability support
• Monitor for round ligament pain

Specific modifications:

Push-ups:

• Incline push-ups (hands elevated)
• Wall push-ups
• Wider hand position for comfort

Squats:

• Wider stance
• Box squats for depth control
• Support available if needed
• Reduced depth if uncomfortable

Planks:

• Incline planks (hands elevated)
• Shorter hold durations
• Side planks may be more comfortable
• Avoid if abdominal doming occurs

Core work:

• Bird dogs (modified for belly clearance)
• Seated exercises
• Standing anti-rotation work
• Avoid crunches/sit-ups

Third Trimester Modifications

General approach:

• Significant modifications likely needed
• Prioritize comfort and safety
• Reduce intensity
• Shorter sessions may be appropriate

Specific modifications:

Push-ups:

• Wall push-ups primarily
• Incline push-ups only if comfortable
• Reduced range of motion acceptable

Squats:

• Supported squats (holding something stable)
• Sit-to-stand from chair
• Very wide stance
• Reduced depth

Core work:

• Diaphragmatic breathing
• Pelvic floor awareness
• Gentle stabilization only
• Avoid loaded flexion

Lower body:

• Supported single-leg work
• Gentle hip strengthening
• Avoid exercises that aggravate pelvic pain

Intensity Guidelines

Using RPE (Rate of Perceived Exertion)

Heart rate monitoring is unreliable during pregnancy due to cardiovascular changes. Use RPE instead:

Target range: RPE 12-14 (somewhat hard)

The Talk Test

Simple and effective:

• Appropriate intensity: Can speak in full sentences
• Too intense: Can only say a few words between breaths
• Too easy: Can sing without difficulty

Warning Signs to Stop Exercise

Stop Immediately and Seek Medical Attention If:

• Vaginal bleeding
• Regular, painful contractions
• Amniotic fluid leakage
• Chest pain
• Headache that won't go away
• Dizziness or feeling faint
• Calf pain or swelling
• Decreased fetal movement (after movement has been established)
• Shortness of breath before starting exercise

Reduce Intensity or Stop If:

• Unusual fatigue
• Pelvic pressure or pain
• Back pain that isn't relieved by rest
• Feeling overheated
• Nausea
• Generally unwell feeling

Sample Prenatal Program

Second Trimester Session (45 minutes)

Warm-up (10 min):

• Walking in place (3 min)
• Arm circles and shoulder rolls (2 min)
• Hip circles and leg swings (3 min)
• Cat-cow stretches (2 min)

Strength Circuit (25 min): 2-3 rounds, 45 sec work, 30 sec rest between exercises:

1. Incline push-ups (against wall or bench)
2. Supported squats (holding stable surface)
3. Standing bird dogs (hands on wall)
4. Resistance band rows
5. Glute bridges (on incline if needed)
6. Pallof press or standing anti-rotation

Rest 2 minutes between rounds

Cool-down (10 min):

• Walking (3 min)
• Gentle stretching: chest, hips, back (5 min)
• Deep breathing (2 min)

Third Trimester Session (30-40 minutes)

Warm-up (8 min):

• Gentle walking (4 min)
• Upper body mobility (2 min)
• Lower body mobility (2 min)

Strength Work (20 min): Light intensity, focus on maintaining function:

1. Wall push-ups: 2 x 10
2. Sit-to-stand from chair: 2 x 8
3. Standing hip abduction with support: 2 x 10 each
4. Seated resistance band rows: 2 x 12
5. Incline bird dogs: 2 x 8 each side
6. Diaphragmatic breathing with pelvic floor awareness: 2 min

Cool-down (8 min):

• Gentle walking (3 min)
• Stretching (3 min)
• Relaxation breathing (2 min)

Pelvic Floor Considerations

Pelvic Floor During Pregnancy

The pelvic floor supports the growing uterus and plays a crucial role in:

• Supporting pelvic organs
• Bladder and bowel control
• Sexual function
• Core stability
• Childbirth

Pelvic Floor Exercise

While specific pelvic floor training is outside most fitness professional's scope, understanding is helpful:

What you can do:

• Encourage diaphragmatic breathing
• Teach awareness of pelvic floor engagement during exercise
• Avoid exercises that cause incontinence
• Refer to pelvic floor physiotherapist if issues arise

Signs of pelvic floor strain:

• Urinary leakage during exercise
• Heaviness or pressure in pelvis
• Difficulty controlling bladder or bowel
• Pain in pelvic region

Communication with Healthcare Providers

What to Ask Clients

Before training, ask about:

• Medical clearance for exercise
• Any restrictions from their provider
• High-risk pregnancy factors
• How they're feeling generally

When to Contact Their Provider

Recommend client contact healthcare provider if:

• Any warning signs occur during exercise
• Significant changes in how they feel
• New symptoms develop
• Questions about exercise safety arise

Documentation

Keep records of:

• Medical clearance confirmation
• Exercises performed and modifications
• Client's reported wellbeing
• Any concerning symptoms and actions taken

Key Takeaways

1. Medical clearance is required before training pregnant clients
2. Benefits of prenatal exercise are well-established when done appropriately
3. Use RPE (12-14) and the talk test for intensity monitoring
4. Modifications increase progressively through trimesters
5. Avoid supine exercises after first trimester
6. Stop exercise immediately if warning signs occur
7. Focus on maintaining fitness, not building it
8. Prioritize safety and comfort over performance
9. Individualize programming based on each client's experience