Strength training is a beneficial component of a prenatal fitness program, providing pregnant women the strength needed to compensate for posture adjustments and weight gain that occurs with pregnancy. The current research on exercise during pregnancy has shown that in an uncomplicated pregnancy, moderate cardiovascular exercise provides benefits to both mother and fetus. Although the focus has predominately been on cardiovascular training, the benefits of strength training for this population is equally important. The biomechanical changes of pregnancy can create stress on muscles and joints, and women who don’t do strength training exercises may experience back and joint discomfort from weak muscles that aren’t able to provide adequate support. A pregnant woman’s center of gravity shifts up and out to accommodate the growing size of the fetus, and resulting compensations such as an increased lordosis and kyphosis of the spine can increase the incidence of back pain.
Most women tend to have poor muscular strength in their upper body and core, so a gentle, progressive strength training program that focuses on these areas can help women improve their ability to maintain support of their spine and prevent muscular strain and injury. In addition, it’s important to start or maintain strength training during pregnancy so that after a woman delivers she is prepared for all the lifting she will be doing with her new baby.
Proper lifting techniques are an important addition to a strength training program. Take time to work with your pregnant client on how to lift correctly by bending from the knees not the waist when picking up an object, and holding the object close to the body as it is lifted. For more information on lifting techniques go to this link. http://www.mayoclinic.com/health/back-pain/LB00004_D&slide=2
There are no established strength training guidelines for pregnancy or weight limits, so using common sense and your clients physical responses to exercise are the best tools for keeping her strength training routine safe. It’s important to teach your pregnant client to listen to her body and employ modifications to exercises that become uncomfortable. All pregnant clients should be cleared for exercise by their healthcare provider, and if her doctor has given her limitations for exercise you need to be aware of those limitations and incorporate them in her exercise routine. Keep in mind that with this population consistent follow up after each workout is vital to ensure that the exercises continue to feel comfortable and aren’t causing any strain or pain. Instruct your clients to advise you of any changes in her pregnancy as well as her exercise response so you can help her fine tune her program for safety and comfort.
The following guidelines will help you develop a strength training routine that will help your client safely maintain or increase her muscular strength throughout her pregnancy:
- Pregnant women can continue their pre-pregnancy weight-training program, but should closely monitor their physical response to exercise and modify or eliminate exercises that cause pain or increased muscle soreness.
- Women who are starting a strength-training program during pregnancy should use a weight level that allow for 10-12 repetitions without excessive strain. One set of 10-12 repetitions, 2-3 times a week is sufficient for strength gains for beginning weight training. Weight amount can be incrementally increased as the repetitions become easier.
- Avoid maximal static lifts. They may cause a sudden increase in cardiac output and blood pressure, and employ the valsalva maneuver. During the valsalva maneuver there is a significant diversion of blood from the internal organs to the working muscles. Maximal lifts may also place extreme stress on the lumbar spine and other joint areas. Never overload an unstable or weakened joint.
- Instruct client to avoid holding her breath and bearing down while doing exercises. Teach proper breathing techniques.
- Strength training machines are generally preferred over free weights because they tend to require less skill and can be more easily controlled. Resistance bands provide a safe and inexpensive alternative to weights and equipment.
- Instruct your client to listen to her body and provide feedback to you. It’s a team effort and the more information she can provide to you about how her exercise program feels for her, the better able you’ll be to fine tune her routine.
- If a particular exercise produces pain or discomfort even after modifications such as reducing weight amount or repetitions, it should be discontinued. If pain persists the client should consult with her healthcare provider.
- Frequently ask your client the health of her pregnancy. If she has developed any complications or conditions require that she talks with her healthcare provider before continuing with any exercise program,
- Eliminate back lying positions (such as a bench press) after the first trimester of pregnancy. The maternal vena cava can be compressed by the weight of the growing baby when she is in a supine position and cause her to become lightheaded and dizzy.
- Modification of weight training exercises (such as dropping down in weight level or repetitions, or adjusting positioning) may be needed as pregnancy progresses.
- Prenatal belly support bands may be used if your client is experiencing back strain. The belt should be carefully placed so that it supports the abdomen without causing discomfort.
- Monitor exercise technique carefully by mirror observation or supervision in order to correct for progressive postural changes that occur with advancing pregnancy. Improper lifting techniques may aggravate back problems and increase soft tissue injuries.
- Maintain a chart of exercises, reps and loads and review before each training session.
When setting up a strength training routine with a client, most trainers don’t consider the pelvic floor muscles, and their role in support. During pregnancy the weight of a growing baby and increased pressure from pelvic organs can cause problems with incontinence and more rarely, prolapse of the uterus or bladder.
Pelvic floor (kegel) exercises should be included in a prenatal strength training routine and continued postpartum to help prevent urinary incontinence. A recent study has shown that pregnant and postpartum women who consistently perform pelvic floor three sets of 8-12 near maximum pelvic floor exercises 3-4 days a week had a significantly reduced incidence of urinary incontinence. The key is to instruct women on what are the correct muscles to contract while doing a pelvic floor exercise and provide encouragement to help them consistently perform the exercises. Here are some tips for instructing how to do determine which muscles to contract during a PF exercise and how to do a near maximal contraction:
- The muscles you use to stop and start urine flow are the pelvic floor muscles. Practice contracting and relaxing these muscles a few times while urinating to get a feel for how to isolate those muscles. You don’t want to continue doing your pelvic floor exercises in this manner-just use this technique to determine how to correctly contract the muscle group.
- The muscles of the pelvic floor form a figure 8 around the urethra, vagina and anus and are key in providing support of the pelvic organs and continence. Think of the muscles as providing a sling for the bladder, uterus and colon and that you’re gently lifting the sling as you contract the PF muscles.
- Work up to doing a near maximal contraction by slowly increasing the contraction to a count of five, then slowly releasing to a count of five. As you become stronger try holding the top of the contraction for several seconds.
- It can help to think of the contraction as an elevator that’s going up a floor at a time. Remember, it’s as important to be able to relax the pelvic floor as to contract, and women who are able to control their PF muscles can use this ability to relax the muscles during the pushing phase of delivery.
- Pelvic floor exercises can be done any time, but it’s helpful to make a habit of doing them at certain times each day, such as when you’re brushing your teeth, or driving to work so doing the exercises becomes a habit.
You may have the occasion to work with a pregnant athlete who is at a high level of strength training. The challenge of working with this type of client is greater than a recreational athlete, but it’s rewarding to be able to work closely with these clients and learn from their feedback and experience. One of the biggest challenges can be reining in the pregnant athlete’s natural inclination to push their training to high intensity levels. You and your client need to be aware of warning signs and pay close attention to increased muscle soreness, back pain or other symptoms of over-training.
Pregnancy isn’t the time for rapid increases in exercise intensity or near maximal effort. Competitive events and training should be discontinued until after pregnancy. Reassure your client that she will be able to build back up to training levels postpartum as long as she keeps injury free during her pregnancy.
The website www.babyfit.com has developed a series modified strength training exercises for upper and lower body and abdominals that can be viewed at this link:
I have reviewed these exercises for the website and encourage any personal trainers who are interested in learning innovative exercises for their pregnant clients to use these videos as a source.
- Exercise During Pregnancy and the Postpartum Period. The American College of Obstetricians and Gynecologists Committee Opinion No. 267, January 2002.
- Clapp III, James F. MD. Exercising Through Your Pregnancy. Addicus Books, 2002.
- Cram, Catherine MS and Stouffer Drenth,Tere. Fit Pregnancy for Dummies.Wiley publishing, 2004.
- Pirie, Alex and Herman, Hollis. MS, PT, OCS. How To Raise Children Without Breaking Your Back.
- Kari Bo. Does Pelvic Floor Muscle Training Prevent and Treat Urinary and Fecal Incontinence in Pregnancy? Nature Clinical Practice Urology. (2009) 6, 122-123