You may have heard people warn that pregnant women shouldn’t raise anything over their heads or lift objects that are heavier than ten pounds when pregnant. These are warnings that still make the fitness trainer rounds when working with pregnant clients, yet these warnings aren’t based on science.  In fact, there’s no evidence for warning pregnant women to avoid lifting over their head unless it causes discomfort or balance issues, and the ten-pound limit is even more questionable, as ten pounds would be too heavy for some women and as easy as a feather for others.

It’s important to always remember that each pregnant woman has a specific fitness level and ability, so setting arbitrary limits is an ineffective way to provide guidelines for this population. In addition, when confronted with statements such as these, always review the research that supports the claim before implementing the information into your training guidelines.

Many women choose to continue their pre-pregnancy strength training program while they are pregnant, and most women may safely start strength training during their pregnancy as long as they are cleared for exercise by their healthcare provider. When developing a pregnant woman’s fitness program, you should take into account her current level of fitness and strength and pay close attention to how she feels during and after exercise. The key to maintaining a safe and effective routine is through consistent modification of the exercises for comfort as pregnancy progresses.

Strength training is an essential prenatal fitness component, providing the muscle power needed to compensate for posture adjustments and weight gain that occurs with pregnancy. Women who continue or even start a strength training routine during pregnancy can help prepare her body for all the lifting done with a new baby and reduce the risk of low back pain. Strength training has not been shown to pose any harm to either the fetus or the mother as long as these general guidelines are followed:

• A gradual reduction in weight loads from pre-pregnancy will likely occur as the pregnancy progresses.
• Women may continue their pre-pregnancy strength training routine (wt/reps/set) as long as they modify the exercises for comfort as pregnancy progresses.
• If training causes muscle soreness during the pregnancy, it is recommended that overload be progressed by increasing the number of repetitions versus the resistance/wt.
• Monitor exercise techniques 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.
• 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 (such as the uterus) 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.
• Modify supine positions after the first trimester of pregnancy by using an incline board or wedge.
• A strength-training workout involving all the major muscle groups should be performed three times per week, with a rest day between each muscle group training bout.
• Machines, free weights, resistance bands, and body weight
• are all options for building a strength training routine.
• Remind client that she should exhale with the lift and avoid holding her breath or bearing down and straining as she lifts.
• If a particular exercise continues to produces pain or discomfort are modification, it should be discontinued. If pain persists, the client should consult with her healthcare provider.

As always, all pregnant women should check with her healthcare provider before starting or continuing an exercise program during pregnancy.

Catherine Cram, MS started her company, Prenatal and Postpartum Fitness Consulting, in order to provide current, evidence- based guidelines maternal fitness guidelines to health and fitness professionals. She was a contributing author for the textbook, “Women’s Health in Physical Therapy” and co-authored the revision of “Exercising Through Your Pregnancy” with Dr. James Clapp.  Her company offers the certification course, “Prenatal and Postpartum Exercise Design” which provides continuing education credits for over 30 health and fitness organization, including ACSM, ACE, ICEA, and Lamaze.

A regular exercise routine has become a way of life for many women, and many choose to continue their exercise routines when they become pregnant.  Research in the field of maternal fitness has shown that exercise during a non-complicated pregnancy is healthy for both mom and baby and may help prevent or reduce some of the physical problems associated with pregnancy, labor, and delivery.

Although exercise is a positive addition to a healthy pregnancy, there are established guidelines that help ensure that a woman’s exercise program is safe and effective.  First and foremost, it is important for a pregnant woman to consult with her healthcare provider before starting any exercise program.  She should bring a list of questions regarding her exercise program and provide an overview of what type, intensity, frequency, and duration of exercise she would like to do.  This enables her healthcare provider to accurately assess whether the fitness program is appropriate for her pregnancy.

Each woman’s level of fitness and health is different, as is each pregnancy. There are several points to consider when choosing to continue a fitness program during pregnancy.  Some types of exercise are more easily continued during pregnancy, and common sense, safety, and comfort all play a role in deciding whether an activity should be part of a prenatal fitness program.

Choosing the type of exercise that will be safe and effective during pregnancy can be determined by reviewing the following points:

• What activities does she enjoy or are skilled at doing?
• Does the activity pose an increased risk of falls or blunt abdominal injury?
• Is she able to do the activity without being compromised by balance and center of gravity changes?
• Can the activity be easily modified as pregnancy progresses?
• Does common sense conclude that this is a safe activity to continue during pregnancy?

Research on prenatal exercise has suggested that greater benefits are achieved by including sustained, weight-bearing exercises such as walking, running, stationary stepping/elliptical machine, or dance classes in a prenatal fitness program.  However, some women may not tolerate weight-bearing exercise during pregnancy and are more comfortable with non-weight bearing activities such as swimming and stationary biking.

There are several activities, such as scuba diving and water skiing, that are never safe to do during pregnancy.  Other activities, such as downhill skiing, horseback riding, and sports with a chance of abdominal impact may also be too risky for most women to continue during pregnancy.

Here are a few tips for keeping a prenatal exercise routine safe:

• Pregnant women need to add 300 calories to their daily food intake to meet the needs of pregnancy. If she is physically active, she may need to increase that amount if she’s not gaining weight normally. The number of extra calories needed depends on the intensity and duration and frequency of the exercise program.  It is important to drink 8-10 cups of water each day and increase that amount during hot and humid weather.
• Exercise in heat and humidity can be dangerous. It is safest to exercise in an air-conditioned facility during the summer months. If she does choose to exercise outdoors during warm weather, she should avoid the high heat times between 11:00 am and 4:00 pm and reduce intensity and duration to prevent overheating.
• She should frequently monitor herself during exercise for signs of overheating, such as dizziness, faintness, or nausea. Drinking plenty of water before, during, and after exercise to replace the fluids lost will help prevent dehydration and overheating. Hot tubs and saunas may cause core temperature to rise to unsafe levels and should be avoided.

A simple method for monitoring intensity level during prenatal exercise is to assess how hard the exercise feels.  A pregnant woman should feel that her exercise level is moderate to somewhat hard.  If she feels out of breath or is unable to talk (termed the “talk test”), she is working at too high a level and should decrease intensity or stop and rest. Her exercise level should feel challenging but not so difficult that she feels exhausted during and/or afterward.

Self-assessment is one of the best ways for a pregnant woman to monitor her exercise program and assure herself that her activity level is safe. A pregnant woman should review the following questions several times each month and follow up with her healthcare provider if she experiences any problems.

• Do you and your healthcare provider feel that you are gaining weight normally?
• Do you feel well physically and mentally?
• Are you able to comfortably follow your exercise program without pain, exhaustion, or problems following exercise?
• Do you experience chronic or extreme exhaustion?
• If you are at the point in pregnancy where you are consistently feeling fetal movement, have you noticed any change in the pattern or amount of your baby’s movements?
• Does your baby move at least two times within 20-30 minutes following exercise?
• Was your last abdominal fundal height measurement (a measurement of fetal growth) or ultrasound assessment within normal limits, and is your baby progressing normally at each medical check?
• Does your healthcare provider have any concern regarding the health of your pregnancy?

Pregnant women who continue a challenging level of exercise need to be aware of signs or symptoms that indicate overwork, such as an elevated resting heart rate, frequent illness, lack of weight gain, depression and chronic exhaustion.   She should decrease or stop her exercise program during illness, when fatigued, under excessive stress or if experiencing any complications with her pregnancy.

Prenatal exercise should enhance pregnancy and help to make a woman’s postpartum recovery smoother.  The best advice for the athletic woman who wants to continue her fitness program during pregnancy is to use common sense, listen to her body, and enjoy all the challenges and changes this incredible experience offers.

Catherine Cram started her company, Prenatal and Postpartum Fitness Consulting, in order to provide current, evidence- based guidelines maternal fitness guidelines to health and fitness professionals. She was a contributing author for the textbook, Women’s Health in Physical Therapy and co-authored the revision of Exercising Through Your Pregnancy with Dr. James Clapp.  Her company offers the certification course, “Prenatal and Postpartum Exercise Design” which provides continuing education credits for over 30 health and fitness organization, including ACSM, ACE, ICEA, and Lamaze.

The need for trained maternal fitness professionals has greatly increased as a result of the number of fit women who desire to continue with their exercise routine once they become pregnant. The past several decades has provided a large body of evidence that supports the benefit and safety of prenatal exercise in uncomplicated pregnancies, and ACOG and other fitness and medical health organizations recognize the importance of fitness in a healthy pregnancy. Studies have shown that women who continue or even start an exercise program during pregnancy gain less fat weight, have fewer complications during labor and delivery, and return to their pre-pregnancy weight faster than women who didn’t exercise while pregnant.

Knowing what the current evidence based guidelines are for pregnant and postpartum women and being able to work with this population will open up opportunities to create a specialized program that fits their unique needs. Fitness professionals who have training in this field offer skilled support and guidance to pregnant and postpartum women and help them confidently include exercise as part of their lifestyle. Pregnant women are unsure of what exercises and activities they can continue throughout pregnancy and need guidance on how to monitor their routine for safety. As pregnancy progresses, women need strategies for modifying their exercise program as their body changes to maintain a comfortable and safe routine.

For more information on prenatal and postpartum exercise and our CE correspondence course, “Prenatal and Postpartum Exercise Design” please visit, www.ppfconsulting.com

Article reprinted from Catherine’s Maternal Fitness blog with permission.

Catherine Cram, MS, is the owner of Comprehensive Fitness Consulting, a company that provides pre- and postnatal fitness certifications and information to hospitals, health & wellness organizations and the military.

Choosing the type of exercise that is best tolerated during pregnancy depends on the following considerations:

• Which activities the client enjoys or is skilled at performing
• Whether the activity poses any risk to the mother or fetus
• Is she is able to do the activity without being compromised by balance and center of gravity changes
• Can the activity be easily modified as pregnancy progresses

Weight-bearing exercise such as walking, dancing, and running help maintain bone mass and some studies suggest they are more effective for keeping pregnancy weight gain within normal limits. As pregnancy progresses some women may not be able to continue weight-bearing exercise because of back or round ligament pain. If modifications such as wearing a belly support don’t relieve discomfort, switching to non-weight-bearing activities such as swimming, stationary biking, or other types of stationary exercise equipment is recommended.

Absolute and relative contraindicated activities for pregnant women are listed below. Pregnant women should always consult with their healthcare provider before taking part in any exercise program and assess the risk/benefit ratio whenever there is a question about the safety of any activity during pregnancy. Keep in mind that activities such as downhill skiing must be assessed for risks that are not controllable, such as the effect of high altitude on oxygen delivery to the fetus.

Contraindicated Activities for Pregnant Women

• High-altitude sports
• Water-skiing
• Hockey
• Gymnastics
• Horseback riding
• Absolute
• Downhill skiing
• Scuba diving

You can also view Catherine’s previous articles on exercise intensity and duration.

For more information on prenatal and postpartum exercise and our CE correspondence course, “Prenatal and Postpartum Exercise Design” please visit, www.ppfconsulting.com

Article reprinted from Catherine’s Maternal Fitness blog with permission.

Catherine Cram, MS, is the owner of Comprehensive Fitness Consulting, a company that provides pre- and postnatal fitness certifications and information to hospitals, health & wellness organizations and the military.

Exercise duration during pregnancy should reflect a woman’s current level of fitness and the type of activity she is doing. If you’re working with someone who’s just starting a prenatal exercise program the duration will be shorter (15-20 minutes) and progress slowly over time to 30-60 minutes. A pregnant woman who is already taking part in a fitness routine can continue with her current duration level, but exercise duration should be modified as needed to enable her to achieve a moderate to somewhat hard level of intensity without discomfort or undue fatigue.

Some exercise activities, such as swimming, may require a longer duration in order to achieve a moderate to somewhat hard intensity, so close monitoring of exercise intensity will help determine whether a longer bout is needed. As pregnancy progresses, pregnant women may find that they are able to tolerate a longer duration, lower intensity exercise bout better than a higher intensity, shorter bout, but avoid taking the intensity below the targeted zone of 12 to 14 on the 20-point scale or 3 to 4 on the 10-point scale.

In the case where a pregnant woman is having difficulty maintaining her normal exercise duration, try dividing the workout into two shorter sessions during the day. This is a helpful tool for enabling women to continue to exercise when she’s experiencing more fatigue in later pregnancy.

Want to learn more about how to develop a safe and effective maternal fitness program? The CE correspondence course “Prenatal and Postpartum Exercise Design” is available ppfconsulting.com

Catherine Cram, MS, is the owner of Comprehensive Fitness Consulting, a company that provides pre- and postnatal fitness certifications and information to hospitals, health & wellness organizations and the military.

Article reprinted from her blog with permission.