Including a properly designed program can be enormously beneficial during pregnancy. Research shows that active women are healthier during and after pregnancy and they deliver healthier babies with fewer complications.
Naturally, pregnancy brings about a variety of changes that will require modification and adjustment to training. Because pregnancy places increased stress on various parts of the body, training programs should be targeted at optimizing function in these areas, while encouraging maternal health and fitness. Workouts that emphasize deep core strengthening, use appropriate modifications, and avoid certain movements will better prepare you for pregnancy, delivery, and the demands of motherhood.
Before engaging in any exercise program, a woman who is pregnant should consult with and get clearance from her doctor. Additionally, clearance should be gotten at the start of each trimester or if any complications or concerns come up during pregnancy.
What follows are general workout guidelines for a healthy and fit pregnancy.
Programs should be designed to target the following goals:
1. Prepare physically for motherhood, promoting functional mobility
2. Strengthen the deep core musculature
3. Create balance throughout the body
4. Promote fitness and energy levels
Maternal fitness goals can best be achieved with a training program that incorporates both resistance and aerobic exercise because the combination is more effective at reducing gestational diabetes and hypertensive disorders than either alone. Exercise can be done 1 to 5 days a week, with 2 to 3 sessions typically being the sweet spot for most women. The key is to ensure you are recovering efficiently (no lasting fatigue or soreness) and feeling that your exercise program is enhancing rather than detracting from your life.
Ideally, you would do resistance workouts separately from aerobic training. However, if this is not possible, they can be combined in one workout as long as you do not find yourself overly fatigued or have trouble recovering.
Training should be done on non-consecutive days and workouts can last 30 minutes to 1 hour. The most recent American College of Obstetrics and Gynecology guidelines state that in the absence of medical complications, 30 minutes of moderate exercise on most, if not all, days of the week is both safe and recommended for pregnant women.
Loading & Rest Intervals
For strength training, volume and loads should be reduced as pregnancy progresses. A general recommendation is to train one exercise per muscle group with the exception of the core, which will benefit from multiple exercises. Beginners should start with 1 set per exercise and can work up to 2 to 3 over time. Intermediate and advanced can start with 2 to 3.
During pregnancy there is a significant increase in the hormone relaxin, which makes joints laxer during pregnancy. Therefore, higher repetition ranges with lighter loads are recommended. A general guideline is to use weights below 70 percent of maximal for reps of 10 or more per set. Exercises should be somewhat challenging but never to the point of absolute muscle fatigue.
Rest periods should be about 2 minutes, allowing time for heart rate to recover to normal. Staying active by walking around the gym or doing dynamic stretches is recommended to improve blood pressure regulation and help promote recovery.
For tempo, a slow to moderate tempo of 1 to 2 seconds for the concentric motion and 3 to 4 seconds for the eccentric movement is suggested.
As pregnancy progresses, exercises will need to be modified or eliminated to ensure optimal fetal and maternal health. In the first trimester most exercises that are appropriate in a woman’s non-pregnant state can be used, however, it is generally best to avoid ballistic and other power movements, including jumping, quick change of directions, and Olympic lifts. Once you reach the second trimester, all ballistic movements should be eliminated due to the increase in joint flexibility.
As you near the second trimester and begin showing, prone (lying face down) and supine (lying face up) movements should be avoided. The supine position can obstruct venous return of blood to the heart, compromising blood flow and increasing dizziness on standing. Substitutions for prone and supine exercises can be made: For example, instead of chest press on a flat bench, try a chest press on an incline bench. Instead of lying leg curls, a cable kick back or leg extension could be used.
Additionally, exercises that require flexion at the hips, such as good mornings or sit ups, should be avoided after the first trimester. As you begin showing, your weight distribution becomes uneven, making movements in which the upper body hinges forward awkward, while placing increased stress on the lower back. Forward flexion can also increase dizziness and heart burn. Suitable alternatives include a plank or bird dog exercise.
Finally, overhead lifting exercises should be avoided after the first trimester. Postural changes can place excessive stress on the lower back, which should be avoided. Front raises, lateral raises, and reverse flies can be substituted to work the shoulder muscles.
As with training when not pregnant, incorporate exercises that utilize all planes of motion. For example, in addition to front step ups, including lateral (side) step ups in a periodized fashion is recommended. Free weights, machines, cables, bands, and body weight can all be utilized.
The Valsalva maneuver, a technique used during training in which you hold your breath, should not be used during pregnancy. Most commonly used in powerlifting or heavy training of exercises such as the deadlift, the Valsalva maneuver increases heart rate and blood pressure. Breath holding also decreases blood flow to the fetus and should be avoided at all costs.
Instead, focus on breathing rhythmically during training. Breathe in on the eccentric or down motion of an exercise and out on the concentric or up motion. During static exercises such as a plank or wall sit, breathing should be even and regimented throughout the exercise.
Warm-Up & Cool Down
As with any training program, ensure adequate warm-up that includes dynamic movements that are appropriate for your fitness level and the type of exercises included in your workouts. Cool downs are also important for recovery and can include easy exercise and stretching. Stretches should be held so that they feel good, but never to the point of pain. Limit movements that could overstretch the pelvic area. Remember that joints are more mobile during pregnancy due to increased levels of the relaxin hormone and it is always better to err on the side of caution
Aerobic exercise is recommended at a light to moderate intensity that feels comfortable. The simplest way to gauge intensity is with the talk test: You should be able to carry on a light conversation during conditioning. If you are extremely winded, the intensity should be decreased. It is always better to stay on the lighter side than to overdo it, especially as pregnancy progresses. Heart rate zones or the Borg Scale can also be used. General heart rate guidelines during the first trimester are between 100-125 beats per minute. A rating of perceived exertion of 4 to 5 on a 10-point scale is appropriate (light to moderate exertion).
Choosing an exercise mode will depend on what you’ve been doing prior to pregnancy and how that exercise feels as pregnancy progresses. Running and other pounding movements can be continued if they were done prior to becoming pregnant and as long as there is no discomfort or pain. As pregnancy progresses, volume should be reduced and replaced with lower impact modes such as walking, swimming, stationary biking, or elliptical.
Specific Exercises To Include:
A special focus should be placed on strengthening the deep core musculature because this may improve delivery, reduce low back pain, and prevent diastasis recti (separation of the abdominal muscles). The deep core muscles include those of the lower back, abdominal area, pelvic area, diaphragm, and hips. These muscles function together and should be trained with the spine and pelvis in neutral.
To activate these muscles, lie on your back with your knees bent. Find the pointy parts of your pelvis in the front. Next place your fingers one third of the way between the pointy part of the pelvis and your belly button. Take deep breaths and as you exhale, try to draw your belly button toward the floor and your spine. At the same time, perform a Kegel exercise—the easiest way to describe it is the motion you do when you stop the stream of urine when going to the backroom. Your fingers should dip down toward the floor as you stabilize the pelvis. Done incorrectly, you will feel your abdominal area pushing up in to your fingers do to the fact that your abs are doing the work instead of your deep core muscles.
Training should also focus on relaxation of these muscles. Many strong women will grip their pelvic floor muscles, especially when in pain, so it is important to learn to relax as you prepare for labor.
As you progress through pregnancy and your belly grows, the muscles and skin of the abdominal area often “feel tight,” especially in first pregnancy. Practice relaxing the belly to allow the abdominal muscles and skin to stretch by kneeling in front of a large stability ball. Lean forward placing the upper arms on the ball and roll yourself slightly forward, engaging the core muscles and allowing the abdominal area to relax and stretch.
Exercises to include are yoga poses such as cat cows, bird dog, and arching and rounding the lower back, which can be done on all fours. Planks and side planks can be modified by planking on a bench, smith machine, or with knee dropped (on side plank). Side lying leg raises or leg circles are another good exercise alternative.
Pelvic tilts and glute bridges can be done on your back as long as you feel comfortable and your doctor has not instructed you to completely avoid lying on your back.
Additionally, full body exercises including squats, lunges, and step-ups can also be used for strengthening the deep core muscles. As abdominal growth increases, modify exercises accordingly. For example, wall squats and wall sits can replace regular squats. Front food elevated split squats with a cable can replace lunges.
Practice getting up: Getting up from a lying position becomes more challenge as you progress through pregnancy. Instead of sitting up directly from a horizontal position, roll to your side before sitting up to get out of bed. Practice getting up from both sides to minimize imbalances. To transition to lying on your back, start on your side, then roll to your back. This will decrease the stress on the lower back.
How Long Is It Safe To Exercise During Pregnancy?
With your doctor’s approval, and assuming there are no contraindications, increased pain or fatigue, you can continue with resistance and aerobic activity up to delivery. As you progress toward pregnancy, stick with the exercises that you are familiar with and make you feel best. Workouts should make you feel good: Your goal is to leave feeling more energized and empowered than when you entered the gym.