Here's the good stuff you've been waiting for. Don't forget to reference the contraindications listed in Part 2 of our Fitness and Pregnancy series.
Regarding specific activities or sports, ACOG recommends avoiding high contact sports and activities that require heavy, repetitive lifting. It is also recommended that activities with an inherently high risk of falling be avoided.
Although I have been cycling outdoors (road and mountain) regularly for 16 years, I resigned myself to the indoor trainer around 20 weeks. Until that point, I was confident in my balance and restricted my routes to a paved trail that was closed to car traffic. But facts are facts: at a certain point, the baby outgrows the bony protection of the pelvis and only soft tissue separates the kiddo from the pavement. Considering all the clumsy fine motor accidents (thanks, wonky proprioceptors) I was making with both feet on the ground, switching to the trainer was an easy choice. As for comfort on the bike, mom will likely need to install a riser to the bike stem to elevate the handlebars. If you have switched to a Spin bike, simply raise the handlebars to a more comfortable height. This decreases lumbar pressure and allows more space for the lungs to expand. Mom's changing pelvis and hips will influence when, or if, she needs a wider saddle. Another option is the recumbent bicycle. If you are looking for some back support and a more comfortable seat, this is a great choice. Piriformis syndrome sufferers may discover a time limit on the recumbent or the need for a recovery day between recumbent sessions.
Skiing, water sports, and contact sports (i.e. football, martial arts, basketball, soccer) should be avoided because they exhibit "an inherently high risk for trauma in pregnant and non-pregnant women." ACOG is also quick to point out scuba diving as contraindicated, due to "risk of decompression sickness secondary to the inability of the fetal pulmonary circulation to filter bubble formation."
Speaking of bubbles, swimming is great exercise for anyone, pregnant or not. Moms-to-be find the water to be an especially soothing form of exercise. Pregnant swimmers should avoid hypoxic or breath-holding situations. As pregnancy progresses, mom may find flip-turns to be uncomfortable, whether due to reduced range of motion in the trunk and hips or extra compression of the lungs. Personally, I discovered the need to alternate flip-turns with the old one-hand-on-the-wall technique. Balling up in a flip turn squeezes that extra bit of air out of my lungs and it takes longer to recover. This also means mom may have to opt out of the typical bilateral breathing patterns for something more comfortable. Yes, muscle memory is hard to fight after years of flip-turning and right/left breathing, but it is only temporary. Regarding strokes, the swimmer is welcome to perform any stroke, as tolerated. This is all assuming that mom swam regularly prior to and throughout pregnancy. It should also be noted that water temperature and outdoor conditions when swimming outside should be taken into account due to ease of overheating. There isn't a magic number here, but athletes know their comfort level, especially if they were competitive swimmers.
Although I would have loved to continue running throughout my pregnancy, it wasn't in the cards. Pregnant runners, like any other pregnant athlete, learn to be comfortable with accepting slower paces, shorter distances and the possibility of run-walk intervals or switching to speed-walking. Some moms can run comfortably while others note their changing bodies make running uncomfortable on a multitude of levels. If the latter is the case, try donning a maternity support belt or switch to a lower-impact activity. Don't worry, mom will get back to her "fix" in a few months. Aqua jogging, with or without a floatation belt, is a great replacement for those seeking some reprieve from gravity. And water aerobics, or "aqua" for those in the know, isn't just for granny's social hour. I have found that aqua is certainly one of those activities that you reap what you sow. Picking up the pace or moving quickly with larger float weights ups the ante.
Walking, especially on an incline, is a wonderful form of exercise during pregnancy, and no modifications are necessary. Maintaining good posture and focusing on a deep, rhythmic breath will help prepare you for focused breathing during labor. The only consideration is the possibility of sore shins from speed walking. Thanks to those pesky proprioceptors, paved and even surfaces are preferred. Steep downhills may have to be approached with a zig-zag pattern as opposed to straight down. This avoids direct forces on the knees and may reduce risk of tripping or falling. Walking on trails, a.k.a. hiking, is also well-tolerated. From personal experience, I encourage the use of trekking poles. I love trekking poles for their dual purpose. They help stabilize your lower half as well as give the back and core muscles a great postural workout. And yes, you can use them on paved surfaces, too. Just purchase rubber tips to slide onto the metal tips. Check Leki's website for pole sizing recommendations. Click on Nordic Walking.
The popularity of CrossFit and countless strength and conditioning facilities has increased our nation's interest in indoor rowing (aka ERGing) for fitness. Although I have not found professional publications on the subject, I read that lowering the feet (toe strap across toes instead of the ball of the foot) and spreading the knees a bit are the two biggest changes most pregnant women make for comfort. Some women are able to row throughout pregnancy while others say the third trimester is difficult. Play it by ear and remember that your stroke's finish may also be altered by your changing body and maintenance of posture is more important as the pregnancy progresses. As for CrossFit and S&C, mom is likely working with a coach of her own. Please reference the coaches' personal recommendations as well as their ability to scale workouts for mom. Thanks to sheer physics, many olympic lifts should be avoided as the pregnant belly grows. Keeping all that loaded bar weight close to midline is very important. But again, this goes back to individualized recommendations from a personal coach in conjunction with mom's ability to safely execute particular movements.
The benefits of maintaining a weight-lifting regimen during pregnancy are numerous. Of course, many of the same benefits exist in non-pregnant clients, most notably, positive body image. And just as in the general population, risks exist. As published in 2012 by ACSM, risks to pregnant women who lift weights include: use of the Valsalva Maneuver, straining, dropping free weights or plates on the abdomen, and performing exercises in the supine (lying on your back) position. Three of these are risks for any exerciser, pregnant or not.
NSCA recommends reducing the lifter's load to 70% or less of her 1RM. This means choosing the appropriate weight to lift 12 reps or more in good form. Please reference NSCA's training load chart for a better association of reps and % load. All professional organizations discourage "lifting heavy" (80% of 1RM or greater), and avoiding movements that can no longer be performed in good form. Since sessions should be energizing and not exhausting, mom should consider performing straight sets if she feels out of breath or overly fatigued. Straight sets include a period of rest in between sets of the same exercise as opposed to performing supersets or circuits. Method of weight or resistance training is not generally limited, however, increased lumbar curve may necessitate the back support found in traditional weight machines or isolateral Hammer Strength equipment. My professional recommendation is that a variety of weight and resistance training should be pursued throughout pregnancy, especially those that encourage great core stabilization.
Core training is of the utmost importance throughout the pregnancy. Maintenance of the pelvic floor can be achieved through kegel exercises as well as planks, oblique planks and bird dog. Traditional core exercises such as sit-ups or crunches, performed while lying on the back (floor or other apparatus) should be avoided after the first trimester. I also recommend staying away from the twisty abdominal machine at the gym that everyone seems to love. I say stay away whether you're pregnant or not. But remember, if you have a well-rounded weight-lifting regimen, you're getting lots of core work.
Yoga is also a great way to keep up your mobility, focused breathing, and core strength. All wonderful things that mom will need to call upon at the end of her pregnancy. Necessary modifications include the use of props to assist in balance and avoidance on hyperextension. Inversions, back bends, front-lying postures, breath holds, and hot yoga are to be avoided. Knees should be spread wide while in child's pose, and twisted positions will likely need modification. Consult with a certified instructor for further personal recommendations.
Listing every single sport or activity would be nearly impossible. Just remember to have mom consult with her care provider as well as a qualified fitness professional to ensure that she is at low risk to proceed with a particular activity or level of intensity. And keep an eye out for the following signs that mom may be overdoing it:
- Vaginal bleeding
- Dyspnea prior to exertion
- Chest pain
- Muscle weakness
- Calf pain or swelling (need to rule out thrombophlebitis)
- Preterm labor
- Decreased fetal movement
- Amniotic fluid leakage
Be smart, be safe, and remember to constantly reassess mom's changing body and level of fitness. Enjoy the journey!