There's a lot of conflicting information out there regarding risky pre-natal training practices. Most of it is emotionally-driven and perpetuated by previous generations that were encouraged to rest and relax during pregnancy. As my friend Leslie pointed out during her own pregnancy, there's no quicker way to clear a weight room than putting a couple of dumbbells in the hands of an 8-month pregnant mom. It makes me recall the heated back-and-forth spawned by this photo on social media back in 2013.
"A healthy woman with a normal pregnancy may continue her regular exercise regimen or begin an exercise program during pregnancy." Simple as it is, this comment by the American College of Sports Medicine (ACSM) has succeeded in confusing many moms and fitness professionals. So no changes for women who have been regularly exercising? How often and what type of exercises should be prescribed for moms who are new to exercise? Should they be treated as a regular "beginner"? Exercise limitations really come down to the individual and her health-care team. This includes a fit pro whenever possible.
Years ago, I attended a lecture on current guidelines for training pregnant and postpartum clients. The presenter did a fantastic job of communicating the contraindications and current recommendations from the American College of Obstetricians and Gynecologists (ACOG; now renamed the American Congress of Obstetricians and Gynecologists). The following lists were updated at the posting of this blog:
ABSOLUTE CONTRAINDICATIONS TO AEROBIC EXERCISE (no exercise, no excuse)
- Hemodynamically significant heart disease
- Restrictive lung disease
- Incompetent cervix/cerclage
- Multiple gestation at risk for premature labor
- Persistent second- or third-trimester bleeding
- Placenta previa after 26 weeks of gestation
- Premature labor during the current pregnancy
- Ruptured membranes
- Preeclampsia/pregnancy-induced hypertension
RELATIVE CONTRAINDICATIONS TO AEROBIC EXERCISE (discuss mom's risk with doctor; benefit of exercise may outweigh the risk)
- Severe anemia
- Unevaluated maternal cardiac arrhythmia
- Chronic bronchitis
- Poorly controlled type 1 diabetes
- Extreme morbid obesity
- Extreme underweight (BMI <12)
- History of extremely sedentary lifestyle
- Intrauterine growth restriction in current pregnancy
- Poorly controlled hypertension
- Orthopedic limitations
- Poorly controlled seizure disorder
- Poorly controlled hyperthyroidism
- Heavy smoker
You likely noticed these lists are contraindications to aerobic exercise. This could be any traditional forms of "cardio" that you are familiar with: walking, running, swimming, cycling, arctrainer, rowing, stairmaster, etc. It could also mean higher intensity or dynamic weight-lifting performed with minimal or no recovery time between sets. This means free weights, machines, bands, TRX, you name it.
But back to the conference. Reading all of these medical terms can be intimidating. And reading the signs of overtraining can be scary. But the practical recommendations presented at our conference were simple. They were all centered around common sense: know your client's limitations prior to pregnancy, take each session/workout as it comes, you may have to scale the intensity of workouts while listening to the pregnant body, if mom needs rest - that's okay, be aware of any signals indicating mommy is overdoing it. According to ACOG's latest report (circa 2011), the signs that mom is overdoing it are as follows:
- Dizziness or feeling faint
- Vaginal bleeding
- Increased shortness of breath
- Chest pain
- Muscle weakness
- Calf pain or swelling
- Uterine contractions
- Decreased fetal movement
- Fluid leaking from the vagina
Manifestation of any of these symptoms should be reported to the fit pro as well as mom's care provider immediately. This is not a situation where one should push through and finish her workout. Be smart.
Many conference attendees shared their own experiences and commiserated about the doctor-trainer information gap. Some of the commonly-heard recommendations passed from doctor to mom were often outdated. Or recommendations changed since mom's last pregnancy. Although the ACOG's recommendations are updated every 3-4 years, I hypothesize that the age of an OB, his/her exposure to active moms, and his/her own level of activity influences the general rules that he/she enforces with patients. It also doesn't help that the practical guidelines published by organizations such as the American College of Sports Medicine (ACSM) or the National Strength and Conditioning Association (NSCA) are rarely referenced by the average general practitioner or specialist. Remember that "team" I was talking about? Having open and direct dialogue between mom, fitness trainer/coach, and health care provider is paramount.
Let me share a couple of poignant examples of the information gap. From my military spouse or active duty clients, I often hear, "don't let mommy's heart rate exceed 140bpm" or "don't lift anything over 40 pounds". I won't go into the details regarding the source that perpetuates these rules. First of all, the 140 bpm HR recommendation is made more for uterine temperature*. Assuming a well ventilated and cooled space, and mom's level of comfort, this recommendation is moot. Research on uterine temperature was performed only on animals. The studies also didn't take into account moms' increased blood volume during pregnancy, a factor resulting in faster temperature dissipation. Plus, have you ever walked up a single flight of stairs while pregnant? Your heart rate skyrockets thanks to the added physical toll of growing that wee babe.
The second suggestion of limiting absolute weight really gets to me. 40 pounds...hmmm. It doesn't take a set of credentials to figure out that goblet squatting 40 pounds is totally different than pressing 40 pounds, or curling 40 pounds for that matter. Not to mention that this number does not take into account the level of fitness that mom was in prior to pregnancy, nor the method of executing a lift (pulley system, straight bar, dumbbells, body weight, bands, etc). A more appropriate general weight-lifting recommendation, as described by NSCA, is to reduce the weight lifted to 70% of 1 Repetition Maximum (1RM) or less. Number of repetitions can then be adjusted to meet the desired intensity.
With 5 weeks remaining before my own little guy arrives, there are movements I should not be performing and weights that I should not be moving. I can safely say this because I am now highly lordotic (excessively curved lumbar/lower back). My ability to brace is out the window. For practical recommendations, this means that overhead movements are out of the picture, too. NSCA recommends no overhead movement after the first trimester. Movements that require extreme hip flexion** (i.e.: squats, deadlifts) may need to be eliminated, too. NSCA sets a threshold of the first trimester for these exercises, too, but I consider there may be some wiggle room in both situations. This critique goes back to my comment regarding listening to your body, understanding your limitations, and having a competent level of fitness prior to pregnancy. Does mom know what bracing her core and maintaining good posture feels like? Can she feel a difference in these areas as her pregnancy progresses?
I may be overreaching here, but I sincerely believe having a solid understanding of what bracing the core feels like as well as what straining feels like qualifies mom to make to make the call on whether or not it is smart for her to perform certain actions. This is tricky territory because it is totally subjective, and many factors are at play when qualifying the ability to brace. Having a qualified professional or training partner can be helpful in determining when mom has hit her threshold with certain movements, weights or repetitions.
If mom couldn't safely deadlift prior to pregnancy, chances are she won't be able to (and shouldn't) when she is in her fourth month. The same goes for push-presses, etc. Katie F., you are the outlier ;-). As the ACSM comment suggests, a healthy woman may certainly begin an exercise program during pregnancy, but only after cautious assessment and understanding that she should begin at a very basic level. The goal should be to acquire or maintain a reasonable level of fitness, not to reach peak fitness.
For example, I have been a runner for over 20 years, but plantar fasciitis has rendered my running shoes inoperable for over a year. Right around my 5th month, my feet started to feel much better. Professional experience and common sense told me that halfway through pregnancy is not the time to re-introduce high-impact activity. The same thing happened with my kettlebell practice. Prior to pregnancy, I had been religious about it. But a drawn-out move and stored equipment left me kettlebell-less until month 6. Not the time to start swinging again. With that much time off and the numerous changes to my body, I was basically a beginner.
But being fit and knowing your limitations can only help you so much. Relaxin is also at play. This hormone is responsible for increasing joint laxity. It softens and spreads all the parts necessary to ease the birthing process. It is also the reason moms run into door frames, knock over water glasses, and trip over imaginary cracks in the sidewalk. All that klutziness comes from wonky proprioception. Proprioceptors in your muscles, joints, and tendons tell your brain where your body is in space. The effects of relaxin, as well as your growing belly and bosom, make it difficult for proprioceptors to do their job. FYI, rapidly growing teens experience their own klutziness due to proprioceptors that just can't keep up.
Yes, being familiar with your body, how it prepares for movement and movement itself is terribly important. But as is the case with relaxin, we see that body chemistry plays a big role in choosing the exercises mom should be practicing. All of this is considering a healthy mom with no chronic medical conditions. That being said, there are some definite contraindications. If mom has any of the aforementioned contraindicated conditions, please consult with her physician regarding a specific plan or limitations for exercise.
No matter what mode of exercise mom chooses, experience with pregnant clients has told me that constant assessment and communication with mom is paramount. If mom is working out without a fitness professional, self-assessment is just as important. I suggest that mom ask herself the following questions every other week through the first trimester, and weekly after that.
- Do I feel energized or exhausted after a workout?
- At any point do I feel lightheaded or dizzy?
- Is the current recovery time between sets (weights or cardio intervals, for example) sufficient? Am I fully recovered before I begin the next set?
- Am I performing an adequate warm up and cool down?
- Is the current duration of my sessions affecting my energy level throughout the day? Should I shave a few minutes off?
- Am I concerned with maintaining a reasonable level of fitness, or am I looking for optimal fitness? The response to this question should always be "reasonable and realistic".
- Do I feel the effects of joint laxity? Especially in the lower back, abdomen, or pelvic region? If feeling it in the lower back, you may have to switch to more supportive equipment such as a recumbent bike or traditional weight machines. If the pelvic floor feels compromised, the depth of your lower-body work may have to be modified or eliminated all together.
- Can I safely continue to perform planks, bird dogs, and side bridges? If no, would reducing the duration help?
- Are there particular movements that cause or increase pelvic girdle pain? Specifically the sacroiliac joints (lower back, right and/or left) or pubis symphysis (crotch bone)?
With some clear, honest answers, mom or her coach can help make any necessary changes to her routine to minimize risk as the pregnancy progresses.
So, yes, I did some baiting with the title of this blog post. We all know that exercise is great, and is highly encouraged throughout pregnancy. Moms who exercise have a smoother labor and recover more quickly from childbirth. But quantifying the level of risk comes down to the care provider's medical assessment as well as the fit pro's confidence with mom's level of fitness. Constant reassessment of mom's risk is paramount, as is remembering the goal of exercise while pregnancy is not to optimize fitness but to achieve and maintain a reasonable level of fitness. Enjoy your journey!
For specific activity recommendations, press on to Part 3 of our Fitness and Pregnancy series.
*It should be noted that these recommendations are made assuming no other factors such as high blood pressure, cardiovascular issues, etc.
**Extreme hip flexion may compromise blood flow to the fetus, and should be avoided. At last check, leg presses are to be avoided past the first trimester, and squats and deadlifts should be avoided if form is compromised by mom's belly. In any case, remove ANY movement that causes dizziness or lightheadedness. Moving to a lighter weight may not be the answer.