Training the Prenatal Client: Exercises for Late-Term Pregnancy
As health and fitness professionals, it is an amazing time to train the prenatal client. Research has emerged over the last 15 to 20 years that has completely changed our understanding of prenatal fitness, moving us far beyond the notion that prenatal fitness is simply acceptable. It is now well established that exercise during a healthy pregnancy is recommended. In fact, the latest guidelines issued by the American College of Obstetricians and Gynecologist (ACOG) in 2015 states that, “Women who begin their pregnancy with a healthy lifestyle (e.g., exercise, good nutrition, non-smoking) should be encouraged to maintain those healthy habits.
Those who do not have healthy lifestyles should be encouraged to view the preconception period and pregnancy as opportunities to embrace healthier routines.” Additionally, “Pregnancy is an ideal time for behavior modification and for adopting a healthy lifestyle because of increased motivation and frequent access to medical supervision.” In addition to these maternal benefits, exercise during pregnancy also offers a host of benefits to the developing baby. Dr. James F. Clapp, one of the leading researchers in the world of prenatal fitness, has confirmed the following benefits from his decades of research:
- Enhanced fetal heart rate variability
- Improved thermoregulatory system
- Increased blood volume from better placental growth
Of course, while exercise during pregnancy is unquestionably beneficial, it also requires certain precautions, particularly as a woman progresses through her trimesters. What follows is a discussion of some of the specific concerns you may encounter when training a pregnant client, including postural deviations and alterations in mindset, as well as exercise recommendations that will best support your client’s needs during her final trimester.
Training in the Third Trimester
A woman in the latter half of her pregnancy will generally require adjustments to her training program based on the unique changes she is experiencing. The third trimester of a woman’s pregnancy, in particular, brings some significant changes that can be addressed or alleviated by your attention to two specific considerations: postural deviations and mindset.
From the beginning of a woman's pregnancy, the hormone relaxin (which causes ligamentous laxity) has been flowing through her body, allowing for essential skeletal shifts that allow for the baby’s growth. However, the presence of relaxin can also lead to exaggerated shifts as a woman moves through her third trimester. The increased weight she is likely carrying can cause an anterior pelvic tilt (lordosis), which may lead to prominent low-back pain. The anterior weight shift also occurs at the breasts throughout pregnancy, profoundly more so in the third trimester. This pull adds to increased kyphosis at the cervical and thoracic spine. Kyphosis pulls her out of a neutral spinal position, which may lead to neck and upper-back pain, as well as diminished power and range of motion when she is operating out of proper posture.
As a woman transitions into the later portion of her pregnancy, her mindset often becomes less focused on her own fitness and more on her upcoming labor and delivery. “All of a sudden, she’s is much larger than she wants to be, is tired of being kicked by the baby, doesn’t sleep well and wonders if the baby is healthy and what labor and delivery will be like,” explains Dr. Clapp. “As a result, her attention turns away from herself to prepare for the labor, the birth and the new baby.”
By keeping these two main considerations in mind, you can create an effective program design for your pregnant clients. So what can/should your pregnant clients do during late-term pregnancy?
Continue exercising. While it might look differently, because she is larger and her gait is continually adjusting for her increased anterior load, most pregnant women can and should keep exercising during the third trimester (with physician approval, of course). With a naturally reduced venous return during the third trimester, it’s very important for a pregnant woman to keep moving to help stave off edema (commonly found in her ankles). This focus on maintaining movement may also lead to a slightly lower birth weight. “Stopping exercise in late pregnancy tends to produce a larger baby who has more body fat,” explains Dr. Clapp.
Focus on improving core strength. As previously mentioned, most women experience an anterior weight shift during the third trimester, which makes core strength essential for helping to pull the pelvis back into neutral. Focusing on strengthening your pregnant client’s three-dimensional core musculature will also help to keep her lumbo-pelvic complex from making shifts, as well. These shifts can lead to pain at the sacroiliac joint and the pubic symphysis.
Reengage the posterior muscular chain. With much of our physical world being anteriorly driven, many of us tend to be over-contracted in our anterior muscular chain. During pregnancy, especially in the third trimester when a woman is at her largest, this becomes more and more apparent. The muscles of a woman’s upper back (mid/lower trapezius and rhomboids) become weakened and elongated, while the muscles of the low back (erector spinae) shorten and tighten in lordosis. Finally, the glutes tend to “shut off,” which means she must rely more heavily on her quadriceps. This disengagement of the glutes also leads to unwanted shifts at the pelvis. Reengaging the posterior chain requires exercises that focus on strengthening the glutes.
Enhance pelvic floor strength (and elasticity). Going into the third trimester, the weight of the baby in utero can drop the pelvic floor up to an inch. Kegel exercises to strengthen the pelvic floor are recommended throughout pregnancy and especially during the third trimester as the pressure is the greatest during this time. It’s crucial to coach your pregnant client through the contraction and then active relaxation of these muscles.
According to ACOG, the warning signs to discontinue exercise while pregnant are:
- Vaginal bleeding
- Regular painful contractions
- Amniotic fluid leakage
- Dyspnea (difficult or labored breathing) before exertion
- Chest pain
- Muscle weakness affecting balance
- Calf pain or swelling
Always listen to her body. While exercise is recommended throughout pregnancy, if something doesn’t feel right, a woman must listen to her body and regress or take a break. Because her balance will be challenged a great deal during her third trimester, make sure to position your pregnant client near something she can hold onto if she feels her balance is compromised. If you are training a pregnant client who is an athlete, being able to listen to her body is even more critical, as she is likely accustomed to pushing through fatigue and pain to get to the next level of her sport. Pregnancy is not the time for that mentality—it is the time for maintenance.
Clapp, J.F. and Cram, C. (2012). Exercising Through Your Pregnancy (2nd ed.). Omaha, Nebraska: Addicus Books.
American College of Obstetricians and Gynecologists (2015). Physical Activity and Exercise During Pregnancy and the Postpartum Period.
Farel Hruska is the Global Fitness Director for FIT4MOM and has nearly 20 years of experience as a personal trainer, group fitness instructor and educator. Hruska manages all fitness-related programs and initiatives for FIT4MOM, supporting thousands of instructors and franchisees nationwide in addition to supervising Instructor Certifications through the FIT4MOM Academy program for Stroller Strides, Fit4Baby®, Stroller Barre® and Body Back®. She is an international educator and presenter in pre- and postnatal, and an approved Continuing Education Provider for ACE and AFAA.