The American College of Obstetricians
and Gynecologists (ACOG) encourages healthy pregnant
women to exercise daily at moderately vigorous
intensity, for 30-60 minutes of non-impact, non-contact
exercise.
While the ACOG recommends physical
activity throughout an uncomplicated pregnancy,
regardless of exercise history or fitness level, it is
absolutely critical that IFPA Certified Personal Fitness
Trainers have the requisite knowledge, skills and
abilities to safely and effectively manage fitness
programs for this special population (See IFPA Certified
Womens Fitness Specialist Course). It is equally
critical that a pregnant woman obtain permission from
her physician for any and all fitness programs and that
all exercise principles (i.e.: SAID, GPO, etc.) be
strictly adhered to.
ACOG guidelines state that exercise
is contraindicated under the following conditions:
Abdominal pain
Excessive fatigue
Growth retardation of the fetus
Multiple gestations (i.e.: twins,
triplets, etc.)
Persistent bleeding or large fluid
discharge from the vagina
Persistent contractions
Pregnancy-induced hypertension
Risk of pre-term delivery
Severe headache
Sudden swelling of hands, face or
ankles or pain in one calf
Unexplained dizziness
Visual disturbance
Obviously, if all of the above should
occur during an exercise session, the trainer should
immediately stop the session, contact the clients
doctor, and if necessary, call 9-1-1!
There is nothing inherently dangerous
about a pregnant woman exercising. Before the advent of
modern technology, a woman was physically active,
working hard, right up to the point of delivery and
oftentimes going almost immediately back to activity
following delivery. The survival needs at the time
sometimes required little or no respite from the harsh
realities of life. Today is considerably different from then so
you must learn to put your client into Risk
Stratifications:
1. Athletes in training prior
to pregnancy, who would like to continue to maintain the
highest level of fitness during pregnancy in order to
return to competition post-pregnancy.
2. Recreationally active women
who have a moderate to high level of fitness prior to
pregnancy and would like to maintain their fitness level
during pregnancy and plan to return to pre-pregnant
levels of fitness as soon as possible post-delivery.
3. Normally inactive women who
want to become physically active during pregnancy to
improve their health and lifestyle. (While everyone
would agree that this group should have gotten into
shape pre-pregnancy, Life is what happens while you are
making other plans!)
4. Women for whom
exercise is contraindicated.
Therefore: No exercise is allowed!
Using the above risk stratification
and the GPO (Gradual Progressive Overload) Principle,
the exercise prescription must be appropriate for each
group according to current fitness level, exercise
history and goals of the pregnant woman. Follow all the
ACOG recommendations for exercise during pregnancy:
1. Avoid exercise in supine
position after the first trimester. (Some mothers have
developed Supine Hypotension caused by compression of
the inferior vena cava by the fetus while the mother is
lying in the supine [on her back] position. Therefore,
avoid crunches, bench presses, etc.)
2.
Avoid exercise to exhaustion, in hot environments
and prolonged intense exercise. (Exercise during the
cooler parts of the day or in a cooler environment.)
3.
Avoid heated spas, saunas, steam rooms, jacuzzis,
etc.
4.
Avoid any exercise activity that increases risk of
abdominal trauma (i.e.: contact sports).
5.
Low to moderate intensity is preferred to high
intensity exercise.
6.
Frequency should be a minimum of 3 days/week.
Regularity is important (3-7 days/week).
7.
Athletes should reduce intensity level as the
pregnancy continues. Check continuously with the doctor
since exercise may become contraindicated in the third
trimester.
8.
Modify or avoid activities requiring balance as
mothers shape and center of gravity changes. The
center of gravity will move up and forward, making the
mother less stable and more susceptible to loss of
balance and falling as pregnancy continues.
9.
Pregnancy requires an additional 300 kcal/day.
Ensure adequate diet and nutrients. Make sure you add
adequate caloric intake to cover exercise expenditure
(typically: 200-500 kcal/day).
10.
Ensure heat dissipation with fluid replacement and
appropriate clothing and choosing cooler exercise
environments (particularly in the first
trimester, maternal hyperthermia, as caused by fever
during the first trimester, has been associated with
neural tube defects. Dehydration can also degrade the
mothers thermoregulatory mechanisms.) Ensure adequate
fluid intake before, during, and after exercise.
11. Gradually resume physical
activity over the 4-6 weeks following delivery.
Because of the numerous
physiological changes taking place in the mother, using
MHR or HRR becomes less accurate. Rate of Perceived
Exertion (RPE) of 11-13 on the 6-20 scale is a safe
recommendation. Use GPO, start low and increase as
conditioning improves.
Some mothers have developed
gestational diabetes during pregnancy that normally
resolves post-delivery. In non-insulin-dependent (Type
2) gestational diabetes, regular moderate intensity
exercise at a frequency of 2-4 days/week at 50% VO2Max
(RPE:11), may stimulate glucose uptake and may possibly
prevent the need for exogenous insulin (Mothers with
Type I gestational diabetes should exercise only with
doctors permission and preferably in supervised
settings).
Exercise throughout pregnancy
suggests that mothers may shorten the second stage of
labor, have less weight gain (maternalno effect on
baby's birth weight), improved self-esteem/body image
and quality of sleep, reduction of back pain, leg
swelling, fatigue and nausea.
Despite these benefits to
exercise it is important for the fitness professional to
have a clear understanding of the many anatomical and
physiological changes that occur to the mother during
pregnancy, including: increased RHR, submaximal HR,
cardiac output, changes in heart rate (HR)-VO2
relationship, increased resting and submaximal minute
ventilation, maternal weight gain (mainly in the
abdominal and pelvic regions), joint laxity and the
possibility of gestational diabetes.
The influence on exercise
capacity and the modifications that must be made to an
exercise program as a result of these changes will be
the subject of future articles. For those interested in
an in-depth study of this special population group,
please see the IFPA Women's Fitness Specialist
Certification and the IFPA Exercise Management
Specialist Certification Courses at
www.ifpa-fitness.com. For those wanting to do
something immediately, light exercise (RPE:11) of
non-impact/non-contact sports such as walking, yoga,
water aerobics, and cardio machines (i.e.: recumbent bike)
should present a safe exercise modality for any mother
who has physician clearance to exercise.
Best regards,
Dr. Jim Bell
CEO, IFPA
IFPA News: IFPA Conference
in Indonesia!
The IFPA will have special events in
Indonesia in October!
October 13-15 in the incredibly
beautiful resort area of Nusa Dua, Grand Hyatt Bali,
Indonesia
October 17-19 in Jakarta, Indonesia
Not only will these events be
outstanding educational events for fitness
professionals, but Nusa Dua is truly among the most
beautiful sites in all the world. Contact the IFPA for
more information.
For more information on Indonesian
events, email:
Indonesia@ifpa-fitness.com
or call +62 21 780 2778
(International).
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James
T. Bell, PhD. is the
founder and CEO of the International Fitness
Professionals Association, IFPA.
More
Books from Jim Bell, PhD.
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