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 Pre & Post Natal Specialist). 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). – 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. – 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 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
Women’s Fitness: Pregnancy (Part 1)
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