Yes, you should start exercising when you fall pregnant – the idea that you shouldn’t start anything new is a MYTH. The health risks of a sedentary lifestyle in your pregnancy are in line with smoking – and I don’t say that to shame or scare you – I say it to emphasise how important it is that we keep working out if we can.
However, it is also not true that we can continue doing everything we always have done – the mother’s risks will change as her pregnancy progresses. Her body is also going through a massive metamorphosis that it’s important that we support, not necessarily challenge, at this time. So this month we are going to cover some key points in exercise during pregnancy, including where to start, what to prioritise, and how to support breastfeeding.
There are exceptions to the “training is good for you” rule during pregnancy, and that is for those women at specific points in their IVF treatment (https://clarehozack.au/product/exercise-through-ivf/ ), and if you have any of the following conditions:
Where to start
If you are sedentary – start with pelvic floor exercise and 15min walking.
Your pelvic floor exercise should be performed in partnership with a women’s health physio, which you can look up your closest one here: http://whta.com.au/, and will essentially be a combination of lifting and dropping and breathing. You’ll start on your back because that’s gravity assisted, but ultimately you need to be able to do them sitting, then standing, and then moving with a pelvic floor that lifts, drops, relaxes, co-ordinates with other muscles and movements, and does all these things at the right time. We have an excellent pelvic floor and core course for trainers available here: https://clarehozack.au/product-category/restore-your-core/ or you can see one of our trainers and get fixed up here: https://into-you.com.au/product/restore-your-core-6mths/
Walking should start with 15min, but ultimately we are aiming to build to 150m per week (30min x 5), providing you remain symptom-free and healthy. Strength training sessions should be introduced slowly, and build to a moderate intensity through her pregnancy, twice a week. For example, you
might start with 1 set of 15-20 reps on the chest, back, legs, and pelvic floor. Then build to 2-3 sets, 2-3 exercises, and increase weight gradually until you’re doing 8-12 reps.
Light to moderate exercise (use RPE) has been shown to be better for your pregnancy than no exercise at all unless you have one of those contraindications above.
When You Already Train a Lot…
The opposite end of the sedentary client spectrum is those women who train extremely hard, who train often, who train every day, or all of the above. These women are the ones that will say that their doctor told them to continue doing what they’ve always done, and to “listen to their body”.
But what does that even mean? Are we waiting for pain? Injury? Fatigue? Moodiness? Unusual aches? Do wait until you’re injured? Or there’s something wrong with the baby?
Here’s my take, as a pregnancy and post-natal master trainer with over 20 years of experience, study, and training under my belt… These women are really high achievers and will need specific instructions regarding what is appropriate at what stage. Furthermore, these populations, depending on what activities they’re engaging in, are often more than twice as likely to develop pelvic dysfunctions such as stress incontinence.
Your pregnancy is time to begin gradually down training your intensity, volume, complexity, and loads (especially if they’re generating a lot of intra-abdominal pressure – how can you tell? Doming! Pain! Stress incontinence! Back pain! Other pelvic sensations!).
This may mean you continue training as you’ve always done during your first trimester – however the risk of miscarriage is between 30-66% depending on where you get your stats, and I am not sure I’d love a miscarriage to happen in my gym, even if it’s impossible that the exercise caused it. As your body changes, your intensity, volume, complexity and load should be reduced at the same rate, with special considerations around what we are preparing your body for.
Not the birth. We are preparing for motherhood.
So if your deadlift looked like a regular deadlift before, it now looks like putting a baby on a changing table. If your squat was technically perfect before, now it’s more about getting the pram out of the back of a car, or putting a baby capsule in… We have to start diversifying your body’s capabilities and training for the purpose for which your body will be used.
Your training doesn’t necessarily have to be gentle and easy, but it does need to be modified, monitored, and specific to your purpose.
What WON’T harm your baby? Moderation
Now we’ve got that out of the way, here’s a little caution on exercise and risk management. There is a lot of scaremongering, which means many of trainers will go the conservative route, but this essentially holds women back from their potential. Conversely, training them to their potential without an understanding of the risks is also less than ideal.
The goal is the middle. Moderate volume, intensity, complexity, and loads have the best bang for the buck when it comes to health outcomes than anything else. What this means is:
- Moderate volume: not training once a week, nor training 7 times a week. Your client now trains 3-5 times a week, for more than 30min, but less than 60min (depending on where they started).
- Moderate intensity: means that they neither workout at 50%RPE (rate of perceived exertion), nor do they hit 90% RPE; rather, they sit in the aerobic zone of 60-80%.
- Moderate complexity means simplifying the movements, even as you make them more diverse and specific to the tasks they’re training for. A burpee becomes a press and squat. A clean and press becomes an upright row, and a deadlift is a completely different exercise.
In this category, you also need to consider what positions you’re in as your body changes; for example, jumping adds extra loads to the pelvic floor and prone positions put extra pressure against the abdominal wall (do you really want to stretch that further right now?). Think about going gently on those structures as they’re already under extra pressure from the pregnancy alone.
In addition, thinking about direction changes and balance work conservatively as you enter your third trimester, when your centre of gravity rises and your risk of falls and soft tissue injury also rise.
- Moderate loads mean instead of doing 20 reps, or just 1-3 reps, you’re now doing 12-15 reps of whatever weight is hard but possible, twice a week instead of 3-5 times.
This is generic, non-specific to-circumstance advice that maximises safety without compromising fitness and health. Moderate exercise also means the least amount of harm to the developing foetus and has in fact been shown to be healthier for the foetus.
Other things to think about
Other things to think about when training while pregnant include the importance of weight during pregnancy, breastfeeding, and lifestyle.
Breastfeeding women lose up to 6% of their bone mineral density in the first 6 months of breastfeeding.
How can we mitigate that loss? Heavyweights.
Risks of heavyweights? Prolapse and pelvic dysfunctions.
So – working with a women’s health physio will monitor your pelvic condition, and learning the kegal will inoculate you somewhat from it getting worse. Both conscious and unconscious pelvic floor work needs to be included in your program. You can look up your closest qualified trainer to guide you through this here: https://clarehozack.au/directory/
- Deliberate lifting work
- Deliberate PF relaxation
- Deliberately timing the lift and/or drop with movement
Unconscious work includes:
- Balance training
- Pelvic mobility work
- Movements that include the arms AND the legs in 3 dimensions
You also need to consider your current lifestyle, are you still working full time or are you at home with other children? How many? How old? What are your stress levels? What are your physical requirements in your other “jobs” (including stay-at-home mothering)?
As a basic rule of thumb, the harder/more stressful your lifestyle, the easier/less stressful your sessions.
In addition, the movements you train have to help you live your life better. If it’s your first pregnancy, then we need to train for the physical role of mothering – you’ve literally never held 3.5kg all day before! However, if you have a 3YO and 5YO at home, then perhaps your training has to be less, and include the things you’re missing; lying down, deep core work, deep breathing, posture, and mobility for example.