How to train pregnant women {real tips for personal trainers and group ex instructors}

by Kim on July 29, 2014

Hey guys! I’m back from a long weekend of traveling and visiting the in-laws. I’ll spare you all the kiddo + grandparent pics this time—for some reason, I get extra trigger-happy on the old camera around them. ;)

On Sunday night, Brent and I saw 22 Jump Street (on a super rare movie date), and…we were so disappointed! I know it’s hard to pull off a good sequel, but after the awesomeness of 21 JS, this was a major letdown. At least I got to look at Channing Tatum for 2 hours, but I’m not sure if poor Brent got anything out of it (oh wait, he did—also looking at Channing Tatum).

Anyway, today, I thought I’d talk a little bit about training pregnant women. I have a lot of thoughts on the topic, since I’ve been both training my own pregnant self for 36 weeks now (+40 with kiddo #1) and leading a prenatal fitness class for the last 6 of those. (I’ve also gotten a lot of info from my prenatal fitness training, of course.)

how to train pregnant clients

There’s some advice out there on this topic (really, not much), but a lot of it is super generic, overly cautious, and/or very outdated.

The thing that makes it so complicated, of course, is that no pregnancy is the same. I’m sure you’ve heard that, but no seriously—they’re really not. Even with subsequent pregnancies on the same person, you never know what you’re going to get.

Which means that no rules are perfectly applicable to everyone. (Story of your life right?)

It also means that you’re going to have to rely on your client’s cues even more than usual. (This is something I’ve had to learn how to do over that past 6 weeks.) While she still needs your encouragement and motivation, you can’t push her as much as you might have before.

Whether you’re working one-on-one with a pregnant woman or teaching a group exercise class that includes them, here’s what you need to know:

Know the moves to avoid (group exercise: have modifications ready)

Here are some of the biggest offenders:

Crunches/anything that puts pressure on the abs/pelvic floor

Pregnant women are prone to diastasis recti (when the ab muscles split apart significantly down the the middle) and the best way to avoid getting it is to be careful during pregnancy. The general rule of the thumb is to opt for core stabilization exercises instead of traditional crunch-like moves (think: planks, stability ball and standing core exercises).

Plyometrics

Explosive movements are generally not appropriate for preggos, just because they tend to be uncomfortable and could force women to hold their breath during the “loading” stage of the movement (more on that later). That said, I’ve been doing modified moves like mini squat jumps (where your feet are literally 1-2 inches off the floor) and rope jumping in my classes, and the girls do fine with those. This is something that’s completely dependent on each woman’s tolerance—luckily, it’s really easy to modify or swap out.

Movements involving getting up/down quickly

Think burpees. The bigger the belly gets, the more awkward these movements feel, and the more exhausting/frustrating they are for mom. If you want to include something like this for functional exercise purposes, I’d recommend surrenders, and I’d slow them waaay down.

Deep stretching

Pregnant women are full of hormones that help ligaments relax and stretch in preparation for birth—but they might not realize it. This is why it’s easy to overstretch when you’re pregnant, potentially causing injury. Remind pregnant clients to stretch just to the point of resistance—and none of that “take a deep breath and see if you can go even further” stuff.

–Supine exercises (on the back)

Here’s an example of something that tends to get exaggerated in prenatal fitness. We know pregnant women should obviously not lay on their stomachs (ta-ta for now, supermans), but what about supine moves? A lot of pregnant women hear that lying on their back restricts blood flow through the inferior vena cava, which means compromised blood flow to baby (um—no good!), but this isn’t quite the red alert situation some women are led to believe.

In reality, only a small percentage of women actually experience this, and they would know. The first sign is dizziness (which happens long before the baby is impacted in any way)—so, by all means, if your client is feeling dizzy laying on her back, supine is out!

For most women, though, a few minutes of lying on their back is totally harmless. Chances are you’re not leaving her there for long, anyway.

Things to do:

–If your pregnant mom is concerned, you can have her prop herself up on a stack of pillows.

–Plan your exercise flow so she’s not going from standing directly to lying supine. A dramatic shift like this can give her a head rush. (Have her first transition into an exercise that’s done on all fours or on her knees, for example.)

prenatal-yoga_thumb.jpg

Know what she needs MORE of

It irritates me a little when I see prenatal workouts that are just dumbed-down versions of regular workouts. Pregnant women are not just less fit women—they have completely different bodies with unique needs.

So it’s not always about doing less, and sometimes, it’s about doing more! For example, pregnant women need more…

Squats!

Something that’s often compromised during pregnancy and labor is the pelvic floor, and the best way to support those muscles is through lots and lots of squatting and other glute work (not just kegels, as many people think).

Make sure women are using their glutes to squat and lunge, not their knees, backs, or quads!

Reminders to breathe normally

It’s very important for pregnant women to avoid using the valsalva maneuver—when you exhale forcefully against a closed airway. Everyone does this naturally right before pushing/pulling an extra heavy load (you might hear people say “huh” or grunt right before the movement). Although it’s technically not ideal for anyone to do it, it’s especially concerning for preggos, since it can disrupt blood flow to both mom and baby and cause fainting.

Pregnant moms’ breathing can be faster or slower—the key is that it needs to be continuous.

Reminders to brace the core

I know, engage the core, bla bla bla. But here’s the deal with the core and pregnancy:

–It’s even more important than ever to work the core muscles during pregnancy, since they have a much bigger load to carry and are responsible for pushing the baby out during birth. (Specifically, the TVA muscles.)

BUT:

–Pregnant women tend to care less about their core muscles (it’s not like they’re working on their 6 packs, right?).

AND:

–Pregnant women can’t work their core muscles in a lot of the traditional ways (either due to too much pressure or the belly literally getting in the way), which means they have to rely on core bracing during non-core-specific exercises as a primary form of working those muscles. (Not to mention it’s just good habit!)

Form checks

The further along a pregnant woman gets, the more her body alignment can shift. Specifically, the belly pulls the lower back forward (pushing the pelvis out below), and the body adjusts by jutting the shoulders and head forward too, leading to an overly arched neck and a slouchy, compressed shape.

posture

(image source)

Here’s the problem: pregnant women can’t tell this is happening. If her shoulders are up to her ears and she’s squatting into her knees, she probably doesn’t know it. (I’ve totally seen pictures of myself pregnant and thought, WOAH, why am I hunched forward so much??) She needs you to tell her what her body is doing.

It also wouldn’t hurt to encourage her to practice movements in front of the mirror at home, to give her muscles a chance to memorize what good form feels like now.

Balance work

Another thing that bugs me is when people say that pregnant women have compromised balance, and should therefore avoid any balance work. What?? Having trouble with balance is all the more reason to work on it! Especially since it’s a great low-impact fitness option.

(The alternative: just hope you don’t fall and actually hurt yourself in real life??)

Obviously, you don’t want to do any wildly challenging balance moves, like push-ups on a stability ball or anything where the feet are on the ball. Just use common sense and make sure women have a support within arm’s reach.

Hip opening and back of the legs stretches

In my prenatal fitness classes, we practice doing deep eastern squats at some point in every class.

eastern squat

Even if the girls can’t get all the way into the squat (they should work towards hovering just above the floor with heels on the ground), they’ve told me that the position feels great. And, of course, it’s super effective for opening the hips. (If women really like it: the eastern squat is also a traditional childbirthing position!)

Stretching the backs of the legs is important for keeping the pelvis loose, so it’s not locked in that jutting-out position that contributes to back pain. I like to do the wide-legged forward fold from yoga, but there are tons of options for this.

forward fold

Know her specific limitations

Again, every pregnancy is different, so it’s helpful to get to know what this specific pregnancy looks like. Ask your clients if they have any doctor-prescribed limitations, if they feel pain when doing specific things, or if anything just “feels wrong.” Some of that is relatively unavoidable in pregnancy (for example, lots of women are uncomfortable rolling over in bed or getting out of the car), but some of it could be translated to specific exercises to avoid.

(Just remember that no one exercise is that important—there’s always something else you can do!)

A common example is pelvic/groin area pain. The safest approach to this is to keep the legs together, but more specifically, avoid exercises that have one leg moving away from the body while the other stays still, such as lateral lunges, fire hydrants, or glute kickbacks.

This is where you need to remind your client that you don’t know how things feel to her—she needs to tell you if anything feels off to her, so you can adjust it as needed.

Understand her goals

Most pregnant women aren’t coming to you to lose weight or get ripped. But the two of you should still spend time talking about what she’s trying to accomplish, like:

–Maintaining as much fitness as possible to support quick postpartum return to activities.

–Having a labor that’s as quick and manageable as possible, with few or no interventions and an easy recovery.

–Keeping pregnancy weight gain under control.

–Reducing pregnancy discomfort by toning muscles that support good alignment.

–Increasing energy.

Someone who’s used to working out mostly to look and feel good might not realize that goals like these are even on the menu during pregnancy. This is your opportunity to show your value as a trainer, and it’ll also help keep her motivated so she’s not just going through the motions of prenatal fitness because she thinks she should.

Lower weights, higher reps

The most important thing here is to make sure your client can do her lifts without holding her breath or compromising her form. She might be used to lifting in a certain weight range, without realizing that her changing body has introduced some form issues that suggest she now needs lighter weights.

Remind her that you can burn out your muscles just as easily with the lower weight/higher rep combo!

Don’t force her to go easier than she needs to

You’re at your client’s mercy to tell you how she’s feeling and what she’s capable of on any particular day. (And it can be totally different from day to day!)

That said, she doesn’t need to be overly cautious either. If she’s worried about hurting the baby, remind her that the baby is very well protected and floating in a barrier of water. As long as she has the thumbs up from her doctor, you and her are using common sense (per above), and she’s not feeling any sudden pains, she’s doing just fine.

In fact, she’s benefiting her baby’s health more by exercising (like, actually exercising) than by avoiding it or holding back too much.

Monitor her ability to talk and breathe (not her heart rate)

The old heart rate rule (keep it below 140 during pregnancy) has been debunked for awhile now, and most doctors are on board with going above that as long as women can still talk and breathe comfortably. (Really, if women were active pre-pregnancy, they can probably get over 140 pretty easily without getting too winded.) Also, since women can have slightly increased heart rates during pregnancy anyway, tracking the HR just isn’t that helpful for monitoring exercise intensity.

The easiest measure of exertion during pregnancy is the good old talk test. Can she respond to your questions without gasping for air?

Make sure she’s using the right muscles

When a growing belly compromises a woman’s normal alignment, she’s  more likely to rely on secondary muscles instead of primary ones to move. And she probably won’t know she’s doing it.

The three most common (and worst) muscle swaps to watch for are:

Knee/back loading instead of hip loading. This is a major one! The biggest example is squatting into the knees and/or with the back instead of with the glutes. (A lot of people don’t realize that the glutes should be the hardest working muscles in lunges, too!)

Shoulder loading instead of chest loading. This is when, during a push-up, the hips fall first, and then the shoulders, and they come back up in the opposite order, rather than the body moving up and down in a unit.

Upper trap loading instead of back loading. During a bent-over row, power should start in the client’s back instead of her upper traps/shoulders.

Be patient

If your pregnant client calls at the last minute to cancel your session, she’s probably not faking it. She might even disappear for weeks at a time. Pregnancy is exhausting, and there’s no telling which weeks are going to be harder than others (generally, women are the most tired in the first and last few months).

That said, if her biggest obstacle is exhaustion, gently remind her that energy begets energy! (Eye roll, I know…) The best ways to fight the fatigue are with good nutrition and exercise—the more she can get, the better she’ll feel.

Be encouraging

Remind her what a great thing she’s doing, both for herself and her baby. Even if she can’t do as much as she used to, the fact that she’s doing something is admirable. She will have people asking her why she isn’t just taking it easy and eating whatever she wants (for two!)—help her remember her motivations (easier delivery, healthier baby, quicker postpartum recovery) and all the awesome benefits prenatal fitness offers her!

Make sure she’s talking to her doctor

This should probably be first in the list, but I didn’t want to scare you away with obviousness. :) As much as you need to be doing your best to keep her safe, it’s the client’s responsibility to make sure she’s also running everything she’s doing by her doctor. Which leads to the last point…

Protect yourself

It’s not a bad idea to have a pregnant client sign a form indicating that she’s accepting the risks of working out both for herself and her baby. Even if you’re doing “100% pregnancy-safe” exercises, working out is like sports—there are always risks.

It’s always a good idea to protect yourself, but it’s even more important when there’s a baby involved!

 

Have you ever worked with a pregnant client? What was your experience like?

If you are or have been pregnant yourself, how many of these things did you run into or incorporate into your exercise routine?

What would you add to this list?

 

Have a great day!

xoxo

Kim

{ 12 comments… read them below or add one }

Peta July 2, 2016 at 5:03 am

This was very helpful, I have just finished my personal training course and looking to learn more about working with pregnant and postnatal women.

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Deborah Hamilton February 29, 2016 at 2:21 pm

Absolutely love this post! I’m a PT in Scotland, working with two 1st trimester clients. Really informative, and just wanted to say thanks for sharing.

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Jessica Rothenberg January 12, 2016 at 2:26 am

Great piece! I’m very impressed at how informative this article is. Thanks so much for sharing your knowledge

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Chris September 2, 2014 at 1:49 am

G’day Kim,

Great piece, good to see you pumping out quality content. Keep it up.
Chris recently posted…#20 Why You’re NOT Losing Weight Despite Doing Everything Right pt.3My Profile

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Bryanna July 30, 2014 at 12:29 pm

I think this is a great post. I am pregnant with my first child, and there is definitely so much I have learned about working out. I really think it’s important to realize every pregnancy is so different, which is why I like this post. I definitely have the pain and pressure in my pelvic area, which makes certain moves feel very painful. Even running can be a challenge for me. I have learned to modify and do different moves. I love squats and agree they are so important to pregnancy. I think cat-cow is another great move for pregnant women as well, as it helps to strengthen the core and back muscles and helps with practicing breathing. This is a great post!! Thanks

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Kim July 31, 2014 at 6:35 am

Congrats on your pregnancy Bryanna! I’m glad you’ve been able to modify and find things you can still do comfortably!

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Tamara @ The Workout Mama July 30, 2014 at 8:37 am

Amen to all this! Seriously annoys me when I see trainers at the gym or online telling women outdated info on working out while pregnant. Thanks for sharing these great tips. Couldn’t agree more!
Tamara @ The Workout Mama recently posted…The First Six Weeks Postpartum: The Second Time AroundMy Profile

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Kim July 31, 2014 at 6:34 am

Exactly! Thanks for reading :)

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Brent July 30, 2014 at 8:36 am

Just want to make sure you’re seeing this comment post, in your gmail, thanks

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Ashley Pitt @ A Lady Goes West July 29, 2014 at 4:41 pm

Hi Kim, This is as awesome post and so beneficial for me. I’m not pregnant, nor have ever been. I’ve been thinking of attending a pre-post natal certification program to get educated in the specifics of training soon-to-be moms. While it seems like the fundamentals of training (proper form, proper activation, firing and alignment) are all the same with pregnant women, the center of balance and pelvic floor area need to be addressed individually. Are there any moves you’ve felt particularly uncomfortable on your own body? How have your own workouts changed? I’d love to learn more about exactly what you do to stay fit while pregnant. Thanks again!
Ashley Pitt @ A Lady Goes West recently posted…Les Mills BODYATTACK 85 class reviewMy Profile

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Kim July 29, 2014 at 5:32 pm

Hey Ashley! The moves that have felt uncomfortable for me are the ones I mentioned in the post–aggressive total-body moves like burpees (only lately, now that my belly’s getting REALLY big), plyometrics, and moves that irritate the pelvic floor (side lunges, fire hydrants, glute kick backs). Running hasn’t been comfortable for a long time (neither is walking really), and I haven’t done any crunches/roll-ups/things that put pressure on the abs/pelvic floor. As for what I have been doing, like I said in the post, lots of squats! :) If I’m tired, I’ll opt for targeted strength training (like just arms or just legs) vs. combo moves that work great but also take way more effort. I don’t do much cardio, but if I had access to a bike, elliptical, or pool, I might use those. Let me know if you have any more specific questions! I’d be happy to do a follow-up post if it would be helpful!

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Kim July 29, 2014 at 5:33 pm

Oh and lots of stabilization exercises, especially for the core. And deep breathing. :) I also love barre for preggos!

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