Top Tips to Help You Better Cue Your Pregnant Clients for Exercise
I am in the field of women’s health, yet even I experienced information overload when I was pregnant, so I can only imagine how puzzling it is for everyone else. There is so much information about what to do and what not to do regarding exercising when pregnant, that it can leave a woman AND a personal trainer completely bewildered and confused.
Before you start a class with a mom-to-be, make sure she has cleared any exercising with her OBGYN.
Look for Signs
STOP all exercises if pain, dizziness, excessive fatigue or any symptoms out of the ordinary occur. The cause of symptoms may have to be determined, i.e bio-mechanical changes associated with pregnancy like round ligament pain or pain associated with poor posture. If needed, follow up with an MD.
Exercise will lay the foundation for a healthy pregnancy, delivery and post-postpartum period. Even if the woman has not exercised, she can still begin in pregnancy. The key is to start slowly. Education on intensity and rate of perceived exertion is important so she can monitor herself during exercise and activities of daily living. Intensity in the beginning may be light with the possibility of building up to a moderate intensity.
For the avid exerciser, she will benefit from being reminded that this is not the time for competition, rather it is for honoring the changes occurring and exercising at a moderate intensity so 60-80% may be more ideal. Educate that an intensity of 90% or greater has been correlated with compromising fetal well-being.
Hydration: Blood volume levels have doubled and fluid needs have been increased, yet the pregnant client may not feel thirsty. Encourage hydration during and after exercise. A decrease in weight post exercise may indicate she needs to hydrate more. Remember hydration is important for ideal physiology, such as blood pressure regulation, kidney filtration, and muscle activation.
Posture is key with exercise. There are lots of bio-mechanical changes occurring each week and each trimester so ideal postural alignment may be hard to attain. Starting from the bottom up: feet may widen, arches may drop, knees to hip alignment may change effecting pressure to the knees. The pelvis is widening, creating changes to the sacrum, low back and hips and the abdominals are lengthening, the rib cage is expanding and the chest increasing.
What to Watch For and Cues to Improve Alignment
Feet: Maintain an arch in the foot by sliding the toes toward the heels. Janda short foot is an exercise to help strengthen the foot intrinsics and alignment.
Knees: Keep the knees straight but not locked. Tighten the front of the thighs. If the knees roll inward, cue to turn the inner thighs out or activate the gluteals to improve hip alignment.
Hips: Decreased hip muscular strength can affect knee and ankle alignment. Decreased strength can be portrayed as hip dropping or hiking when standing on one leg and or increased low back pain. Hip strengthening can help offset the bio-mechanical strains of pregnancy.
Lumo-pelvic positioning: Avoid excessive arching or tucking of the hips, both of which can place greater strain to the sacroiliac and lumbar region. If the low back is flattened, cue to visualize arching the back to help promote improved alignment. If there is excessive arching, then cue to gently tuck the hips under or sway the hips slightly forward to help restore a small arch in the low back.
Thoracic: Ribs are widening to accommodate the baby. With the widening of the ribs, breathing may be more challenging and muscular length shifting. Cuing to continue to breathe into the sides and the back of the rib cage can help oxygenation. Be mindful of diastasis recti, a separation of the abdominals. Stretching the obliques and training the transverse abdominis by gently pulling navel to spine can assist with counteracting these thoracic changes.
Increasing breast size can influence upper thoracic and chest muscular alignment as noted by shoulders rolling forward and shoulder blades moving apart from one another. Cue to lift the sternum gently up, like showing off a beautiful necklace. Widen through the collarbones while gentle gliding the shoulder blades down and together. Watch for excessive scapular retraction as that may result in hinging of the lower thoracic spine.
Whether you are teaching one-on-one or in a group setting, the above postural cues can benefit all. In a class setting, make a personal connection with your pregnant clients to convey education regarding hydration, intensity and modifications. If teaching a class geared only pregnant women, then chose different educational topics to highlight each week. Provide education at a rate that is not overwhelming.
There are lots of pregnancy myths that can create fear or anxiety. For instance, avoid raising the arms over the head. When I first heard this, I thought “that’s crazy, of course you can raise your arms over your head!” But I also had to honor that the person who told me, truly believed that this may be true and was scared to do any exercise involving lifting her arms. I had to honor her concern then coach her to dispel the myth using education. This myth may have arisen from some old recommendations to avoid heart rates going over 140bpm, and upper body movement may increase heart rate. Or it may have stemmed from the arms moving over the head resulting in poor postural changes. In any case, I reassured her that it is safe to bring the arms overhead but if she feels uncomfortable, then stop and we can try and find a modification. Honor, educate and empower is what I adhere to with pregnant ladies.
How Far Into Pregnancy Can a Woman Exercise?
Lastly, women can exercise until the day they deliver. Often women are discouraged around 32 weeks and told to rest and slow down. And, yes it may be important to slow down, decrease the intensity and modify exercise but it is also important to keep moving. Become your pregnant client’s cheerleader. Labor requires strength, flexibility, and mindfulness, all of which exercise can help enhance!
About the Author
Elizabeth Leeds, DPT, owner of Seaside Fitness and Wellness, combines her background in physical therapy, personal training and Pilates in her practice and teaching. As a pelvic floor physical therapist working at Comprehensive Therapy Services in San Diego, her passion for pregnancy and postpartum is seen in her mission to empower women with knowledge and understanding of their physical changes, and how to address them to prevent future issues. Additionally, Elizabeth is a Master Trainer and developer for Total Gym’s GRAVITY education.