Pregnancy (2/4)
Training during the First Trimester
If there's ever a great time to start building physical fitness and strength, it's the first trimester. And this will really set your client up for success through her pregnancy.
In the first trimester, the main aim should be to increase strength and muscle mass, particularly in the upper back, anterior core and posterior chain. Strengthening the trunk and upper body will help build up your client’s strength to support her breasts as they grow, improve her ability to carry the growing weight and size of the uterus, and help to offset the forward shift in her centre of gravity.
And the great news is that you don't need to throw the baby out with the bathwater when it comes to program design. Programming during the first trimester should follow a similar structure to a 12-week transformation program.
The main focus during this time should be upper and lower multi- joint movements, with single-joint motions targeting the musculature needed to support weight gain.
The first trimester is also a good opportunity to establish a good base of cardiovascular fitness. This can improve your client’s training capacity and reduce her risk of gestational diabetes, pre-eclampsia, premature birth, incontinence, and back pain. Light cardio work or low-impact activities (e.g. walking) are preferable.
Training during the Second Trimester
Now that your client is moving into the second trimester, it's a good time to consolidate the gains you made during the first twelve weeks.
The second trimester is when many of the more unpleasant symptoms of pregnancy begin to subside, and clients may start to feel more energised.
But be mindful that bigger changes, like weight gain, increased breast size and various aches and pains, may not be too far away. So you will need to plan your client's training more carefully during the second trimester. Here's some of the key things to remember.
Key training considerations
1. Adjusting (and avoiding) exercises
Some exercises can be adjusted to the client (e.g. stride length during split squats, foot width placement in during squatting movements, bench angle in pressing), whereas others may need avoiding (e.g. Sumo deadlifts, step-ups, single-leg RDLs and drop-lunges).
2. Avoid prone-based exercises
Instead, opt for variations that do not involve prone support (e.g. swap a lying hamstring curl with a seated hamstring curl).
3. Reduce the intensity
During the second trimester, your client’s core and pelvic floor muscles will experience increased pressure. This is likely to affect her internal stability and strength. If your client feels a lot of downward pressure on her pelvic floor, sensations of bulging through the pelvic floor or a bulging or doming feeling along the linea alba, you may need to reduce the training intensity.
4. Change the training goal
The second trimester isn’t a time to push your client to her maximum limits. Instead, focus on movement and exercises that your client enjoys performing and keep her feeling energised.
5. Manage training volume
While it would be fantastic for your client to continue making progress on specific exercises, don't be frustrated if the total volume does not increase during this time. Some clients may require a tapering down in total training volume over time during pregnancy.
Can pregnant women lie down while exercising?
Your client might be cautious about lying down when they are pregnant. But this doesn't have to be a blanket recommendation.
Women are often advised not to lie flat on their backs for extended periods during the second trimester, as the baby’s weight can impinge the vena cava, the main vein that carries blood back to the heart from the lower body.
But exercising for short periods, e.g. a 30-60 second dumbbell bench press, is likely to be safer for your client than lying her back for extended periods.
Keep an eye on how she feels. If she feels uncomfortable, try raising the angle of the bench or using a mat or pad for back support.
Training during the Third Trimester
The third trimester is when things get a bit more complicated and you may have to be more flexible. The third trimester is likely when your client will see the biggest changes to her body, especially her midsection as it expands to its biggest. As a result, she is likely to be a lot less mobile, and even simple day-to-day tasks will feel like they require a lot more effort than usual. And don't forget about the recovery side of things either.
Your client may report a reduction in sleep quality and quantity, so may not feel quite as energized for training. It’s completely ok for her not to be smashing it in the gym – remember to praise and encourage her for whatever activity and exercise she can continue to perform and commit to. And don't forget the key focus is just consistency rather than aiming for a major goal.
As your client reaches the final stages of pregnancy, training should take on a supporting role rather than provide a competing demand on the body. As a result, you may need to tweak the exercise selection based on how she feels. If she can continue with her current program, great. However, if she feels like she needs to rest or she isn’t feeling up for a certain exercise, that’s also ok.
In these final stages, offering a flexible approach to training and programming is key. Here's how that might play out:
Key training considerations
1. Adjust supine and remove prone exercises
Look for alternative exercises (e.g. swap prone leg curl for seated/kneeling leg curl), or adjust the client set-up (e.g. elevate the bench by 15-30 degrees in a press).
2. Reduce the intensity
This may involve reducing the load, reps, sets, or a combination of all three. It is important that your client does not hold her breath.
3. Replace spinal flexion (e.g. abdominal crunches) with stability/isometric abdominal exercises
Think loaded carry variations, palov press, wood chops, etc.).
4. Avoid exercises that cause the stomach to bulge or dome across the linea alba and cause downward pressure on the pelvic floor
This may feel like heaviness in the perineum or increased need or urgency to urinate. If your client experiences symptoms of pelvic floor dysfunction, refer her to a pelvic health physiotherapist.
Final Training Considerations
You don't need to panic about training a pregnant client and if you follow the guidance listed so far, it should be plain sailing.
The main thing is to keep a close eye on how your client feels during her session, encourage her to speak out if she feels uncomfortable, and stop altogether if she experiences any of the following symptoms:
- vaginal bleeding
- feeling dizzy or faint
- shortness of breath before starting an exercise
- chest pain
- headache
- muscle weakness
- calf pain or swelling
- regular, painful contractions of the uterus
- fluid gushing or leaking from the vagina
- significant pain of any kind.
As a trainer, you are not medically qualified to decide whether your client is fit enough to train. If you or your client are unsure or concerned about exercising during pregnancy, recommend that she speak to her doctor or midwife.