How to Train a Pregnant Client Who’s New to Exercise

What do you do if your new client is not only pregnant, but has
never really been an “exerciser?”

This can be a challenging situation for a fitness professional,
especially if you are new to training pregnant women. You will
likely find conflicting information on what your client should and
should not be doing, and it can be hard to know where to start, so
let’s start with with basics.

First of all, we think it is brilliant that your new client has
come to you for advice during this special time. Pregnancy can be
an incredible opportunity for many women to start on a journey
towards healthy living (that may extend well beyond the pregnant
period).


The fact that your
client has reached out to you for coaching is important, as we know
that statistically very few women (around 15 percent) actually meet
the recommended guidelines for exercise in pregnancy. There can be
many barriers to exercise in pregnancy including factors like
fatigue, family and work demands, musculoskeletal pain or lack of
motivation.1 If she has made the effort to reach out to you, you
will want to do your best to support her through this special
time.

In years past, women were given advice from health professionals
such as “don’t start any new form of exercise during
pregnancy”, which eventually got watered down to “don’t start
anything new in the first trimester.” Women were often scared to
exercise and health professionals were very conservative in their
recommendations.

Here’s the thing: for women with no contraindications, the
benefits of exercise in pregnancy are so substantial that they far
outweigh the risks.

Doctors now agree that in an uncomplicated pregnancy, all women
should be encouraged to exercise regularly — even if they
haven’t done much exercise before. Some of the benefits of
exercise in pregnancy to mother and baby include:1-7

  • Improved (or maintained) cardiovascular fitness.
  • Improved maternal glucose tolerance.
  • Reduced risk of excessive weight gain.
  • Improved quality of life scores.
  • Potentially improved sleep quality and reduced insomnia.
  • Reduced lower limb edema and low back pain (exercise in
    water).
  • Improved psychological well-being (reduced rates of anxiety and
    depression).
  • Better self-esteem and body image satisfaction.
  • Decreased resting heart rate of the fetus and improvement of
    viability of the placenta.
  • Potential reduction in risk of preeclampsia.
  • Lower birth weight of baby, increased gestational age and
    potentially improved neurodevelopment.
  • Leaner body mass at age 5 for the infant.

So now that you know just how amazing exercise is for pregnant
women, the next step is to find out if your client is safe to
exercise. This requires screening by a medical practitioner
(typically the obstetrician or GP), who will check to make sure
your client does not have any medical or obstetric reasons why
exercise might be problematic for her or the baby.

You can find a list of contraindications and relative
contraindications in the recent Canadian
guidelines for physical activity in pregnancy
.10 Your
client’s medical practitioner can also advise her on any
precautions that she should undertake when exercising through her
pregnancy.

What About Miscarriage?

It is important to understand that miscarriage rates have been
reported to be as high as 12–15 percent, with most occurring in
the first trimester.8,9 However, research has shown that exercise
in the first trimester does not increase the risk of
miscarriage.10

Although there is no link between exercise and miscarriage, it
is worth finding out if your client has any fears around
miscarriage, has experienced a previous miscarriage or has been
undergoing IVF. In some of these circumstances, your client may
prefer to commence her program in the second trimester —
especially if she is new to exercise.

Once you have determined that your client is safe to begin
exercise, it is important to find out:

  1. What are her goals?
  2. What has her previous experience with exercise been like?
  3. What is her current level of fitness and skill?
  4. What does she enjoy?

Let’s go through each of these questions individually.

1. What Are Her Goals?

Given that this client is not a regular exercise-goer, it seems
prudent to find out why she is starting now. Is she concerned about
her pelvic floor muscles? Does she want to have a healthy pregnancy
so that she can offer her baby the best start in life? Is she
concerned about putting on weight?

Your initial screening process will help you ascertain your
client’s goals so that you can help her work towards them.

Your client’s goals for exercising in pregnancy may surprise
you. If she states that her sister or mother had pelvic floor
dysfunction and she is scared that she might have the same issues,
it would be worthwhile referring her to a pelvic health
physiotherapist for screening and advice. In the meantime you can
use your sessions to help her gain better awareness of her
breathing, posture and pelvic floor muscles.

If your client is scared about putting on too much weight during
pregnancy, you can use your coaching skills to learn a little more
about this mindset (we cover this in a lot more detail in the
Coaching
& Training Women Academy Pre- and Postnatal Coaching
Certification
).

Understanding your client’s motivation to begin exercising
will give you a common ground in your work together.

2. What Has Her Previous Experience With Exercise Been Like?


This new client has
does not have a regular habit of exercise — why is this the case?
Is it because of she has lacked the motivation or time in the past?
Does she hate the sensation of sweating? Do loud gyms give her the
heebie-jeebies? Has she had bad experiences with fitness
professionals in the past?

Finding out what her previous experience has been like and why
she doesn’t participate regularly in exercise may help you avoid
some of the same mistakes and get your client to develop a
long-term love of exercise — or at least remove her distaste for
it!

3. What Is Her Current Level of Fitness and Skill?

Where you start with this client will of course be very
different if she a total beginner to strength training compared to
if she was a college athlete but has taken a few months off more
recently.

For women who are completely new to exercise (or have not done
anything significant in recent years), it is recommended that you
start with a reduced level of intensity and volume.

For example, the current guidelines for exercise in pregnancy
are for women to do 150 minutes of moderate-intensity exercise (or
75 minutes of higher intensity exercise), plus two sessions of
strength training per week. If your client has done nothing more
than walking for 10 minutes per day, then you may start with
walking 15 minutes per day over five sessions and then build up
from there. You would start with a level of intensity where she can
maintain a conversation (she should be able to talk, but not
sing).


In terms of strength
training, if your client has never lifted weights before, then you
would use this opportunity to teach her the fundamental lifts with
light weights and a focus on form. You should avoid more complex or
high-skill exercises, where the risk of injury would be high.

For example, while low-skill exercises such as squats, deadlifts
and bent-over rows might be a great place to start, high-skill
exercises such as snatches and cleans should be avoided.

In terms of load, given her low starting point, you may well
find that she increases the weight lifted over the course of the
pregnancy, as compared to more experienced lifters who will usually
reduce the weights as the pregnancy progresses. As always, this is
going to be dependent on your client and her response to exercise.
If your client has poor coordination and balance, start with
exercises that use a wide base of support and fewer elements for
her  to control.

4. What Does She Enjoy?

Does your client like a structured exercise program, that is
familiar and repetitive? Does she prefer variety and crave new
exercises each week? Does she love that sensation of a burn in her
thighs, or does she really love the “lengthening” sensation
from yoga?

When it comes to exercise in pregnancy, there is no “perfect
exercise” that suits everyone.

We have spoken to hundreds (if not thousands) of pregnant women
and found that that many different forms of exercise have been
enjoyed by pregnant women around the globe,  including weight
training, swimming, yoga, pilates, dancing, walking and so much
more.

Find out what your client enjoys and what makes her feel good.
Often, incorporating some mobility exercises into a program can not
only be fun, but can help relieve aches and pains during
pregnancy.

The Bottom Line

As you can see, the guidelines for exercising for “newbies”
is very similar to what we would use for those who have exercised
on a more regular basis. The main differences are that the starting
point will usually be lower in intensity and volume and that the
rate of progress through the exercises might be slower.


Be sure to monitor your
client’s response to exercise to progress and regress
appropriately, and be aware of the symptoms that will warrant
ceasing exercise (such as bleeding, leaking amniotic fluid or chest
pain) for any pregnant client.

As always, there are no recipes or strict rules, and as a good
coach it is up to you to develop a good relationship with your
client and monitor her through the pregnancy, adapting the
exercises wherever required. Keep in mind that when working with
pregnant or postnatal clients, exercises may need to be modified or
changed frequently due to your client’s changing needs.

References

  1. Prather H, Spitznagle T, Hunt D, Benefits of exercise during
    pregnancy, PM R. 2012 Nov;4(11):845-50; quiz 850. doi:
    10.1016/j.pmrj.2012.07.012. https://www.ncbi.nlm.nih.gov/pubmed/23174548
  2. Kramer MS, MacDonald SW, Aerobic exercise for women during
    pregnancy, Cochrane Database Syst Rev. 2006 Jul 19;(3):CD000180.
    https://www.ncbi.nlm.nih.gov/pubmed/16855953
  3. Barakat R, Cordero Y, Coteron J, Luaces M, Montejo R, Exercise
    during pregnancy improves maternal glucose screen at 24-28 weeks: a
    randomised controlled trial, Br J Sports Med. 2012
    Jul;46(9):656-61. doi: 10.1136/bjsports-2011-090009. Epub 2011 Sep
    26. https://www.ncbi.nlm.nih.gov/pubmed/21948120
  4. Montoya Arizabaleta AV, Orozco Buitrago L, Aguilar de Plata AC,
    Mosquera Escudero M, Ramirez-Velez R, Aerobic exercise during
    pregnancy improves health-related quality of life: a randomised
    trial, J Physiother. 2010;56(4):253-8 https://www.ncbi.nlm.nih.gov/pubmed/21091415
  5. Nascimento SL, Surita FG, Cecatti JG, Physical exercise during
    pregnancy: a systematic review, Curr Opin Obstet Gynecol. 2012
    Dec;24(6):387-94. doi: 10.1097/GCO.0b013e328359f131. https://www.ncbi.nlm.nih.gov/pubmed/23014142
  6. Kasawara KT, do Nascimento SL, Costa ML, Surita FG, e Silva JL,
    Exercise and physical activity in the prevention of pre-eclampsia:
    systematic review, Acta Obstet Gynecol Scand. 2012
    Oct;91(10):1147-57. doi: 10.1111/j.1600-0412.2012.01483.x. Epub
    2012 Jul 24. https://www.ncbi.nlm.nih.gov/pubmed/22708966
  7. Hollenbach D, Broker R, Herlehy S, Stuber K,
    Non-pharmacological interventions for sleep quality and insomnia
    during pregnancy: A systematic review, J Can Chiropr Assoc. 2013
    Sep;57(3):260-70. https://www.ncbi.nlm.nih.gov/pubmed/23997252
  8. Maconochie N, Doyle P, Prior S, Simmons R, Risk factors for
    first trimester miscarriage-results from a UK-population-based
    case-control study, BJOG, https://doi.org/10.1111/j.1471-0528.2006.01193.x
  9. Lashen H, Fear K, Sturdee DW, Obesity is associated with
    increased risk of first trimester and recurrent miscarriage:
    matched case–control study, Human Reproduction, Volume 19, Issue
    7, 1 July 2004, Pages 1644–1646, https://doi.org/10.1093/humrep/deh277
  10. Mottola MF, et al., 2019 Canadian guideline for physical
    activity throughout pregnancy, Br J Sports Med. 2018
    Nov;52(21):1339-1346. doi: 10.1136/bjsports-2018-100056. https://www.ncbi.nlm.nih.gov/pubmed/30337460

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How to Train a Pregnant Client Who’s New to Exercise