Considerations for Training the Pre- and Postnatal client
Traditionally, pregnant women have been encouraged to reduce levels of physical exertion due to concerns that exercise could negatively affect pregnancy outcomes. However, more recent investigations by the Centers for Disease Control (CDC) and American College of Sports Medicine (ACSM) suggest that these early recommendations were overly conservative. Currently, pregnant women are encouraged to accumulate 30 minutes or more of moderate-intensity exercise on most—if not all—days of the week in the absence of medical or obstetric complications. Although there are many benefits to beginning an exercise program, it is still important for women to receive a thorough clinical evaluation before starting an exercise program.
In the absence of any contraindications, pregnant women are encouraged to participate in regular, moderate-intensity physical activity, but they should not exercise if any of the following health conditions are present: risk factors for pre-term labor, vaginal bleeding or premature rupture of membranes.
Fitness professional should also be familiar with both absolute and relative contraindications to exercise. (See Table 7-1 and 7-2 below)
Here are general exercise guidelines that should be followed by pregnant clients:
-Do not begin a vigorous exercise program shortly before or during pregnancy.
-If you have been previously active, continue current program during the first trimester to a maximum of 30 to 40 minutes per day as tolerated.
-With no previous activity, begin slowly with 15 minutes of low-intensity exercise and gradually increase to 30 minutes.
-During the second and third trimester, the intensity and duration should be gradually reduced.
-Use the RPE scale rather than heart-rate monitoring.
-Avoid high-impact activities, contact sports, bouncing while stretching, activities with a high risk of falling, deep knee bends, full sit-ups, double leg raises and straight-leg toe touches.
-Avoid exercise in the supine position after the first trimester.
-Avoid long periods of standing.
-Avoid exercise in high temperatures and/or high humidity.
-Modify exercise intensity if post-exercise body temperature exceeds 100° F.
-Focus on hydration.
-Utilize extended warm-up and cool-down periods.
-Walking or running should occur on flat even surfaces.
-Wear a bra that fits well to support the breasts.
-Some pregnant women may benefit from a small snack prior to exercise to help avoid hypoglycemia.
As fitness professionals, you should also be aware of the following warning signs that warrant stopping an exercise session and referring the pregnant client to a doctor before exercise is resumed:
-Dizziness or feeling faint
-Shortness of breath
-Calf pain or swelling
-Decreased fetal movement
-Amniotic fluid leakage
Returning to physical activity after pregnancy also has benefits and is associated with decreased incidence of postpartum depression. Although some recovery time to regain strength is required, during the initial six weeks following delivery your client could begin to slowly increase physical activity as a means of relaxation, personal time and regaining a sense of control.
The following guidelines should be followed with the postnatal client:
-Obtain physician clearance.
-Start with walking several times per week.
-Avoid excessive fatigue.
-Wear a supportive bra.
-Stop session if unusual pain is experienced.
-Stop session if vaginal bleeding is more than normal.
-Drink plenty of water.
Maintaining a physically active lifestyle is a great way for women to support a healthy pregnancy and for them to return to a normal healthy lifestyle after delivery. Being aware of general guidelines, contraindications and signs for discontinuing exercise are key aspects to creating a safe and effective exercise program for both the pre and postnatal client.