One of the most rewarding aspects of being a trainer is when I have the opportunity to train a pregnant client. They are so excited and so eager to learn everything they can about their morphing bodies and fetal development. Pregnancy is one of the most miraculous experiences and unique life changing events in a woman’s life. Her skin glows and her hair shines, but there is also a mix of emotions and physical changes.
If it hasn’t happened already, know that at one point in your career one of your clients will become pregnant and understanding the physiological and psychological changes that will occur requires extensive knowledge on how to execute her fitness program. As more women are requesting that they work with a trainer that has a perinatal certification, it is important that each club has a few qualified trainers on staff to meet the needs of this growing population.
History of ACOG Guidelines
Prenatal exercise guidelines have been one of the most controversial topics since the America College of Obstetristics and Gynecology (ACOG) first introduced exercise guidelines in 1985. The research published stated:
1. Women should exercise with caution, stay under a heart rate of 140 beats per minute (bpm).
2. Strenuous exercise duration should not exceed 15 minutes.
3. No supine exercise after the fourth month.
4. Core temperature should not exceed 38º C.
At the time, the research studies were conducted on pregnant animals, not humans. Therefore the guidelines were changed in 1994. Dr. James F. Clapp III, the worlds foremost researcher in the area of exercise and pregnancy since the early 1980s, “Women who exercise feel better, perform better and have babies that will be stronger physiologically and perhaps better developed neurologically.”
An addendum was added in 1994 eliminating the 140-bpm heart rate rule and guiding women to use the talk test as a way to measure intensity. The ACOG also stated pregnant women should exercise at least 30 minutes on most days, if not all days of the week and wear loose, comfortable and breathable clothing to dissipate heat efficiently.
In 2003, the ACOG suggested that women who were previously active prior to pregnancy shouldcontinue to be active during pregnancy. However, if the client is inactive or has a history of pregnancy-related medical problems, they should seek medical clearance prior to exercise. As a rule of thumb, according to the ACOG, all women wishing to begin or continue an exercise program during their pregnancy should have a documented written clearance from their health care provider. No prenatal care equals no exercise, no exceptions.
Last year the American College of Sports Medicine (ACSM) released a Roundtable Consensus Statement, which provided evidence for women and their health care providers supporting the safety of exercise and physical activity during pregnancy and the postpartum period.
When to Stop Exercise The ultimate goal of training a prenatal client is to maintain their level of fitness. Client expectations are often higher than what their bodies may actually be able to handle. Our role as fitness trainers is to prevent physical stress and provide encouragement and emotional support that they need during this phase of their life. Knowing when to stop the session or exercise is an important part of your program. It is also our responsibility to educate clients about the warning signs during exercise. If a pregnant client experiences the following signs or symptoms during or immediately following exercise, have her call or go to see her doctor right away:
· Pain of any kind
· Pelvic pressure or cramps
· Uterine contractions
· Faintness or persistent dizziness
· Unusual shortness of breath
· Vaginal bleeding or fluid leakage
· Heart palpitations or chest pains
· Headaches and/or visual disturbance
· Temperature extremes (hot or clammy)
· Nausea or vomiting
· Marked swelling or fluid retention in the calves
· Preterm labor
· Decreased fetal movement
Clients with these symptoms should not be allowed to exercise again until the trainer has received a written clearance from their health care provider. This is for everyone’s safety and liability.
Next month, we will discuss physiological changes and how to modify the fitness program through each trimester, including the postpartum period.