Resistance Training & Metabolic Conditioning Guidelines During Pregnancy by Evie Garren

[Evie Garren, M.M., B.S., is a Certified Strength and Conditioning Specialist and Personal Trainer in Durham, NC. She is currently pursuing the Athletic Lab CHPC Level 1 Certification and participating in the Athletic Lab internship program.]

Continuing an intelligent and appropriately designed strength training and metabolic conditioning regimen will greatly help you remain healthy and feeling strong throughout the duration of your pregnancy. Many previously perceived contraindications around training while pregnant may no longer be cause for such alarm. Rather, it is in your best interest to train consistently throughout the duration of your pregnancy and even begin training while pregnant if you have not previously.

The American College of Sports Medicine notes that healthy pregnant women without exercise contraindications are encouraged to exercise throughout pregnancy. Some of these benefits may include prevention of excessive gestational weight gain, gestational diabetes mellitus as well as decreased occurrence of low back pain, pelvic floor pain, incontinence, preeclampsia and a decreased postpartum recovery time.

Per the ACSM, the FITT recommendations (Frequency – Intensity – Time – Type) for women who are pregnant may be applied to all types of training. Table 1 (below) outlines these recommendations as well as those from the American College of Obstetricians and Gynecologists. In short, healthy pregnant women with no contraindications for exercise should accumulate a minimum of 150 minutes of exercise per week spread over the course of 3 to 5 days coming from both strength training and metabolic conditioning.

Table 1

It is worth noting that as your body changes drastically throughout the course of your pregnancy, how often and how intensely you train may need to be adjusted. Some exercises, such as running and jumping, may become too uncomfortable to perform as you progress through your pregnancy. Others, however, may just need simple modifications. Please consult with your health care providers to determine if it is safe for you to begin or continue an exercise regimen. Table 2 (at the end of this article) lists in detail several exercise modifications as a reference guide.

The basic guidelines and principles of strength training should still apply. Continue to follow a training program that includes movement patterns such as:

• Squat
• Hinge
• Upper Body Push
• Upper Body Pull
• Lunge
• Midline Stabilization

There are very few exercises that should be avoided altogether – even if you are new to exercise. Some may need to be adapted as the pregnancy progresses in addition to time spent training and relative intensity levels.

Heart Rate & Rate of Perceived Exertion

Research has shown that when pregnant women exercise, there does seem to be a transient reduction in the fetal heart rate as well as an increase in resting heart rate of the mother as a natural response to pregnancy. Consider using a rate of perceived exertion scale of 1 to 10 in lieu of monitoring your heart rate.

• Between 1-4: Very light work load and effort
• Between a 6-7: Considered moderate-intensity activity
• Between a 7-8: Maximal recommended exertion reserved for high-intensity activity

If you are an elite athlete or well seasoned with your training, you may benefit; however, from utilizing a HR monitor. In this case, it is recommended to keep your HR below 90% of your max HR. Discontinue activities if you experience pain in your pelvis, low back, urinary incontinence, bulging of the linea alba, chest pain, dizziness or shortness of breath.

First Trimester Recommendations

The first trimester is the time from week 1 to 14 of pregnancy. During this time, many hormonal fluctuations will occur and symptoms such as nausea, dizziness, indigestion, and trouble sleeping are often reported. It is increasingly important during this time to stay well hydrated and monitor your energy expenditure during exercise.

While once thought that exercise during the first trimester could result in miscarriage, new research shows that to be untrue. Although miscarriage in the first trimester is quite common, if you have been cleared for exercise, the likelihood of exercise inducing a miscarriage is extremely unlikely.

During the first trimester it is the best time to maintain strength you already have or gain strength if you are new to exercise. This is especially true for muscles of the upper back, pelvic floor, and posterior chain. This will assist in later stages of pregnancy as your center of mass shifts with an increased anterior load due to increased size through the mid section and breasts.

Second Trimester Recommendations

The second trimester is the time from week 14 to 27 of pregnancy. During this stage of pregnancy, movement variability is a priority. Including movements standing, seated, kneeling, half kneeling, and side lying are of increased importance. This may assist in reduction of discomfort related to growth and development of the fetus.

While many movements may still be included in your exercise regimen, lifts that involve explosive movement through the midline may need to be adapted or eliminated at this time. This includes movements such as the snatch, clean and jerk, and barbell hip thrusts. These movements may increase risk of fetal trauma if violent barbell contact is made with the midline.

A common concern during this stage of pregnancy is known as diastasis recti. If you see or feel bulging or doming along your linea alba, the exercise should be modified or eliminated altogether. As your midline and abdomen grow, this connective tissue thins which may cause this separation between the rectus abdominis muscles.

Third Trimester Recommendations

The third trimester is the time from week 27 to 40 of pregnancy. During this period, maintain exercise variance and activity levels as much as possible. Movements to decrease discomfort during this period may simply include:

• Cat/Cow Pose
• Child’s Pose
• Thread the Needle
• Hip Circles
• Pelvic Tilts

Modifications from trimester 2 to 3 may be minimal with the exception of eliminating exercises that require deep flexion of the abdominals. Aim to minimize position changes during training and consider performing multiple exercises in the same position (on the floor, seated, standing, etc).

Managing Intensity

As previously mentioned, it is recommended throughout the duration of your pregnancy to not exceed an RPE of 8 on a scale of 1 to 10. In addition, it is advised to leave a few repetitions in reserve when strength training. Examples include:

• 2-3 Sets of 12-15 Repetitions
  • RPE should be between 5-6
  • You should feel like you could do 1 to 2 more repetitions before reaching muscular failure
• 3-4 Sets of 6-12 Repetitions
  • RPE should be between 5-8
  • You should feel like you could do at least 2 or 3 more repetitions before reaching muscular failure