Prenatal Exercise Program Design: Exercise Type

Choosing the type of exercise that is best tolerated during pregnancy depends on the following considerations:

• Which activities the client enjoys or is skilled at performing

• Whether the activity poses any risk to the mother or fetus

• Is she is able to do the activity without being compromised by balance and center of gravity changes

• Can the activity be easily modified as pregnancy progresses

Weight-bearing exercise such as walking, dancing, and running help maintain bone mass and some studies suggest they are more effective for keeping pregnancy weight gain within normal limits. As pregnancy progresses some women may not be able to continue weight-bearing exercise because of back or round ligament pain. If modifications such as wearing a belly support don’t relieve discomfort, switching to non-weight-bearing activities such as swimming, stationary biking, or other types of stationary exercise equipment is recommended.

Absolute and relative contraindicated activities for pregnant women are listed below. Pregnant women should always consult with their healthcare provider before taking part in any exercise program and assess the risk/benefit ratio whenever there is a question about the safety of any activity during pregnancy. Keep in mind that activities such as downhill skiing must be assessed for risks that are not controllable, such as the effect of high altitude on oxygen delivery to the fetus.

 Contraindicated Activities for Pregnant Women

Relative

High-altitude sports

Water-skiing

Hockey

Gymnastics

Horseback riding

Absolute

Downhill skiing

Scuba diving

Prenatal Fitness Program Design: Exercise Frequency

In my blog last week I discussed exercise duration, the second of four components used when developing a prenatal fitness program. This week exercise frequency is the focus.The number of days each week that a pregnant woman can safely exercise depends upon several factors. They include:
• Her current level of fitness
• How well she is tolerating pregnancy (ie: any discomfort, lack of weight gain or excessive fatigue)
• The intensity and type and duration of activity she is doing
• How well her body is responding to her exercise routine
Some women find that they can comfortably exercise 5-6 days a week as long as they modify the intensity, duration, and type of activity as needed to maintain a comfortable routine. Three days a week is the minimum needed to achieve cardiovascular benefits and gain improvements in fitness, and many women find that exercising most days is the best way to remain consistent with their program.
Pregnant women should reduce their exercise frequency if they experience signs of overtraining, (see below) and allow for more rest days between exercise sessions.
Signs of Overtraining:
•Lack of weight gain
•Extreme fatigue that doesn’t resolve with rest
•Increase in illness or very slow recovery from illness
•Sustained muscle soreness or pain
•Inability to maintain exercise routine 
•Increased resting heart rate
•Depressed mood 
•Slowed fetal growth 
Want to learn more about how to develop a safe and effective maternal fitness program? The CE correspondence course "Prenatal and Postpartum Exercise Design 2016" is available at: www.ppfconsulting.com

Prenatal Exercise Program Design: Exercise Duration

Exercise duration during pregnancy should reflect a woman’s current level of fitness and the type of activity she is doing. If you’re working with someone who’s just starting a prenatal exercise program the duration will be shorter (15-20 minutes) and progress slowly over time to 30-60 minutes. A pregnant woman who is already taking part in a fitness routine can continue with her current duration level, but exercise duration should be modified as needed to enable her to achieve a moderate to somewhat hard level of intensity without discomfort or undue fatigue. 

Some exercise activities, such as swimming, may require a longer duration in order to achieve a moderate to somewhat hard intensity, so close monitoring of exercise intensity will help determine whether a longer bout is needed. As pregnancy progresses, pregnant women may find that they are able to tolerate a longer duration, lower intensity exercise bout better than a higher intensity, shorter bout, but avoid taking the intensity below the targeted zone of 12 to 14 on the 20-point scale or 3 to 4 on the 10-point scale.   

In the case where a pregnant woman is having difficulty maintaining her normal exercise duration, try dividing the workout into two shorter sessions during the day. This is a helpful tool for enabling women to continue to exercise when she’s experiencing more fatigue in later pregnancy.

Want to learn more about how to develop a safe and effective maternal fitness program? The CE correspondence course "Prenatal and Postpartum Exercise Design 2016" is available at: www.ppfconsulting.com

          Prenatal Exercise Program Design: Exercise Intensity


When designing a prenatal fitness program the key components of intensity, duration, frequency, and mode are used, but specific modifications in the level of progression, supervision, and monitoring are needed in order to keep the exercise safe for mother and fetus. The goal of a prenatal exercise routine is to maintain or improve overall fitness, strength, and flexibility. Keep in mind that each woman’s fitness level and ability will vary, and as pregnancy progresses changes in her body will affect her ability to exercise comfortably. 


Although there are general physical changes during each trimester, not every woman will experience the same limitations or have the same response to exercise as other women at that stage in pregnancy. Developing modifications to exercise routines that enable your client to comfortably continue with their exercise routines throughout pregnancy is an important goal for fitness professionals working with this population. Close monitoring and a reliance on a consistent feedback loop will ensure that you are providing a safe and effective fitness routine to your client. 


Determining and Monitoring Prenatal Exercise Training Intensity 
The use of a training heart rate to measure intensity during exercise has been determined to be a poor indicator of pregnant woman’s exertion level and here’s why:During early pregnancy, hormonally  induced blood vessel dilation and the resulting vascular underfilling will cause a woman’s heart to beat more rapidly to make up for the drop in volume. If she exercises at her usual prepregnancy level, her heart rate response will be much higher than normal because of her body’s attempt to pump blood through her system. As pregnancy progresses, blood volume increases to correct the changes in circulatory volume, causing cardiac output to rise, but the continued physiological changes of pregnancy impact the heartrate response to exercise, making it a less accurate assessment of exertion.


Because of the pregnancy-induced changes affecting exercise heart rate response, the most accurate and safe way to gauge exercise intensity is to use the Borg Rating of Perceived Exertion scale (RPE). Pregnant women should exercise at a level that feels moderate to somewhat hard (12 to 14 on the 20-point scale or 3 to 4 on the 10-point scale). Some women may not be able to accurately gauge their RPE level, especially if they are just starting an exercise program, so it's recommended to use the “talk test” a simple tool for gauging exertion. Instruct the client to avoid exercising to the point where they are unable to carry on a conversation (if they’re so out of breath that they cannot talk, it is a sign that they are working past the advised Borg rating range for pregnancy). Tell clients to reduce their intensity if they feel out of breath, and instruct them on how to use the Borg scale to help them
quantify their intensity rating. 


Next week my blog will discuss prenatal exercise duration guidelines.
For more information on prenatal and postpartum exercise and our CE correspondence course, "Prenatal and Postpartum Exercise Design" please visit:www.ppfconsulting.com