Fit for Two

How to safely stay fit during and after pregnancy.

Something was obviously bothering Diane. "I guess I'm going to have to stop working out," she sighed. As her personal trainer, I was stunned at this statement. After all, she had made terrific progress in her training endeavors, literally redefining her physique. She paused for a moment and then continued, "I just found out that I'm pregnant."

Misconceptions

Sadly, many women still believe that pregnancy requires a sedentary lifestyle. Even worse, some continue to train while pregnant without understanding the proper contraindications for exercise. This lack of information can seriously jeopardize their own health and well-being, as well as that of their fetus. There are many misconceptions regarding fitness training during pregnancy. However, when properly implemented, an exercise regimen can provide a multitude of benefits for the pregnant woman with virtually no negative impact.

Post-Partum Weight Gain

As a personal trainer, perhaps the most frequent complaint I hear from women is that they cannot lose the excess weight often gained after pregnancy. During pregnancy, a woman undergoes many physiological and hormonal changes that can alter her metabolism and body habitus. It is commonplace to gain 30 pounds post-partum, and most women are unprepared to deal with this event.

While it is certainly possible for a woman to reshape her body after pregnancy, the best way to counteract postpartum weight gain is to stay in shape during pregnancy. By remaining dedicated to a workout regimen, a woman can virtually return to her original shape shortly after delivery. In addition to the short-term calorie-burning effects associated with an exercise program, a disciplined training regimen increases muscle mass. This, in turn, elevates the body's resting metabolic rate, thereby helping to burn additional calories on an ongoing basis--even while asleep!

Moreover, adopting a workout routine helps increase energy levels while reducing the fatigue associated with pregnancy.[1] Regular exercise promotes an increased sense of well-being and helps to improve a woman's self-esteem during this fragile period.

Exercise Benefits

Numerous other exercise-related benefits have been reported, including a lower incidence of back pain, reduced edema and fewer leg cramps.[2] There is also positive influence on labor and delivery. Research has shown that women who train during pregnancy experience a shorter active labor and a decreased amount of fetal stress.[3] One study even found that the children of women who exercised had significantly lower body fat levels than those who were sedentary--even after a five-year follow-up period![4]

However, there are many unique principles to pregnancy training and extensive care must be taken to ensure a safe, effective workout. The goal of exercising while pregnant should be to maintain the highest level of fitness consistent with maximum safety. By understanding the basic guidelines of pregnancy training and adopting a workout program, a woman can reap all the rewards of staying fit during and after pregnancy without risking injury to herself or her fetus.

Get Checked

Before beginning a fitness routine, it is essential to get a physician's clearance to rule out any possible exercise-related contraindications. Conditions such as hypertension, bleeding, cardiac arrhythmia and other afflictions can be potentially injurious. Even things that might seem innocuous under normal circumstances can be of dire consequence at this delicate time. Therefore, medical clearance is a necessary prerequisite prior to undertaking a training regimen. Follow-ups should be obtained on a regular basis to monitor any changes in health. In this case, an ounce of prevention really is worth a pound of cure.

Assuming there are no contraindications, a woman should plan to exercise at regular intervals. A three-day-per-week training regimen is ideal, preferably allowing at least one rest day between workouts. By using such a schedule, training on a Monday-Wednesday-Friday or a Tuesday-Thursday-Saturday basis will afford maximal effectiveness while allowing adequate rest and recuperation time.

Aerobics classes (especially high-impact and step) are generally not recommended. During pregnancy, hormonal changes relax the connective tissues, which may produce, joint instability. 5 Bouncing movements, jumping motions and rapid directional changes--all common elements in aerobics classes--place significant stress on the joints and tendons. This will substantially increase the risk of injury to these areas. Moreover, the flow of an aerobics class, which is oriented to a group rather than to the individual, makes it difficult for pregnant woman to remain in control. It is therefore better to proceed with an individual workout program consisting of cardiovascular activities, stretching and strength training, whereby proper form and function can be maintained at all times.

Environment

In choosing an exercise facility, it is imperative that the workout area be well ventilated and air-conditioned. During pregnancy, basal metabolic temperature is increased, which can predispose a woman to overheating--a phenomenon that has been shown to cause neural tube defects.[6] Therefore, a pregnant woman should make sure not to exercise in a hot, humid environment and monitor changes in body temperature.

Warm-up

The workout should begin with a 10-minute cardiovascular warm-up on a treadmill or stationary bike at a low resistance to warm up the muscles. A proper warm-up will help circulate blood throughout the body, thereby decreasing the risk of joint injury. The chosen activity should be performed at roughly 50 percent of maximal heart rate. In order to estimate this number, subtract your age from 220 and multiply the difference by 50 percent. Thus, a 30-year-old woman would have a target heart rate of 95 (220 - 30 = 190; 190 x 0.5 = 95).

After a cardio warm-up, it is beneficial to perform about 10 minutes of light stretching. Because of connective tissue laxity, care should be taken in the degree of stretching. Stretches should not be taken to the point of maximum resistance and should be performed in a relaxed manner that stays within a comfortable zone. Slow, stationary stretching is recommended, and one should avoid any ballistic, bouncing movements.

The Workout

Next, a comprehensive weight training session should be undertaken. While there are many ways to approach this endeavor, a total body workout targeting each of the major muscle groups with one exercise is perhaps the best approach. This allows circulation of blood into all areas of the body and maintains the goal of optimal fitness with maximal safety. High repetitions (approximately 12 to 15 per set) are recommended and two to three sets of each should be performed (see the "Sample Weight Training Routine" table).

Sample Weight Training Routine

             DAY ONE

Muscle
Group          Exercises

Back           Seated row
Shoulders      Lateral raise
Chest          Pec deck
Triceps        Pushdowns
Biceps         Seated dumbbell curve
Quadriceps     Leg extension
Hamstrings     Standing leg curl
Calves         Seated calf raise
Abdominals     Knee-ups

             DAY TWO

Muscle
Group          Exercises

Back           One-arm dumbbell row
Shoulders      Upright row
Chest          Cable crossover
Triceps        Kickbacks
Biceps         EZ bar curl
Quadriceps     Lunge
Hamstrings     Abductor pulls
Calves         Standing calf raise
Abdominals     Bench leg raise

             DAY THREE

Muscle
Group          Exercises

Back           Straight-arm pull-down
Shoulders      Front raise
Chest          Modified push-up
Triceps        Overhead extensions
Biceps         Cable curl
Quadriceps     Seated leg press
Hamstrings     Floor kicks
Calves         Toe press
Abdominals     Side bend

During the weight training phase, it is important to follow certain safety precautions. Weight training should be performed at roughly 75 percent intensity. Repetitions should be smooth and controlled, and basic form should always be maintained. Breathing should be regulated during each repetition and a woman should never hold her breath while lifting. Finally, heart rate should be measured at times of peak activity, keeping maximal heart rate in a comfortable range.

Contraindications

Due to the physiological and hormonal changes that occur during pregnancy, there are contraindications for certain exercises. First, exercises that require bending from the waist should be avoided. This can cause dizziness and heartburn in pregnant women, as well as place undue stress on the lumbar spine. Therefore, exercises such as stiff-legged deadlifts and bent rows should not be performed.

Second, it is best not to utilize any overhead lifting exercises. Because of the increased lordotic curve associated with pregnancy, overhead exercises can place heightened stress on the lower lumbar area, resulting in an increased incidence of lower back pain. Thus, exercises such as the military press and incline chest press are contraindicated.

Lastly, exercises performed in the supine position should be excluded after the first trimester. Due to a predisposition to decreased blood pressure (hypotension), the pregnant woman is more apt to become lightheaded and dizzy while lying down. Furthermore, when supine, the fetus tends to press on the vena cava, decreasing venous blood flow and potentially causing harm to the fetus.7 Thus, movements such as the bench press, crunch and lying triceps extensions can be used if adapted with an incline or an exercise ball.

Cool-down

After weight training, it is best to finish the workout with a cool-down period. The cool-down should involve about 10 to 15 minutes of slow walking or stationary cycling combined with additional gentle stretching movements utilizing the same principles as the warm-up. This will ensure a gradual stabilization of body temperature and help flush lactic acid from the muscles.

That's it--a comprehensive routine that is safe and effective. The entire workout will last about 90 minutes, leaving a woman feeling healthy and invigorated. By following these simple principles, a woman can maintain her shape throughout pregnancy and ultimately look as good or better than before conception.

By the way ... despite her trepidation, I was able to convince Diane that it would be beneficial for her to continue working out--which she did until her eighth month. I am happy to report that she now has a healthy baby boy and was within five pounds of her ideal weight after delivery. She is back into her training routine, trying for a baby girl next.

Brad Schoenfeld, CPT, CSCS owns and operates the Personal Training Center for Women in Scarsdale, New York. He is a nationally recognized expert on women's fitness and is the author of Sculpting Her Body Perfect (Human Kinetics Publishing, $19.95). To order, call (800) 747-4457.

[1] Lee VC, et al., Exercise and pregnancy: choices, concerns and recommendations, Obstetric and Gynecologic Physical Therapy, New York, Churchill-Livingstone

[2] Lee VC, et al., Exercise and pregnancy: choices, concerns and recommendations in: Obstetric and Gynecologic Physical Therapy, New York, Churchill-Livingstone

[3] Clapp JF, The course of labor after endurance exercise during pregnancy, Am J Obstet Gynecol, 1990; 163:1799-1805

[4] Clapp JF, Morphometric and neurodevelopmental outcome at age five years of the offspring of women who continued to exercise regularly throughout pregnancy, J Pediatr, 1996; 129(6): 856-863

[5] Dumas GA, et al., Laxity of knee cruciate ligaments during pregnancy, J Orthrop Sports Phys Ther, 26(1): 2-6 1997 Jul

[6] Milunsky A, Maternal heat exposure and neural defects, JAMA, 1992; 268(7): 882-885

[7] Bell R, et al, Exercise and pregnancy: a review, Birth, 21(2): 85-905 1994 Jun

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