exercise programming 1st trimester

key moves of the first trimester

1. Teach proper Kegel Exercises 2. Teach proper modified abdominal exercises 3. Alignment exercises 4. Lower back/body strengthening

bottom lines of first trimester

ACOG Guidelines: ACOG's guidelines encourage pregnant women to exercise for at least 30 minutes on most, if not all, days of the week. The ACOG guidelines are the industry standard for what is acceptable and appropriate in prenatal exercise. Talk about the guidelines in class, share them with your clients, and learn them by heart. If you take nothing else from this manual, follow and program around these guidelines. Updates to ACOG Guidelines: You will have many clients who come to class with misinformation about what exercise is safe during pregnancy, which may have been given to them by their doctors . It is extremely important for you to know the current ACOG guidelines and educate your clients (and have them present the current guidelines to their doctors if necessary). Pre/postnatal Exercise Gauges and Programming: Watch your clients carefully during class. Give modifications for most exercises: start with a simple exercise and then offer a more difficult variation for clients who are feeling energetic that day. This way, clients can tailor their workout to their own specific needs on any given day. Increased Hormones: You will have clients in your class that are experiencing both nausea and lightheadedness. Have chairs available for clients to sit if needed, and encourage frequent water breaks. Watch and train a first trimester client as you would a client in the last few weeks of pregnancy, as the fatigue and discomfort they experience are very similar. Relaxin: Relaxin causes joints to relax, become unstable, and more prone to injury. When you are working with a client, pay particular attention to any exercise or move that places significant strain on an isolated joint. Because of the increased relaxin in the body, pregnant women have the tendency to overstretch when performing flexibility exercises. Caution your clients to stay within a normal range of motion when stretching. Blood Supply Increases : Relaxin loosens veins and arteries and therefore affects blood pressure in first trimester clients. If a client feels lightheaded, have her sit down immediately. Blood supply increase can also cause edema in the first trimester. Stroke Volume Increase: Your client's heart is getting stronger and more efficient during pregnancy. Because of the changes in stroke volume, it is not always accurate to gauge a pregnant client's exertion by looking at her heart rate alone. Oxygen Supply: Even though a pregnant woman's lung capacity is decreased, she will be okay exercising because her tidal volume has increased. Although she may feel breathless at times, her lungs supply her body and baby with ample oxygen. Remind clients not to hold their breath during exercise. Cue steady, easy breathing throughout class. Hyperthermia: Watch the temperature of the room in a land class. Look for classrooms where you can control the air conditioning and/or for rooms with fans. If you are teaching a water aerobics class, be sure the pool temperature is below 88 degrees. In warm pools or in warm environments, modifications to the intensity of the workout may be necessary. Abdominal Exercises: Teaching your client how to do a safe, modified abdominal exercise is very important. Strong abdominals are key to a healthy pregnancy. Let women in your class know that if they begin practicing abdominal exercises early in pregnancy and do them regularly, they will have better posture and will be able to easily push their baby out during labor. Recovery after delivery also will be easier with strong abs. Also, remind moms strong abs will make everyday tasks like carrying car seats and strollers easier. Kegel Exercises: Kegels are a key exercise during and after pregnancy. Strengthening the pelvic floor can help to prevent urinary stress incontinence and pelvic organ prolapse and often means faster healing after delivery. Make sure your clients understand their importance for a healthy pregnancy, and be sure each client knows how to perform a proper Kegel. Lower Back Strength: The lower back is an important part of the core box. Strengthening and stretching these muscles is one of the best ways to help clients achieve healthy pregnancy posture. Lower Body Strength: Strong legs help carry an ever increasing load. Squats and lunges are key exercises to continue throughout pregnancy. Encourage proper form and for clients to slowly and carefully execute these exercises. Measuring Exercise Intensity: The "Talk Test" and "Rate of Perceived Exertion" are the best measures of exercise intensity for pregnant women. Heart rate monitoring varies too much from person to person for it to be a standard guideline. Make sure your client understands she should be able to talk comfortably during a workout and should never exercise to exhaustion. Exercise Frequency: Oh Baby! Fitness suggests pregnant women try to fit activity into their lives on a daily basis but keep more intense workouts to three to four times per week. Instructors may need to encourage some clients to increase their workout frequency and intensity. For more fit clientele, such as athletes and fellow fitness professionals, the number of intense workouts per week may need to decrease.

managing ailments

Although exercise may be the last thing on the mind of a newly pregnant woman with gas, constipation, and morning sickness, exercise can actually help alleviate these symptoms (Lewis, 2008). Movement can manually massage the intestines, helping food move along the pathway more comfortably and release trapped air. Exercise increases the heart rate, which can help circulate more blood up to the brain, helping to eliminate dizzy spells. Fresh air can often quell a queasy stomach, and deep breathing has been shown to improve mood. Exercise generally helps improve the quality of sleep for everyone, pregnant or not, and a good night's sleep can help combat the fatigue that often accompanies the first trimester. Studies have shown fewer symptoms of depression in women who participate in regular exercise. Exercise also results in a positive benefit to a pregnant woman's mood comparable to other, more invasive, mood management techniques (Polman, 2007).

bottom line

COG recommends that pregnant women "avoid exercise to exhaustion". Remind your pregnant clients to check how they feel a couple of hours after exercise. Do they feel energized after an Oh Baby! workout or do they feel more fatigued? Their answers will help determine if the workout was at an appropriate level of exertion. Bottom Line on Measuring Exercise Intensity The "Talk Test" and "Rate of Perceived Exertion" are the best measures of exercise intensity for pregnant women. Heart rate monitoring varies too much from person to person for it to be a standard guideline. Make sure your client understands she should be able to talk comfortably during a workout and should never exercise to exhaustion.

programming

Clients should not lie on their backs for more than a few minutes. Foam wedges or stability balls can be used to keep the head and shoulders elevated. 2. Avoid oblique exercises. Instead, encourage clients to perform abdominal work that tracks up and down the spine rather than across the body. 3. Begin all abdominal exercises by asking clients to draw up their pelvic floors. 4. When clients are performing leg or upper body exercises, encourage them to "hold the baby high and tight" or "hug the baby up towards their heart" with their abdominals. Just as in a normal exercise class, clients should be engaging their abdominals nearly the entire class.

abdominals

It is especially important to train pregnant clients to strengthen the transverse abdominals . The transverse abdominals are the interior (or deepest) abdominals, and the rectus abdominals are the exterior abdominals. Most women are only familiar with their exterior abs (rectus and obliques). These are the muscles that are worked during the most common abdominal exercises (sit ups, rollups, etc). However the deeper abs, the transverse abdominals, are the muscles that will help with posture when pregnant. These are the muscles that are engaged when you cue your clients to "hug their baby", or "pull their belly button to their spine". These muscles are the key to a healthy, correct pregnancy posture. It can be helpful to have your clients visualize their transverse abdominals as the sling that carries the baby. Stress to your clients that during pregnancy, they will primarily focus on strengthening the inner abs and pelvic floor muscles.

bottom line

Kegels are a key exercise during and after pregnancy. Strengthening the pelvic floor can help to prevent urinary stress incontinence and pelvic organ prolapse, and often means faster healing after delivery. Make sure your clients understand their importance to a healthy pregnancy, and be sure each client knows how to perform a proper Kegel.

cont's

Late in pregnancy (and during the postpartum period), moms may have trouble with incontinence when they laugh, sneeze, or perform cardio moves. Daily pelvic floor exercises may help to alleviate or even prevent this problem. Kegel exercises are targeted to help strengthen the muscles that support the bladder, uterus, and bowels. If a woman has a strong pelvic floor, she will have strong abdominal muscles. It is important to educate your clients on why doing Kegels properly will improve abdominal strength. The muscles of the pelvic floor and abdominals are inter-related and there is co-contraction. When the pelvic floor contracts, the transverse abdominals contract automatically. Let your clients know that Kegel exercises are beneficial in two ways: they build both a strong pelvic floor and strong abdominals

injury prevention

More relaxed joints combined with a changing center of gravity and slower reaction times are a perfect equation for injury. This, coupled with the restriction of many pain medications, makes injury prevention a main goal of exercising during pregnancy. As an instructor, you should always ask yourself not only can your client do a certain exercise, but should they. Then, you must assess how you can make this exercise safer, or if there is a different exercise that would accomplish the same strength goal in a less risky manner. It is our job as instructors to think ahead to potential pitfalls of every exercise situation and program safer alternatives. It is also a good idea for the instructor to constantly be aware of dangerous situations for the pregnant woman while she is exercising. Untied shoelaces, too long pants hems, or carelessly placed exercise equipment are common, potentially hazardous situations. An instructor should always be on the lookout for these situations as a client may not think of or be able to see a potential danger. Overstretching, as stated earlier, is another injury concern. Because of the increased relaxin in the body, pregnant women have the tendency to overstretch when performing flexibility exercises. Caution your clients to stay within a normal range of motion.

monitoring exercise intensity and frequency

Most experts currently agree that using more than one method to gauge intensity is the best way to effectively monitor a pregnant woman's exertion (Mottola, 2006). There are three methods commonly used to monitor intensity: the "talk test", the rate of perceived exertion (RPE) scale, and heart rate . Pregnant women frequently ask about heart rate and exercise. Many women have heard the old ACOG recommendation that pregnant women should not get their heart rate above 140 Beats Per Minute (BPM). However, recall that the American Congress of Obstetrics and Gynecology (ACOG) removed the 140 BPM as an upper limit for heart rates in its 1994 update of Prenatal Exercise Guidelines. Research demonstrates that heart rates vary wildly from person to person and that no pre-determined, one-size-fits-all number can be appropriate for everyone. Also, pregnant women sweat more easily, making it harder to raise their heart rate to a dangerous level. Many doctors will still caution their patients not to go over 140 BPM. You need to ask the doctor if there is a specific reason for that recommendation, or find out if the doctor is aware of the updated guidelines.

exercise frequency

Mottola also commented on exercise frequency in her research. ACOG recommends pregnant women exercise on most, if not all days of the week. But Mottola reminds women who are normally very intense exercisers to decrease the frequency of these intense sessions to three to four times per week (Mottola, 2006). She agrees all healthy pregnant women should consistently exercise at least three times a week for the greatest health benefits to both mom and baby. Bottom Line on Exercise Frequency Oh Baby! Fitness suggests pregnant women try to fit activity into their lives on a daily basis but keep more intense workouts to three to four times per week. Instructors may need to encourage some clients to up their workout frequency and intensity. But for more fit clientele, such as athletes and fellow fitness professionals, the number of intense workouts per week may need to decrease.

kegels

Programming for Kegels (pronunciation: rhymes with bagels) 1. Have the clients go into a sitting position (cross-legged is generally good) and have them imagine their pelvic floor (sometimes it can be helpful to describe it as a trampoline or elevator). 2. To help them locate their pelvic floor, you can ask them to imagine that they are "stopping the flow of urine" (although they should not do this while urinating as it can cause bladder infections), or ask them to imagine they have to pee and are "holding it." Then ask the client to relax those muscles. 3. See if they can find different degrees of tightening the pelvic floor. If they imagine an elevator, ask them to lift it to the first floor, second floor, third floor, and then reverse back down. Sometimes a straw image is helpful; they want to "suck up" the pelvic floor, and then slowly release. 4. Have the clients contract their pelvic muscles slowly for a count of three. Hold it. Then release for a count of three. (Do a set of 5). 5. Note: the release of the pelvic floor is just as important as engaging the pelvic floor. If your clients have a vaginal birth they will need to relax their pelvic floor during the pushing stage, so it is vital to teach this release section of the Kegel. 6. While doing Kegel exercises, try not to move the leg, buttock, or abdominal muscles. Try doing Kegels in a side-lying position or on hands and knees. Women in their third trimester may find these positions more comfortable as the weight of the baby is not on the pelvic floor. 7. Perform a proper Kegel exercise at the beginning of class so you can cue clients to perform them throughout class. They are also a good exercise to do at the end of class during cool down. 8. "Quick Flicks" are also important. Have women contract their pelvic floor every second for 30 seconds. 9. No one should be able to tell when a woman is doing Kegel exercises, so clients can do them anywhere. 10. Encourage clients to practice their Kegels on their own. They can do them when they are at a red light, or on hold on the phone, or when commercials come on. 11. Tell clients, as new mothers, they can practice Kegels when they are breastfeeding their newborn. Getting in 10 sets of elevator Kegels a day or 30 "Quick Flicks" is a great way to get the pelvic muscles back in action postpartum. 12. Note: tell clients if they want to know if they are performing a Kegel exercise correctly, they should place their hand on the perineum area and see if they can feel it lift. They will probably want to try this at home. If your client expresses difficulty in performing a Kegel, refer them to a Physical Therapist for further instruction.

how to talk to clients about ab work

Some pregnant women believe the baby grows outside the abs, but under the skin; others think their abdominals "melt" during pregnancy and then grow back afterward. So you should start with the basics: the baby grows under the abdominals, and the abdominals stretch as the baby grows. As the baby grows, a client's waistline can increase 20 inches and the abdominal muscles can stretch and lengthen about 8 inches. More room gives baby someplace to grow. Most clients will not feel this growth as it is not painful. Explain where your client's transverse abdominals are (good cues are: from hip bone to hip bone, or where your lap seat belt hits you). Let them know these are the most important muscles for keeping the baby pulled "up and in" while in the most aligned posture. If clients imagine pulling their baby up and in, they will be able to feel where their transverse abs are. Be sure to let your clients know that it does not hurt the baby when they engage their abdominals. Engaging the abdominals actually "hugs" the baby.

bottom line

Strong legs help carry an ever-increasing load. Squats and lunges are key exercises to continue throughout pregnancy. Encourage proper form and for clients to slowly and carefully execute these exercises.

Bottom Line on Abdominal Exercises

Teaching your client how to do a safe, modified abdominal exercise is very important. Strong abdominals are key to a healthy pregnancy. Let women in your class know that if they begin practicing abdominal exercises early in pregnancy and do them regularly, they will have better posture and will be able to easily push their baby out during labor. Recovery after delivery will be easier with strong abs. Also, remind moms strong abs will make everyday tasks like carrying car seats and strollers easier.

core training: abs, pelvic floor and low back

The core can be thought of as a box. The top of the box is the diaphragm, and the bottom of the box is the pelvic floor. The front wall is the abdominals, and the back wall is made up of the back and hip muscles. When thinking of the core in this way, it is much easier to see that training these areas is multifaceted. Core training during pregnancy should focus on all sides of the box. The abs and pelvic floor provide the primary stabilization and "sling" to keep the baby in place.

bottom line

The lower back is an important part of the core box. Strengthening and stretching these muscles is one of the best ways to help clients achieve healthy pregnancy posture.

goals

The main goals of first trimester exercise are: 1. Building strength: a. Core Training: Abdominals, Pelvic Floor, and Low Back b. Lower Body Strengthening 2. Monitoring exercise intensity and frequency 3. Injury prevention 4. Managing ailments 5. Education about exercise techniques and appropriate cautions / contraindications

strengthening low back

You want to work lower back in two ways. First, you want to teach your clients to become aware of their low back muscles and how to articulate movement in their lower spine. This will help them with correct pregnancy posture and improved flexibility. Second, you want to focus strength training on the back muscles to help women balance their increased breast and belly size.

exercises

cat/cow ; wall sits (1-2 min); kegels; songbirds

programming kegels

https://youtu.be/DS3ZM8lQT8k

links > abs

https://youtu.be/a8FoR2d3SAs (abs on stability ball) songbirds (or bird dogs) https://youtu.be/xHE6BPU8Dz8 Modified plank https://youtu.be/aQ9zDymjwV4 rolling like a ball https://youtu.be/KDYrNzcgyhA modified pushup https://youtu.be/n65fckZGqE8

lower body strenthening

legs are also an important area to strengthen early on as they will be carrying an increased load as the pregnancy progresses. Functional movements such as squats and lunges, not only strengthen the large muscle groups in the lower body, but also serve to functionally prepare the body for the bending and lifting that motherhood requires. In addition, lower body strengthening can help alleviate conditions such as swelling and varicose veins that are common during pregnancy.

cautions and contradictions

n the first trimester we caution pregnant women to learn to listen to their bodies . A pregnant woman should exercise at an appropriate level for her, based on her previous fitness level, and how she is feeling on any given day (and that is likely to change daily). Whether she is new to exercise or a seasoned athlete, big changes are taking place in her body, and care should be taken at all times to work out at an appropriate level. The guidelines in this manual provide explanation of the ins and outs of prenatal fitness; however, no one knows a pregnant woman's body better than she does, and as an instructor, it is just as important to empower a woman to trust her own body, as it is to teach her proper technique.

exercises

squats on a ball (against wall) / add pulses: https://youtu.be/Pc23LbwdkPQ lunges (walk/wide stride) https://youtu.be/GZx4a8ECiUw outer and inner thigh raises https://youtu.be/eUA7CrPCfBI

pelvic floor strengthening/kegels

the pelvic floor undergoes massive changes both pre- and postpartum. Teaching pre- and postnatal clients the correct way to perform a Kegel exercise (a pelvic floor strengthening exercise) is one of the most helpful things you can do as an instructor, both to prepare your client for a healthy labor (better pushing ability) and to help them recover from delivery (faster healing of the perineal tissues, muscle repair, and better urinary control)