Pre- and

Anthony
ACE’s Guides for Fitness Professionals provide the latest research
and information on the most important aspects of the fitness industry. Each title picks up where ACE’s Personal Trainer Manual and
Group Fitness Instructor Manual leave off, providing the specific
and safe exercise programs or group fitness classes.
Pre- and Post-Natal Fitness, which covers both personal training
programs and group fitness classes, discusses the physiological
changes associated with pregnancy and explains how these changes
influence the design and effectiveness of exercise programming for
PRE- AND POST-NATAL FITNESS
knowledge and skills fitness professionals need to develop effective
A
By
Guide for
this special population. This book also provides creative post-natal
exercise recommendations, and will remain a valuable resource
Fitness
throughout your career in the fitness industry.
American Council on Exercise
MISSION STATEMENT
The American Council on Exercise is committed to promoting active,
healthy lifestyles and their positive effects on the mind, body and
spirit. ACE pledges to enable all segments of society to enjoy the
benefits of physical activity and protect the public against unsafe and
ineffective fitness products and instruction.
Professionals
from the
American
Council
www.healthylearning.com
P02-012
Copyright ©2002 American Council on Exercise® (ACE®)
Pre- and
Post-Natal
Fitness
$14.95
on Exercise
Lenita
Anthony
C H A P T E R O N E Benefits and Risks of Exercise during Pregnancy
Pre- and
Post-Natal
A Guide for
Fitness
By Lenita Anthony
Fitness
Professionals
from the
American
Council
on Exercise
First edition
Copyright © 2002 American Council on Exercise (ACE)
Printed in the United States of America.
All rights reserved. Except for use in a review, the reproduction or utilization of this work
in any form or by any electronic, mechanical, or other means, now known or hereafter
invented, including xerography, photocopying, and recording, and in any information
retrieval system, is forbidden without the written permission of the American Council on
Exercise.
ISBN 1-58518-691-0
Library of Congress Control Number: 2001099217
Distributed by:
American Council on Exercise
P.O. Box 910449
San Diego, CA 92191-0449
(858) 279-8227
(858) 279-8064 (FAX)
www.ACEfitness.org
Managing Editor: Daniel Green
Technical Editor: Cedric X. Bryant, Ph.D.
Design & Production: Karen McGuire
Director of Publications: Christine J. Ekeroth
Associate Editor: Lisa Frantz Adlam
Editorial Assistant: Jennifer Schiffer
Index: Bonny McLaughlin
Models: Melanie Ham and Linda Green
Photography: Dennis Dal Covey
Acknowledgments:
Thanks to the entire American Council on Exercise staff for their support and guidance
through the process of creating this manual.
NOTICE
The fitness industry is ever-changing. As new research and clinical experience broaden our knowledge,
changes in programming and standards are required. The authors and the publisher of this work have
checked with sources believed to be reliable in their efforts to provide information that is complete and
generally in accord with the standards accepted at the time of publication. However, in view of the
possibility of human error or changes in industry standards, neither the authors nor the publisher nor
any other party who has been involved in the preparation or publication of this work warrants that the
information contained herein is in every respect accurate or complete, and they are not responsible for
any errors or omissions or the results obtained from the use of such information. Readers are encouraged to confirm the information contained herein with other sources.
Published by:
Healthy Learning
P.O. Box 1828
Monterey, CA 93942
(888) 229-5745
(831) 372-6075 (FAX)
www.healthylearning.com
iii
iv
Ann Cowlin, M.A., is assistant clinical
REVIEWERS
PRE- AND POST-NATAL FITNESS
Sara Kooperman, J.D., owner of Sara’s City
professor, Yale University School of Nursing;
Workout and founder of the MANIA Fitness
movement specialist, Yale University Athletic
Instructor Trainer Conventions, is an AVIA
Department; founder and director of Dancing
athlete. Kooperman was a faculty member for
Thru Pregnancy®, Inc.; author of “Women and
the Kenneth Cooper Institute for Aerobic
Exercise” in Varney’s Midwifery; and expert
Research, a lecturer and trainer for the American
consultant to the US Army Pregnancy and
College of Sports Medicine, and an advisory
Postpartum Fitness Program. Her textbook,
board member for the Aquatic Exercise
Women’s Fitness Program Development, will be
Association. She has been a continuing education
published by Human Kinetics in spring 2002.
provider for the Association of Women’s Health
Obstetric and NeoNatal Nurses (AWHONN),
International Childbirth Educators Association
(ICEA), AFAA, AEA, and ACE. Kooperman is a
licensed attorney and veteran pregnancy exercise
instructor at Northwestern Hospital in Chicago.
v
vi
Introduction . . . . . . . . . . . . . . . . . . . . . ix
CONTENTS
PRE- AND POST-NATAL FITNESS
Chapter Five . . . . . . . . . . . . . . . . . . . . 35
Recommendations for
Pre-natal Exercise
Chapter One . . . . . . . . . . . . . . . . . . . . . 1
Benefits and Risks of
Exercise during Pregnancy
Exercise Intensity
Exercise Duration
Exercise Frequency
Muscular Imbalances
Abdominal and Pelvic Floor Exercise
Relaxation and Stress Management
The ACOG Guidelines: Clearing up the Confusion
Benefits of Pre-natal Exercise
Contraindications and Risk Factors
High-risk Exercise
Chapter Six . . . . . . . . . . . . . . . . . . . . . 47
Popular Group Exercise
Modes during Pregnancy
Chapter Two . . . . . . . . . . . . . . . . . . . . . 9
Physiological Changes
Associated with Pregnancy
Traditional Aerobics
Step Training
Group Indoor Cycling
Yoga
Aquatic Exercise
Group Strength Training
Cardiovascular System
Respiratory System
Hormonal and Metabolic Changes
Musculoskeletal System
Chapter Three . . . . . . . . . . . . . . . . . . . 15
Fetal Risks:
“Can Exercise Harm My Baby?”
Chapter Seven. . . . . . . . . . . . . . . . . . . 61
Post-natal Exercise
Recovery from the Birth Process
Resuming Exercise
Resuming Exercise after Caesarean Delivery
Breastfeeding and Exercise
Mother and Baby Classes
Hyperthermia
Carbohydrate Utilization
Supine Hypotensive Syndrome
Chapter Four . . . . . . . . . . . . . . . . . . . . . . 19
Minimizing Common Maternal
Conditions and Discomforts
Index . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Round Ligament Pain
Diastasis Recti
Pubic Pain
Low-back Pain
Leg Cramps
Carpal Tunnel Syndrome
Varicose Veins
References and
Suggested Reading . . . . . . . . . . . . . . . 87
vii
viii
T
INTRODUCTION
PRE- AND POST-NATAL FITNESS
he American Council on Exercise (ACE) is pleased to
introduce Pre- and Post-Natal Fitness, a guide for fitness
professionals. As the industry continues to expand,
evolve, and redefine itself, the need for safe, well-designed
programs and expert guidance for pregnant women and new mothers has
grown as well. The intent of this book is to educate and give guidance to
fitness professionals that wish to train pre- and post-natal women. It is also a
valuable resource for group fitness instructors that encounter pregnant women
and new mothers in their classes. As with all areas of fitness, education is a
continual process. ACE recognizes this is a broad subject requiring serious
study and we encourage you to use the References and Suggested Reading to
further your knowledge.
ix
PRE- AND POST-NATAL FITNESS
x
CHAPTE R ON E
PRE- AND POST-NATAL FITNESS
Benefits
A
ttitudes about exercise
during pregnancy have
changed dramatically over
the last 10 to 20 years. The
stereotype of pregnancy being a time of
“fragility” and “weakness” that necessitates near inactivity has long been
and Risks
of Exercise
during
discarded. This is largely due to the
increasing body of scientific information
regarding the safety and benefits of
maternal exercise, as well as anecdotal
reports by thousands of active women.
In fact, cross-sectional surveys have
reported that approximately 42% of
pregnant women engage in regular
activity (Zhang & Savitz, 1996). This is
4% higher than is reported for nonpregnant women of childbearing age.
1
Pregnancy
PRE- AND POST-NATAL FITNESS
outcome data on the topic at that time, the 1985
Armed with increased knowledge regarding
the efficacy and safety of pre-natal exercise, most
guidelines were written from a perspective of
doctors are no longer reluctant to give their
“first do no harm” and thus were extremely
patients the “green light.” Women, in turn, are
conservative. Specifically, restrictions were
recognizing the many positive influences an
placed on the type of exercise performed,
active lifestyle can have on the pre- and post-
duration, and intensity.
natal periods. In fact, it is hard to walk by a
However, the guidelines were soon challenged
magazine rack these days that does not display at
by individuals in the exercise science and fitness
least one cover featuring a pregnant woman in
communities, as well as by women who had
form-fitting workout gear extolling the virtues of
continued to exercise vigorously through their
maintaining a fitness regimen. Conversely, many
pregnancies with no ill effects. A number of
questions and concerns remain for most
research studies using human subjects were
expectant women about the specific “do’s and
published over the ensuing years, leading to the
don’ts” of exercise during pregnancy.
need for substantial revisions to the original
Are the benefits of exercise during pregnancy
document. In 1994, ACOG published a second
really that significant? Are all types of exercise
set of guidelines. The specific application of these
safe for pregnant women? Are there restrictions?
guidelines for pre-natal exercise, as well as the
Are there special needs during pregnancy that
2002 ACOG guidelines, are discussed in detail
should be addressed in an exercise program? And
in Chapter Five.
should every pregnant woman exercise? These are
Although most of the restrictions outlined in the
all important questions you need to be able to
1985 ACOG guidelines became “outdated” with
understand and answer.
the publication of the 1994 guidelines, the use of
the earlier document is still widespread among
The ACOG Guidelines:
Clearing up the Confusion
T
physicians and fitness professionals. You must
understand the differences that exist between the
he American College of Obstetricians and
three sets of recommendations and the confusion
Gynecologists (ACOG) first published
surrounding them. It is likely that, in some cases,
recommendations on exercise and
pregnant women will have been given information
pregnancy in 1985. This information was widely
based on the original guidelines published in 1985
disseminated to physicians, fitness professionals,
that is outdated and unnecessarily restrictive.
and concerned women, who were eager to hear
While we have much more research today on
the long-awaited answers to their questions. Due
the effects of exercise and pregnancy than we did
to the limited scientific evidence and lack of
in 1985, there are still areas in which the literature
2
C H A P T E R O N E Benefits and Risks of Exercise during Pregnancy
is limited. For example, most of the current
levels (Sternfeld et al., 1992). While even very fit
research involves the effects of cardiovascular
women will experience fatigue at some point
exercise, with little data on the effects of strength
during their pregnancy, their energy reserve and
training during pregnancy. Additionally, current
fatigue “threshold” remain consistently higher
studies using human subjects have utilized a
than in unfit women. Fit pregnant women also
rather homogeneous subject group; the effects on
retain a lower resting heart rate, a higher stroke
a more diverse sample may impact future results
volume, and higher VO2max throughout
and conclusions. As a fitness professional
pregnancy and during the post-partum period.
•
working with this population, it is important for
Pregnant women who exercise have a lower
you to keep an eye toward ongoing research
incidence of excessive weight gain and are more
developments and how this information applies to
likely to stay within the range recommended
pregnant exercisers.
by ACOG. Exercise also helps to stabilize
mood states during pregnancy. Active women
Benefits of Pre-natal Exercise
have been shown to experience fewer feelings
of stress, anxiety, insomnia, and depression—
Benefits During Pregnancy
negative emotions that are commonly
The potential benefits of a well-designed prenatal exercise program are numerous. Pregnant
experienced during pregnancy (ACSM, 2000, 1;
women who exercise can maintain or even
Goodwin et al., 2000). In general, exercise
increase their cardiovascular fitness, muscular
appears to enhance women’s psychological well-
strength, and flexibility. Research has shown that
being, increase confidence in their changing
women who exercise during pregnancy
body image, and decrease feelings of appre-
experience fewer common pre-natal discomforts
hension about labor and delivery.
Pregnancy is one of the critical “windows” of
such as constipation, swollen extremities, leg
cramps, nausea, varicose veins, insomnia, fatigue,
time in the female lifespan during which positive
back pain, and other orthopedic conditions (Clapp
health-behavior changes are more readily
& Little, 1995; Artal, 1992). Exercise can assist in
accepted. During pregnancy, many women sense
controlling gestational diabetes and help prevent
an increased responsibility toward their personal
urinary incontinence, pregnancy-induced hyper-
health as they become aware of how what they do
tension, diastasis recti, and deep venous
impacts the health and well-being of their unborn
thrombosis (Hall & Brody, 1999; Yeo et al., 2000).
child. There is frequently an increased motivation
Additionally, exercise can improve posture and
to eat more healthfully, stop smoking, and become
body mechanics, facilitate circulation, reduce
more physically active. By seizing this oppor-
pelvic and rectal pressure, and increase energy
tunity to help pregnant women acquire an exercise
3