Situation #1: A client you’ve been training gets pregnant. She asks you what this means for her strength training program. What do you say?
Situation #2: A new client wants to start strength training with you… but she’s pregnant. What do you do?
If you’ve ever found yourself in one of these situations, you’ve probably already wondered about strength training during pregnancy.
And if you haven’t come across scenarios like these yet, it’s likely that you will, eventually. More than 85 percent of women will have children at some point in their lives. That means that among your female clients, almost 9 out of 10 will either become pregnant, are pregnant, or are postpartum.
In other words, pregnant and postpartum clients aren’t a niche market. Most of your female clients will go through pregnancy at some point.
If you’re uncertain about how to train pregnant women — especially if your focus is strength training — you’re definitely not alone. It can be tricky to get real, reliable information.
In fact, while pregnancy has been studied extensively, there isn’t much research that provides specific information about strength training during pregnancy.
As a result, if you’re a health and fitness professional who works with pre- and postnatal women, you might be unsure of what to do.
You might wonder:
We’ll also show you how to create a safe and effective pregnancy strength training program.
At Girls Gone Strong, we sometimes use the terms resistance training and strength training interchangeably.
In technical terms, resistance training is any type of training in which the muscles work against some form of resistance. While resistance training is the most common form of training for building strength, the goal may not always (or only) be to get stronger.
Resistance training is also useful for building muscle mass, losing body fat, improving certain aspects of physical performance, or rehabilitating an injury. Resistance can be created by a variety of tools and strategies such as barbells and plates, dumbbells, kettlebells, sandbags, medicine balls, bands, suspension straps, and even bodyweight working against gravity.
In those same technical terms, strength training on the other hand often refers specifically to training to increase strength.
The short answer is that it depends (as do so many things in life).
If you’re unsure about what type of exercise is appropriate for pregnant and postnatal women, imagine how your client feels! For many women, pregnancy is a time filled with change and uncertainty. Plus, there’s no shortage of misinformation and flat out myths circulating about pregnancy and fitness.
In our experience, while there are some women who might overdo things when exercising during pregnancy, common misconceptions about pregnancy and strength training lead many women to be overly cautious during pregnancy — sometimes to the point of avoiding exercise altogether.
(On the other hand, this same type of misinformation — combined with pressure to get their “pre-baby bodies back” — means some women are overly relaxed about post-pregnancy strength training and jump back into intense exercise too soon after giving birth.)
Common advice pregnant women receive (sometimes from well-meaning people in their lives, sometimes from their own doctor) often sounds like this:
The trouble is, that advice is not always accurate or helpful.
Several organizations considered trusted authorities on this subject offer evidence-based guidelines and address the nuances typically not acknowledged by blanket advice.
Based on the most recent review of the literature and based on the quality of the evidence available, the Society of Obstetricians and Gynaecologists of Canada’s (SOGC) and the Canadian Society for Exercise Physiology (CSEP)’s new jointly issued guidelines advise that all pregnant women who have clearance from their physician and who have no contraindications (health conditions or concerns for which training would be inadvisable), should be physically active throughout pregnancy.
These experts encourage pregnant women to be active daily and recommend at least 150 minutes of moderate-intensity physical activity each week (accumulated over a minimum of three days per week) to gain meaningful health benefits and reduce their risk of pregnancy complications.
According to the panel’s recommendations, pregnant women should engage in a variety of aerobic and resistance training activities. They also suggest that adding yoga or gentle stretching may be beneficial. The panel further advises that daily pelvic floor muscle training (such as the core-floor connection breath and Kegel exercises) may help to reduce the risk of urinary incontinence.
So, according to experts from multiple countries and across several disciplines, it looks like strength training during pregnancy can be safe.
If you're going to train pregnant clients, you need to be aware of contraindications that make strength training unsafe or downright dangerous for some of your clients.
If your client tells you (or you can see) she has any of the following symptoms or conditions, refer her to her doctor before going any further.
Note: Some of these require a diagnosis by a medical health professional, which is outside of a coach’s scope of practice. Of course, your client’s doctor should screen her before she starts her exercise program with you, but it’s still valuable for you to know the contraindications in case her general practitioner or obstetrician isn’t aware of recent updates to exercise guidelines for pregnant women.
Absolute contraindications (strength training is definitely inadvisable):
Relative contraindications (strength training may be inadvisable and should, therefore, be specifically approved by the medical team):
Additionally, experts advise that elite athletes who continue training while pregnant do so under the supervision of a doctor who is knowledgeable about the effects of vigorous-intensity physical activity on the pregnancy and the health of the mother and the baby.
For a woman who is sedentary or has a BMI of 30 or more, and who has received medical clearance to begin or continue an exercise program, the recommendations are as follows:
Regardless of your client’s training level prior to pregnancy, keep these considerations in mind for training throughout her pregnancy.
Bottom line here: Someone who was sedentary before becoming pregnant can start an exercise program during pregnancy, even if she didn’t exercise prior to becoming pregnant — unless she has any of the contraindications mentioned earlier.
Now that we’ve established when a strength training program is safe and suitable for a pregnant client, let’s explore why it’s worth doing.
Experts from various professional organizations of obstetricians, gynecologists, and physicians agree that training programs that combine aerobic activity and resistance training seem to improve pregnancy outcomes more than aerobic activity alone.
Exercise during pregnancy offers many benefits, including:
Now that we’ve covered the basics of whether or not pregnant clients should strength train (and the benefits of doing so), let’s get into what specific exercises are safe, and which are best avoided during pregnancy.
Hundreds of exercises are appropriate during pregnancy. If your client is cleared for exercise, you can generally choose from a wide variety of strength training exercises that are both safe and beneficial for her.
For example, your client can do variations of squats, hinge movements, bridges, rows, pulldowns, and presses.
You don’t need to feel like your options are limited — though there are a few we do recommend avoiding, which we’ll address in just a moment. You can rest assured knowing that pregnant bodies are strong, capable, and resilient, and can be appropriately challenged in pregnancy.
In addition to strength training, other activities that are generally safe and can be continued or started slowly include:
*As with strength training, your client should be cleared to take part in these activities, and then continuously monitored by her medical professional.
Aside from strength training, there is one other thing we highly recommend you help your pregnant client do. It’s called the Connection Breath, and it can be done both in and out of the gym. (It’s also something most women and health practitioners don’t know about).
The Connection Breath is a breathing strategy that teaches your client to intentionally connect with her deep muscular system (often referred to simply as the “core”) and pelvic floor while breathing.
To be clear, the deep abdominal muscles, pelvic floor, and diaphragm are already “connected” in a neurological sense, but in our experience, practicing this intentional breathing strategy helps women tune into what’s happening with their pelvic floor and can improve their pelvic floor’s ability to respond appropriately to the task at hand.
For some women, it makes them aware of their tendency to hold their breath or grip excessively with their abdominal or pelvic floor muscles. For others, it can improve the coordination of their pelvic floor and abdominal muscles with natural breathing and with exercise.
Some forms of exercise should be avoided in pregnancy due to the unacceptably high risk to the baby, the mother, or both. These include:
Other activities, though not contraindicated, may pose higher risk than reward in pregnancy. These include:
The good news is that you can often reduce the risk associated with an exercise and make it beneficial by modifying either the exercise itself or your client’s technique.
For example, if your client is doing deep goblet squats with a kettlebell and feels some mild pressure in her perineum, reduce the depth of her squat, give her a lighter kettlebell (or remove external weight entirely), or change her exercise or breathing technique to see if that reduces or eliminates her symptoms.
Additionally, recently updated guidelines for prenatal exercise suggest the following:
Olympic lifts (the snatch and the clean and jerk) and any other lift that requires the bar to move explosively past the midsection. While possibly still OK in the first trimester for someone who had already been training with these movements, may pose a risk of fetal trauma from impact as the pregnancy progresses and the woman’s midsection grows. At that point, they should likely be avoided.
Pregnant women living at altitudes below 8200 ft. (2500 m) should avoid physical activity at altitudes greater than 8200 ft. (2500 m), and those considering physical activity at higher altitudes are advised to do so under the supervision of a doctor or obstetric care provider who understands the impact of high altitude on maternal and fetal health.
The most recent guidelines issued by the SOGC/CSEP, mentioned earlier, advise that women who experience light-headedness with excessive Valsalva maneuver (straining while holding their breath) during exercise should avoid holding their breath. However, the Valsalva maneuver or breath holding may not only affect blood pressure, but it may also direct more pressure downward into the pelvic floor. For that reason, the consensus among our pre- and postnatal experts at GGS is that pregnant women avoid the Valsalva maneuver and breath holding altogether.
One way to ensure your client can participate in an exercise program is to first have her complete the PARmed-X for Pregnancy with their medical professional. This form clarifies whether it’s safe for a woman to engage in activity during pregnancy. Having that information in hand should always be your first safety precaution.
Other safety precautions based on the available research include:
Pregnancy is a great time for your client to really tune into what her body is telling her. Encourage her to listen for any subtle hints from her body and to speak up and let you know if she thinks something feels weird or “off” in an exercise so that you can help her modify.
You should never let a pregnant client continue an exercise if it’s causing her pain. Pain or discomfort during an exercise can occur for a variety of reasons, from inappropriate exercise selection to improper technique.
In addition to pain, your client should stop exercising and call a member of her healthcare team immediately if she experiences:
Important note: Make sure all your pregnant and postpartum clients are familiar with these symptoms and understand they should listen to their body above all else.
Additionally, while exercising in pregnancy is generally very safe, specific modifications must be made to depending on the client’s trimester, based on how her body and its functions are changing as her pregnancy progresses.
As you’ve learned, if there are no contraindications, most pregnant women can benefit greatly from strength training throughout their pregnancy.
However, a woman’s body undergoes many changes during pregnancy that may have multiple implications for exercise. When working with pregnant clients, your coaching mindset, goals, and program design will all need to be a bit different.
Here’s how to create a safe and effective strength training experience for a pregnant client:
When working with pregnant clients, remember that coaching with a positive, encouraging mindset can have a profound effect on how safe and capable your client feels.
Here are some ways you can put your mindset into practice:
If you choose to modify or to not include certain exercises in a client’s program, avoid language that evokes fear, shame, blame, or self-consciousness.
Avoid making assumptions about your client’s feelings.Acknowledge her feelings and based on what she shares with you, respond accordingly. Sometimes simply responding with a neutral comment is the best move. For example, when your client first shares that she’s pregnant — don’t assume she’s excited. She may feel scared, angry, or confused. A neutral response would be, “Thanks for sharing that with me! How are you feeling?” That creates a non-judgmental space for her to share how she’s really feeling, and you can follow-up with a response that mirrors hers.
If words such as vagina, labia, cervix, dilation, and cervical mucus make you uncomfortable, practice using these words. They’re the correct anatomical terms used in the language of pregnancy and birth — and you’re a professional!
If it’s early in her pregnancy, she may not have told very many people. In fact, her news may not even be public yet. And at any point throughout her pregnancy, make sure you keep in confidence anything she shares with you about her pregnancy, her health, and any personal information. Trust between client and coach is a cornerstone of a strong coaching relationship.
Have a conversation with your client about what’s realistic during pregnancy.
Sometimes a pregnant client may want to lose weight or continue working toward a max strength goal. For pregnant clients, however, the underlying goal of a strength training program is to maintain activity rather than to push for aesthetics or improved performance like hitting new personal records or developing bigger shoulders.
A well-designed prenatal exercise program should set up both the mother and baby for healthy days ahead. Ideally, your client’s program should help her:
Once you and your client have established some training goals, you can design her strength training program.
When designing a safe and effective prenatal strength training program:
There’s no universally agreed-upon, clearly defined method to categorize a client’s ability level.
Some coaches use training age (how long a client has been working out consistently), and others use strength or skill level within particular exercises. Still, others judge ability level by the rate at which their client adapts to their training program before hitting a plateau.
We recommend using training age because it’s an easy and consistent measure of ability level that aligns with the recommendations established by the American College of Sports Medicine (ACSM). According to this:
To reduce a pregnant client’s risk of injury or complications in pregnancy, it’s generally better for her to start at a lower level and progress from there.
How often a client can train each week will help to determine how you set up her training split (full body, upper/lower, or a combination of the two).
For example, for a beginner, training two to three times per week with at least one day of rest between sessions is ideal. At this frequency, a full-body training program is most effective.
Intermediate and advanced pregnant and postpartum clients who can train two to four times per week may benefit from either a full-body or upper-/lower-body split routine. If a client can only commit to two or three workouts a week, stick to a full-body routine that focuses solely on compound movements using major muscle groups. A split routine is great when the client can train up to four times per week.
Sometimes a client wants to train more often, but as her pregnancy progresses, her energy will fluctuate or she may not have as much time to train. She may not like the idea of doing fewer workouts or working at a lower intensity during pregnancy. Be prepared to have a conversation about this. Reassure her that training just two days per week throughout the duration of her pregnancy can help her stay strong, retain physical function, and feel great.
If a client trained more than three or four days per week before becoming pregnant, was intermediate or advanced, and wants to continue training frequently, an upper-lower body split training program might be a good option. This type of split will allow your client to keep training frequently while getting more movement variation within her program and still getting adequate recovery.
Although many coaches use the same exercises for nearly all of their clients, you should always consider the client in front of you to ensure that you’re selecting the right exercise and level of difficulty for that client and her goals.
There are several ways to categorize exercises: type of movement pattern, whether the exercise is bilateral or unilateral, and whether it’s a compound or isolation exercise. Understanding these categories will help you better understand where certain exercises fit within an appropriate training program.
There are six major movement patterns for the upper and lower body:
Additionally, there are stabilizing exercises for the core that focus on resisting movement:
And core exercises that focus on movement:
A well-balanced prenatal strength training program should include exercises from each category, with a slight bias toward hinge/hip-dominant exercises, pulling/rowing exercises, and stabilizing core exercises, all of which can help pregnant and postpartum clients adapt to the growing abdomen. Keep safety top of mind when structuring the workouts.
In most programs, not just prenatal programs, the most challenging exercises requiring the most effort and attention to technique should go earlier in the workout (e.g., Olympic lifts, kettlebell snatches or cleans). While many pregnant women won’t be doing those anyway, some more advanced lifters may do them early in their pregnancy.
Compound exercises and exercises that involve large muscle groups should also be near the beginning of the workout (e.g., squat, deadlift, bench, pull-up). Follow these with any isolation exercises that use smaller muscle groups and are less taxing to complete (e.g., leg extension, biceps curl).
In this order, as your client moves through her workout and begins to fatigue, she should still be able to safely and effectively perform the remaining exercises.
As you learned earlier, some high-skill/high-effort exercises may not be appropriate for your pregnant and postpartum clients. To be safe — unless you have specific training that allows you to assess and coach your client effectively or your clients are already highly trained and highly competent with complex or explosive movements and skills — stick with exercises that are lower in skill and require less central nervous system activation.
In every stage of pregnancy, the volume and intensity of your client’s program will depend on:
Encourage ongoing, open communication to help your client feel comfortable enough to share concerns. Your client should be able to continue training during pregnancy as long as she feels good and has the time and energy.
Here are some of the adjustments to consider in each trimester...
In the first trimester, your client may experience shortness of breath and less stamina than she had before pregnancy. She may notice that it feels more difficult to progress by increasing weight or resistance and that some exercises feel more challenging than they used to.
All of these things are normal, and if she’s feeling pretty good in general, you won’t have to modify her program much.
We suggest using an effort scale that ranges from one to 10 to monitor her effort and adjust the intensity of her strength training sessions as necessary.
Your client’s effort along this scale will vary based on the exercise and the set-rep scheme of the program. For example, she may feel significantly more fatigued from a set of heavy squats than from a set of heavy biceps curls. Here are some general guidelines:
Important note: In the first trimester, your pregnant client may only be lifting in this last rep range if…
Beyond the first trimester, your client shouldn’t be lifting within this set and rep range due to concerns about increased intra-abdominal pressure and excessive downward pressure on her pelvic floor.
Pregnancy is not a time to “max out” or get close to “missing” a lift due to overexertion. In this trimester, to ensure that your client is safely working at the intensity you prescribe, if she’s lifting in the 6–10 rep range, she should use a weight that she knows she could confidently lift for three to four additional reps. At any rep range above 10, she should feel confident that she could lift one or two extra reps with that load at the end of each set.
Your client is probably going to physically feel her best during the second trimester. However, the American College of Sports Medicine and The American College of Obstetricians and Gynecologists recommend a few modifications.
As your client’s midsection expands, you’ll need to reconsider some of the barbell exercises in her program. If she was performing Olympic lifts, adjusting the trajectory of the bar to clear her belly will alter her technique and may increase the risk of injury for both her and the baby.
She may be able to continue back- or front-loaded barbell exercises such as back squats or front squats as long as she feels safe and is symptom-free. If there’s doming in her abdomen or bulging or heaviness in her pelvic floor, that’s a sign that it may be time to reduce the load or change from the barbell to another implement.
Your client shouldn’t need to hold her breath to lift weights. This strategy increases intra-abdominal pressure and can lead to pelvic floor dysfunction and a rise in blood pressure. Remind her to focus on her alignment and cue her to connect her pelvic floor to her breath as she exhales through the most challenging part of the movements.
Your client’s linea alba and abdominal muscles may already show some noticeable changes, so you should monitor her abdomen (by observing or by feeling, with permission) for any bulging in the midline when she’s doing exercises that require a lot of effort from the muscles in that area. Some examples include front planks, squats, deadlifts, and push-ups.
If you notice any bulging, you can modify the exercise, reduce the range of motion, lighten the load, or have her try a different breathing strategy. Here are some examples:
Your client may need to use lighter weights now, depending on how she’s handling her training loads. Her abdominal and pelvic floor muscles are increasingly under strain as her pregnancy progresses (due to weight gain, hormonal changes, and the baby’s increasing size), so she might not be able to generate as much force as she used to. Reassure her that it is normal to need to reduce the load as the pregnancy progresses.
As mentioned earlier, if you include a supine exercise in your client’s workout, check in with her regularly and stop the exercise or modify it if she experiences any of the following symptoms:
If she’s feeling any of these symptoms, try modifying the exercise from a flat position to a slight incline of about 15 degrees, or avoid the exercise altogether.
Strength training programs in the third trimester often require modifications due to changes in abdominal musculature, the extra load on the pelvic floor, and the increasing size of your client’s midsection.
Now more than ever, continue to encourage your client to connect her pelvic floor to her breath and exhale through the most challenging parts of a movement, rather than holding her breath. Awareness of the pelvic floor muscles may be particularly useful in preparation for birth, as she will need to relax the pelvic floor if she is planning a vaginal delivery.
Monitor your client’s abdomen to check for any bulging or doming in the midline as she’s performing exercises that require a lot of effort from the abdominal musculature. Planks, crunches, and other high-load exercises in a front-loading position often cause doming, but so can simple dumbbell exercises. Monitor the abdominal wall and adjust or remove exercises if there is doming along the linea alba.
Your client will probably need to keep decreasing her loads during this trimester. As she nears the end of her pregnancy, she may be using pretty light weight, and that’s OK.
While pregnancy has been studied extensively, unfortunately, there isn’t much research specifically on strength training during pregnancy, which is what many coaches are interested in.
Most of the research available focuses on low- to moderate-intensity aerobic training (e.g., walking, hiking, stationary biking, and swimming) and some resistance training. Doing research at higher intensities with pregnant participants carries some ethical complexities, as researchers typically aren’t willing to conduct studies in which the potential outcome may cause harm to a participant or her baby.
So, with gaps in information and recommendations that are constantly being updated, it can be challenging for a health and fitness professional who works with pre- and postnatal women to know what to do.
Here are a few ways you can continue learning:
On that last note about ongoing education and professional development…
We can help!
85% of women will have a baby at some point in their life. If you work with women, you work with pre- and postnatal women.
Whether your clients are currently pregnant or have already had their baby, they’ll have questions about everything — how to exercise safely in each trimester, which foods they should and shouldn’t eat, how to exercise the right way post-pregnancy.
And they’ll look to you for the answers.
That’s why we created our Pre- & Postnatal Coaching Certification: So current and aspiring professionals have the tools, knowledge, and confidence they need to help their pre- and postnatal clients navigate their health and fitness — both during and after pregnancy.
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