Sophia McDermott Drysdale: Training Pregnant Clients — Beneficial Exercises

Strategies and exercises to ensure a successful workout when training pregnant clients

The transformation of a woman’s body during pregnancy can be uncomfortable at times, but it is also incredible.


The body changes to be able to create and support another life inside it.  As mentioned in my previous articles, there is a persistent, overwhelming archaic notion that pregnant women need to stop everything they are doing and basically be put to bed rest.

This is not the case at all. 

A pregnant woman can still do almost everything she previously did, but with some modifications. This statement extends to training or working out. If you are a trainer and have clients who are pregnant, you must be aware of everything that is going on in your client’s body and the conditions, movements and positions that should be avoided while working out.

In the first article of this series, I discussed all the changes that occur in an expectant mother’s body during pregnancy and childbirth. These include both hormonal and physiological changes, which can affect everything from emotions to hip structure and pelvic alignment. In the second article, the focus was on particular exercises or conditions that should be avoided because they put the fetus’ health at risk or cause severe discomfort for the mother.

In this piece, I will be discussing specific exercises and demonstrating how (and why) you should safely train pregnant clients who have been cleared for activity. Workouts can still be achieved that deliver progress. They just need to be modified. Working out is beneficial to the mother and baby for countless reasons. One of the most important: movement through exercise increases circulation and blood flow which helps deliver essential nutrients to the baby.

With that knowledge in mind, it is the notion that pregnant women shouldn’t be training that should be put to bed rest!

Alternative exercises for engaging the core

As the mother’s growing belly expands, her abdominal muscles stretch and weaken. In addition, her rectus abdominis may begin to separate down the center line as the baby grows, creating huge weaknesses and what is called Diastasis Recti. Training the abdominals the usual way, by performing sit ups or plank holds for example, will only lead to pressure on the uterus and overworked lower back muscles that are trying to compensate for the lack of abdominal strength.

The abdominals can still be trained, but in a different way. Have your client perform exercises that require the core to engage for balance instead, such as quadruped arm/leg extensions.


Alternative angles for exercises that involve laying flat on her back

The inferior vena cava is the main vein that transports blood from the pelvis, legs and feet back to the heart. It also provides blood flow to the placenta, which supplies oxygen and nutrients to the growing baby.

To make sure that there are no constrictions, avoid movements that place the mother flat on her back, particularly in the 3rd trimester. Create angles or have your client sit up instead. Hands and knee balancing variations are a great way to work the core without performing sit ups where your client is flat on her back. Push ups on a bench or a wall are a great modification to chest press or other chest exercises where the client is usually lying flat.



Work the legs bilaterally, not unilaterally

The pelvis consists of several bones that include the sacrum, coccyx (tail bone), and the left and right coxal (hip) bones. The bones connect at the front by the pubis symphysis joint and at the back by the sacroiliac joints.

During the later stages of pregnancy, many women experience hip pain and pain in the front of the pelvis known as symphysis pubis dysfunction whereby the ligaments connecting the bones at the joint widen and begin to separate. This is caused by the hormone called relaxin, which loosens the pelvis for birth. (1) Some women experience quite pronounced pain when performing side-stepping motions and unilateral motions such as climbing stairs or lunge steps.  Especially during the later stages of pregnancy, always have your client perform leg exercises bilaterally and stay away from unilateral or single leg movements such as lunges or step ups. Exercises such as squats, seated leg extensions, seated hamstring curls, (not lying prone hamstring curls) are all fine. The exercises need to be stable with the weight distributed evenly on each leg to avoid the pain in the front of the pelvis and instability in the hip joints.


Work the upper body

The upper body is one of the areas that is not as affected by pregnancy. Throughout the later stages of the pregnancy, focus more on working the upper body and spend less time on the core and, possibly, the legs since your client’s legs may already be fatigued from carrying the extra baby weight.

I recommend performing upper body exercises while seated such as shoulder press, bicep curls, and seated rows. Seated rows are especially important since this exercise keeps the rhomboids, lats and rear delts strong. It develops strength in these upper back muscles and shoulder muscles that keep the shoulders pulled back that helps maintain good posture. In many cases, pregnancy can cause the shoulders to roll forward because of the weight from enlarged breasts and the change in posture from carrying the baby. Performing these exercises will help to counter this.



Keep Mom moving with breaks to sit

During pregnancy as the baby grows, there is a lot of pressure on the mother’s lower back, hips and pelvis. Aside from the added weight of the baby, the placenta and the amniotic fluid, there is a shift in the weight distribution and the center of gravity. As the baby belly sticks out from the front this causes the pelvis to tilt forward, which tightens the hip flexors and conversely stretches and weakens both the gluteal and hamstring muscle groups.  This imbalance causes lower back pressure and can result in a lot of pain for some mothers. Standing for long periods of time can exacerbate the pain. During rest periods, give your client the option to sit in order to take the weight off her feet and the pressure off her lower back.

During the later stages of pregnancy, the mother can experience swelling in the lower limbs and varicose veins. The recommended weight gain during pregnancy is between 30 – 50 pounds. So much of the weight is due to the amniotic fluid and increased blood volume and extracellular fluids. This additional fluid retention is necessary to help cushion the baby and the joints of the pelvis, knees and ankles that support the baby weight. However, it takes its toll on the lymphatic system which helps maintain fluid balance in the body by collecting excess fluid and depositing it in the bloodstream. (2) For ‘heavily’ pregnant clients who are standing for long periods of time, the lymphatic system has trouble filtering all the fluids fast enough and this leads to a buildup of fluid in the lower limbs and ankles. Help to mitigate the swelling by keeping your client moving with rest periods to sit.

Smooth movement for joint stability

As we know, the hormone relaxin loosens up the cartilage and the ligaments in the joint to widen the pelvis for birth. But relaxin affects all the joints of the body, not just the pelvis which means that it also increases instability in the knees and ankles.  High impact movements with lots of running and jumping around and direction changes are not recommended. Switch to walking on a steady incline. Also encourage mom to go outside get her daily dose of Vitamin D which is so important for creating strong bones in the developing fetus and then for nutrient rich breast milk later on.

Heart rate, make sure Mom can make conversation

The mother’s blood volume increases by a whopping 40-50% during pregnancy and her heart rate increases up to 15% to about 80 – 90 beats per minute. (3) Basically her heart is working so much harder to pump all that blood around her body. In addition, she needs more oxygen for every breath. Be mindful not to overexert your client and leave her too out of breath. Overexertion can lead to oxygen deprivation for the baby.  As a rule of thumb make sure that your client can maintain a conversation while she works out.

Keep Mom cool and hydrated

During pregnancy the mother’s blood volume doubles in order to transport essential nutrients to the developing fetus. The baby is surrounded by amniotic fluid which is an entire sac comprised of mostly water. Basically her body is sucking up water like a sponge to do what it needs to do to ensure a healthy pregnancy.  It is absolutely essential to keep your pregnant client hydrated throughout the entire training session. Dehydration in the later stages of pregnancy can cause premature contractions and pre-term labor.

Make sure that your client stays cool throughout the session. The baby does not have the ability to cool itself down inside its mother’s womb. Make sure your client works in a cooler environment and stays hydrated. Add rest intervals to allow your client to cool down also.


It is absolutely crucial that you know and understand all the changes that are going on in your client’s body and to know what conditions and specific exercises or movement patterns to avoid and why. Workouts can still be achieved that deliver progress, they just need to be modified.

Basically, when training pregnant clients:
Keep your client cool and hydrated. Make sure she can make conversation. Get creative and have her performing the exercises sitting up rather than flat on her back. Focus on keeping the upper body strong and give the standard sit ups a rest for now. Finally, have your client perform bilateral leg exercises instead of unilateral exercises.

Focus on what your client CAN do so that you can prescribe and safely guide your client through effective workout sessions during her pregnancy.

More on training pregnant clients from OTP:
Training Through Pregnancy, Personal Training For New Mothers, How To Train A Pregnant Client

Galina Denzel: Training the Pregnant Client

Tips for Fitness Pros:
Rachel Cosgrove Fitness Pro - How To Become A Fitness Pro - Women Fitness Pros
Rachel Cosgrove: Seven Secrets for Women Fitness Pros

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  1. Pregnancy Day By Day. Maggie Blott MD, 2009, New York. DK Publishing. Page 470
  2. Encyclopaedia Brittanica, Biology, Fluid Balance.
  3. Blood Volume Changes In Normal Pregnancy. October 1985