 Before coaching the pregnant woman, the personal trainer must get in touch primarily with her doctor and midwife in order to get informed about her medical record, and secondly with her family as it is necessary to know about her psychological and mental state and find out about the support the family offers during her pregnancy. The trainer must train both her body and mind, focusing as well on the positive aspects of her pregnancy.  She must be informed about her diet and monitor her weight gain. The pregnant woman “doesn’t eat for two” as it is commonly said. She should eat all kind of food in moderation.  If the pregnant woman was working out before her pregnancy, she can continue doing so. However, her training program must be personalized and one should consider her lever of pre-pregnancy fitness. She should “listen to” the messages her body sends her because, in some cases, they show her if it is necessary to lower the intensity or the duration of an exercise program. In no way should she reach her limits of physical exhaustion or shortness of breath.  If the pregnant woman wasn’t working out before her pregnancy, she can start a low to moderate-intensity fitness program after her 2nd trimester of pregnancy. The routine intensity, duration and further difficulty increase should be done gradually. Even though the pregnant woman and the trainer must work together in collaboration, the pregnant woman is the one who sets the limits. Working out should be fun and joy, not an activity that creates anxiety.  She should either work out alone or be part of a group with other pregnant women at the same week of pregnancy. Her doctor’s approval is a necessary.  According to ACOG (American Congress of Obstetricians and Gynecologists) aerobic exercise should be mild and limited to periods of 20 to 40 minutes, three times a week. Heart rate (HR) should not exceed 140 beats per minute. She can walk, do stationary cycling or swim. The trainer can use the “talk test” in order to determine that the exercise routine has the appropriate intense. This means that the woman should carry on a conversation without being short of breath while exercising. The Ratings of Perceived Exertion Scale (RPE) or Borg Scale has been recommended by many in order to monitor intensity, based on how hard you feel you are working. Named by Gunnar Borg, the scale is ranged from 6-20. The recommended intensity during pregnancy is between 12 and 14 (moderate effort).  Every session should include a warm-up and a cool-down set of exercises, as well as stretching exercises so as the heart rate to return to its normal heartbeat.  Walking is less stable and in some cases painful because the body is trying to adapt to the changes it undergoes: the pelvic size changes, the realigning of the centre of gravity, the increased lordosis and the constant contraction of certain muscles.  Recommended activities are stationary cycling because the pregnant woman doesn’t move around and water workouts because her body weight is less.  When the pregnant woman decides to do water workouts, she must make sure the swimming pool is microbiologically monitored.  She must learn to breathe freely and correctly without holding her breath (Valsalva  Isometric exercises should be avoided because they can cause high blood pressure.  Weight lifting exercises done above the head should be avoided because they can possibly cause high blood pressure and at the same time the spine is susceptible to pressure.  Particular attention should be paid to high temperatures, especially when the pregnant woman is exercising in hot and humid conditions. According to ACOG (American Congress of Obstetricians and Gynecologists) the maternal body temperature should not rise over 38°C. So, she should pay attention to sun exposure, hot baths and showers and any kind of exercise that can increase her core temperature (High Intensity Training or HIT). Water workouts don’t increase her temperature. It is forbidden for the pregnant woman to work out when she has a fever.  In order to avoid respiratory track infections, a cold, etc., the woman should pay particular attention to air conditioning systems when working out indoors. The working out area should be properly ventilated and if the weather is hot a ventilator must be used.  According to ACOG (American Congress of Obstetricians and Gynecologists) exercising in supine position is allowed during the 1st semester of the pregnancy only when the woman was working out before her pregnancy. During the 2nd and 3rd semesters these exercises are forbidden as they reduce the blood flow to the baby.  During the 2nd and 3rd semesters the pregnant woman might feel dizziness when doing certain exercises, especially the ones in standing positions. The trainer should stop the exercise and if and only if the woman feels better, she can continue in a sitting position. What is more, standing still for a certain amount of time can cause dizziness as well.  Working out routines which involve sudden or twisting movements, weight lifting as well as competitive activities/sports are forbidden.  According to ACOG (American Congress of Obstetricians and Gynecologists) sports or activities including the element of touching or hitting can endanger the mother and the baby increasing the probability of injuries. The same applies to exercises with the element of balance or a large range of motion. Changing the centre of gravity can cause increased imbalance and a higher risk of a probable fall leading to a subsequent injury.  In the case the pregnant woman is working out outdoors, she should discuss the workout route with her trainer. The terrain must be smooth and not uneven in order to minimize the risk of falls or joint dislocation. The reason why the ligaments are so loose is because of the hormone relaxine which cause gradual looseness of the joint ligaments.  The trainer should point out the importance of comfortable sports shoes (which should support the ankle joints and the arches of the feet) and sportswear. She is recommended to wear special reinforced sport bra because of the increased breast size.  The pregnant woman should drink a lot of fluids especially during the workout  She should avoid caffeine, smoking and drug use.  The trainer should let the pregnant woman choose the music she likes. Working out during pregnancy is fun and it shouldn’t cause stress.  The ob/gyn and her trainer should constantly remind her not to work out on an empty stomach because she might feel dizziness. She shouldn’t either eat before her session as she will probably have heartburns. It is advisable to eat a meal based on carbohydrates (potatoes, rice, spaghetti, whole wheat bread) approximately three hours before working out in order to have enough energy.

Source: http://www.pilates4pregnants.gr/downloads/english/ti_prosexei_o_gymnastis.pdf

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