All too often fitness instructors are faced with the challenge of providing prenatal clients safer or better alternatives to common exercises performed in the gym that become somewhat challenging or contraindicated during pregnancy. This article identifies safe and appropriate alternatives for your pregnant clients that use the BOSU® Balance Trainer (BT) in four (4) different exercise modalities: static stretching, yoga, core work and strength training.
Modality I: Stretching
|Groin/Butterfly Stretch (short adductors), Straddle (long adductors) or Hamstrings stretch. The BT assists the pregnant exerciser in elevation of the hips thus allowing more space for the abdomen and also keeps the pelvis in a neutral position and on top of the "sits bones" or ischial tuberosities (Clapp p.201).|
|Modified Supine Back Extension: The BT provides a passive stretch for the entire back, especially the thoracic region. A properly inflated BT will provide extra stretch needed to open up the chest cavity whilst also stretching the back in an area that contributes to low back problems and poor posture during pregnancy. Maximal extension is considered contraindicated during pregnancy so using the BT is a safe and effective modification for this exercise (ACOG 2003).|
|Horizontal Position- Lateral (side) Torso stretch: Lying side-down over the dome of the BT with legs staggered-top leg extended back and bottom leg forward provides the exerciser with a wonderful and important stretch. It helps "open-up" the rib cage, lat area, and also stretches the lateral hip, lower back and hip flexor.|
• The increase in a woman's weight during pregnancy, and the enlarging abdomen, place a greater degree of stress on the hips, back, pelvis and neck. In addition, an increase in a hormone called "relaxin" is present during the first trimester and lasts several weeks post partum. Relaxin causes a shift in a woman's bony structure toward more pliable, which makes it possible for a woman to give birth (Clapp p. 41). The downside to relaxin is lax or loose ligaments. This results in a greater degree of laxity or freedom of motion in major joints. Be certain to stretch slowly and deliberately, do not overstretch or strain.
• A decrease in Synovial fluid, or lubrication of the joints, is evident during pregnancy (ACOG 2003). Because of this physiological change, a longer more gradual warm-up is recommended prior to more vigorous exercise.
Modality II: Yoga
|Down Dog: The BT allows a pregnant exerciser to perform this posture without having to reach for the floor, and also decreases the amount of pressure applied to the wrists and shoulders. Placement of the hand on the BT should be determined individually; some may like to place the hands directly on top of the dome whilst others may prefer hand placement on the side of the dome.|
Child's Pose: The BT provides a higher point from which to place the arms for this pose. This position provides more space for the abdomen, and also allows for additional back and lat stretching.
Plank (modified or traditional): The BT works in two ways as an "assistor" for the plank posture. First, it provides and opportunity to place the hands slightly externally rotated which results in less pressure/stress on the wrists. Second, it provides the exerciser with a more upright position which creates less strain on the low back. To modify this movement the exerciser can place the knees on a yoga mat in lieu of the feet.
Modality III: Core
||Abdominal Crunches: The BT provides the exerciser with a slight incline that helps prevent supine hypertensive syndrome (SHS), and also gives the exerciser greater range of motion whilst completing a basic to more advanced crunch.|
|Lateral or Side Crunches: The BT is of great assistance in performing lateral flexion in a horizontal position. The dome provides the exerciser with a good stretch beyond what one could do in a standing position, and reduces stress on the back.|
• Core work on your back during pregnancy: Supine Hypotensive Syndrome (SHS) can happen during the later stages of pregnancy (3rd trimester as the baby becomes larger). This condition occurs due to the pressure the growing-fetus places on the inferior vena cava that is responsible for delivering deoxygenated blood to the heart. This pressure can cut off or slow blood-return back to the heart. Because of this, the pregnant exerciser may feel lightheaded or nauseous post exercise in a supine position. It usually takes at least 3-7 minutes for a significant effect to be noticed. This is why many fitness professionals will steer clear of supine work after month-5 or limit the work to less than 3 minutes (ACSM p. 231).
• In order to prevent SHS one can do core work in the water, or on a modality such as a stability ball (or BOSU Ballast Ball) or BT to provide more cushion and also a slight incline. This is also true for strength training exercises for the chest.
• Diastasis Recti: Diastasis recti is a condition that occurs during later stages of pregnancy where the rectus abdominis separates along its tendonous insertions to accommodate the growth of the baby. Due to the possibility of this occurring it is advised to discontinue oblique torso exercises late in pregnancy (beyond 25 weeks) to prevent further separation or extensive diastases (Clapp p.141). A health practitioner can determine whether the pregnant exerciser has a significant enough separation to discontinue oblique and/or abdominal work.
Modality IV: Strength Training
|Supine Chest Press/Fly: The BT provides the exerciser with an incline position that will be supportive yet provides a slight incline for chest work. This is especially useful in a group fitness setting or at home when exercising alone. The BT allows the exerciser to choose how much or little support she needs, as established by where she positions herself on the dome. The amount of hip extension is also variable depending on the stage of pregnancy or level of challenge desired.|
• Pregnancy increases a woman's BMR (basal metabolic rate) by 15-20% at rest (Clapp p.40).
• Strength training is highly recommended (ACSM p. 229-231) during pregnancy especially for the upper body due to the extra weight gained and resultant postural changes. Also, later in the pregnancy and then on into motherhood (e.g., carrying the child and/or nursing) increased strength has its advantages. Lower body strength training can also assist in labor itself.
• The latest research (ACOG 2003, ACSM p. 229-231) states that beginning an exercise program once a woman finds she's pregnant is indicated as long as she checks with her doctor first. The exercise should be gradual and not too intense. Significant progressions should not be made until after the first trimester.
About the Author:
Becky has worked in the education/fitness field for over 17 years and holds an undergraduate background in health promotion and wellness, a master's degree in exercise physiology, and is certified through ACSM, NSCA and ACE. She owns Training Wheels Education Services Inc., a domestic and international fitness consulting business where she operates as a fitness expert, writer, personal trainer and presenter. Also a Schwinn® Cycling Master Trainer, Becky has worked for companies such as PrecorUSA, YMCA, Nautilus Institute and is a premier consultant for Sunshine Fitness Resources. Currently based in North Caroline, she regularly lectures at schools, local colleges, for community organizations and universities on various topics of health and fitness. In addition, Becky writes for newspapers, magazines, and websites and appears regularly on local television and radio.
American College of Sports Medicine, ACSM's Guidelines For Exercise And Testing And Prescription; Lea & Farber, 229-232, Seventh Edition, 2006.
Clapp, James. Exercising Through Your Pregnancy. Omaha, NE: Addicus Books, 2002.
American College of Obstetrics and Gynecology. "Exercise During Pregnancy Guidelines " 2003. http://www.acog.org/.