Generally speaking, exercise (especially a combination of strength training and aerobic training) during pregnancy is a great idea.
As long as your client …
- Has the go-ahead from her doctor to exercise,
- Doesn’t have any contraindications, and
- Follows some simple safety guidelines
…then exercise can help keep her safe, healthy, and strong throughout her pregnancy, and beyond.
But what about high impact-exercises in particular?
If you typically incorporate high-impact work into your clients’ training programs (for example, if you run bootcamp classes or coach CrossFit) you may be wondering about how to adapt your programming for a client who is pregnant.
Similarly, if your client is an avid exerciser or athlete who’s used to high-impact work, you might wonder whether she can continue safely, or what you need to modify to help keep her safe and healthy throughout her pregnancy.
In this article, we’ll answer some common questions about high-impact exercise and pregnancy:
- What are high-impact exercises?
- What are the risks of high-impact exercises for pregnant clients?
- When should you modify or swap out high-impact exercises for pregnant clients?
- What if my client doesn’t want to stop doing high-impact exercise?
- What should we watch for when a pregnant client is doing high-impact exercise?
Let’s take a look.
What are High-Impact Exercises?
High-impact exercises are those that require both feet to be off of the ground at the same time, and they typically result in a lot of force on your body and joints. Box jumps, burpees, sprints, and plyometrics are all considered high-impact. While these can be great exercises for people who are not pregnant, they can pose risks for pregnant clients.
What are the Risks of High-Impact Exercise For Pregnant Clients?
In general, high-impact exercise (e.g., running, jumping lunges, jumping rope) during pregnancy is considered safe if your client was working in that range before becoming pregnant and her doctor says it’s OK. That said, it is important to be aware that high-impact work comes with risks.
Here are two of the big ones:
Risk #1: Falling
Falling is a concern with exercises like box jumps and plyometrics. Approximately 27 percent of women fall during pregnancy,1 and falls are the most common way prenatal women get injured.2
Risk #2: Pelvic floor dysfunction
Pelvic health is an important consideration when working with pregnant clients. (That’s why we devote an entire chapter to it in our Pre- and Postnatal Coaching Certification.)
Exercises that suddenly increase intra-abdominal pressure (e.g., high-impact activities like running and box jumps) can lead to unwanted pelvic floor symptoms, and potentially contribute to pelvic floor dysfunction during and after pregnancy.
(Additionally, over-exertion and breath-holding are things you want to avoid when exercising during pregnancy, and these can be more likely when doing high-impact work. We cover the full range of considerations for training during pregnancy in our Pre- and Postnatal Coaching Certification.)
Why Does High-Impact Exercise Affect the Pelvic Floor During Pregnancy?
High-impact exercise puts pressure on the pelvic floor via rises in intra-abdominal pressure. This type of movement results in ground reaction forces (the force exerted by the ground onto the body in contact with it) often several times a person’s body weight, and brings a corresponding increase in intra-abdominal pressure.
(Fun fact: the maximum vertical ground reaction force for running is 3–4 times body weight; for jumping, it’s 5–12 times body weight! That’s a lot of load!)
In the second and third trimesters when the baby (plus placenta and amniotic fluid!) is already adding extra downward pressure on the pelvic floor, adding additional pressure through high impact exercise may be more than your client’s pelvic floor can handle. This may increase the risk of pelvic floor dysfunction like incontinence and/or pelvic organ prolapse.
When Should You Modify or Swap Out High-Impact Exercise for Pregnant Clients?
As your client enters her second trimester, it’s probably wise to have a conversation about regressing high-impact exercises toward lower-impact options. Together, you can discuss the benefits versus the risks of continuing with high impact exercises. (We’ll talk about what to do if your client wants to continue high impact exercises below).
While you always have the option of omitting high-impact work entirely (if your client is okay with it), you can also modify or swap out exercises gradually as needed. For example, if she starts struggling with form on particular exercises, or begins noticing symptoms of pelvic floor dysfunction (e.g., leaking, heaviness in the perineum), don’t hesitate to regress, modify, or swap-out the exercise. For example, this might mean changing box jumps to box step ups, or swapping treadmill jogging for uphill walking. Work with the client to find that sweet spot where she is getting a good work-out, but without symptoms.
Research (and experience) shows that many women self-select out of high impact exercises during the second trimester. Many women find that exercise at higher intensity becomes very challenging, due to the physiological changes such as increased blood volume and body weight. In fact, some research studies showed only 16% of recreational runners and 31% of competitive runners were still running in the final trimester of pregnancy.3,4
As your client enters her third trimester, it may be safest to remove all the high-impact exercises from her programming if you haven’t already.
(For some ideas on how to modify or provide alternative exercises, see the table below: How to Modify High-Impact Exercises.)
What if My Client Doesn’t Want to Stop Doing High-Impact Exercises?
Many clients will want to stop doing high impact exercise at some stage of their pregnancy—whether for their own comfort, energy levels, or safety concerns. If your client wants to reduce or omit high impact work, honor that request.
However, depending on your client base, you may have a client who wants to continue engaging in higher-load activities, even when her body is hinting otherwise. (For example, if you’re a CrossFit coach, your client may be reluctant to have her “happy place” taken away.) If that’s the case, and your client has been cleared by her medical team, here are some things you might do:
#1 Provide high intensity exercise alternatives.
Remind your client that low impact doesn’t have to mean low intensity. She can still get a great workout while staying within a safe intensity-of-effort range and reducing risk of falling or other complications. For example, instead of doing sprints on a track, maybe your client can do sprints on a bike, or push or drag a heavy sled, both of which are lower impact, but still plenty challenging.
What counts as a safe intensity-of-effort? Both the American College of Sports Medicine (ACSM) and the American College of Obstetricians and Gynecologists (ACOG) advise that high-intensity training (aerobic training at an intensity between 7 and 8.5 on the 10-point perceived effort scale) can be appropriate for some pregnant women, so if your client is an experienced exerciser, this may be appropriate. A systematic review (i.e. a review of lots of different research studies) showed that “vigorous intensity exercise completed into the third trimester appears to be safe for most healthy pregnancies.5
Provide your client with some other options and see how she feels about swapping some of the high impact stuff for things that are low impact, yet still provide a challenge. (You’ll find some suggestions in the table on modifying workouts a little later in this article.)
#2 Ensure she knows the risks of continuing.
If your client wishes to continue with high impact exercise during her pregnancy, ensure she is aware that there is a higher risk of pelvic health dysfunction, as well as falling. You can let her know that with appropriate scaling, some women continue with high impact exercises through their pregnancy without any issues, but most opt to reduce or stop these activities, either because they have symptoms or because it just doesn’t “feel right” anymore. Allow her to gauge the pros and cons for herself.
#3 Encourage your client to listen to her body.
In general, it’s a good idea to ask all pregnant clients to watch for any concerning symptoms, and to stop if they feel pain, unusual discomfort, or anything that feels “off”. This is especially important if your pregnant client is doing high-impact work.
In particular, ask her to be on the look out for any heaviness in the perineum or leaking urine, as these could be signs of pelvic floor dysfunction. She may also experience joint aches and pains, especially around the lumbar spine, pelvis and lower limbs which might also limit her desire to continue with impact exercise.
#4 Offer a referral to a pelvic health physiotherapist.
Ideally, all pregnant people would have a pelvic health physiotherapist at their disposal, as pelvic health can be greatly affected by pregnancy, and pelvic health is part of overall health. If your client is an athlete and wants to do high impact work throughout her pregnancy, a visit with a pelvic health physio will be even more prudent.
If you have a trusted physio in your network (which we highly recommend!), offer to make a referral.
(Hint: We provide plenty of guidance on how to build your referral network, including step-by-step instructions and sample forms, in our Pre- and Postnatal Coaching Certification.)
#5 Remember, your client is the boss of her body.
While it’s great to share information and help her weigh the risks vs. rewards, keep in mind that your client is the expert on her own experience. Women who are pregnant will often receive unwarranted “feedback” or advice about what they should or shouldn’t do. Strive to provide any recommendations or information you give in a neutral, non-judgemental manner, and let your client make the final call about what she will or won’t do.
How to Modify or Swap Out High-Impact Exercises For Pregnant Clients
The chart below demonstrates exercises, sample symptoms that necessitate a modification, and possible regressions that are likely appropriate depending on your client’s trimester and how she’s feeling.
Remember, each client is unique, so while this chart can provide guidance, make sure you coach the woman in front of you based on her individual needs.
Click to download a copy of this high-impact exercise modification cheat sheet.
What to Watch For When a Pregnant Client is Doing High-Impact Exercise
If you notice that your client is experiencing pain, modifying her form or technique in an odd way, or is exceedingly short of breath, then it’s a sign that something is amiss. Check in with your client and ask her if something feels off or uncomfortable.
If it feels appropriate, you might also ask your client the following:
- Are you having leakage of any fluid during or after exercise?
- Do you have pain in your pelvis, pubic bone or tailbone?
- Are you noticing any protrusion of organs outside your body? (This could be a sign of herniation or prolapse).
If she says yes to any of these questions, it’s probably a good idea to stop the exercise and switch to something else.
And, as we like to say at GGS, “When in doubt, refer out!” The symptoms we’ve mentioned (e.g., leaking urine, pain, feeling of heaviness in the perineum) are out of a coach’s scope of practice to diagnose and treat, though a coach can offer basic exercise modifications to try and reduce or eliminate the symptom itself.
If your client is having any of these issues (or other medical concerns) encourage her to see a specialist and receive medical clearance before continuing with her exercise program.
Meanwhile, keep building your referral network, and don’t hesitate to use it. Referrals are a great way to help your client, and strengthen your credibility as a reliable, trusted professional at the same time.
