It’s Monday morning, and you are pumped and ready for your bootcamp class.
A new client comes in and heads over to you.
“Hi, I signed up for your boot camp online, but I just want you to know I’m pregnant. Is that going to be OK with what you have planned? I might need to have a few things modified.”
What do you say?
If you aren’t sure of how you’d respond, or if the idea of training a woman who is pregnant freaks you out a bit, you’re not alone.
Many health and fitness professionals receive little to no training in working with women who are pregnant or postnatal.
That’s why we created this article. Not only so you know exactly what to do the next time a client asks you those questions, but also so you learn:
- Whether or not bootcamps are safe (and beneficial) to attend during pregnancy.
- How to modify your bootcamp exercises (even if you’ve got ten other people taking the class) to keep your client safe.
- What to do when it isn’t safe for a client to take your boot camp class, and how you can refer her out.
Let’s dive in, starting with…
How Do We Define a “Bootcamp” Class?
Typically, bootcamp classes:
- Are high intensity.
- Result in a high caloric burn.
- Help participants develop strength, endurance, and agility.
However, they can also span the gamut in terms of location (inside or outside), exercise selection, use of weighted implements or resistance bands (or lack thereof), and timeframe (e.g., 30 minutes, 60 minutes).
So while there’s no single universal definition of what a bootcamp class entails, in general, a bootcamp is a class that combines aerobic exercise and strength training while giving participants a high-intensity, full-body workout.
Classes may include:
- High-impact exercises (e.g., sprints, burpees, jumping exercises)
- Strength training exercises (e.g., glute bridges, squats, lunges, mountain climbers)
- Core exercises (i.e., anti-rotation, anti-extension, anti-lateral flexion, hip flexion with neutral spine, rotation)
- Cardio exercises (e.g., running, rowing machine, jumping jacks)
One of the exciting parts about bootcamps is that different instructors and different classes can focus on totally different aspects of the workout. In many cases, they also help participants to make gains in a variety of aspects of their training (e.g., agility, strength, speed) during one exercise block. And because they do vary so much, almost anyone can find a bootcamp class that suits what they’re looking for.
Now it’s time to turn our attention to the burning question: When can women who are pregnant do bootcamp classes — and is it a good idea?
Exercise During Pregnancy: Is It Safe?
In our experience, while there are some women who might overdo things when exercising during pregnancy, common misconceptions about pregnancy and physical activity lead many women to be overly cautious during pregnancy — sometimes to the point of avoiding exercise altogether. This is most likely one of the reasons that only 15 percent of women meet the recommended guidelines for exercise during pregnancy.1
The Society of Obstetricians and Gynaecologists of Canada’s (SOGC) and the Canadian Society for Exercise Physiology (CSEP)’s new jointly issued guidelines encourage all pregnant women who have clearance from their physician and who have no contraindications to be active daily and get at least 150 minutes of moderate-intensity physical activity each week to gain meaningful health benefits and reduce their risk of pregnancy complications. This includes women who haven’t done much exercise before (more on this in this article). You can learn more about how to create a safe training program for clients who are pregnant here.
The benefits of exercise during pregnancy include:6,7
- Improved (or maintained) cardiovascular fitness.
- Improved psychological well-being (prevention/improvement of depression symptoms and reduced rates of anxiety).
- Improved quality of life scores.
- Improved viability of the placenta.
- Potentially improved sleep quality and reduced insomnia.
- Lower birth weight of baby and increased gestational age.
- Potentially improved neurodevelopment of the baby.
- Reduced risk of gestational diabetes.
- Decreased risk of high blood pressure associated with pregnancy (preeclampsia).
- Decreased postpartum recovery time.
- Decreased risk (and decreased severity) of low back pain.
- Decreased risk of urinary incontinence.
Are Bootcamp Classes Safe and Healthy for Women Who Are Pregnant?
The short answer: It depends.
Make it a priority to check in with your new clients who are pregnant and ensure that they are familiar with symptoms and contraindications and understand they should listen to their body above all else. (We’ll talk about how to do this in a group setting shortly.)
Here’s When They’re NOT Safe…
Bootcamps are typically unsafe for pregnant women when:
They have not been cleared by their doctor for exercise.
Getting clearance from their doctor to confirm that they can exercise should always be the first step.
The temperature in the room is high or the airflow is poor.
Women who are pregnant are more prone to overexertion, dehydration, and overheating.
They have exercise contraindications.
While we aren’t going to go into more detail on contraindications here, this article is a great resource for more information on these issues, and we also cover the topic in detail in our Pre- & Postnatal Coaching Certification. You can also find a list of contraindications and relative contraindications in the recent Canadian guidelines for physical activity in pregnancy.2
They are experiencing symptoms during the class that aren’t relieved by a modification.
Symptoms to be on the lookout for include pain, heaviness in the perineum, dizziness, and bulging or doming of the abdomen in later trimesters. Pain or discomfort during an exercise can occur for a variety of reasons, but if the discomfort isn’t relieved by a modification, then they should stop the exercise altogether.
They are completely new to exercise.*
As the increase in blood volume during pregnancy causes an increased load on the cardiovascular system, a workout may quickly become more challenging than expected! Someone who is used to working at a high level of intensity is more likely to be able to accommodate these changes.
In addition, a woman who is new to this activity may be at a higher risk of injury than, say, a woman who is more accustomed to intense forms of exercise and who has a better understanding of the movement patterns.
The programming includes high-intensity interval training (HIIT).
True HIIT involves maximum effort, or 9.5–10 out of 10 on the perceived effort scale and involves periods of maximum effort movement followed by rest. While 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) is sometimes appropriate for pregnant women, they also agree that women who are pregnant should not engage in high-intensity interval training.8
*If you do have a client who is new to exercise and wants to take your bootcamp class anyway, we recommend advising her to stay around a 4–6 on the perceived effort scale. Alternatively, she can use the talk test when exercising — she should still be able to hold a conversation, but not be able to sing.
Here’s When They MAY BE Safe…
If your client has been cleared by her doctor and is free of contraindications, then she can likely participate — but there are some questions you should try to ask first that may help you keep her safe.
If at all possible, take five minutes to have a private conversation with your client before class.
In that conversation, ask her about:
- Her pregnancy experience thus far and if she is experiencing any symptoms.
- Her current and previous activity levels.
- If she’s taken bootcamp classes before, and if she’s taken them while pregnant.
- What trimester she is in.
- If she has clearance to exercise from her doctor.
- Any contraindications she may be experiencing that you need to be aware of.
- Any health conditions that may contraindicate exercise.
If any of her answers concern you, you can refer her to a specialist for clearance before she takes your class.
We know that going over these questions in a group setting or pulling a client aside can be hard. If you can’t get through these, it’s OK — but make sure that you do these two things:
- Make sure she has received clearance from her doctor.
- Emphasize the importance of listening to her body.
The key point to take away is that while sometimes bootcamps are not a good idea for women who are pregnant, if you know how to modify your program appropriately (which you’ll learn in a moment), you can most likely make your programs safe and accessible.
But the really exciting part here is that your bootcamp class can be so much more than just safe and accessible! Your class can actually be a super awesome thing for pregnant women to do.
Because women who are pregnant can reap a ton of benefits when they take bootcamp classes.
You already learned the benefits of exercise during pregnancy in general, so let’s take a closer look at exactly why bootcamps are valuable.
Why Bootcamp Classes May Be Awesome for Women Who Are Pregnant
If we assume that bootcamp includes, in general, strength training and high-intensity training (HIT), then there are benefits to be had for each of these components for women who are pregnant — if they have been cleared by their doctor, don’t have any contraindications, and were engaging in high-intensity and high-impact training prior to pregnancy.
The benefits of strength training:
Experts from various professional organizations of obstetricians, gynecologists, and physicians (plus a systematic review of randomized control trials on exercise in pregnancy) concur that training programs that combine aerobic activity and resistance training seem to improve pregnancy outcomes more than aerobic activity alone.3
The benefits of HIT:
According to the American Journal of Obstetrics and Gynecology, in their first pregnancy, women who exercised more than five times per week or reported doing high impact exercise during their pregnancy had lower rates of acute C-section.4
Additionally, Frontiers in Physiology recommends both high- and low-impact exercises for pregnant, continent women who can properly contract their pelvic floor muscles (especially those who are accustomed to higher exercise intensity during pregnancy) as it has been shown to improve the neuromuscular activity of the pelvic floor.5
On top of that, bootcamps…
- Are an efficient use of time. They work most major muscle groups while also giving both a strength and aerobic workout.
- Create an atmosphere of camaraderie and the feeling of “we’re all in this together!” This may be additionally helpful for women who are feeling isolated or alone, or who don’t want to feel like pregnancy is setting them apart from their peers.
- Can be modified or scaled to suit an individual’s ability level — which is crucial when it comes to working with clients who are pregnant.
So essentially, in the right circumstances (and if you do your due diligence and know how to modify your exercises for the client in front of you), bootcamps are an awesome and generally safe source of exercise for women who are pregnant.
If you’re wondering how you’re supposed to modify your bootcamp exercises, keep on reading…
Exactly HOW to Modify Bootcamp Exercises
This section is broken into four parts (by exercise type) so you’ll have the tools to adapt your bootcamp appropriately depending on your chosen programming.
Remember: Always coach the woman in front of you.
Your client’s individual fitness levels and pregnancy experience will need to guide your adjustments. Women who were highly active before pregnancy will probably need fewer adaptations than women who were not highly active, but not always!
Many women will also require specific modifications in their form or training program as their pregnancies progress. We’ve provided trimester-specific exercises within each category, but while these regressions are likely they are not definite, and will vary client by client. You can find more information on adaptations to be made during each trimester here.
1. High-Impact Exercises
High-impact exercises are those that require both feet to be off of the ground at the same time. So box jumps, burpees, sprints, and plyometrics are all considered high-impact. While these are great exercises for women who are not pregnant, they can be problematic during pregnancy for a couple reasons:9
- Risk of falling: Falls are the most common mechanism of injury during pregnancy, with 25–27% of women reporting a fall while pregnant.10, 11, 12 This increased risk of falling has been postulated as being related to: changes in center of gravity, increased body weight, the effects of hormonal changes on ligamentous and muscular function, and changes in proprioceptive function.
- Pelvic floor pressure: High-impact exercise can cause a lot of downward pressure on the pelvic floor, especially in later trimesters when the pressure is in addition to the weight of the baby. This increase in load may lead to pelvic floor dysfunction, such as prolapse and/or incontinence.
In many cases, women will self-regulate when it comes to high-impact exercise because it doesn’t “feel right” anymore or it causes symptoms. However, women who were high-level athletes prior to pregnancy may be able to continue high-impact activity with no issues.
Modifying High-Impact Exercises
If a woman who is pregnant comes to your bootcamp class, especially if she is in her third trimester (or late in her second), the more conservative approach would be to modify her high-impact exercises so that they are low-impact instead. This means she can continue the workout and reap the benefits, but be at less risk for potential issues.
As Amanda Vander Tuig, a Pre- & Postnatal Coaching Certification grad, group fitness instructor, and healthcare professional says: “I give lower-impact versions during demos regardless of presence of pre/postnatal clients.”
This is a fantastic way to make sure you are respecting your client’s privacy while still making sure the class is safe for her to attend (as well as anyone else who may have limitations or concerns!).
For example, if you’re having your class do burpees, you can also demonstrate or recommend a “baby burpee.” Or for box jumps, consider having your client perform alternating step-ups instead so that she keeps one foot in contact with the ground or box throughout the movement.
(Depending on your class, you may also wish to give a more general comment at the beginning of the session about things that all women should look out for during the workout — whether they are pregnant or not and regardless of age. For example, something along the lines of: “When doing the circuit, you shouldn’t feel any heaviness or dragging sensation in your perineum — this may be a sign of prolapse.” This way, your class as a whole will know what to be aware of, and you can help prevent possible injury.)
What to Watch Out For
If you notice that your client who is pregnant is experiencing pain, modifying her form or technique in an odd way, or is exceedingly short of breath (making it hard to speak), then it’s a sign that something is amiss. Head over to your client and check in with her.
Remember, in a group setting you don’t want to make her uncomfortable or sacrifice her privacy, so try gently recommending a modification, taking it from high-impact to low-impact, or from low-impact to a more assisted movement, and watch her complete it. If that doesn’t seem to resolve her symptoms quickly, or if she mentions having pain or another problem, then she should not continue the exercise. Ask her to take a quick water break or perform a gentle stretch while the class finishes up that movement.
Always encourage your client to listen to her body. If something doesn’t feel right or if she’s concerned, uncomfortable, or doesn’t feel safe, she should not continue the class.
The following chart (as well as those in the next three sections) demonstrates exercises, sample symptoms that necessitate a modification, and possible regressions that are likely appropriate depending on your client’s trimester.
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.
2. Strength Training Exercises
There are hundreds of strength training exercises that are appropriate during pregnancy, so if your client is cleared for exercise, she may reap lots of benefits from the strength training components of a bootcamp. 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.
Modifying Strength Training Exercises
When selecting whether or not to modify strength training exercises for your pregnant client, first consider what not to do. There are two things that you should avoid having her do from the start:
- Olympic Lifting: Olympic lifts (such as the barbell snatch and the barbell clean and jerk) and any other lift that requires the bar to move explosively past the midsection should be avoided. While possibly still OK in the first trimester for someone who had already been training with these movements, they may pose a risk of fetal trauma from impact as the pregnancy progresses and the woman’s midsection grows.
- Valsalva Maneuver: The Valsalva maneuver (the act of attempting to exhale with the nostrils and mouth [or the glottis] closed as a way to increase intra-abdominal pressure and intra-thoracic pressure, which can create more trunk stiffness and more stability when attempting to lift something heavy) may not only affect blood pressure, 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.
For other types of resistance exercises, modifications will be dependent on the particular client you are working with and how she is feeling. If she starts experiencing symptoms, make a modification as appropriate.
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 change her technique to see if that reduces or eliminates her symptoms. If it doesn’t, try having her move to the next regression instead. If the regression doesn’t relieve her symptoms, then it’s time to stop.
What to Watch Out For
The strength training exercises that you need to keep an eye out for are those that:
- Cause pain or altered technique to avoid discomfort.
- Cause the abdominal wall to bulge along the midline, whether this is something that you notice or something she points out. (For more information on diastasis recti, check out this article.)
- Keep her in the supine position for a prolonged period of time in later stages of pregnancy or at any point when the position begins causing dizziness, nausea, tingling or numbness, or other symptoms.
- Require a heavy load that may lead to overexertion, poor form, or breath holding.
- May present injury to the abdomen (e.g., snatch, clean).
- Exercises performed at such a high intensity that she can’t speak comfortably.
If you are noticing any of these issues, or your client reports them to you, you can try cueing her on things that she may need to pay more attention to (e.g., breath holding). If that doesn’t work, modify her exercise to try and relieve her symptoms via an adjustment. Keep modifying until she is comfortable or decides to take a break, or the class moves to the next exercise.
3. Core Exercises
Up to a point, core exercises can still be performed by your clients who are pregnant as long as your client feels safe and comfortable while doing them. Exercises like planks, side planks, and Pallof presses are likely fine up until the beginning of the third trimester as long you modify it as needed as the client’s abdomen grows.
Consider the changes that are occurring to the length of the abdominal muscles as the baby grows and how this impacts on the amount of force the muscles can generate — most women will find that their abdominal exercises need to be regressed significantly as the pregnancy progresses.
Modifying Core Exercises
Core exercises will likely need to be modified starting around the middle of the second trimester (though it could also be sooner or later) to help accommodate your client’s growing abdomen. For example, depending on how she’s feeling, planks could be completed on an incline to help reduce the overall load on her abdominal muscles and back, or she could drop both knees and hold a plank in a more supported position.
As the pregnancy progresses, some of the more common exercises that we note become challenging during the later stages of pregnancy include planks, pull-ups, V-ups and crunches. However, as always, this is dependent on that individual.
The other concern with activities like crunches in this period is that the supine position may put pressure on a major blood vessel, which can lead to dizziness and nausea. Instead, she could perform standing crunches, Pallof presses, or straight-arm pull-backs with a band in place of these types of movements. The goal of core modifications here is to prevent an overload of pressure on the abdomen, prevent symptoms, and strengthen the muscles of the trunk while maintaining proper form.
What to Watch Out For
You’ll want to watch for those exercises that both place excessive pressure on the linea alba and cause doming of the abdomen. And of course, if your client is experiencing pain or any pelvic floor symptoms that don’t resolve with a modification, she should not continue with the exercise. The easiest way to avoid this in a bootcamp class is to provide alternate movement examples to the class (you don’t need to call her out as the reason why, but could instead demonstrate two possible movements) so that she can self-adjust if she becomes symptomatic.
4. Cardio Exercises
Cardio exercises are exercises that increase our breathing rate, raise our heart rates, and challenge our cardiovascular systems. While some people link cardio with aerobic activity, aerobic activity is really only one form of cardio. So wall balls, medicine ball slams, kettlebell swings, running, rope slams, jogging, swimming, bootcamp classes… you get it — they all qualify.
There are tons of potential benefits to doing cardio during pregnancy, including improved mood and sleep, possible reduction in hip and back pain, and decreased stress.
There are still a couple of possible risks, though. Cardio exercises that could result in a fall, like skiing, should be avoided during pregnancy so as not to endanger mother or child. Additionally, many cardio exercises are high impact, and you already learned that this can cause some potential health issues, such as pelvic floor dysfunction.
Modifying Cardio Exercises
The main way to modify a cardio exercise for a client who is pregnant is to reduce the intensity or the load. If she’s in her first trimester and running, but running is causing pain or incontinence, reduce the distance or slow her down to a walk. If she’s taking your bootcamp class and is struggling to keep the pace, have her slow down, work toward fewer reps, or modify the exercise to make it a bit easier. Encourage plenty of water breaks so that she stays hydrated and doesn’t overheat, as well.
The general rule here is to modify the exercise if she can’t carry on a conversation (or a few sentences of one, at least) without gasping for air.
What to Watch Out For
Just as with our other exercises, if you notice that your client is struggling, losing form, or excessively out of breath — and modifying the exercise doesn’t relieve this right away — it’s time to stop.
The Challenge of a Group Setting
You probably noticed, in the charts above, the multitude of possible symptoms that your client might struggle with during a bootcamp, but some of the most common ones that coaches need to be aware of and really look out for during a bootcamp class include:
- Pain or aggravation of existing pain.
- Bulging of the abdominal wall, especially along the midline.
- Dizziness, nausea, tingling in legs, or difficulty breathing caused by prolonged exercise in supine in the later stages of pregnancy.
- Breathlessness or overexertion.
- Leaking urine.
- Heaviness or dragging sensation in the perineum.
While you might be able to see some of these symptoms, there are other ones you won’t be able to see. For example, you may not realize that high-impact and cardio exercises are causing your client to leak urine, or that a strength training exercise is giving the sensation of heaviness or dragging in her perineum, but these are signs that her exercise needs modification.
So what do you do?
Courtney Claggett, a kinesiologist, bootcamp instructor, and Pre- & Postnatal Coaching Certification student, has this to say about how to address a possible issue during a group fitness class:
“[If a student was demonstrating signs of discomfort during class], I would subtly approach her to check in and ensure everything is going OK. [I] remind her to work within her pain-free range and without symptoms, and ask if there are any modifications we can try… Listen to the client, they know their body better than you do. They will be able to do a lot more than you expect, but keeping open communication is huge, so they know they can approach you with any concerns.”
As Courtney says and as we discussed earlier, maintaining open lines of communication with your clients who are pregnant (and really, all of your clients!) is vital to making sure your bootcamp classes are safe and accessible.
That’s why we created our Pre- and Postnatal Coaching Certification: so coaches can trainers know exactly what symptoms to watch for, what the symptoms indicate, what they can do to help while staying within their scope of practice, and how exactly they can talk to their clients about these issues — whether they’re in a group fitness class or in a one-on-one session.
But what do you do when something is beyond your scope? Or when you really don’t know what to do?
When to Send Your Pregnant Client to a Health Professional
Our Pre- and Postnatal Coaching Certification students learn the mantra, “When in doubt, refer out!”
Most, if not all, of the symptoms we’ve talked about so far (e.g., leaking urine, pain, feeling of heaviness in the perineum) both contraindicate bootcamp classes and are out of a coach’s scope of practice to manage (beyond the basic exercise modifications). If your client reports any of these symptoms, or you see them, it’s important to make sure she sees a specialist and receives medical clearance before taking a(nother) bootcamp with you.
Look at referrals as an opportunity to raise the standard of care for women: The best coaches know that there’s a balance between taking care of their clients to the best of their ability and knowing when something is beyond their scope. They also know who to send their client to for the best care to help keep them safe and healthy (e.g., pelvic health physio, GP, obstetrician).
Students and graduates of our Pre- and Postnatal Coaching Certification are encouraged (and taught exactly how) to not only to continue building their expertise and competency, but also to develop strong referral networks.
As CPPC grad, personal trainer, group fitness instructor, and clinical exercise physiologist Kathryn Heaslet says:
“I am very lucky to work with two pelvic health physical therapists, and we share patients and refer patients to each other. I am able to provide strength and conditioning coaching with cues and awareness of pelvic floor dysfunction to assist my patients in using the skills they learn in PT in their everyday life to continue to strengthen and relax and improve overall health and wellness, including pelvic health. If I am working with someone who would be a good candidate for pelvic PT, I am able to get them in to be seen… Make sure women know that pelvic floor symptoms may be common, but [they] are not normal and that there are resources out there to help them.”
Your referral network can put you in a unique position to support your clients and grow your business — if you know how to do it right.
Want to Make a Difference in the Lives of Your Pregnant Clients and Patients?
Then it’s time to set yourself apart from other coaches and trainers by gaining the knowledge and tools you need to make real, lasting change in the lives of your clients — all while keeping your bootcamps exciting, fun, challenging, and safe!
Consider taking the next step with us and checking out our GGS Pre- & Postnatal Coaching Certification.
We’ll teach you exactly how to answer client questions, help you obtain an even better understanding of what they’re going through, and give you hundreds of pages of evidence-based information to keep at your fingertips.
Our team of experts (including PhDs, pelvic health physios, OB/GYNs, and pre- and postnatal fitness experts) created this cutting-edge, evidence-based, comprehensive curriculum to teach health and fitness professionals exactly how to confidently coach pre- and postnatal women and keep them safe, healthy, and strong — both during and after pregnancy. You won’t find anything like it anywhere else.
Enrollment opens again soon! Just click this link to join our free, no-obligation pre-sale list. Joining the pre-sale list gives you the chance to enroll early and save up to 33% off the general public price.
If you’re a health, fitness, or nutrition professional (or you want to be)…
Learning how to coach your pre- and postnatal clients, patients, friends, or family members so that they can feel healthy and strong through pregnancy and beyond is both an art and a science.
If you’d like to learn more about both, consider enrolling in our Pre- and Postnatal Coaching Certification, which opens for enrollment VERY soon.
Our Pre- and Postnatal Coaching Certification is the most respected coaching certification in the world for working with pregnant and postpartum women
If you’re like most of the folks who enroll in our certification, you’re probably aware — maybe from personal experience — there’s a serious gap in high-quality, well-vetted, up-to-date information about helping pre- and postnatal women.
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