Training Clients during Pregnancy—Modifications and Considerations

by Stephanie Paplinskie, MA
Personal Training Quarterly May 2019
Vol 6, Issue 1


Personal trainers should be aware of the physiological changes during pregnancy for each trimester in order to provide appropriate exercise modifications and alternatives for their prenatal clients, to positively influence overall health.


Pregnancy is an incredibly unique time in a woman’s life and brings about a multitude of physiological and psychological changes to the mother in each trimester. Trimesters refer to the stages of pregnancy and are broken down into three parts: the first trimester spans weeks 1 – 12, the second trimester spans weeks 13 – 27, and the third trimester spans weeks 28 – 40. During these trimesters, pregnant women experience musculoskeletal structure changes and adaptations, decreased glucose sensitivity, hormonal changes, and gestational related weight gain. Additionally, pregnancy can sometimes be associated with a number of possible negative health outcomes for the mother, including but not limited to: morning sickness, gestational diabetes mellitus, gestational hypertension, preeclampsia, and depressive symptoms. Consequently, these conditions pose challenges that might impede a woman’s ability to participate in physical activity; however, exercise is considered to be a primary means of preventing negative health outcomes (8). Resistance training, alone and in combination with aerobic activity, has been associated with a multitude of health benefits to the mother and growing fetus during pregnancy, including: improved blood glucose regulation, improved oxygen and nutrient transport, improved sleep, decreased depressive symptoms, weight management, and fewer newborn complications. Despite the benefits, less than 15% of women are actually meeting the recommended pregnancy exercise guidelines of 150 min of moderate physical activity per week (5).

Personal trainers are in a unique position to assist prenatal women on how to begin or continue with an exercise program in order to meet the world consensus on physical activity recommendations during pregnancy, as well as guide women safely through their workouts (4). In order to do this effectively, personal trainers should be aware of the physiological changes at each trimester in order to provide appropriate exercise modifications and alternatives for their prenatal clients.

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This article originally appeared in Personal Training Quarterly (PTQ)—a quarterly publication for NSCA Members designed specifically for the personal trainer. Discover easy-to-read, research-based articles that take your training knowledge further with Nutrition, Programming, and Personal Business Development columns in each quarterly, electronic issue. Read more articles from PTQ »



1. American College of Obstetricians and Gynecologists. ACOG Committee opinion No. 650: Physical activity and exercise during pregnancy and the postpartum period. Obstetrics and Gynecology 126(6): e135-142, 2015.

2. American College of Obstetricians and Gynecologists. ACOG Committee opinion No. 548: Weight gain during pregnancy. Obstetrics and Gynecology 121: 210-212, 2013.

3. Davenport, MH, Charlesworth, S, Vanderspank, D, Sopper, MM, and Mottola, MF. Development and validation of exercise target heart rate zones for overweight and obese pregnant women. Applied Physiology and Nutrition Metabolism 33(5): 984-989, 2008.

4. Evenson, KR, Barakat, R, Brown, WJ, Dargent-Molina, P, Haruna, M, Mikkelsen, EM, et al. Guidelines for physical activity during pregnancy: Comparisons from around the world. American Journal of Lifestyle Medicine 8(2): 102-121, 2014.

5. Mottola, MF, Davenport, MH, Ruchat, S, Davies, G, Poitras, V, Gray, CE, et al. Canadian guideline for physical activity throughout pregnancy. British Journal of Sports Medicine 52(21): 1339-1346, 2018.

 6. Runge, SB, Pedersen, JK, Svendsen, SW, Juhl, M, Bonde, JP, and Nybo Andersen, AM. Occupational lifting of heavy loads and preterm birth: A study within the Danish national birth cohort. Occupational and Environmental Medicine 70(11): 782-788, 2013.

7. Schoenfeld, B. Resistance training during pregnancy: Safe and effective program design. Strength and Conditioning Journal 33(5): 67-75, 2011.

8. Smith, KM, and Ziel, E. Special populations: Training the pregnant client. Strength and Conditioning Journal 39(4): 49-54, 2017.

9. Swank, AM, and Hagerman, P. Resistance training strategies during pregnancy. Resistance Training for Special Populations 17: 345-365, 2009.

10. Weiss, M, Nagelschmidt, M, and Struck, H. Relaxin and collagen metabolism. Hormone and Metabolic Research 11(6): 408-410, 1979.

11. Wolfe, L, and Mottola, MF. Physical activity readiness medical examination for pregnancy: PARmed-X for pregnancy. Canadian Society of Exercise Physiology & Health Canada 2002.

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Stephanie Paplinskie, MA, CSCS

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Stephanie Paplinskie is a prenatal and postpartum fitness specialist, entrepreneur, professor, student, and business owner. With over nine years of ex ...

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