Adapting Physical Activity for Antenatal and Postnatal Clients (2026 sample manual)

Manual
Adapting Physical
Activity for Antenatal
and Postnatal Clients
Version AIQ007239

Section 1
Benefits, barriers and concerns for antenatal and postnatal clients to participate in physical activity
Government guidance on
physical activity in pregnancy
The UK Chief Medical Officers (CMO) have published
a clear, evidence-based infographic highlighting the
benefits of physical activity during pregnancy and
offering simple, practical guidance. This resource
is useful for fitness professionals and encourages
the individual to aim for at least 150 minutes of
moderate-intensity activity per week, even if starting
gradually.
The infographic also reinforces key safety messages,
such as:
• Every activity counts.
• Listen to your body and adapt.
• Include muscle-strengthening activities twice
a week.
• Avoid activities that may cause trauma to the
abdomen (‘Don’t bump the bump’).
Barriers and concerns of
physical activity for antenatal
and postnatal clients
Engaging in physical activity during pregnancy and after
birth is both safe and beneficial for most individuals
with a healthy, uncomplicated pregnancy. According to
the Royal College of Obstetricians and Gynaecologists
(2022), when exercises are appropriately selected,
adapted and carried out with attention to safety and
individual circumstances, there is no evidence to
suggest increased risk of miscarriage, low birth weight
or early delivery.
Despite this, many antenatal and postnatal clients
experience a range of physical, emotional and social
barriers that may influence their ability or willingness
to be active. These barriers are often unique to the
perinatal period and may not be encountered with
other client groups.
It is important for fitness professionals to be able to
identify and respond to these barriers appropriately.
While in many cases the aim may be to adapt and
support continued participation in physical activity,
during pregnancy it is equally important to consider
whether certain barriers indicate a need to pause
activity, modify the approach or seek medical guidance.
Not active?
Start gradually
Physical activity for women
after childbirth (birth to 12 months)
Time for yourself -
reduces worries and
depression
Improves fitness
Out and about
Start
pelvic floor
exercises as
soon as you can
and continue daily
It’s safe to be active.
No evidence of harm
for post partum
women
aim for
at least
150
minutes
of moderate intensity activity
every week
Depending on your
delivery listen to
your body and
start gently
Helps to control weight
and return to prepregnancy
weight
Improves mood
Home
UK Chief Medical Officers’ Physical Activity Guidelines, 2019
Improves tummy
muscle tone and
strength
Improves sleep
Active before?
Restart gradually
Leisure
Build
back up
to muscle
strengthening
activities twice
a week
You can be active
while
breastfeeding
Figure 1.1 Government guidelines for physical activity for antenatal and postnatal clients
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Section 2
Physiological and biomechanical changes that take place during pregnancy and the postnatal period
Pelvic floor muscles and pregnancy
The pelvic floor muscles form a sling-like structure supporting the uterus, bladder and bowel. These muscles wrap
around the urethra, vagina and anus, maintaining control over urinary and bowel functions, and contributing to
posture and pelvic stability.
During pregnancy, these muscles are under increased strain due to the growing uterus and hormonal changes
(especially relaxin), which increases tissue laxity.
Figure 2.10 Pelvic floor anatomy
Top tip
As the uterus grows, it places more pressure on the bladder and pelvic floor, which can make pregnant
clients feel the need to urinate more frequently.
Always ensure that physical activity sessions are held in locations with easy access to a toilet – this helps
clients feel more comfortable, confident and in control during exercise.
As pregnancy progresses, the extra load from the baby,
combined with softened tissues, may lead to pelvic
floor dysfunction. This can lead to urinary incontinence
(leaking urine during coughing, sneezing or exercise),
constipation, haemorrhoids and in some cases pelvic
organ prolapse (where pelvic organs shift downward).
Evidence insight:
Recent systematic reviews indicate that pelvic
floor muscle training (PFMT) and general prenatal
exercise can improve pelvic floor outcomes —
for example, PFMT during pregnancy has been
shown to reduce the odds and symptom severity
of urinary incontinence both during pregnancy
and postpartum compared with no exercise
(British Journal of Sports Medicine, 2020).
During labour and birth, the pelvic floor must relax
significantly to allow the baby to descend through
the birth canal. Although relaxin helps to improve the
elasticity of these muscles, a strong but flexible pelvic
floor is still required to support the baby’s turning and
descent, reduce the risk of tearing and promote better
postnatal recovery.
Figure 2.11 Baby growing in the womb
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SECTION
SUMMARY Section 3
The following symptoms require physical activity to stop immediately:
• Vaginal bleeding.
• Reduced foetal movements.
• Painful or regular contractions.
• Amniotic fluid leakage.
• Severe pelvic pain.
• Headache.
• Shortness of breath prior to exertion.
• Dizziness, faintness or
visual disturbance.
• Chest pain or palpitations.
• Muscle weakness affecting
balance.
• Swelling, redness or pain in the calf (sign of DVT).
Signs of pelvic floor
dysfunction:
❯ Leaking urine during
exercise, coughing or
sneezing.
❯ Heaviness, dragging or
bulging in the vagina
(possible prolapse).
❯ Difficulty controlling bowel
movements.
❯ Passing wind involuntarily.
Signs of abdominal wall
dysfunction (diastasis
recti) may include:
❯ A visible doming along the
midline when moving.
❯ Reduced core control or
lower back pain.
Absolute contraindications
❯ Significant heart disease impacting function
(hemodynamically).
❯ Restrictive lung disease.
❯ Cervical insufficiency (incomplete) or cerclage.
❯ Multiple pregnancy with risk of preterm labour.
❯ Persistent second/third trimester bleeding.
❯ Placenta previa after 28 weeks gestation.
❯ Preterm labour during current pregnancy.
❯ Ruptured membranes.
❯ Pre-eclampsia or pregnancy-induced hypertension.
❯ Severe anaemia.
❯ Uncontrolled severe medical diseases e.g.,
uncontrolled type 1 diabetes, uncontrolled
thyroid disease, uncontrolled hypertension and
uncontrolled seizure disorder.
❯ Intrauterine growth restriction.
Relative contraindications
❯ Mild to moderate anaemia.
❯ Unelevated maternal cardiac arrhythmia.
❯ Chronic respiratory conditions (e.g. bronchitis).
❯ Severe obesity (BMI >40).
❯ Underweight (BMI <16).
❯ History of extremely sedentary lifestyle.
❯ Malnutrition.
❯ Twin pregnancy after 28 weeks.
❯ Orthostatic hypertension.
❯ Heavy smoking.
❯ Recurrent pregnancy loss.
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37

Section 8
Designing an individualised, safe and effective physical activity programme for an antenatal and postnatal client
Guidelines for flexibility
FITT
Frequency
and time
Intensity
Time and
type
Guidelines
At least 2–3 times per week and on days when
most active and participating in physical activity.
Stretching to the point of feeling tightness or slight
discomfort is encouraged, but not pain.
Static stretches for 10–30 seconds.
Dynamic stretches for 8–10 repetitions.
Table 8.3 FITT guidelines for flexibility
Both control and relaxation are important when
stretching. Maintenance of normal range of movement
is advised for all major muscle groups. Some muscle
groups warrant particular attention during pregnancy,
such as the pectorals, hamstrings, adductors, hip
flexors, calves and lower back muscles, because of
the biomechanical changes that are taking place. Care
should be taken not to overstretch to avoid soft tissue
tears and hyperextension, because of the effects
of relaxin. Developmental and advanced stretching
techniques, such as PNF and ballistic stretching should
be avoided during pregnancy and in the postnatal
period, and longer if the client is breastfeeding.
As a result of the centre of gravity changes, in the
second and third trimesters, seated, kneeling and
supported standing stretches are advised. If partnerassisted
stretches are to be performed, care must
be taken not to push joints into an extreme range of
motion.
Selecting appropriate
activities
Physical changes will occur to varying degrees
for different clients. Each pregnancy, even for the
same client, can vary in the degree of physiological
and biomechanical changes and symptoms that
take place. Table 8.4 shows a number of suggested
modifications to be made in each trimester and the
postnatal period, to ensure that both mother and baby
are exercising safely and effectively.
74
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Designing an individualised, safe and effective physical activity programme for an antenatal and postnatal client
Section 8
Core and functional training
In order to prevent lower back pain, due to weakened
abdominals, it is important to programme muscular
strength and endurance exercises for antenatal and
postnatal clients. It is also common for clients to want to
maintain their abdominal musculature and physique during
and after childbirth. Appendix 4 outlines appropriate core
training exercises.
The same list of exercises can be used for postnatal clients,
once they have been cleared for exercise and after their
postnatal check-up.
Top tip
A wide range of cable, resistance band and
suspension training exercises can be utilised
to activate the core muscles for antenatal and
postnatal clients. For example:
• Resistance band wood chops, chest press,
back rows.
• Suspension inverted rows, chest press,
triceps press.
• Cable machine wood chops, chest press,
one-arm row.
KEY POINT
If diastasis recti and pelvic floor dysfunction present, avoid spinal flexion or uncontrolled rotation
against gravity, such as supine crunches, sit-ups and Russian twists. This is to avoid ‘doming’ and
further weakening the linea alba and abdominal wall. Anything that makes the stomach bulge will
further weaken the area and prevent rehabilitation. If the client’s stomach ‘bulges’ when performing
exercises such as a plank, avoid these exercises until the abdominal separation has decreased to a
normal range.
Rehabilitation of diastasis recti
For the abdominal wall to ‘knit’ back together in the postnatal period, core exercise should focus on the following:
• Avoid any exercises that encourage the belly to push out. Instead, encourage the abdominals to pull in as if
having a ‘corset’ effect on the core muscles, while breathing in a controlled manner.
• Avoid holding the breath when abdominals are in a contracted position.
• The abdominals can be contracted in a four-point kneeling position or a supine position for exercises such as
hip bridges, knee raises and pelvic tilts.
Adapting physical activity for antenatal and postnatal clients
Functional exercises
The role of any parent is both active and varied; an antenatal and
postnatal client will need to be ‘functionally fit’ to participate in
the many activities of daily life (ADLs) that they will be required to
do as a mother. Designing programmes that mimic the real-life
tasks that a mother must carry out every day, such as bending
and carrying, bathing, pushing a buggy and putting their baby
in a car seat, will prepare their body for these tasks and help to
prevent injury in the process.
In addition, to prepare for the baby’s delivery, functional training can be employed to train a prenatal client for the
demands of labour. Providing that the ACSM’s guidelines for aerobic exercise prescription are used as a guide, aerobic
interval training can be used to mimic the demands of labour, as both contractions and ‘pushing’ will come in waves.
Intervals of one-minute work and one-minute active recovery are suggested timings for aerobic training during the main
component. The number of intervals can be increased to progress within the ACSM guidelines for exercise duration.
Appendix 5 details a selection of exercises that mimic ADLs for both antenatal and postnatal clients.
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&Exercise prescription for
antenatal and postnatal clients will require careful
PLANNING
MODIFICATION
as a result of the physical changes that are taking place.
Safe to exercise
Managing risk
High
MEDIUM
HIGH
CRITICAL
THREAT
LEVEL
PROBABILITY
Medium
LOW
MEDIUM
HIGH
Low
LOW
LOW
MEDIUM
Low
Medium
High
IMPACT
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Appendix 5
ADL
Pushing buggy
Exercise selection
(prowler push).
Alternative
Suspension training
chest press.
Twisting to check
child is OK in back
car seat
(medicine ball
‘controlled’ wood
chop).
Alternative
In later stages of
pregnancy, and if
diastasis recti presents,
then a resistance band
horizontal wood chop
would be appropriate.
Placing child in and out
of car seat – push–pull
(kneeling push up and
one-arm row).
Alternative
In the early stages of
pregnancy, a bent-over
row would be appropriate.
92
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