You’re helping participants get set up on their bikes in your 6 p.m. cycling class when someone taps you lightly on the shoulder: Is it okay to ride if she’s pregnant? To your knowledge, you’ve never had a pregnant participant in class, and you don’t know how to respond.
So, what is the right answer? That will vary, of course, depending on the woman’s specific circumstance, including what trimester she’s in and if she has clearance from her doctor. But the short answer is yes. Evidence is strong that prenatal exercise is essential, and indoor cycling continues to be one of the most effective, motivational and inclusive group exercise options.
There are things to consider, however, before you give the green light. Instructors must screen participants, consider the latest research, educate themselves on what to expect, be aware of contraindications and know when to recommend alternatives. The newly published 2019 Canadian Guideline for Physical Activity Throughout Pregnancy—the product of an extensive, systematic review of the literature, expert opinion and end-user consultation for prenatal fitness training—provides “evidence-based recommendations regarding physical activity throughout pregnancy in the promotion of maternal, fetal and neonatal health” (CSEP 2019).
Here are some of the key messages and recommendations to support and promote prenatal fitness participation in your indoor cycling classes.
An Overview of the Recommendations
First and foremost, make sure your prenatal cyclists have been screened by their healthcare provider prior to participating in your class. The American College of Obstetrics and Gynecology recommends “a thorough clinical evaluation . . . before recommending an exercise program” (ACOG 2015).
When you have the approval form in hand, review the participant’s current training, check for contraindications or risks, and keep caregiver contacts on file. Check with your group fitness manager to make sure you’ve taken any other steps your facility requires.
It’s also helpful, though not mandatory, to be familiar with the pregnancy journey when teaching prenatal participants. It’s good to have a base understanding of trimester milestones, the realities of pregnancy and how the pregnant woman is feeling. The books What to Expect When You’re Expecting (Workman Publishing 2016) and Exercising Through Your Pregnancy (Addicus Books 2012) are both good resources, and it’s not a bad idea for facilities to keep in-house copies as a resource.
Additionally, note these exercise guidelines:
- It is safe and encouraged for pregnant women who do not have any contraindications to be physically ac┬¡tive throughout pregnancy.
- To achieve clinically meaningful health benefits and reductions in pregnancy complications, pregnant women should strive to accumulate at least 150 minutes of moderate-intensity physical activity each week.
- Physical activity should be accumulated over a minimum of 3 days per week; however, being active every day is encouraged.
- Incorporating a variety of cardiovascular and resistance training activities will produce greater benefits.
(Source: Mottola et al. 2019.)
Parameters for cardiovascular intensity are dictated by the participant’s age and fitness level. For beginners between 20 and 39 years old, 128–144 beats per minute is the target; intermediate riders can shoot for 130–150 bpm; and advanced participants may go to 135–160 bpm (CSEP 2006). If using the Borg Scale of Perceived Exertion, aim for 12–14, which is fairly light to somewhat-hard intensity (ACOG 2015). Alternatively, use the talk test, which may be ideal; if the participant is able to have a continuous conversation, this indicates an appropriate training intensity (Reed & Pipe 2014).
See also: Abdominal Separation and the Female Core
When to Shift Gears
As a pregnancy progresses, symptoms can worsen and cycling may become contraindicated. The body’s movement patterns usually shift significantly during the middle of the second trimester or the start of third, but it can happen earlier for women who have had previous pregnancies (Catena et al. 2019). Joint laxity can become a factor (Calguneri, Bird & Wright 1982).
Gait patterns will dramatically change, along with basic functional movements such as squats, lunges, pulls, presses and one-limb balance moves. As core stabilizers become overloaded and stretched, the pelvis relaxes and widens, front load increases and hips externally rotate, all of which can affect indoor cycling.
While group fitness instructors don’t usually assess participants, you can encourage your pregnant attendees to self-assess or work with a personal trainer in your facility (or book time with you if you’re also certified as a trainer).
If the class member is self-assessing at home, share this quick drill, which can be performed in front of a mirror. Alternatively, you can arrange to meet 5–10 minutes before class to take her through the process. Do the following:
- 10 squats
- 10 lunges
- 10 pushups (off wall or step)
- 10 seated rows (scapular stabilization and movement)
- 10-second one-leg stand on each leg
Alignment of the ankles, knees and hips should be maintained during most exercises. Squats will be wider and more externally rotated as she progresses from the first trimester to the third. The spine should remain stable throughout all moves. Trouble areas include pronated collapse in the standing foot, valgus collapse of the knee(s), internal rotation of the moving or standing hip, anterior pelvic tilt, exaggerated head flexion and/or a kyphotic posture (Chu et al. 2019; Catena et al. 2019; Pauk & Swinarska 2018).
These errors can sometimes be corrected by cuing correct weight placement in the standing foot; neutral pelvis; gluteal, core and scapular stabilization; head neutralization; and diaphragmatic breathing.
See also: Functional Fitness for Pregnancy
Common Discomforts: Quick Reference List
The following is a partial list of common symptoms pregnant cyclists might encounter. Many of these will directly affect one’s ability to ride on any given day.
- morning (or all-day) sickness, nausea
- shortness of breath
- weight gain
- constipation, hemorrhoids
- varicose veins
- swollen and sore joints
- muscle cramps
- pelvic floor weakness
- urinary incontinence
- low self-esteem
- anxiety, mood swings
- breast tenderness
- round/broad ligament pain
- shin splints
- lordosis, kyphosis
Sources: ACOG 2015; HHS 2019; Pauk & Swinarska 2018; Young 2015.
Stopping the Cycle
If the participant struggles to maintain neutral alignment and/or good biomechanics, then it’s time to get off the bike and do other forms of exercise.
While the ACOG screening that the participant does with her caregiver will indicate any absolute or relative contraindications to cardiovascular exercise during pregnancy, be aware of when to suggest a different type of training. Below are specific areas of concern for pregnant cyclists:
- Pelvic realignment (pelvic widening and/or a symphysis pubis shift) in mid to late pregnancy can increase pelvic floor pressure when seated on the bike. Note that weak pelvic floor muscles may increase the risk of preterm labor (Aran et al. 2018).
- Hip mechanics shift into an externally rotated position, making proper sagittal-
plane tracking problematic for hips, knees and ankles. This may create joint pain or swelling (Catena et al. 2019).
- Decreased core stability—due to increased front load and overstretched stabilizers—can stress the sacral/lumbar spine. A lordotic posture can lead to sciatica, numbness and decreased leg power.
- Prolonged handgrip and load on handle bars can cause pressure on the wrist, radial and ulnar nerve and increase risk of carpal tunnel syndrome (Akuthota et al. 2005).
- Cycling’s forward flexed position promotes a kyphotic posture, which is compounded by increased breast and abdominal weight and size. This position may also worsen neck and shoulder pain.
- Gastrocnemius and plantar muscles cramping/pain are common due to increased front load for prolonged periods. Cycling can exacerbate this type of cramping and trigger tendinitis.
- Resting heart rate, blood volume and blood pressure change throughout pregnancy. Encourage prenatal participants to do longer warmups and cooldowns to avoid overheating, and recommend that they monitor their heart rate (Soultanakis-Aligianni 2003).
When the Answer Is No
If the answer to “Can I ride while pregnant” is no—for any reason—there are other ways to safely stay active. Recommend low-impact, partial or non-weight-bearing activities that do not involve quick directional change or ballistic motion. Options include strength training, balance work, mobility, flexibility, relaxation training, pool conditioning or resistance training. Even if your attendees have to take a break from indoor cycling in late pregnancy, they can cross-train, remain fit and return to cycling after they give birth.
Be sure to keep an open dialogue and ask for updates throughout the pregnancy. Review screening prior to participation, regularly watch for faulty movement mechanics and solidify a plan once cycling is no longer suitable. When in doubt, refer the participant to her caregiver. Help women embrace the benefits of fitness during pregnancy and respect their limitations in late pregnancy.
Akuthota, V., et al. 2005. The effect of long-distance bicycling on ulnar and median nerves: An electrophysiologic evaluation of cyclist palsy. American Journal of Sports Medicine, 33 (8), 1224–30.
ACOG (The American College of Obstetrics and Gynecology). 2015. Physical activity and exercise during pregnancy and the postpartum period. Accessed July 8, 2019: acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Physical-Activity-and-Exercise-During-Pregnancy-and-the-Postpartum-Period?IsMobileSet=false.
Aran, T., et al. 2018. Association between preterm labour and pelvic floor muscle function. Journal of Obstetrics and Gynaecology, 38 (8), 1060–64.
Calguneri, M., Bird, H.A., & Wright, V. 1982. Changes in joint laxity occurring during pregnancy. Annals of the Rheumatic Diseases, 41 (2), 126–28.
CSEP (Canadian Society for Exercise Physiology). 2015. PARmed-X for pregnancy. Accessed July 8, 2019: csep.ca/CMFiles/publications/parq/parmed-xpreg.pdf.
CSEP. 2019. 2019 Canadian Guideline for Physical Activity throughout Pregnancy. Accessed July 8, 2019: csepguidelines.ca/wp-content/uploads/2018/10/4208_CSEP_Pregnancy_Guidelines_En_P2A.pdf.
Catena, R.D., et al. 2019. Stand-to-sit kinematic changes during pregnancy correspond with reduced sagittal plane hip motion. Clinical Biomechics, 67, 107–14.
Chu, S.R., et al. 2019. Pregnancy results in lasting changes in knee joint laxity. PM&R, 11 (2), 117–24.
HHS (U.S. Department of Health and Human Services). 2019. Body changes and discomforts. Accessed July 9, 2019: womenshealth.gov/pregnancy/youre-pregnant-now-what/body-changes-and-discomforts.
Jensen, D., et al. 2007. Effects of human pregnancy and advancing gestation on respiratory discomfort during exercise. Respiratory Physiology & Neurobiology, 156 (1), 85–93.
Krkeljas, Z. 2018. Changes in gait and posture as factors of dynamic stability during walking in pregnancy. Human Movement Science, 58, 315–20.
Mottola, M.F., et al. 2018. 2019 Canadian Guideline for Physical Activity Throughout Pregnancy. Journal of Obstetrics and Gynaecology Canada, 40 (11), 1549–59.
Pauk, J., & Swinarska, D. 2018. The impact of body mass on spine alterations in pregnant women: A preliminary study. Technology and Health Care, 26 (S2), 665–69.
Reed, J.L., & Pipe, A.L. 2014. The talk test: A useful tool for prescribing and monitoring exercise intensity. Current Opinion in Cardiology, 29 (5), 475–80.
Soultanakis-Aligianni, H.N. 2003. Thermoregulation during exercise in pregnancy. Clinical Obstetrics and Gynecology, 46 (2), 442–55.
Young, G. 2015. Leg cramps. BMJ Clinical Evidence. pii: 1113.