One on One

The One-On-One Column provides scientifically

supported, practical information for personal trainers
who work with apparently healthy individuals or
medically-cleared special populations.
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COLUMN EDITOR: Paul Sorace, MS, RCEP, CSCS*D

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Guidelines and
Practical Tips for
Training the Prenatal
Client
Erica Ziel, BS1 and Katie M. Smith, PhD, RDN, LD2
1
Knocked-Up Fitness and Core Athletica Inc., Ankeny, Iowa; and 2Department of Sport Science and Health Education,
Simpson College, Indianola, Iowa

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided
in the HTML and PDF versions of this article on the journal’s Web site (http://journals.lww.com/nsca-scj).

ABSTRACT
PRENATAL AEROBIC AND RESIS-
TANCE TRAINING CAN HAVE
TREMENDOUS BENEFITS FOR
MOTHER AND CHILD, IMPROVING
DELIVERY AND POSTPARTUM
RECOVERY. DAILY MOVEMENTS TO
ENCOURAGE DEEP CORE
STRENGTHENING, EMPHASIZING
THE IMPORTANCE OF POSTURE,
AND AVOIDING EXERCISES THAT
CAUSE DISCOMFORT MAY MINIMIZE
COMMON AILMENTS OF PREG-
NANCY MEANWHILE IMPROVING
MOBILITY OF DAILY FUNCTION. A
VIDEO ABSTRACT OF THIS ARTICLE
CAN BE FOUND IN VIDEO, SUPPLE-
MENTAL DIGITAL CONTENT 1,
HTTP://LINKS.LWW.COM/SCJ/A218.
Address correspondence to Katie M. Smith,
katie.smith@simpson.edu.
regnancy can bring about a vari-
P ety of changes that will require
modification and adjustment of
workouts as the pregnancy progresses
but including both aerobic and resis-
tance training can bring about tremen-
dous benefits for both mother and
child (18–19). Appropriate modifica-
tions and emphasizing deep core
strengthening, while avoiding certain
movements, will better prepare your
client for pregnancy, delivery, and the
functional and physical demands of
motherhood.
Before beginning any exercise sessions
with a prenatal client, it is recommen-
ded the exercise professional (EP)
has written permission from her phy-
sician, along with asking the following
questions:
 How far along is her pregnancy
(how many weeks)?
 How many pregnancies has she had
in the past? If any, how old are her
other birth children?
 Was she on bed rest or limited activ-
ity any time during the current or
previous pregnancy?
 What types of exercise is she inter-
ested in and has she previously
engaged in (weight training, pi-
lates, yoga, high intensity, low
intensity, spinning, running, cross-
fit, etc.)?
 Does she have a history of miscar-
riages, surgeries, chronic pain, scoli-
osis, etc.?
 Is she currently experiencing any
discomfort?
 Does she have diastasis recti (see
Diastasis Recti section)? Umbilical
hernia? Pelvic organ prolapse?
Incontinence daily or with force
(coughing, sneezing, jumping)?

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 One on One

The more that is known about the pre-
natal client’s current health and health
history the better because a specific pro-
gram can be created. Create a workout
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awareness.” Include exercises she will pain, especially if she already has
(or may) not be able to do later on in another young child.
the pregnancy such as back strength- Tips:
ening exercises in the prone position,  Ask how she spends her days, (sitting,

that is more than just a workout but full range of motion lunges and var- standing, or slouched over) and
also creates balance throughout the iations, planks and variations, and encourage her to change positions
body. Provide take home tips that the core exercises. often, get up from sitting, and do
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client can perform throughout the day,
such as “stand or sit tall”; such simple
little tips can help carry out
the techniques taught in the exercise
sessions and apply them to daily life.
Start each session by asking how she is
feeling; some days she may feel much
better than others, and adjust the work-
out accordingly. Although it is important
to work on increasing strength during
the first trimester (described in the next
section), it is also important to help the
client feel her best. The client should
leave feeling better than she was when
she walked in. If she is more exhausted
when she finishes a workout session that
indicates intensity or duration or both
may be too high. Each and every exer-
cise must serve a purpose, and if it does
not feel good for that day, or for a longer
period even after the appropriate mod-
ifications, move on to other exercises.
PRENATAL EXERCISE GUIDELINES
During the first trimester, it is impor-
tant to focus on strength, helping her
find her deep core connection, creat-
ing good posture, and teaching “body
It is recommended that prenatal
women exercise most days, if not every
day of the week for approximately
30 minutes or (1) even up to an hour,
(5) at a moderate intensity; using the
talk test to determine intensity, she
should be able to carry on a light con-
versation; if she can hardly speak, she is
working too hard and the intensity
should be decreased (1). Include resis-
tance training, as research has shown
resistance training and aerobic exercise
to be more beneficial than just aerobic
exercise on its own, specifically noting
a significant decrease in gestational dia-
betes and hypertensive disorders (18). It
is important to understand the absolute
and relative contraindications to exer-
cise for your prenatal clients (See Tables
2 and 3 in the complimentary Special
Populations column “Training the Pre-
natal Client”). For specific exercise pre-
scription recommendations using the
frequency, intensity, time, type (FITT)
principle, see Table 1 of this column.
ENCOURAGE GOOD POSTURE
Encourage good posture and proper
lifting to prevent and minimize back
a short set of squats or walk around.
 Remind her to lightly activate her
deep core throughout the day, by
standing tall and lifting through the
top of her head and avoid locking
her knees.
 Properly pick things up and avoid
lifting with her back. Lunges and
squats are good exercises for teach-
ing proper techniques for picking up.
DIASTASIS RECTI
Diastasis recti is the separation of the
rectus abdominals, specifically wid-
ening of the connective tissue, the
linea alba (9). Pregnancy creates tre-
mendous stretch on both the skin
and fascia of the abdomen, and
women older than 45 years appear
more likely to experience more severe
diastasis recti (9). There is a lot of mini-
mizing of diastasis recti that can be done
for the prenatal client.
These suggestions could help in pre-
venting and minimizing separation:
 Avoid supine forward flexion (11)
once in the second trimester or
sooner if there is coning of the

Table 1
Using the FITT principle during pregnancy

Aerobic Resistance
Frequency 3–5 d/wk 2–3 d/wk
Intensity Moderate exercise, RPE 12–13; Vigorous exercise, RPE 8–10 repetitions or 12–15 repetitions at a submaximal intensity
14–17 to a point of moderate fatigue
Time 30 min/d, totaling $150 min/wk of moderate- One set for beginners, 2–3 sets for experienced women;
intensity exercise or 75 min/wk of vigorous
intensity exercise
Type Weight-bearing and non–weight-bearing activities Variety of machines, free weights, and body weight exercises
such as walking, swimming, group exercise, and such as squats, lunges, seated rows; target all major muscle
hiking groups
American College of Sports Medicine, ACSM’s Guidelines for Exercise Testing and Prescription, 10th ed, Wolters Kluwer, 2017 (15).

RPE 5 rating of perceived exertion.

56 VOLUME 39 | NUMBER 4 | AUGUST 2017

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  If her belly feels really tight (most
common with first pregnancies),
have her practice relaxing her belly
(Figure 1) to allow the abdominal
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muscles and skin to stretch.

 To transition to lying on her back,
teach her to start on her side, then
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roll to her back. This can greatly

decrease the intra-abdominal pres-
sure. To transition from a supine
position to an upright position, teach
her to roll to either side to get up
Figure 1. Relaxed belly position and deep breathing. Include this relaxed belly from her back or out of bed. It is
position and deep breathing to help relieve low back pain, improve good to practice getting up from
oxygenation and breathing, and allowing for relaxation of the deep core both sides to minimize creating im-
muscles. This is particularly important in the third trimester. balances. If she is feeling the need to
rest, or is feeling lightheaded, recom-
mend to lie down on her left side to
belly. This holds true for any exercise aration or at least widening and thin- avoid compression of the inferior
that creates any coning effect of the ning of the linea alba. vena cava and decreased blood flow
belly. The pregnant belly should be  Focus on strengthening the deep core to the heart.
smooth and round in the center; muscles (see section on Deep Core– It is important to understand that
coning is when you see a slight bulg- Focused Strengthening), along with strengthening the deep core by stim-
ing in the midline of the belly, this good lengthened posture for each ulating fascia in the abdominal wall
could indicate that there is some sep- exercise. plays a big role in helping to mini-
mize diastasis recti during pregnancy
and promotes easier healing postpar-
tum (9). Even if she has previously
experienced diastasis recti or already
has diastasis recti, further separation
can be minimized by strengthening
the deep core effectively (see
Deep Core–Focused Strengthening
section).

DEEP CORE–FOCUSED
STRENGTHENING
A structured exercise program,
including exercises focused on
strengthening deep core muscles with
the pelvis in a neutral position, is opti-
mal (12). This combination can help
minimize current symptoms of incon-
tinence or prevent future occurrences,
low back pain, hip pain, neck pain,
poor posture, pelvic organ prolapse
symptoms, and diastasis recti. It is
important to avoid exercises that put
stress on the pelvic floor or cause
incontinence, as that indicates the
deep core is not strong enough for
such movements or exercise (9).
Figure 2. Cat cows. Include cat cow exercises to help relieve hip, low back, and pelvic
pain. Inhale to lengthen and exhale to round for cat cow. This is a good The deep core includes the following:
movement for strengthening the deep core muscles throughout preg-  The pelvic floor muscles and obtura-
nancy and relieving tightness around the hips, abdomen, and low back. tor internus muscles (8).

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 One on One
 Transversus abdominis and internal
obliques (8,12).
 Multifidus, intercostals, and thoraco-
lumbar vertebral column (8).
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 Diaphragm and psoas muscle
because of the fascia that blends with
the pelvic floor (8).
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 The fascia that intertwines within
the core, including the layers of fas-
cia in the abdominal wall (8,9).
All the deep core muscles play a critical
role in functioning together (8). Pelvic
floor strengthening has been shown to
increase the likelihood the active phase
of labor will last under 60 minutes (16).
The importance of relaxation also plays
a major role as discussed in the third
trimester in preparing the body for labor.
Strengthening deep core muscles
through movement and exercise plays
a key role in improving overall strength
and energy, decreasing aches and pain,
improving confidence, minimizing diasta-
sis recti, and setting up for a potentially
easier and quicker labor and recovery,
while decreasing the chances of an emer-
gency cesarean delivery (1,4,16,18,20).
Instruct how to connect her deep core:
 First relax the deep core muscles on
the inhale (including pelvic floor)
 Exhale to initiate light contraction of
the pelvic floor muscles (from pubic
bone to tail bone and sit bone to sit
bone)—then move if doing an exercise
 Cue to “lightly zip up” or “lift a wet
towel” from the pelvic floor up
through the top of the head.
 Avoid sucking the belly to spine as
this restricts deep core activation and
proper breathing (9).
 Lengthen tall through the torso and
top of the head to positively affect
posture and deep core strength.
 Encourage diaphragmatic breathing
(inhaling out to the sides and back
of the ribcage); exhale feeling the
lengthening as stated above while
also adding a light wrapping “down
and around” of the lower ribcage.
Avoid exercises that cause her to
hold her breath as this could put
unnecessary force on the pelvic
floor (9).
Teaching her to lightly connect and
avoid gripping the pelvic floor muscles
58 VOLUME 39 | NUMBER 4 | AUGUST 2017
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and glutes is key; an EP can partially of the spine with deep core activation
identify that by the client’s breathing (Figures 2, 3, 4). Full body exercises
and position of the pelvis. If holding such as squats with rotations (Figure 5)
of the breath or tucking of the pelvis along with foam rolling release exer-
is noticed while trying to keep the deep cises (Figure 6) and encouraging good
core connected, she is likely overacti- posture throughout the day, can help
vating. For many, this feels foreign ini- minimize back pain during pregnancy.
tially, but with practice and time, it will
improve. Squats and other full-body REMAIN STRESS-FREE
exercises can be good for strengthening Anxiety during pregnancy has been
deep core muscles, whereas lengthen- related to outcomes such as fetal devel-
ing through movement plays a critical opment (17), fetal distress, premature
role in helping her find and keep mus- labor, low birth weight (6), and possible
cle and fascial activation. childhood problems (13). Keeping the
pregnant client’s workouts stress-free is
MINIMIZING BACK PAIN extremely important. You want her to
More than 60% of pregnant women leave feeling more energized and em-
experience some form of low back powered then when she walked in. This
pain during their pregnancy (1); how- will vary depending on your client, as
ever, pain can be minimized and pre- some need a more intense workout to
vented from getting worse as the relieve their stress but many, especially
pregnancy progresses. Teaching deep as they near the end of their pregnancy,
core strengthening plays a major ro- will find it more of a stress release if
le, including exercises that encourage exercises are chosen in order to feel
articulation of the spine which can better, while executing each repetition
help minimize range of motion from in a slow breath-focused manner.
decreasing too drastically. Including
stability ball exercises may reduce EDUCATING ABOUT THE
low back pain during pregnancy and BENEFITS OF EXERCISING
make daily life function easier (20). Proper awareness and education are
Encourage daily movement and pro- popular roadblocks for many prenatal
vide 1 or 2 simple exercises such as moms. Physical activity declines dur-
forward rolls, cat cows, and arch and ing pregnancy for many, with more
round, which all focus on articulation than half of prenatal women thinking
Figure 3. Arch and round. Include this arch and round exercise to help relieve hip, low
back, and pelvic pain. It is a good movement for teaching your prenatal
client how to find and strengthen the deep core muscles throughout
pregnancy while relieving tightness around the hips and abdomen.

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Figure 4. Forward rolls. Forward rolls can help to relieve back pain and neck
pain, improve deep core strengthening, and elongate the spine. It is
important to focus on articulating the spine through the movement
and keeping the hips over or behind the knees to avoid increasing
intra-abdominal pressure.
activity will actually decrease their
energy (10). Many are unaware that
staying active during pregnancy could
decrease their risk of gestational diabe-
tes and do not realize that if they are
overweight they are more likely to
have a child who is overweight (10).
EPs see firsthand that working out can
actually increase energy, which is why it
is recommended to keep the line of com-
munication open and adjust the work-
outs accordingly. EPs may know their
client is capable of working out harder
Copyright ª National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
but at this stage of pregnancy she may
not feel comfortable doing so. Thus, it is
important to follow her lead but con-
tinue to encourage her to keep staying
physically active and moving often.
TRIMESTER-SPECIFIC
MODIFICATIONS
A summary of modifications and sug-
gestions for exercise prescription
within each trimester of pregnancy is
available in Table 2. More details are
provided regarding each modification
within the sections here forward.
59 Strength and Conditioning Journal | www.nsca-scj.com
FIRST TRIMESTER EMPHASIS AND
MODIFICATIONS (GESTATIONAL
WEEKS 1–12)
 Avoid supine forward flexion:
after the pregnant belly becomes
noticeably present, or
if abdominal coning is present and
she can no longer maintain deep core
connection in a neutral spine position,
or she reaches week 12 of pregnancy.
 Avoid overstretching because of the
hormone relaxin (2); encourage
stretching to a point that feels good
but never painful. Limit movements
that could overstretch the pubic sym-
physis and surrounding pelvic areas. It
is more likely she may notice discom-
fort in and around her pelvis as her
pregnancy progresses. Stretching
through exercises that encourage
length and strength will best benefit
as pregnancy progresses (Figures 2, 3,
4, 5).
 Avoid positions that increase the
likelihood of falling. Changes in
hormones causing vasodilation and
an increase in blood volume can
cause her to feel lightheaded or
dizzy easily (4).
 Modifications to the total volume of
exercise may not be necessary.
Dr. James Clapp II demonstrated
conditioned pregnant athletes can
safely exercise 5 + times/week at
65–90% of their regular intensity
providing they do not feel overly ex-
hausted afterward (4).
 Use the talk test to determine moder-
ate intensity. She should be able to
carry on a light conversation; if she
is extremely winded, the intensity
should be decreased (1). It is always
better to stay on the lighter side than
overdo the pregnant client.
 Avoid jarring exercises, movements
that change direction quickly, and ex-
ercises such as downhill skiing, con-
tact sports, and scuba diving (2) (See
Table 4 of the complimentary Special
Populations column in this issue enti-
tled “Training the Pregnant Client”).
 Running may be a good option for
some pregnant women if they
have previously been regularly run-
ning before pregnancy, but if
 One on One
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Figure 5. Squats with rotations. Squats with rotations are an important full-body exercise to improve overall body strength and
fascial stimulation, while improving posture, deep core strength, and relieve aches and pains.

running does not feel good or is
causing pain, running volume can
be decreased or replaced with
other cardiovascular exercises such
as walking, swimming, and ellipti-
cal and stationary biking (2).
 Staying hydrated is important when
working out especially if working out
in a warmer temperature. However,
the concern about body temperature
getting too high is actually low
because of pregnancy improving
 It is important to work the major
the ability to get rid of heat through
the skin and lungs (4). That said, it is
still best to play it safe and avoid
extremely warm temperatures.
Encourage dressing for warmer
weather with layers and encourage
her to drink plenty of water.
muscle groups using a variety of body
weight, free weight (15), and exercise
band exercises such as squats, lunges,
seated or standing rowing, lat pull-
downs, tricep pull-downs or kick-
backs, and bicep curls and modify
as pregnancy progresses by:
 decreasing the weight
 decreasing range of motion
 changing the direction of the pull
(such as seated lat pull-downs may
need to be adjusted to kneeling lat
pull-downs to decrease intra-
abdominal pressure, typically occur-
ring midway through pregnancy).

SECOND TRIMESTER EMPHASIS

(GESTATIONAL WEEKS 13–26)
Many pregnant women may not
feel like exercising during their
first trimester because of increased
Figure 6. Foam rolling release. These foam rolling releases can help to relieve aches fatigue or nausea or may have had
and pains of the low back, hips, and sciatic area. reasoning from their physician to

60 VOLUME 39 | NUMBER 4 | AUGUST 2017

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 Table 2
Overview of trimester-specific modifications

First trimester Second trimester Third trimester

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Use the “Talk Test” to determine moderate intensity X X X

Decrease intensity as needed X X X
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Avoid any prone lying exercises X X X

Avoid supine forward flexion (includes traditional crunches in any X X X
position)
Avoid overstretching, encourage stretching to a point that feels X X X
good and never painful
Limit movements that could overstretch pubic symphysis and X X X
surrounding pelvic areas
Avoid changing positions too quickly X X X
Include exercises to strengthen deep core muscles X X X
Include exercises that improve energy X X X
Teach her to go from her side, to her back when laying on her back, X X
and then roll to her side to get up from her back or out of bed
Encourage deep belly breathing; practice daily X X
If experiencing round ligament pain, minimize movements such as X X
lunges, running, and walking
If experiencing symphysis pubis dysfunction, minimize X X
movements, such as deep squats and lunges, running, and
possibly walking
Minimize lying in the supine position for more than a couple X X
of minutes and avoid completely if she does not feel good lying
supine or has been instructed by her doctor to avoid
Encourage increased emotional relaxation and general movement X
throughout the day
A brief overview of modifications specific to each trimester is listed to aide in developing an exercise program for the progressing prenatal client.

avoid or limit first trimester activity.
Once in the second trimester of
pregnancy and a physician has given
permission to begin or resume physi-
cal activity, it is then safe and encour-
aged to get started on a regular
prenatal workout routine. The EP
should gradually progress and modify
exercises as appropriate for the cur-
rent level of fitness.
Create workouts that include both
resistance and aerobic exercises. There
is a positive correlation between exer-
cise and improved fetal oxygenation,
even when a prenatal woman begins
exercising during the second trimester
(14). Improvements in fetal oxygena-
tion may reduce risk of gestational dis-
orders associated with impaired
endothelial function (14).
SECOND TRIMESTER
MODIFICATIONS (IN ADDITION
TO FIRST TRIMESTER
MODIFICATIONS)
 Avoid supine forward flexion move-
ments once in the second trimester.
 Avoid exercises that create coning of
the belly, as this indicates she is not
properly activating the deep core
and that the intra-abdominal pres-
sure is too great.
 Minimize lying in the supine position
for more than a couple of minutes.
Avoid it completely if she does not feel
well lying supine or has been instructed
by her doctor to avoid it completely.
Signs to avoid lying on the back:
 lightheadedness
 nausea
 contractions
 she simply “does not feel good”
 Encourage her to deep belly breathe
(relaxing her belly and body while
breathing deeply into the sides and
back of her ribcage and abdomen
while also relaxing her pelvic floor)
a little each day to encourage relaxa-
tion of her deep core muscles along

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 One on One
with stretching of the abdominal
muscles, fascia, and skin to help min-
imize severity of diastasis recti (Figures
1, 2, 3, 4).
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 Challenge her with exercises that
encourage the deep core to engage,
such as squats with rotations (Fig-
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ure 5), lunges with full range of
motion and light weights, or for the
advanced client with previous bal-
ance and BOSU training, squats on
a BOSU. Squats on a BOSU should
be supervised, and the EP should
remain close by to prevent a fall, if
the client was to lose balance. Body
weight only is encouraged on the
BOSU, so it is easier to focus on bal-
ance and catch herself in the event
she starts to lose balance.
 The point at which lunges may need to
be modified to more supportive sta-
tionary movements will need to be
individualized. This is largely because
of the rate of gestational weight gain
and abdominal growth that will result
in a shift of the women’s center of
gravity. When the exercise needs mod-
ified, a variety of squats can be included
such as wall squats and sits, wall squats
with a medicine ball between the legs,
squats with rotations (Figure 5) or use
of a cable pulley, or on a BOSU.
 Minimize movements that may con-
tribute to round ligament pain such
Figure 7. Pelvic tilts and hip rolls. Include pelvic tilts and hip rolls to relieve low back and hip pain, specifically for those
experiencing round ligament pain and to encourage deep core strengthening. Can be taught through pregnancy as
long as she feels well on her back or her doctor has not instructed her to completely avoid lying supine.
62 VOLUME 39 | NUMBER 4 | AUGUST 2017
Copyright ª National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
as lunges, running, and walking. The
pain is usually a sharp or jabbing pain
in the lower belly or groin area. As
the baby grows, the round ligament
which attaches from the uterus to
the groin stretches and can cause
pain for some during part or all of
the pregnancy. Include exercises
such as pelvic tilts and hip rolls
(Figure 7) keeping the feet wider
than hip-width apart (3).
 Minimize movements that may exac-
erbate symphysis pubic dysfunction
(movement or spreading between
the pubic bones causing pain) such
as deep wide squats and lunges, run-
ning, and possibly even walking (9).
Choose exercises that help stabilize
the pelvis but encourage strength
such as side lying leg exercises, small
range of motion squats, quadruped-
positioned exercises, pelvic tilts, hip
rolls (Figures 2,3,7), and seated or
standing upper-body exercises.
 Swimming is a good physical activity
option as pregnancy progresses and
could help with managing and decreas-
ing pelvic or low back pain or both (7).
THIRD TRIMESTER EMPHASIS
AND MODIFICATIONS
(GESTATIONAL WEEKS 27–40+)
The third trimester allows continua-
tion of training the prenatal client
according to what she was doing in
the second trimester with the possi-
ble need to decrease intensity. The
EP should be aware of the potential
for the client to fatigue more easily;
be aware that some exercises are
likely to not work now and eliminate
those movements. Include move-
ments and exercises that help the
client feel better and encourage her
to continue to strengthen her
deep core.
As the end of her pregnancy nears,
encourage and include some relaxa-
tion exercises (Figure 1). Teach her
to relax, specifically the pelvic floor
muscles. Many strong women may
tend to grip their pelvic floor muscles,
especially when in pain, so it is impor-
tant now to encourage her to think
about relaxing as she prepares for
labor. She can continue resistance
and aerobic activity up until she deliv-
ers. Sticking with the exercises that
feel best is encouraged, even if the
EP finds himself or herself feeling as
though the same exercises are taught
during those last sessions of the
pregnancy.
SUMMARY
Creating a well-balanced, deep core–
focused, regular (preferably daily)
workout regimen including both
 aerobic and resistance training will
likely help the prenatal client to feel
better both physically and emotionally,
while increasing the chances of an
Downloaded from http://journals.lww.com/nsca-scj by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywC
easier and quicker delivery, improving
maternal and fetal outcomes, and
facilitating an easier recovery post-
X1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 10/26/2023
partum and life beyond pregnancy.
Conflicts of Interest and Source of Funding:
The authors report no conflicts of interest
and no source of funding.
Erica Ziel is the founder of Knocked-Up
Fitness and Core Athletica Inc.
Katie M. Smith is an Assistant Profes-
sor of Sport Science and Health Educa-
tion at Simpson College.
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