Strength training during pregnancy, especially in late pregnancy, has been considered controversial for years. There were concerns about negative effects on the expectant mother as well as on the child but recently positive aspects of strength training has been shown (1) (2). Pregnant women can benefit of strength training concerning the blood pressure, the flexibility of the knee joints and the strength of trunk muscles. Further improvements during childbirth, such as reduced intensity of labor contractions, decreased incidence of cesarean and episiotomy, and less frequent use of analgesia are reported (1). Other studies have found that prenatal strength training with exercises specifically targeting the pelvic floor muscles can significantly reduce urinary incontinence symptoms, prevent urinary incontinence, strengthen pelvic floor muscles, and improve quality of live, compared to pregnant women who did not train specifically (2). 
The aim of this study was to investigate, whether and to what extent healthcare experts in Austria recommend strength training in the third trimester of pregnancy, what benefits it can offer pre-, peri- and postnatally in terms of the health of the expectant mother, and what risks need to be considered.

In this qualitative study five healthcare experts in the field of women's health (gynecologist, midwife, physiotherapists, sports scientist), treating at least ten pregnant women per year, were interviewed. Therefore, the appointments were arranged via email and written consent forms were obtained prior the online meeting. The interviews were conducted via Microsoft Teams, using a half-structured interview guide. The collected data were first transcribed, then paraphrased, and finally categorized and classified into four categories via deductive category formation. Mayring’s content analysis method was used for the analysis of the data.

The first category comprised the benefits and risks of strength training in the third trimester of pregnancy concerning the health of the expectant mother. Benefits mentioned in the interviews included increased body awareness, permpartum physical performance, and faster postpartum recovery of the pelvic floor. Risks included bleeding and the development of rectus diastases. 
The second category, regarding professional experiences, included leading childbirth preparation and postpartum recovery classes, as well as personal experiences during pregnancy. 
The perspective of the general population described the third category. Interview participants expressed that the topic remains controversial and that interest primarily exists among already very active and experienced women in this field. 
The last category consisted of recommendations from the experts, from which a tendence of guidance could be created, providing an overview of the opinions and recommendations of the five experts. This indicates that in general, strength training is possible and advisable in the third trimester if an individually adapted training plan is created and the woman has prior experience. The execution must be controlled, with a focus on the quality of performance. Regarding intensity, strength endurance training is recommended 2 to 3 times per week, focusing on the pelvic floor muscles, core muscles, upper extremity muscles required for lifting activities, and lower extremity muscles, especially the extensors. Training should primarily consist of functional bodyweight exercises with additional weights up to ten kilograms or resistance bands. Exceptions such as bodybuilding should be supervised one-on-one. For CrossFit or training with more than ten kilograms of additional weight, a stable core is a prerequisite. Other motor basic properties recommended for the third trimester include endurance training through activities such as walking, Nordic walking, and breaststroke swimming, flexibility training through yoga with a focus on the core-hip area, and coordination training in the form of balance exercises. But there are also contraindications in the third trimester. These include extreme training without experience, breath holding, heavy weights with trunk instability, training to exhaustion, heart rates exceeding 140 beats per minute, maximal strength and competitive training, and training of the rectus abdominis muscles through exercises such as crunches.

The collected data show that all five healthcare experts recommend the implementation of strength training in the third trimester of pregnancy, regarding the health benefits for expectant mothers, although there are some important aspects to consider. 
However, the study has some limitations and aspects that can be improved in future studies. Firstly the term ‚strength training‘ covers a broad area and experts as well as the general population have many different conceptions of this term. Strength training ranges from maximal strength training to strength endurance training to speed and reactive strength training. Sports such as bodybuilding, CrossFit, or weightlifting and powerlifting can also be included in this category. Therefore, it is difficult to cover all aspects of ‚strength training‘ in one study. 
Furthermore, there are currently few studies specifically addressing strength training all alone. Mostly combined training programs of aerobic and strength exercises are found. Also, the number of randomized controlled trials regarding sports, especially in the third trimester, is still very low. In this work, mainly the experiences of the experts were relied upon. It is also important to note that this work does not show any effects of training during late pregnancy on the health of the fetus or newborn.
Existing literature demonstrates consistent recommendations regarding the implementation of strength training during pregnancy. Several countries, such as Norway, Denmark, Australia, and Canada, have developed guidelines for the safe practice of controlled weightlifting during pregnancy. It is advised that pregnant individuals engage in a balanced exercise regimen comprising both aerobic endurance training and strength training, with moderation an individualization supervised by healthcare professionals. Typically, a weekly exercise duration of 150 minutes Is recommended. Additionally, established studies outline criteria for discontinuing sports activities during pregnancy, which encompass symptoms such as vaginal bleeding, onset of labor contractions, amniotic fluid leakage, dyspnea, headaches, dizziness, chest or leg pain, or swelling (3). 
The research provides, in addition to these existing guidelines already mentioned, more concrete ideas on how strength training can be conducted until birth. Therefore, it would be desirable to verify the developed approaches through further research. Furthermore, clear training plans for pregnant women could be created and subsequently adjusted by medical professionals to suit the pregnant woman.

Referring to the numerous benefits of strength training that are already known, it is recommended to perform high-quality, controlled training focusing on strengthening the core muscles and pelvic floor muscles until childbirth, while considering the anatomical, physiological, and pathological aspects of late pregnancy.

Rodríguez-Díaz, L., Ruiz-Frutos, C., Vázquez-Lara, J. M., Ramírez-Rodrigo, J., Vil-Iaverde-Gutiérrez, C., & Torres-Luque, G. (2017). Effectiveness of a physical activity programme based on the Pilates method in pregnancy and labour. Enfermería Clínica. 27(5), S. 271-277. doi: 10.1016/j.enfcli.2017.05.008
Mørkved, S., Bø, K., Schei, B., & Salzseen, K. A. (2003). Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single-blind randomized controlled trial. British Journal of Obstretics and Gynecology. 101(2), S. 313-319. doi: 10.1016/s0029-7844(02)02711-4
Ferrari, N., & Graf, C. (2017). Recommendations for Physical Activity During and After Pregnancy. Das Gesundheitswesen. 79(S 01), S. 36-39. doi: 10.1055/s-0042-123698