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pregnancy-fitness-1

Can a Pregnant Woman Safely Continue her Pre-Pregnancy Workout Routine?

A regular exercise routine has become a way of life for many women, and many choose to continue their exercise routines when they become pregnant.  Research in the field of maternal fitness has shown that exercise during a non-complicated pregnancy is healthy for both mom and baby and may help prevent or reduce some of the physical problems associated with pregnancy, labor, and delivery.

Although exercise is a positive addition to a healthy pregnancy, there are established guidelines that help ensure that a woman’s exercise program is safe and effective.  First and foremost, it is important for a pregnant woman to consult with her healthcare provider before starting any exercise program.  She should bring a list of questions regarding her exercise program and provide an overview of what type, intensity, frequency, and duration of exercise she would like to do.  This enables her healthcare provider to accurately assess whether the fitness program is appropriate for her pregnancy.

Each woman’s level of fitness and health is different, as is each pregnancy. There are several points to consider when choosing to continue a fitness program during pregnancy.  Some types of exercise are more easily continued during pregnancy, and common sense, safety, and comfort all play a role in deciding whether an activity should be part of a prenatal fitness program.

Choosing the type of exercise that will be safe and effective during pregnancy can be determined by reviewing the following points:

  • What activities does she enjoy or are skilled at doing?
  • Does the activity pose an increased risk of falls or blunt abdominal injury?
  • Is she able to do the activity without being compromised by balance and center of gravity changes?
  • Can the activity be easily modified as pregnancy progresses?
  • Does common sense conclude that this is a safe activity to continue during pregnancy?

Research on prenatal exercise has suggested that greater benefits are achieved by including sustained, weight-bearing exercises such as walking, running, stationary stepping/elliptical machine, or dance classes in a prenatal fitness program.  However, some women may not tolerate weight-bearing exercise during pregnancy and are more comfortable with non-weight bearing activities such as swimming and stationary biking.

There are several activities, such as scuba diving and water skiing, that are never safe to do during pregnancy.  Other activities, such as downhill skiing, horseback riding, and sports with a chance of abdominal impact may also be too risky for most women to continue during pregnancy.

Here are a few tips for keeping a prenatal exercise routine safe:

  • Pregnant women need to add 300 calories to their daily food intake to meet the needs of pregnancy. If she is physically active, she may need to increase that amount if she’s not gaining weight normally. The number of extra calories needed depends on the intensity and duration and frequency of the exercise program.  It is important to drink 8-10 cups of water each day and increase that amount during hot and humid weather.
  • Exercise in heat and humidity can be dangerous. It is safest to exercise in an air-conditioned facility during the summer months. If she does choose to exercise outdoors during warm weather, she should avoid the high heat times between 11:00 am and 4:00 pm and reduce intensity and duration to prevent overheating.
  • She should frequently monitor herself during exercise for signs of overheating, such as dizziness, faintness, or nausea. Drinking plenty of water before, during, and after exercise to replace the fluids lost will help prevent dehydration and overheating. Hot tubs and saunas may cause core temperature to rise to unsafe levels and should be avoided.

A simple method for monitoring intensity level during prenatal exercise is to assess how hard the exercise feels.  A pregnant woman should feel that her exercise level is moderate to somewhat hard.  If she feels out of breath or is unable to talk (termed the “talk test”), she is working at too high a level and should decrease intensity or stop and rest. Her exercise level should feel challenging but not so difficult that she feels exhausted during and/or afterward.

Self-assessment is one of the best ways for a pregnant woman to monitor her exercise program and assure herself that her activity level is safe. A pregnant woman should review the following questions several times each month and follow up with her healthcare provider if she experiences any problems.

  • Do you and your healthcare provider feel that you are gaining weight normally?
  • Do you feel well physically and mentally?
  • Are you able to comfortably follow your exercise program without pain, exhaustion, or problems following exercise?
  • Do you experience chronic or extreme exhaustion?
  • If you are at the point in pregnancy where you are consistently feeling fetal movement, have you noticed any change in the pattern or amount of your baby’s movements?
  • Does your baby move at least two times within 20-30 minutes following exercise?
  • Was your last abdominal fundal height measurement (a measurement of fetal growth) or ultrasound assessment within normal limits, and is your baby progressing normally at each medical check?
  • Does your healthcare provider have any concern regarding the health of your pregnancy?

Pregnant women who continue a challenging level of exercise need to be aware of signs or symptoms that indicate overwork, such as an elevated resting heart rate, frequent illness, lack of weight gain, depression and chronic exhaustion.   She should decrease or stop her exercise program during illness, when fatigued, under excessive stress or if experiencing any complications with her pregnancy.

Prenatal exercise should enhance pregnancy and help to make a woman’s postpartum recovery smoother.  The best advice for the athletic woman who wants to continue her fitness program during pregnancy is to use common sense, listen to her body, and enjoy all the challenges and changes this incredible experience offers.


Catherine Cram started her company, Prenatal and Postpartum Fitness Consulting, in order to provide current, evidence- based guidelines maternal fitness guidelines to health and fitness professionals. She was a contributing author for the textbook, Women’s Health in Physical Therapy and co-authored the revision of Exercising Through Your Pregnancy with Dr. James Clapp.  Her company offers the certification course, “Prenatal and Postpartum Exercise Design” which provides continuing education credits for over 30 health and fitness organization, including ACSM, ACE, ICEA, and Lamaze.

Sliced-steak

The Naturopathic Chef: Grilled Steak Salad

The main reason to eat meat of any kind is the top quality Heme-Iron that isn’t present in plants (Non-Heme Iron).

Beef also contains a big dose of stress-reducing B vitamins as well as Zinc. Anytime we eat foods high in Zinc, our bodies produce Super Oxide Dimutase, or SOD. This is a supercharged anti-aging antioxidant! And, your body does all the work for you.

virtual-personal-training

Taking Your PT Business Online

With most, if not all health clubs and fitness facilities closed, or in a quasi-opened state, thank God that we live in the age of technology. For many of us, being “quarantined” does not have to stop us from conducting business as usual.

We know for a fact that exercise can help boost the immune system. This should be reason enough for EVERYONE to be moving, not using this time as…

Human Osteoporosis

Does Low Bone Mass Mean Osteoporosis?

Nearly 30 years ago when I was in school, I wrote an exercise physiology paper on exercise and osteoporosis.

At that time there wasn’t much research available. But even then, the studies I found on tennis players, astronauts, and bed rest pointed in the direction that weight-bearing exercise could help maintain the bone density you have and even promote bone growth. I was intrigued. I’ve followed the research over the years and even created an osteoporosis exercise program.

In working with my clients, I often hear the question, “What’s the difference between osteoporosis and low bone mass (osteopenia)? And what can I do about it?”

Well to answer these questions, I have to start at the beginning.

Osteoporosis is a disease, which, over time, causes bones to become thinner, more porous and less able to support the body. Bones can become so thin that they break during normal, everyday activity. Osteoporosis is a major health threat. 54 Million are at risk, nearly 80% are women.

Postmenopausal women are particularly at risk because they stop producing estrogen, a major protector of bone mass.

As we age some bone loss is inevitable. Women age 65 or men age 70 should get a bone mineral density test. If you have a family history of osteoporosis or other risk factors, you may need a BMD much earlier.

The test is completely painless, non-invasive and takes only a few minutes. It compares your bone mineral density to that of an average healthy young person. Your results are called your T score. The difference between your score and the average young person’s T-score is called a standard deviation. (SD)

Here is how to interpret your T score:

  • Between +1 and –1: normal bone density.
  • Between -1 and -2.5: low bone density (osteopenia).
  • T-score of -2.5 or lower: osteoporosis.

Until recently it was thought that if you had low bone mass (osteopenia) you were well on your way to getting osteoporosis. But it’s now known even at this stage bone loss can be slowed down, stopped and even reversed. You and your doctor will have a number of options depending upon your particular condition.

Many MDs like to start with a calcium and vitamin D rich diet coupled with weight-bearing exercise. For many of us, that’s all we need. Others will require medication and there are many bone-building medications available.

Remember it’s never too early to start taking care of your bones. The more bone density you have as a young person the less likely to end up with osteoporosis later in life.

EASE IN, BECOME MOBILE, GET STRONG, LIVE LONG!  May is Osteoporosis Prevention Month! It’s Never Too Late To Take Care Of Your Bones!


Mirabai Holland MFA, EP-C, CHC is one of the foremost authorities in the health and fitness industry. Her customer top rated exercise videos for Health issues like Osteoporosis, Arthritis, Heart Disease, Diabetes & more are available mirabaiholland.com. Join her NEW Online Workout Club at movingfreewithmirabai.com. Mirabai offers one-on-on Health Coaching on Skype or Phone. Contact her at askmirabai@movingfree.com.

Fitness-Exercise-Data

The Top Big Data Issues – and How Wellness Can Do Them Better

Big data is here to stay within the healthcare profession.  More and more engineers and data programmers are being hired to sift through the myriad of data that consumes the field.  Of concern to executives at the top are certain attributes of healthcare that may need “fixing”.  The aspects of this report are to highlight what are perceived as the biggest concerns in healthcare, and how the wellness industry – if they can stay on track – can supersede all of these types of issues as they transition to the data analytics side of their health offerings.  

#1 – In network utilization.  

This is a very big concern for hospital systems and physician network groups, as patients have a tendency to switch providers if they think they will get better service, better medicine, or better prices.  One of the reasons is that most patient contracts don’t require patients to stay in a network – which puts the responsibility of good care, competitive prices, and follow ups squarely on the doctors.   If patients are unhappy with their doctor or practice for any reason, they can leave.  Now that these organizations are getting bigger and more complex – it’s easier to see why patients may become disgruntled, and try to find a better solution in a private practice, or smaller group or hospital practice. 

From the wellness side – it’s not uncommon for health club members to stay at their club or studio for years.  Prices don’t change that much, and most members have a very personal relationship with their instructors and club owners.  They have group classes, personal exercise programs, child care, plenty of free parking, and clean facilities that provide some of the latest in technology every few years.  So – should healthcare systems look to health clubs to see why people stay in clubs longer?  Perhaps they should be partnering with these health clubs for specific programs for their patients.

#2 – Customer satisfaction.  

This is a priority in most businesses.  Hospitals and physician practices are no exception.  However, most people still associate going to the doctors with being sick.  So there is already an inherent negative connotation to the doctor’s office.  Therefore physicians need more than a lab coat and a prescription to make sure patients are getting what they need.  They need a team-orientated approach that can help with the issue NOW, and use the team to follow up with the patient to make sure the situation and health concerns are taken care of over time.

Again – the health and fitness industry is concerned about customer satisfaction.  With cut-rate gym memberships, and a new club coming into communities almost every month, clubs and owners need to offer clean facilities, professional trainers and instructors, and technologically advanced equipment that doesn’t break down and that is easy for members to take advantage of.  The issue between the two programs – is that although some exercise programs push the body and may be painful – it’s a good pain and the rewards of long term participation should be better health and less risk of using the healthcare system over time.  It’s the old adage of “pay me now, or pay me later” axiom, and more people are willing to put their trust in health clubs – and the risk of injury or illness or death is extremely low compared to even trips to the doctor’s office. 

#3 – Looking at the mounting data to convene the best possible approach to patient care.  

Again – this is a huge concern in healthcare – that doctors can’t read the thousands of new studies that come out in their field each month, so they rely more and more on their clinical experience (which may be a good thing), but they will stick to the tried and true methods they have always been using, and may not prescribe the most effective type of treatment for their patients.  Big data in many instances can do two things – one is look over millions of studies in a particular field, and two – through machine learning, hone in on what may be the best type of treatment plan for a particular patient, based on their age, severity of disease, family history, weight, and other factors.  This is a powerful tool to help doctors prescribe and treat better.

However, it’s still the same paradigm.  They are looking over medical studies, many of which may not be in the best interest of the patient.  One of the most cited studies in medicine came in 2005 when Stanford epidemiologist John Ionnidis reported that the majority of medical research finding are false, because they have inherent bias from their authors, their findings are not statistically significant, they were published by industry officials, and are not relevant, and conclusions may not match the actual results of these very papers.  Ionnidis opened the floodgates for many professionals who have gone after medical research and institutions for publishing false studies.  It is estimated that almost 40% of medical research studies are false, in that their findings do not hold relevance regarding the enhancement of patient care.

In contrast, sports medicine has been methodological in its research for a century – from the basis of treadmill cardiac and performance testing in the 1930s, to the onset of physical activity studies in the 1950s and 60s, to cardiac rehab and exercise safety studies in the 1980s, to the onset of exercise for special population groups in the 1990s.  There are very few reports on sports medicine research fraud, and the foundation of this research usually shows some level of benefit to those who participate.  In almost all cases, no harm is done to subjects while performing these studies.  This has now transitioned into many successful clinical health club programs for persons with cancer (Sunflower Wellness, Cancer Well-fit, Fast Trac Cancer Program), spinal cord injury (Claremont Club), multiple sclerosis, diabetes, hypertension, weight management, bariatric recovery, and medical fitness in general. 

#4 – Cost savings. 

 One of the biggest attributes of big data and population health is to drive policymakers and physicians to deliver the highest quality care at the most competitive prices.  In many opinions, this is a misnomer of sorts, and medicine is continually advancing technology, which is very expensive, and works through a third party reimbursement system — which is many times more expensive than if they offered the service or procedure or product at market value.  Many hospitals are undergoing facelifts (no pun intended) and look more like five-star hotels than medical centers.  All of these amenities cost the patient and insurance pool more money.  This is why healthcare costs usually rise at more than twice the rate of inflation, and have some of the highest costs of any industrialized business model.

As far as health and fitness, the rate of price changes for the average health club has held steady at just below inflation for years.  The prices for café food, personal training, specialty exercise, or apparel has also held steady.  Even with the rush of new technologies for equipment and personal monitoring devices (such as FitBit), prices have remained constant. 

Big data in the health and fitness setting should be concentrated on health outcomes.  There are many software programs in the industry now that look at finances, front desk management, club administration, and human resources.  They do their functions well.

If big data is going to continue to look at all aspects of healthcare, and continue to miss the boat regarding improved patient health and well-being, then no amount of data can help repair the continual dysfunction that exists between an over-burdened and (in many opinions) under caring system, and the continued increase in poor health in the US.  Prescribing more pain meds, vaccines, or antibiotics will not help improve health – and in many cases is making health worse. 

The health and fitness profession is on the mark moving into the realm of special populations at every level.  As the amount of population health and data analytics becomes a more ingrained part of wellness, we will see at many levels how these types of interventions improve health, reduce costs, and vastly improve patient satisfaction and retention to their favorite health club, exercise program, or personal trainer. 


Eric Durak is President of MedHealthFit – a health care education and consulting company in Santa Barbara, CA. A 25 year veteran of the health and fitness industry, he has worked in health clubs, medical research, continuing education, and business development. Among his programs include The Cancer Fit-CARE Program, Exercise Medicine, The Insurance Reimbursement Guide, and Wellness @ Home Series for home care wellness.

 

References

https://www.optum.com/content/dam/optum3/optum/en/resources/gated/Optum_NYUPN_Topic_Spotlight.pdf

Ionnidis, JPA.  Why most published research findings are false.  2005.  PLoS Medicine.  Aug. 30. Doi: 10.1371/journal.pmed.0020124

 

family meal

Food, Athletes & Joy of Eating

Once upon a time (before WWII), daily life revolved around structured meals: enjoying a hearty breakfast, dinner (at noon), and supper (at night). When women entered the workforce, eating patterns changed — lighter breakfasts and lunches, with bigger family-focused dinners. Fast forward to pre-COVID 2020, youth sports and life’s busy-ness totally disrupted dinner-times; structured meals got lost in the shuffle.

Today (week #8 of COVID shut-down), our stay-at-home lifestyle has gifted many of us with time to cook breakfast, enjoy lunch, and have family dinners. Yet, many athletes are feeling confused and/or uneasy about how they are eating:

“I’m sleeping until 11:00 a.m. Should I eat breakfast — or lunch — when I get up?”

“I now have easy access to food given I’m working at home. I spend too much time grazing. Seems like I am hungry all the time.”

“My eating habits are weird. How should I be eating? What is “normal” eating?”

Sound familiar? To add a supportive framework, joy to meals, and answer the question What is normal eating?, I turn to eating authority Ellyn Satter, author of Secrets of Feeding a Healthy Family (a book every parent should read; EllynSatter-Institute.org).

Here is her definition of “normal eating”:

Normal eating is going to the table hungry and eating until you are satisfied. It is being able to choose food you like and eat it and truly get enough of it — not stopping eating just because you think you should.

That is, did you stop eating breakfast today because the oatmeal in your bowl was all gone? Or were you truly satiated? At the end of lunch, did you stop at your one-sandwich allotment, even though you wanted more? If you are “feeling hungry all the time,” you likely ARE hungry; your body is requesting more fuel. Trust it. You’ll end up eating more sooner or later, so please honor that hunger and eat more now.

Normal eating is being able to give some thought to your food selection so you get nutritious food, but not being so wary and restrictive that you miss out on enjoyable food. That is, have you put yourself in food jail and banned “fun foods” like cookies, cupcakes, and chips, out of fear of over-eating them? Ideally, your meal plan includes 85-90% quality foods, with 10-15% fun foods. You need not eat a perfect diet to have an excellent diet. Some “fun food” in the midst of a pandemic can be, well, fun!

Normal eating is giving yourself permission to eat sometimes because you are happy, sad, or bored, or just because it feels good. Yes, food is a way we celebrate, mourn, and entertain ourselves. Sometimes we even need a hug from food, despite being not hungry. One bowl of ice cream will not ruin your waistline nor your health forever. That said, routinely overindulging in ice cream as a means to distract yourself from life’s pain will not solve any problem. If you are using food as a drug, to not start eating can be easier than stopping once you have started.

Normal eating is mostly three meals a day, or four or five, or it can be choosing to munch along the way. Most athletes require fuel at least every 3 to 4 hours. Those who “graze all day” commonly under-eat at meals. If you stop eating because you think you should, not because you are satiated, you will feel the urge to graze. Solutions: eat the rest of your breakfast-calories for a mid-morning snack, eat an earlier lunch, or better yet, give yourself permission to eat enough satiating food at breakfast. Living hungry all the time puts a damper on your quality of life, to say nothing of impairs athletic performance.

Normal eating is leaving cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful. If you are banning fun foods from your house because you can’t eat just one cookie, think again. Denying yourself permission to enjoy a few cookies boosts the urge to eat the whole plateful. I call that “last chance eating.” You know, “last chance to have cookies, because tomorrow I am back on my cookie-free diet.” Depriving yourself of cookies leads to binge-eating. Try planning in forbidden foods every day. They will soon lose their power.

Normal eating is overeating at times, feeling stuffed and uncomfortable. And it can be undereating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Yes, even normal eaters overeat. It’s normal to have too much birthday cake, too much Sunday Brunch, too much ice cream. When competent eaters overeat, they listen to their body’s signals – and notice they take longer to get hungry again. That is, if you have a hearty brunch, you will be less hungry that evening. Trust me. Rather, trust your body.

Hunger is your body’s way of telling you it has burned off what you gave it, and now it is ready for more fuel. You want to honor hunger and eat intuitively, like kids do. Kids eat matter-of-factly; they stop eating when they are content. Adults (especially weight-conscious athletes), don’t eat when they are hungry, then don’t stop when content. Rather, they “cheat” and guiltily stuff themselves with forbidden foods —last chance before the diet starts again!

Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life. If you are spending 90% of your time thinking about food, you are likely hungry 90% of the time. (If humans didn’t think about food, they would never think to eat.) If you eat until you are satisfied, you will stop incessantly thinking about food. That said, food-thoughts can be a way to distract yourself from stuff you really don’t want to think about. In that case, talking with a counsellor might be helpful. Smothering your feelings with chocolate will not solve any of your problems.

In short, normal eating is flexible. It varies in response to your hunger, your schedule, your proximity to food, and your feelings. Many athletes very rigidly eat the same foods every single day. A sports nutritionist can help add variety (more nutrients), flexibility, and more joy to eating. Food can and should be one of life’s pleasures, both when training and in the midst of the pandemic.


Boston-area sports nutritionist Nancy Clark, MS, RD counsels both casual and competitive athletes, helping them learn how to eat competently. Her best-selling Nancy Clark’s Sports Nutrition Guidebook is a helpful resource. For more information, visit NancyClarkRD.com.