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postnatal exercise

Tips on Postpartum Exercise Programming for the Fitness Professional

Many women post-pregnancy are very eager to rejoin the exercise world and at least resume the physical activities they once enjoyed prior to pregnancy. More and more women are seeking out fitness professionals or exercise programs to help them lose the baby weight and engage in safe and effective exercises. Many women understand the toll pregnancy and childbirth took on their bodies and they are ready and willing to seek out professional advice. Working with the postpartum client has benefits for both the trainer and the client. I encourage those who treat this population to get as much education in this area so you can better serve their needs.

Once you begin your journey caring for the postpartum client, there are several important factors to consider when beginning exercise program design.

First, remember she gave birth. Look at birth like any client who is rehabilitating from any type of injury or surgery. The postpartum phase is typically the first 12 months after having a baby but can be longer if a woman is nursing.

Second, consider how long it has been since exercise has been part of her regular routine. Even if she exercised regularly during pregnancy, she probably was limiting the intensity compared to her pre-pregnant self. Keeping that in mind, it may feel like for you (and her) that you are working on a beginner level as you begin.

Third, it’s really important to know the type of birth the woman had and how it affected her pelvic floor muscles. Obviously for vaginal birth pelvic floor prolapse, vaginal tearing or possible Pubic Symphosis diastasis could have occurred. For women who have gone through a cesarean (C-section), the abdominal muscles have been affected through the incision made into the abdominal wall and uterus.

Fourth, it is vital to understand the fitness level of the woman prior to pregnancy and the activities in which she participated. The fitness level or prior activities or sports in which she participated could shape the type of recommended exercises in her program.

Finally, consider any injuries or medical history that may affect her current fitness especially if she has been inactive or just returning back into exercise. Many of this information may be obtained in your initial meeting or phone consultation. You can use a PAR-Q (Physical Activity Readiness Questionnaire) to access this information. I suggest customizing the Par-Q to be very postpartum specific and asking detailed questions about pregnancy and delivery before you begin treatment.

Considering all of these factors, lets now look at how to exercise safely and effectively following delivery.

Procede Gently

Start with basic range of motion exercises and corrective, posture-based movements that will help her body begin to feel restored. A little movement goes a long way.

Get to Know Her Limitations

As with other injuries, or surgeries, childbirth is comparable for your client as her body is still healing, hormones are still adjusting that affect range of motion, core is weak and most women are sleep deprived for months after giving birth. With this in mind, her balance and equilibrium are affected. Careful of movements that change position briskly or go from standing to lying.

Establish Realistic Expectations

Develop reasonable exercise goals for your client. Along with her physical health, mental health is also affected.
Exercise is directly linked in helping to prevent postpartum depression, however, setting fitness goals may create anxiety or worsen her mental state, so be sensitive to this. Start with manageable times to exercise during the week. As the client become stronger you can increase the number of days you exercise per week in addition to the exercise intensity.

Create a Supportive Network

Connecting clients who are going through similar life experiences may help motivate them to exercise more regularly and in a small group setting the cost is usually less per person and more efficient for the trainer for the hour. This may also help give the client additional accountability.

Teach Sustainable Lifestyle Habits

Help your client embrace this journey as a marathon rather than a sprint. Explain that the baby weight will come off but the end goal is to do this safely and cautiously. You must be ready to advise on sustainable, healthy eating habits and adapt if the woman is nursing.

Get Started Working with Prenatal and Postpartum Clients

Check out Danielle Spanger’s online course with MedFit Classroom, Prenatal and Postpartum Exercise, for an introduction to working with this population.


Danielle Spangler, C.PT, has been a fitness professional for over 20 years. Danielle is the creator of “Coremom” (Corrective Obstetrical Related Exercises) for purposes of creating a pre and postnatal small group-training program in a variety of fitness facilities. Danielle’s goal is to train other qualified fitness professionals and group exercise instructors on teaching pre and postnatal small group exercise classes using her method. Visit her website, daniellespangler.com

Pregnant-woman-at-gym

Pregnancy and Childbirth During Unprecedented Times

Being pregnant and having a baby is stressful on its own. Now imagine being pregnant and delivering a baby during a global pandemic. Being a mother myself and treating pregnant women and new mothers, I recognize this population struggles with support, proper healthcare (especially postpartum), isolation and they may have limited resources at their disposal. It is important to understand that for many of these women the unexpected turn of events, has left them disappointed and it has affected the entire pregnancy and postpartum experience affecting both their mental and physical health. 

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Risks Associated With the Development of Gestational Diabetes

Gestational diabetes mellitus (GDM) appears to be on the rise in the US, with the CDC suggesting that the prevalence of GDM may be as high as 9.2%. The disease is defined as the onset of impaired glucose intolerance during pregnancy as diagnosed from a glucose screening test (also called a glucose challenge test or GCT) between 24 and 28 weeks. Pregnant women who develop GDM are at higher risk of complications during pregnancy and delivery, and the fetus may develop macrosomia, and neonatal hypoglycemia. In addition, women who develop GDM have a greater than 7-fold increased risk of developing type 2 diabetes later in life. There’s some suggestion that babies born to mothers with GDM have a greater risk of developing impaired glucose tolerance.

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The Increasing Need For Trained Maternal Fitness Instructors

The need for trained maternal fitness professionals has greatly increased as a result of the number of fit women who desire to continue with their exercise routine once they become pregnant. The past several decades has provided a large body of evidence that supports the benefit and safety of prenatal exercise in uncomplicated pregnancies, and ACOG and other fitness and medical health organizations recognize the importance of fitness in a healthy pregnancy. Studies have shown that women who continue or even start an exercise program during pregnancy gain less fat weight, have fewer complications during labor and delivery, and return to their pre-pregnancy weight faster than women who didn’t exercise while pregnant.

Knowing what the current evidence based guidelines are for pregnant and postpartum women and being able to work with this population will open up opportunities to create a specialized program that fits their unique needs. Fitness professionals who have training in this field offer skilled support and guidance to pregnant and postpartum women and help them confidently include exercise as part of their lifestyle. Pregnant women are unsure of what exercises and activities they can continue throughout pregnancy and need guidance on how to monitor their routine for safety. As pregnancy progresses, women need strategies for modifying their exercise program as their body changes to maintain a comfortable and safe routine.

For more information on prenatal and postpartum exercise and our CE correspondence course, “Prenatal and Postpartum Exercise Design” please visit, www.ppfconsulting.com

Article reprinted from Catherine’s Maternal Fitness blog with permission.


Catherine Cram, MS, is the owner of Comprehensive Fitness Consulting, a company that provides pre- and postnatal fitness certifications and information to hospitals, health & wellness organizations and the military.

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Can Exercise help treat women with postpartum depression?

According to several studies, exercise has been proven as an effective method of treating and preventing depression. Some studies suggest that physical activity may be as powerful as anti-depressants for treating mild to moderate depression over time. The same is true for women experiencing mild to moderate postpartum depression. It’s important to note that there are different levels of postpartum depression and screening is available through hospitals and doctors’ offices if PPD is suspected. Both the Edinburgh Postnatal depression scale questionnaire and a PAR-Q medical history questionnaire will help give insight to healthcare practitioner and patient on treatment methods.

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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.

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High Altitude Sports During Pregnancy: Are the Risks Worth the Thrill?

Research in the field of prenatal fitness has conclusively shown that exercise during pregnancy provides health benefits to mother and fetus, and the American College of Obstetricians and Gynecologists encourages pregnant women without complications to continue or start a fitness routine during pregnancy. Although prenatal exercise is considered safe for most pregnant women, some activities are more controversial because of potential injury risks or because of the environment where they take place.

Many women enjoy downhill skiing, cross country skiing, and snowboarding, and have questions about whether it’s safe for them to continue these sports during pregnancy. The safety of these sports, as well as the effect higher altitudes, may have on pregnant women and their fetuses, are important factors to consider before taking part in high altitude snow sport activities.

Several studies have examined pregnancy outcomes and complications comparisons between pregnant women who were exposed to high altitudes versus pregnant women who did not travel to high altitudes. One study (1) that examined the association between high altitude exposure and self-reported pregnancy complications found that there is a low rate of complications for pregnant women who participated in activities and travel in high altitude areas.

Another study (2) suggested that pregnant women who traveled to high altitudes (determined as above 2440 meters, or 8,000 feet) did not have a higher risk of pregnancy complications when compared to women who did not have high altitude exposure. These women were more likely to have preterm labor than those not exposed to high altitude, but the percentage of preterm labor in the study were below the US population rate of preterm births. There was a statistical increase in newborn oxygen need at birth, but no complicating issues were associated with this.

Although these study results are reassuring, more rigorous research is needed to provide further information regarding the safety of high-altitude exposure and exercise during pregnancy.

There are key factors that may influence the degree of hypoxia-related pregnancy complications for the fetus and mother.

  • Duration of exposure
  • Intensity of activity
  • Degree of altitude
  • Difference between altitude at home and sport

These factors should be taken into consideration by a pregnant woman who is planning to travel to (and exercise in) high altitude. If she lives in a low altitude area, it’s a good idea to build in several days of progressive altitude increase to allow time for her to adjust. If possible, she should vary the duration of her exposure by sleeping at lower elevations. She should be aware of signs of hypoxia (see list below) and move to a lower altitude if she experiences increased symptoms.

Complications from exercise at higher elevations may be compounded by increased dehydration as a result of dry and cold air. Maintaining adequate fluid intake and allowing for rest breaks to hydrate can avoid this issue.

The key to avoiding altitude-related issues is being aware of how altitude is affecting the body and pregnancy and knowing the signs and symptoms of hypoxia.  As long as a pregnant woman continues to feel well and isn’t experiencing any issues while exercising at higher altitudes, she can feel confident that her pregnancy won’t be negatively affected.

*Signs of Hypoxia

  • Feeling dizzy and lightheaded
  • Persistent cough
  • Headache
  • Vision changes
  • Extreme fatigue
  • Nausea
  • Confusion and mental status change

It’s important also to consider the risks of some types of snow sports. Downhill skiing and snowboarding require good balance, and as pregnancy progresses, the changes in a woman’s center of gravity can affect her balance and make her more prone to falls. Also, the risk of collisions with other skiers and snowboarders is a concern, especially when slopes are crowded. Careful consideration of a woman’s skill level and difficulty of the ski slope should be weighed, and modifications such as switching to easier slopes and terrain can reduce risk.


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 organizations, including ACSM, ACE, ICEA, and Lamaze.

 

References

Wilderness Environ Med, 2016 Jun;27(2):227-35. doi: 10.1016/j.wem.2016.02.010. Outdoor Activity and High Altitude Exposure During Pregnancy: A Survey of 459 Pregnancies. Keyes LE1Hackett PH2Luks AM3.

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Building Strength is an Important Component in a Prenatal Fitness Routine

You may have heard people warn that pregnant women shouldn’t raise anything over their heads or lift objects that are heavier than ten pounds when pregnant. These are warnings that still make the fitness trainer rounds when working with pregnant clients, yet these warnings aren’t based on science.  In fact, there’s no evidence for warning pregnant women to avoid lifting over their head unless it causes discomfort or balance issues, and the ten-pound limit is even more questionable, as ten pounds would be too heavy for some women and as easy as a feather for others.

It’s important to always remember that each pregnant woman has a specific fitness level and ability, so setting arbitrary limits is an ineffective way to provide guidelines for this population. In addition, when confronted with statements such as these, always review the research that supports the claim before implementing the information into your training guidelines.

Many women choose to continue their pre-pregnancy strength training program while they are pregnant, and most women may safely start strength training during their pregnancy as long as they are cleared for exercise by their healthcare provider. When developing a pregnant woman’s fitness program, you should take into account her current level of fitness and strength and pay close attention to how she feels during and after exercise. The key to maintaining a safe and effective routine is through consistent modification of the exercises for comfort as pregnancy progresses.

Strength training is an essential prenatal fitness component, providing the muscle power needed to compensate for posture adjustments and weight gain that occurs with pregnancy. Women who continue or even start a strength training routine during pregnancy can help prepare her body for all the lifting done with a new baby and reduce the risk of low back pain. Strength training has not been shown to pose any harm to either the fetus or the mother as long as these general guidelines are followed:

  • A gradual reduction in weight loads from pre-pregnancy will likely occur as the pregnancy progresses.
  • Women may continue their pre-pregnancy strength training routine (wt/reps/set) as long as they modify the exercises for comfort as pregnancy progresses.
  • If training causes muscle soreness during the pregnancy, it is recommended that overload be progressed by increasing the number of repetitions versus the resistance/wt.
  • Monitor exercise techniques carefully by mirror observation or supervision in order to correct for progressive postural changes that occur with advancing pregnancy. Improper lifting techniques may aggravate back problems and increase soft tissue injuries.
  • Avoid maximal static lifts. They may cause a sudden increase in cardiac output and blood pressure and employ the Valsalva maneuver. During the Valsalva maneuver, there is a significant diversion of blood from the internal organs (such as the uterus) to the working muscles.
  • Maximal lifts may also place extreme stress on the lumbar spine and other joint areas. Never overload an unstable or weakened joint.
  • Modify supine positions after the first trimester of pregnancy by using an incline board or wedge.
  • A strength-training workout involving all the major muscle groups should be performed three times per week, with a rest day between each muscle group training bout.
  • Machines, free weights, resistance bands, and body weight
  • are all options for building a strength training routine.
  • Remind client that she should exhale with the lift and avoid holding her breath or bearing down and straining as she lifts.
  • If a particular exercise continues to produces pain or discomfort are modification, it should be discontinued. If pain persists, the client should consult with her healthcare provider.

As always, all pregnant women should check with her healthcare provider before starting or continuing an exercise program during pregnancy.


Catherine Cram, MS 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.