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Woman Doing Stretching Exercises In Gym With Trainer

Physical Activity and Menopause

Menopause is bad.

Exercise is good. 

More exercise is the solution!

Is that it?

It’s not quite that simple, although most things you will read will tell you that any form of physical activity is helpful. There is a lot of truth to it. Physical activity at any age is beneficial and for women during mid-life exercising carries additional substantial health benefits. The menopausal transition is associated with many health risk factors such as increased risk for cardiovascular disease, osteoporosis, decreased bone mineral density, metabolic syndrome, and musculoskeletal symptoms. Exercise prescriptions for those health risks are the same as for non-menopausal women.

However, according to my research, not all forms of physical activity are of equal benefit in helping with menopause symptoms. In fact, some forms of exercise can exacerbate certain types of symptoms such as hot flashes and insomnia.

I believe that it is important to pick the type of exercise depending on your symptoms rather than just exercise to exercise.

So how do you know which exercise is best for you? You start by reading this article! 🙂 To help you find your way through the labyrinth of research that is out there, I’ve consolidated the findings of the last 20 years of research on this topic so you don’t have to.

First I want to highlight the overall benefits of exercising regardless of symptoms…

Exercise Increases:

  • Benefits brain function and functional capacity
  • Increases beta endorphins
  • Quality of Life
  • Strength and balance
  • Increased Bone Mineral Density
  • Increase in quality and length of sleep
  • Maintenance of healthy BMI
  • Self-perceived physical condition
  • Sport competence
  • Body image & physical self-worth

Exercise Decreases:

  • Vasomotor Symptoms
  • Somatic & psychological symptoms
  • Depression (1 exercise session/week = 22% reduction)
  • Osteoporosis
  • Body Mass Index
  • Musculoskeletal symptoms
  • Cardiovascular Disease (50% reduction)
  • Overall mortality (20% reduction)

Exercise has many benefits but can also be stressful on the body.

Too much exercise and/or intensity can:

  • Decrease sleep quality and length, which in turn is correlated with adverse physiological and psychological outcomes
  • Increase circulating cortisol levels, which can lead to increased abdominal fat (read last week’s post for more info on this)
  • Have negative effects on thermoregulation as it causes substantial increases in metabolic heat production and core temperature (during exercise, metabolic heat production can increase by ten to twenty-fold and recent studies suggest that hot flashes are triggered by small elevations in core body temperature)

Moderate intensity appears to have the most benefits…

  • Highest menopause-specific quality of life
  • Lowest number of symptoms
  • Increased sleep, energy, confidence, mood

The following exercise guidelines are specific to helping you with menopause symptoms as well as increased quality of life throughout the menopausal transition. These recommendations do not apply to overall physical health.

Type of Exercise 

  • Endurance/aerobic training best for increased sleep
  • Strength training for body image, strength, body aches
  • Yoga for vasomotor (VMS) symptoms and overall menopause-specific quality of life (Hatha yoga for cognitive function (memory, concentration)
  • Walking at ~3-3.5 mph for anxiety and depression

Duration & Intensity

  • Moderate Intensity (60-70% Target HR)
  • Min. 3 x week (more days = decreased severity of symptoms)
  • Programs lasting at least 12 weeks

Special Considerations

  • Keep body core temperature at comfort level to avoid increases in VMS
  • Focus on activities that are enjoyable to you. Forcing yourself through workout regimens that you dislike can have negative effects on quality of life. I hear too many people say: “I think I should run more” and my question to them is “Why? Do you like running?”. “No, but it’s good for you”. Really? Is it? I don’t believe in doing things just because someone said they’re good, especially in regards to exercise. If you don’t like it, you won’t stick to it. It’s as simple as that. And when it comes to working out, consistency is the key. So find activities that you truly enjoy. Not only will you continue doing them and reap the physical and mental benefits but doing things you love will help you reduce stress and keep off that unwanted meno-pod (if you don’t know what a meno-pod is, you have to read last week’s post).

All information is based on peer-reviewed research. I usually add a reference list of all the articles I read to put together an article but this one would be way too long. If you’re interested in finding out more about specific research articles used for this blog, contact me.

Article reprinted with permission from Dr. Maria Luque.

 


Dr. Maria Luque is a health educator and fitness expert that specializes in helping women take charge of their own wellness. A native of Germany, she pursued a career driven by a passion for health and fitness. Dr. Luque currently teaches at the College of Health Sciences at Trident University International, in addition to conducting workshops, group/personal training, and writing. She’s an IDEA Fitness Expert and has been published in the IDEA Fitness Journal as well as appeared as a guest at local news channel to talk about quality of life and menopause. Visit her website, doctorluque.com

High intensity interval training workout

How Much High Intensity Exercise is Too Much?

Are you doing too much high intensity exercise? High Intensity Interval Training (HIIT) has been the holy grail of fitness trends for the past several years. Is it the Holy Grail for YOU? Here’s what a recent study says and how to interpret that if you’re a woman flipping (or wanting to) her second half with flare.

Exercise is stress. High intensity exercise is greater stress. Stress causes cortisol.

Cortisol plays two roles in our lives. It’s both the stress hormone and the energy hormone. The perfect amount of stress makes you feel alive and thrive. Too little or too much cortisol each causes problems.

When you’re exercising with the right amount of “overload” or stress you create a positive, not negative, stress response. That’s not to say (because I hear you saying that’s how you negate stress) that exercise doesn’t relieve stress. It can. But we sometimes don’t give ourselves the right dose, frequency or intensity to optimally relieve stress without having it come back to bite us you-know-where.

Better Stress

The key is to find your personal optimal exercise. I’m an advocate for the right exercise for you right now. Women in midlife are more susceptible to the negative effects of stress as they go through other major hormone changes. What worked once – even as recently as months ago or last week – may not be your ideal exercise this week.

That doesn’t mean you’re going to suffer, gain weight, get moody or any of the above. If you adjust your exercise according to what’s going on, respond to it even if you can’t predict what changes will be, you’ll sail through those years from peri-menopause to beyond menopause better. That sets you up for a full Flipping 50 (49-99) feeling as young as your habits will allow you. It’s habits that determine how your genetics express or suppress (epigenetics).

What’s the best exercise?  The answer is not the same for you and for every other woman over 50. We’ve got common denominators but your details are unique to you. If you’re deconditioned, conditioned, or an athlete it changes your exercise prescription. If you’re in adrenal fatigue, you’re estrogen dominant, or have low testosterone will change what I suggest you do. If you have osteoporosis, are trying to prevent it, or you have 20 or more pounds to lose, each of these (and more) will change the exercise plan that’s best for you.

A recent study of weight training performed as high intensity interval training (HIIT) was created to determine if HIIT weight training was better than traditional weight training. Researchers asked, is heavy weight training better than the moderate-to-light weight training recommended for decades?

A side note here: the fear of “bulk” from strength training is legit. The three sets of 10-to-12 repetitions taught for decades, as some kind of gold standard actually IS a bulk-building protocol. Ten or fewer repetitions is the optimal strength, bone building, and fat reducing/lean increasing protocol while higher repetition ranges are best for performance enhancement and influencing smaller muscle activation.

Your personal exercise protocol is also influenced by whether you’re a mesomorph, endomorph, or ectomorph. Each body type can respond differently to a protocol.

ACE Research

According to the study performed by the American Council on Exercise, a leading authority in fitness, moderate or average exercise should occur between 70 to 80 percent heart rate intensity, HIIT training requires at least 85 percent heart rate intensity, the study says. Les Mills’ researchers (creators of Body Pump) wanted to determine how to best achieve a healthy balance between one’s HIIT volume (minutes of HIIT per week) and one’s positive stress response. Their hypothesis was that more than 30 or 40 minutes of weekly HIIT volume would prompt a reduced positive stress response.

“A positive stress response to exercise is a critical part of creating the bio-chemical changes in the body that help build new muscle and improve fitness,” the study says. “The stress response can be measured effectively by examining cortisol and testosterone concentrations in saliva.”

Not to repeat myself but as mentioned earlier, this is really what we refer to as the principle of overload in fitness. The stimulus of exercise must be adequate to provide overload such that the body responds after (when between sessions fitness occurs IF you have adequate rest, food, and sleep).

Remember Your Hormones

It’s key for YOU to remember, Flipping 50 friend, that you have another thing to consider. The status of your hormones, not just of your mind’s desire to lose fat, or get in shape needs to be considered when designing your exercise program. Pushing through … following lame social media memes suggesting that “sweat is fat crying” can backfire on you and increase fat storage when stress goes the wrong way. When you read “move more” interpret it as walking down the hall to deliver a message as opposed to going to boot camp 6 days a week or doing two-a-days.

Let me take a step back here and describe what it feels like to lift at a level defined as HIIT. There’s a lot of confusion about HIIT. Anything that gets you breathing slightly harder is NOT HIIT. Lifting with a weight that causes fatigue at 10 repetitions correlates with 80% intensity. So in order to lift and a HIIT level of 90% as per the study, you’d be lifting a weight closer to 5 repetitions.

Don’t panic. You definitely progress to this point. You also can reduce the weight slightly and use power, increasing speed on the lift but always controlling the lowering (eccentric) phase of exercise to achieve this overload without a heavy weight. You do this in daily life… the wind grabs the car door, the door to a store is heavy, or you heft the garbage bag out to the curb… so if you’re worried about injury (valid) do consider whether your daily activity warrants the work so you’re prepared.

Fatigue vs Tired

Moving fast to get breathless is not necessarily overloading the muscles in a way that muscle changes and creates lean muscle tissue that assists in fat burning.

THIS is a key distinction most program creators and attendees fail to make. Going to a boot camp where you’re moving fast from a strength exercise to a cardio exercise to a core exercise will likely tire you. Tired is not muscle fatigue. Muscle fatigue must be reached so your body changes.

Will it burn calories right now? Yes. Will it change your body, your body composition, and set you up for years of a stronger leaner body? No.

The study used strength training as the mode of high intensity exercise. Researchers compared one set of 5 repetitions for each of 10 exercises to 1 or 2 sets of 10 repetitions for 10-12 exercises. The subjects were both male and female and ages up to 59.

The results showed body fat decreased significantly for both groups. Blood pressure and LDL (bad) cholesterol decreased only for the HIIT group.

“When it comes to HIIT, adding volume doesn’t deliver better results,” the report says.

“It actually hinders. To get the full benefits of HIIT and prevent overreaching, our recommendation is to…

Do a maximum weekly HIIT sessions that are above 90 percent maximum heart rate for 30-40 minutes…

…and balance them with other less demanding workouts.”

“It’s also imperative that you let your body recover properly after a HIIT session. This way, you’re likely to perform better when you do your HIIT workouts and benefit from the positive results,” researchers added.

The key exercise flips:

  1. More is not better when it comes to High Intensity exercise
  2. An understanding of what constitutes high intensity interval training is key if you’re to reap benefits
  3. The more health markers (blood pressure and cholesterol) you’re trying to target with your exercise, the more HIIT could benefit you done with adequate progression
  4. low volume of HIIT (no more than 40 minutes a week) is far better for results (and reduction of injury) than more volume (frequency, or duration)
  5. If you’re doing high intensity exercise that is also high impact cardio or high intensity strength training every day you may be inhibiting your recovery and results.

This distinction of when to work hard and when to recovery is so important. It’s not intuitive for a generation that witnessed the work harder, get better results discipline of our parents.

Article reprinted with permission from Debra Atkinson. Originally printed on flippingfifty.com.


Debra Atkinson is the #youstillgotitgirl who is flipping 50 and changing the way thousands of women think about their second half. She’s the host of the Flipping 50 TV Show and the Flipping 50 podcast. As a master personal trainer, strength and wellness coach with over 30 years fitness industry experience, she works with women who are pro-aging with vitality and energy. She is an international fitness presenter, author of hundreds of articles and multiple books. Visit her website, flippingfifty.com

woman heating pad

Why Suffer in Silence?

In America today, 40% of females, including women, children and teens, suffer in silence with either primary or secondary dysmenorrhea every month. Primary dysmenorrhea accompanies the monthly menstrual cycle without any underlying medical conditions. Secondary dysmenorrhea means that there is another medical issue present, such as endometriosis. This condition makes it hard to function, with most women being bedridden for three to five days or longer. Dysmenorrhea is not a weakness, but a real medical issue.

Generally, the female client will have severe throbbing pain from the waist down. They can feel it in their stomach, low back, legs and feet, making it hard to move. Other symptoms include nausea, vomiting, diarrhea, anxiety, stress, depression, lightheadedness, fatigue, headache, fever, and depression, weakness and fainting. Risk factors are smoking, obesity, being underweight, strong family history, high levels of stress, anxiety and/or depression. Women can still have painful stomach cramping well after menopause if they have Endometriosis.

This is a silent stressor for many women because they rarely choose to speak about it. Some have been living with the pain for twenty years or more and think there is nothing they can do. If a client comes to you and mentions that they have a lot of pain, urge them to see their doctor. This conversation is more likely to happen with a female personal trainer. The good news is that fitness professionals can help their clients to feel better during this painful time of the month.

It is important to acknowledge this painful condition because of the physical and mental implications that come along with it. As the trainer you, may be working with a therapist as well as an OB/GYN. You are trying to help your client feel better overall. We recommend scheduling an assessment first to understand the client’s medical history. As a fitness professional, you may want to refer your clients to other professionals as well. Acupuncture, for example, is well known for helping women to ease and reduce anxiety. When you network with other professionals, you form a referral system to obtain more clients for yourself, too.

After completing your assessment, you will develop a wellness program for your client. The program will include: exercise, meditation (specific to this condition), and aromatherapy, as well as other components. Try to have your client establish a regular daily wellness routine. Journaling is also important as it helps to connect your thoughts, feelings and behaviors. Support groups can also help as women share their experiences with others.

If you’re interested in learning more about this topic, The Stress Management Institute will be launching a new program called “Living Well” in January 2019. Fitness professionals can learn how to enhance the lives of women who live with this condition.


Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 18 years of experience in medical based fitness.

References:

Feet on bathroom scale

The Dreaded Menopod – Menopausal Belly Fat

The most common concern I hear from women in their 40’s and 50’s is increased belly fat. It isn’t weight gain that they are mostly upset about but where it’s deposited…right around the belly button.

Even women that don’t gain weight, see changes in where the fat is deposited. Is it an evil magic trick? I’ve heard it being called the belly bagel, spare tire, jelly center, and my favorite the menopod. Regardless of its name, it’s unwanted and you want to know how to get rid of it. Can you get rid of it or are you doomed to everlasting belly fat increases? Well, let’s break down why it happens and I’ll give you some ideas on what you can do.

Aging 

As we age, it is normal to see some weight gain. This is not something unique to women but women do see a larger increase in abdominal fat. In fact,  the prevalence of abdominal obesity in women in 2008 was 65.5% for women aged 40-59 years. So you’re not alone in this experience. Many different factors play a role in this. Changing hormone levels, loss in muscle mass, decreased activity level, and increased caloric intake, are just a few.

Estrogen

This is the queen bee of all hormones and sadly, this is the one that you’re being robbed off during menopause. Why is this such a big deal? Because she controls everything!! Estrogen plays a role in endocrine, immune, and neurologic systems. That’s why when it’s taken away, many women feel symptoms ranging from hot flashes to forgetfulness, depression and insomnia. One of the biggest connections of estrogen on increased belly fat is its relationship to cortisol. Ahhh, there it is, one of the biggest baddest buzz words in the health industry right now.

If you believe what you read in headlines, this is the one to blame for everything. If it’s out of control, you lose, but to control it seems impossible. Is it? How is estrogen related to it and how does it play a role in belly fat?

Cortisol deserves an entire article by itself (which will come soon) so here is the condensed version on why cortisol is so important to your menopod.

Cortisol is:

“Cortisol regulates energy by selecting the right type and amount of substrate (carbohydrate, fat or protein) that is needed by the body to meet the physiological demands that is placed upon it.” (5)

  • Energy production, exercising, eating, and under stress.
  • This chronic stress can cause excess fat storage deep in the abdomen (visceral fat).
  • Deep abdominal fat has greater blood flow and four times more cortisol receptors. That’s why when there is too much cortisol in your body, it goes right to your belly.
  • It naturally is higher in the morning when you wake up and tapers down as the day goes on.
  • When the body remains under constant stress, cortisol levels remain high regardless of time of day.

Estrogen – Cortisol Connection 

Estrogen has anti-cortisol properties, which helps the body counteract some of the negative effects of cortisol. So as estrogen starts disappearing, so do its cortisol-fighting superpowers. This means that if your body was able to handle some of the excess day-to-day stress before, it may not be able to handle it quite as well now, which translates into excess belly fat.

What can you do?

Chill out!!

  • This is the most important thing you can do
  • Eliminate little, unimportant things that drive you crazy. This is unnecessary stress.
    • In my case, every time I feel like getting stressed out over some inconsiderate driver on the road, I say to myself “menopod alert, menopod alert…not worth it!!” It helps 🙂
    • Stress will always be a part of life. Learning how to cope with it, is essential to controlling weight gain, belly fat, and overall health and well-being.

Resistance training

  • Don’t wait!
    • It is easier to maintain than to try and lose weight during menopause
    • Nobody knows exactly when menopause starts. It can be as early as mid-30’s to late 50’s.
    • Being active before midlife has advantages as it can contribute to entering menopause with lower BMI, higher bone density, lower fat mass, higher lean body mass.

Muscle mass decreases with age for every person, not just women. However, this decrease is accelerated in women as they transition through menopause.

Mindful exercises such as yoga, Tai Chi, meditation.

  • It can help with stress reduction as well as other psychological symptoms, such as anxiety and depression

Eat healthy and adjust your caloric intake to your energy output.

  • If you’re not working out as much as you did before, you can’t eat like you did

As we age, we are faced with many physical changes that affect us not only physically but also psychologically and emotionally. As women, those changes are exacerbated during menopause. Understanding these changes is a key factor in being able to overcome these challenges and transition happily through menopause. In regards to increased belly fat, you must remember that weight gain doesn’t happen overnight and it doesn’t start with menopause.

Don’t wait until you’re unhappy with your body… live healthy now!

Exercise, eat well, find a good balance between work and personal life, and enjoy the smaller things in life. Most importantly, don’t let inconsiderate drivers give you a menopod! 🙂

Have a comment or question? Tweet me @doctorluque

Republished with permission from doctorluque.com


Dr. Maria Luque is a health educator and fitness expert that specializes in helping women take charge of their own wellness. A native of Germany, she pursued a career driven by a passion for health and fitness. Dr. Luque currently teaches at the College of Health Sciences at Trident University International, in addition to conducting workshops, group/personal training, and writing. She’s an IDEA Fitness Expert and has been published in the IDEA Fitness Journal as well as appeared as a guest at local news channel to talk about quality of life and menopause. Visit her website, doctorluque.com

References

  1. Davis, et al. (2012) Understanding weight gain at menopause. Climacteric 15;419-429. doi: 10.3109/13697137.2012.707385
  2. Sammel, et al (2003). Weight gain among women in the late reproductive years. Family Practice, 20: 401-409. doi: 10.1093/fampra/cmg411
  3. Lovejoy, J. C., Champagne, C. M., De Jonge, L., Xie, H., & Smith, S. R. (2008). Increased visceral fat and decreased energy expenditure during the menopausal transition. International Journal of Obesity, 32(6), 949-58. doi:http://dx.doi.org/10.1038/ijo.2008.25
  4. Epel, E. S. (1997). Can stress shape your body? stress and cortisol reactivity among women with central body fat distribution. (Order No. 9930948, Yale University). ProQuest Dissertations and Theses, , 96-96 p. Retrieved from http://search.proquest.com/docview/304388219?accountid=28844. (304388219).
  5. Maglione-Graves, C., Kravitz, L., Schneider, S. (no date). Cortisol Connection: Tips on Managing Stress and Weight. http://www.unm.edu/~lkravitz/Article%20folder/stresscortisol.html
menopause

The “M” Word – Let’s Talk Menopause

We’ve all heard about menopause, but what really is it? When does it start? How long does it last? How will I know if I’m in menopause? What are the symptoms? Does everyone have the same symptoms? These are just a few of the many common questions that I’m asked on a regular basis. This natural phase in every woman’s life is still a big mystery surrounded by misinformation, confusion, and yes, quite a bit of secrecy. In the next few installments of this series, I will address hormone replacement therapy, alternative therapies, the role of nutrition & physical activity, and any questions you may have. Let’s blow the top off this taboo topic – let’s talk menopause!

Menopause has morphed from an experience that only a small percentage of women lived through to a natural part of every woman’s life today. At the turn of the 20th century, women were not expected to live past 50. Now life expectancy for women is 78 years of age.  If you’re a woman in your 20’s or 30’s, you might ask yourself: why should I care? I’m way to young for this. Well, I hate to be the bearer of truth but the reality is that you will eventually go through it; so you might as well be educated.

The fact is that 75% of all women will experience hot flashes, night sweats, insomnia, weight gain, and irritability. Menopause symptoms can be debilitating for many women, often appearing before they realize hormonal changes have begun to take place. Women don’t expect to experience these symptoms in their mid-thirties, but it happens all the time. Yet an alarming number of women still think they don’t have to “worry” about menopause until their 50s. Don’t wait! Educate yourself early on. So let’s start with the basics: what is menopause?

The Menopausal Transition Defined

Menopause is not a singular event but rather a transition lasting on average 3.8 years. It is often described in three phases: premenopause, which is the time when menstruation is normal, to perimenopause, which is the time when menstruation becomes more infrequent and also includes the one year after the final period, after which postmenopause begins, which is defined as the time in a women’s life when the ovaries stop functioning and menstruation has ceased for at least 12 consecutive months.  You’re also considered postmenopausal if the ovaries were surgically removed or were damaged during chemotherapy. (Note: a hysterectomy, where only your uterus is removed, does not affect your ovaries or menopause). For a more detailed breakdown of the adult female reproductive life, the most recent Stages of Reproductive Ages Workshop (STRAW) is a great resource (Harlow, et al., 2012). It provides guidance on the different stages, their lengths, characteristics, and signs. Although there is no exact test to determine perimenopause,  STRAW also provides guidelines for hormone levels that play a role in determining the stages in the menopausal transition. The most common hormone used for determination of perimenopause is the Follicle Stimulating Hormone (FSH), with levels greater than 25 IU/L indicating decline in ovarian function and beginning of perimenopause. As estrogen drops, FSH climbs to kickstart the follicle cycle and make up for the lack in estrogen.

Symptoms – oh no!

Menopausal symptoms are often summed up to hot flashes and night sweats although that couldn’t be further from the truth. Both hot flashes and night sweats are symptoms of menopause but there are many more, often subtle symptoms, that are not commonly attributed to the menopausal transition but are indeed symptoms linked to declines in ovarian function.

Menopausal symptoms fall into four categories to include vasomotor, psychosocial, physical, and sexual.

Vasomotor symptoms (VMS)

About 75% of women experience VMS
Hot flushes, night sweats, sweating

Psychosocial

Anxiety, impatience, poor memory, depression (prior depression is the highest risk factor for subsequent depression)

Physical

Body aches, fatigue, insomnia, weight gain, changes in skin appearance, migraines

Sexual

Vaginal dryness, painful intercourse, avoiding intimacy, lack of sexual desire

In addition, reduced levels of neurotransmitters (serotonin, dopamine, oxytocin) can  cause changes in brain function and behavior, and declines in cognitive function, mood, and memory.

I know, I know, this all sounds very scary and depressing but this article is not designed to scare you into expecting the worst. Its purpose is to inform you of changes that will happen and that can come in all forms and intensities. Every woman is different; some women experience all symptoms to the extreme but there are also women that don’t experience any symptoms at all. It is impossible to predict what your experience will be. My goal is to equip you with the knowledge to be able to identify changes that are attributable to the menopausal transition and how to successfully and hopefully happily transition through this time in your life.  Let’s start this conversation.

Have a comment or question? Tweet me @doctorluque

Republished with permission from doctorluque.com


Dr. Maria Luque is a health educator and fitness expert that specializes in helping women take charge of their own wellness. A native of Germany, she pursued a career driven by a passion for health and fitness. Dr. Luque currently teaches at the College of Health Sciences at Trident University International, in addition to conducting workshops, group/personal training, and writing. She’s an IDEA Fitness Expert and has been published in the IDEA Fitness Journal as well as appeared as a guest at local news channel to talk about quality of life and menopause. Visit her website, doctorluque.com

group of happy pregnant women talking in gym

Pelvic Floor Dysfunction in Pregnant Women and New Mothers, Preventable & Treatable

 

Pelvic floor dysfunction, or PFD, is a broad term used to describe several physical conditions that occur mainly as a result from pregnancy and childbirth. As a pre and postnatal fitness specialist for over 20 years, almost every one of my clients has had some form of PFD. What does this mean and why is it relevant to women’s fitness? I will further define PFD in detail and explain how it changes the way we as exercise professionals program design for this clientele.

First, let’s look at the pelvic floor muscles. The pelvic floor looks like a sling or hammock that forms the floor of the bony pelvis and it serves several important functions in our bodies.  The internal layer or “pelvic diaphragm” work with the external muscles of the pelvic floor to support our internal organs, stabilize our bodies, allow for sexual function, urinary and bowel movements and assist in contracting and pushing in the birthing process. These muscles are prone to trauma from the various functions they perform.  The stress of the growing uterus in the body during pregnancy coupled with the changing gravity, posture and production of the hormone Relaxin all contribute to weakening the pelvic floor muscles.

Second, consider the whole Neuromuscular Core system. Pelvic floor muscles connect to the Transverse Abdominus (TVA) and they work together in harmony essentially hold the body upright. It is almost impossible to engage one without the other. Tightness in the hips combined with weak pelvic floor muscles creates PFD.

Diastasis Recti, Symphosis Pubis Dysfunction (SPD), Urinary and or fecal incontinence, pelvic pain, chronic lower back pain, Piraformis syndrome, sciatic pain, pelvic organ prolapse are all conditions under the pelvic floor dysfunction umbrella.  Below these conditions are listed and defined in more detail.

Diastasis Recti: This is a separation of the right and left side of the Rectus Adbdominus in the Linea Alba connective tissue more than 2 cm in width

Pubic Symposis Disorder: A separation of the pubic bones, which often occurs during birth but sometimes during the third trimester.

Urinary incontinence: Uncontrollable leakage from bladder.

Fecal incontinence: Uncontrollable leakage of fecal matter from colon. Usually as a result from severe tearing during birth.

Pelvic pain: This type of pain can be during sex or when performing a movement that is irritating or uncomfortable, many possible underlying issues.

Chronic lower back pain: Unexplainable chronic lower back pain

Sciatica: Pain that radiates from lower back down one leg along the sciatic nerve as a result of compression of the sciatic nerve

Piraformis syndrome: Also a result of an inflamed sciatic nerve but more localized

Pelvic organ prolaps: When organs of the pelvis fall as a result of weak pelvic floor muscles.

These conditions can be limiting for many women and go untreated because they are embarrassed or told that they are normal “experiences” after giving birth. Until recently, very few fitness programs existed to help women strengthen pelvic floor muscles. It is my opinion that every pregnant woman and new mother should be automatically screened for PFD and treated right away. If women do not learn proper strengthening exercises of pelvic floor muscles they can potentially live in discomfort for years. The sooner preventative care is offered the better the quality of life for these women.

As mentioned earlier, many of these conditions are preventable and remedied through a combination of functional strength with corrective, posture-based range of motion exercises. When a woman becomes pregnant there is an immediate increase in pressure to the pelvic floor muscles. The body begins to produce relaxin which affects the joints throughout the body, especially the pelvis as it prepares to accommodate the growing uterus and eventually for birth. If treatment begins to help women continue strengthening the muscles surrounding the hips immediately, the pressure on the pelvic floor muscles will be reduced.

It was common practice until recently that women were advised to learn and perform Kegel Contractions. We understand more now as movement therapists that Kegel contractions are very hard to teach, very isolated, and in most cases, when examined internally by a women’s healthcare PT, women are not performing them correctly.  A more effective approach to strengthening the pelvic floor muscles is to treat the entire hip complex as “one”– or a “global approach” — as described in applied functional science.

So, how do fitness professionals help create beneficial, safe and effective exercise programming for pregnant clients and new mothers that hone in on the core and pelvic floor? We must start by helping our clients improve their posture first and foremost, then work on proper breathing techniques and lastly incorporate larger exercises that do not isolate, but recruit many muscles from the hip complex and surrounding muscles groups. By incorporating all three planes of motion instead of working primarily in the sagittal plane (forward and backward) when performing even the most basic of exercises (i.e., the squat), you must change the movement by foot placement, arm placement, direction, tempo, range of motion etc. The variety in actions creates good stress to the pelvic floor and core muscles. Additionally, increasing the adduction and abduction action simultaneously while performing various exercises will help activate and recruit pelvic floor muscles subconsciously. Anatomically speaking, everything is connected in the body. Understanding that big global movements of the upper body and lower body together affect the position and strengthen of pelvic floor and core muscles is essential. The body is most efficient at strengthening the small muscles when big muscle groups are stimulated in combination. Throughout my years, I have seen much success with clients that incorporated these types of movements into their workout regimen and were safe and conscientious not to perform exercises that added bad stress to the external abdominal muscle group or impact exercises.

Each woman is different on how quickly it takes her to recover from PFD. The most important rule of thumb is to be reassuring and provide support and remember the time line is different for everyone depending on severity of PFD, the fitness level of the client, if the client is breast feeding and prior injuries that could prolong healing time.


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

Sports pregnant young woman. Fitness.

Exercise & Pregnancy

Beautiful pregnant woman gym fitness exerciseThe understandable fear (due to things like decreased oxygen supply to the baby) that existed with pregnancy & exercise years ago is no longer warranted.  Because of substantial research, it is now safe for women to continue or start exercising while pregnant.  As long as she gets approval from her doctor & seeks out a qualified and certified fitness professional, she should be confident in knowing that the recommendations below will help her.

Considerations & Exercise Suggestions

1. Posture Change from the Growth of the Baby: As a result of the baby growing in the wound, the mother to be’s posture will change. This causes certain muscles to become weak, particularly her core. In the 1st and 2nd trimester, a mother to be should focus on strengthening her core through exercises such as planks, bridges, and birddogs. Once the 3rd trimester hits, it would be wise for the mother to be to avoid supine or prone core exercises. She can still work her core by doing standing exercises such as medicine ball chops, reverse chops & rotations. All of these exercises can be performed 2-3 days/week, 1-2 sets of 12-15 reps with appropriate rest time (45-90 seconds) between sets.

2. Cardiovascular Exercise: With the growth of the fetus, also comes more stress to the mother to be’s heart and lungs. As a result, her ability to work harder and longer is decreased. However, a mother to be can still perform low impact or step aerobics that do not involve jarring motions. Walking on the treadmill, stationary cycling and water aerobics done 3-5 days/week for 15-30 minutes is suggested.

3. Flexibility Exercise: Because the mother to be’s body posture has changed, this may cause certain muscles to overwork or become tight. As a result, she may feel the need to stretch certain muscles. This is ok to do so. Static and active stretches are advised along with foam rolling that can be tolerated. However, foam rolling on varicose veins or swollen muscles should not be done. I would advise stretching muscles that appear to be overworking such as her calves and lower back. This can be done everyday for 1-2 sets, holding each stretch for 30-60 seconds.

Pregnant woman holding dumbbells4. Weight Training Exercise: Circuiting training has shown to be very effective for mother’s to be throughout their entire pregnancy. These include exercises that work the entire body and can be performed back to back with little rest in between.  I recommend exercises that work the following muscles: legs, chest, back, shoulders and arms. They can be done 2-3 days/week, 1-2 sets of 12-15 reps. The rest period can be in between 45-75 seconds.

5. Cautions: Mothers to be should stop or avoid exercises that cause nausea, dizziness, stomach pain, prolonged shortness of breath, bleeding and fainting.

Conclusion

By taking the appropriate precautions, mothers to be can safely exercise during pregnancy. As a result, the pregnancy can be smoother and the recovery can be quicker.

Helpful links for exercises

http://blog.nasm.org/fitness/exercise-pregnancy-physiological-changes-exercise-programming/
http://www.fitpregnancy.com/exercise/prenatal-workouts/weight-training-pregnancy


Maurice D. Williams is a personal trainer and owner of Move Well Fitness in Bethesda, MD.

Source
Clark, Sutton, Lucett. NASM Essentials of Personal Fitness Training, 4th Ed. Revised. 2014

 

 

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Prenatal Exercise: Training for the Main Event

Say Good-bye to the myth of the “delicate” condition and Say “Hello” to pregnancy in the 21st Century!

Current research shows that women can safely exercise and maintain their fitness level during the perinatal period.

Pregnant women doing squatting exercise.The mom who laces up her sneakers instead of heading to the couch will be rewarded with a healthier pregnancy and a healthier baby.

Pregnancy is a time of excitement, uncertainty, fear, and many profound physical and emotional changes. This “season in life” affords mom a wonderful opportunity to adopt a healthier lifestyle.

Starting an exercise program during pregnancy is a great way to begin and continue a healthier lifestyle, both for mom and baby.

With obesity on the rise in the US, it is important for everyone to increase their level of physical activity. This is especially important for pregnant women as the results of obesity and excessive weight gain have been shown to be detrimental to mom and baby in the short and long run.

A Historical Perspective on Prenatal Exercise Guidelines

Moms today are inundated with information about pregnancy and exercise. Unfortunately, a great deal of this information is outdated. It is important for women to have a working knowledge of the most current guidelines so that they can make intelligent choices.

For many years, pregnant women were advised to “take it easy” during pregnancy. Mom was advised to rest and gain weight in order to ensure a healthy pregnancy. In the 1950’s women were “allowed” to walk a mile a day for exercise and this mile was preferably “broken up” into smaller segments.

The American Congress of Obstetrics and Gynecology (ACOG) issued the first formal guidelines for perinatal exercise in 1985 (1). These guidelines were highly restrictive as they were not based on extensive research and were designed for the majority of pregnant women without regard to pre-pregnancy fitness levels. Four of the original guidelines are highlighted below:

  • Mom should exercise at a heart rate less than 140 bpm.
  • Strenuous exercise should not exceed 15 minutes
  • Maternal core temperature should not exceed 38 degrees C
  • No supine exercise after the first trimester

A great deal of research involving both sedentary and trained subjects was published after the release of the 1985 guidelines.

This prompted The American Congress of Obstetrics and Gynecology to publish a revision of the original guidelines in 1994 which lifted specific limitations for prenatal exercise (2).

ACOG said, “There are no data in humans to indicate that pregnant women should limit exercise intensity and lower target heart rate because of adverse effects.”

In this revision, there was no mention of the 140 bpm maximal heart rate or an exercise limit of fifteen minutes. Women were advised to use the “talk test” and “perceived exertion” as ways to measure exercise intensity. We were making progress!

Although the 1994 guidelines were a refreshing change in the right direction for ACOG, they still did not address the pregnant athlete. In 2002, The American Congress of Obstetrics and Gynecology published “Exercise During Pregnancy and the Postpartum Period:

In this publication, which was reaffirmed in 2009, ACOG recognized that “in the absence of contraindications, pregnant women should be encouraged to engage in regular, moderate intensity physical activity to continue to derive health benefits during their pregnancy as they did prior to pregnancy.”

This revision focused more on the athlete as well and was the first formal recommendation by an American physician group to include prenatal exercise. The major points of the 2002 update include:

Previously sedentary women and those with any medical or obstetrical problems
should obtain medical clearance before embarking on an exercise program; NO PRENATAL CLEARANCE, NO EXERCISE, NO EXCEPTION.

  • Thirty minutes or more of moderate exercise daily, or on most days of the week is recommended. This brings the exercise guideline for pregnancy more in line with the American College of Sports Medicine (ACSM) guidelines for the general population.
  • Competitive and recreational athletes with routine pregnancies can remain active, “listen to their bodies” and modify their exercise routines if medical necessity arises.
  • Physically active women with a history of or risk for preterm labor or fetal growth
  • restriction should reduce their activity in the second and third trimesters

In 2006, the “American College of Sports Medicine Roundtable Consensus Statement: Impact of Physical Activity
During Pregnancy and Postpartum on Chronic Disease Risk” was published (4).

This report, based on an analysis of the most current research by a panel of scientific and clinical experts, supported the safety and long term benefits of prenatal and postpartum
exercise for both mom and baby.

Pregnant woman exercisingSome of the benefits highlighted in this report and
other studies show that exercise:

  • Reduces the risk of preeclampsia (a condition marked by high blood pressure, protein in the urine and marked fluid retention in the mom which can lead to serious maternal and fetal complications).
  • Treats or prevents gestational diabetes, the diabetes of pregnancy. For some women exercise alone may stabilize blood sugar. Moms with gestational diabetes are more prone to Type II diabetes later in life.
  • Helps manage or alleviate pregnancy related musculoskeletal issues. Exercise
  • may help with low back pain, urinary incontinence, abdominal muscle and joint
  • and muscle issues.
  • Links breastfeeding and postpartum weight loss. Weight loss can occur with moderate exercise and caloric restriction without affecting the quantity and quality of breast milk or infant growth.
  • Positively impacts mood and mental health. Exercise is a “mood elevator.” It reduces stress, fatigue, anxiety and improves self-image.
  • Baby’s health and development: The panel advised that beginning or continuing a prenatal exercise program had both short and long term positive effects.

The most recent guidelines for prenatal exercise were included in the 2008 US Dept. of Health and Human Services Physical Activity Guidelines (5).

Women who are not currently active should strive for at least 150 minutes of moderate intensity cardiovascular activity per week. This translates to 30 minutes of exercise 5 days a week, very similar to the ACOG guideline.

They recommend that those women who are currently active may continue their normal routine providing there is an open line of communication with their healthcare providers

The latest research continues to showcase the benefits of prenatal exercise.

A 2013 review of the international evidence reinforced the fact that women who engage in prenatal exercise have a decreased risk of developing gestational diabetes and other hypertensive disorders during their pregnancies.

They are also less likely to deliver big babies (> 9 pounds). Other studies suggest that babies born to active moms are lighter and leaner at 1 and 5 years of age (6). Additional research has supported these findings and has extended the benefits to older children (8-10 year olds) (7).

This is quite significant considering the fact that childhood obesity is on the rise. We now have exciting evidence that the in utero environment of exercising mothers may provide long term effects for their offspring with regards to bodyweight and body fat.

Prenatal exercise may also boost babies’ brain activity.

Canadian research has shown that babies of exercising moms had greater brain activity 8 – 12 days after they were born, as evidenced by an increased ability to process repeated sounds (8). This was the first study to link prenatal exercise with babies’ brain development.

Warning Signs and Symptoms to Discontinue Exercise (9)

If a woman experiences any of the following, she should cease exercise and contact her health care provider as soon as possible:

  • Vaginal bleeding or fluid leakage
  • Shortness of breath prior to exertion
  • Pelvic pressure or cramps
  • Dizziness
  • Headache or any vision problem
  • Pain of any kind
  • Uterine contractions
  • Muscle weakness
  • Calf pain or swelling
  • Preterm labor
  • Decreased fetal movement
  • Chest pain
  • Temperature extremes (hot or cold; clammy)
  • Nausea / Vomiting

As a result of almost 30 years of research showing the benefits of prenatal exercise, we have seen a substantial increase in the number of motivated personal trainers who are certified to work with this very special population.

No two pregnancies are the same and no two prenatal fitness programs should be the same. Trainers certified in perinatal fitness and wellness possess the knowledge and skills to design and implement individualized programs to help mom prepare for the “marathon of labor” and the “tasks of mothering” after the baby is born.


Sheila Watkins is a perinatal fitness specialist with over 25 years of experience training 2500+ pregnant and new moms, and educating hundreds of fitness instructors, health professionals, and childbirth educators on the rapidly changing field of perinatal fitness. She is the creator of Healthy Moms® Fitness Programs to provide safe and effective group exercise classes and personal training for new and expectant moms, as well as education and training in the field of perinatal exercise for fitness professionals, childbirth educators and other health professionals.

References

1. ACOG. The ACOG Guidelines for Exercise During Pregnancy and Postpartum; Home
Exercise Programs, 1985.
2. ACOG. Exercise During Pregnancy and the Postpartum Period. ACOG Technical Bulletin, No.189, February 1994.
3. ACOG. Exercise During Pregnancy and the Postpartum Period, ACOG Committee
Opinion, No. 267, Washington, DC: ACOC, January 2002 (reaffirmed in 2009).
4. Pivarnik, J. et al. American College of Sports Medicine Roundtable Consensus Statement, June 2006.
5. http://www.cdc.gov/physicalactivity/everyone/guidelines/pregnancy.html
6. Mudd LM, Owe KM, Mottola MF, Pivarnik JM. Health benefits of physical activity during pregnancy: an International Perspective Med Sci Sports Exerc. 2013 Feb;45(2):268-77.
7. Pivarnik. J. and Kuffel, E. ACSM Sports Medicine Bulletin; Active Voice: More Maternal Physical Activity May Lead to Leaner Pre-Adolescent Children; June 20, 2010.
8. http://www.nouvelles.umontreal.ca/udem-news/news/20131111-exercise-during-pregnancy-gives-newborn-brain-development-a-head-start.html
9. Watkins, Sheila S. “Healthy Moms@ Perinatal Fitness Instructor Training Manual.” 2013.