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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.


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


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

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.


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.


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.

Pregnant woman using exercise bike at the gym

Prenatal Exercise Program Design: Exercise Type

Choosing the type of exercise that is best tolerated during pregnancy depends on the following considerations:

  • Which activities the client enjoys or is skilled at performing
  • Whether the activity poses any risk to the mother or fetus
  • Is she is able to do the activity without being compromised by balance and center of gravity changes
  • Can the activity be easily modified as pregnancy progresses

Weight-bearing exercise such as walking, dancing, and running help maintain bone mass and some studies suggest they are more effective for keeping pregnancy weight gain within normal limits. As pregnancy progresses some women may not be able to continue weight-bearing exercise because of back or round ligament pain. If modifications such as wearing a belly support don’t relieve discomfort, switching to non-weight-bearing activities such as swimming, stationary biking, or other types of stationary exercise equipment is recommended.

Absolute and relative contraindicated activities for pregnant women are listed below. Pregnant women should always consult with their healthcare provider before taking part in any exercise program and assess the risk/benefit ratio whenever there is a question about the safety of any activity during pregnancy. Keep in mind that activities such as downhill skiing must be assessed for risks that are not controllable, such as the effect of high altitude on oxygen delivery to the fetus.

Contraindicated Activities for Pregnant Women

  • High-altitude sports
  • Water-skiing
  • Hockey
  • Gymnastics
  • Horseback riding
  • Absolute
  • Downhill skiing
  • Scuba diving

You can also view Catherine’s previous articles on exercise intensity and duration.

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.

Senior Man On Cross Trainer In Gym

Where to Begin When You Are Working Out With a Health Condition

The gym can be a confusing place especially for individuals with health concerns. Many times, these clients are trying to navigate their workouts by themselves because they are unsure of the appropriate questions that they need to ask.

First of all, there are two different types of trainers. There are trainers who have a four year degree and certifications. These trainers are sometimes called Fitness Specialists and have had many hours of study related to a wide variety of diseases and injuries. They are used to modifying exercises and programs based on any specific condition you may have. Fitness Specialists are usually found in a medically based fitness facility affiliated with a hospital. Please note that some Fitness Specialist’s will specialize in a certain area. Some work with individuals with diseases and disabilities and some don’t.

Personal Trainer, Gym, Pull Down Machine, Exercising, AssistanceWhen you finally narrow down who you might like to hire you will want to ask some questions. Please don’t be afraid to ask these questions as they will help you to decide which trainer is right for you. It is also recommended that you observe Fitness Specialists training clients.

First you want to make sure that the trainer has had experience with your condition. If not, they should be willing to research it and or speak with your doctor with your permission. There are exercise guidelines that all Fitness Specialists should follow when working with clients who have health conditions.

You will also want to ask about the trainers background. It is alright to ask about education, certifications, and years of experience. You also want to hire someone who is patient with you. This is extremely important as you figure out which exercises work best for your body. I would also like to add that you need to be patient with yourself as well. Try to relax and enjoy your training session.

Asking the questions from above help to keep you feeling confident. Exercise can seem frustrating in the beginning but you have to keep a positive mindset. In the beginning, set small goals and do the best you can during each training session.

Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 15 years of experience in medical based fitness.

Beautiful pregnant woman thinking of her baby

Benefits of Prenatal Massage

Prenatal Massage, Easing the Changes

What better way to show you are dedicated to giving this new life every advantage in the world than to arrange for a pregnancy massage from a specially certified therapist. Each session is designed to focus on the special needs of a mother-to-be as her body goes through the dramatic changes of the child-bearing year, which includes pregnancy, birth, and post-delivery. Massage provides a nurturing touch, which in turn, nurtures the life of your unborn child.

A woman’s body changes a great deal over nine months. Her weight increases, her breasts change, her blood pressure elevates, organs are compressed and pushed up, and the muscles in her abdomen become stretched and strained. Massage can help relieve pressure and tensions created by these changes.

Benefits of a Pregnancy Massage Include:

  • An opportunity for much-needed rest and relaxation
  • Balances hormones (relieving moodiness and nausea)
  • Increases fetal circulation
  • Reduces swelling
  • Relieves back and neck pain
  • Improves skin tone elasticity
  • Deepens maternal bonding
  • Enhances body awareness (making delivery easier)

Benefits of massage after Birth

  • Post-delivery/Postpartum massage addresses the mother’s stress of carrying and caring for a newborn, speeds recovery and relieves sore muscles.
  • The childbearing year includes not only the three trimesters of pregnancy, but also during labor, and three months after delivery.
  • After delivery, a new mother must gradually regain her postural strength and pre-pregnancy state of of fitness. Your therapist will give you stretches and exercise you can do at home to help your body get back to normal.

How is pregnancy massage special?

The mother-to-be is always carefully supported in several positions. When lying face-up, she is supported with the back lifted, to provide comfort and maximum circulation to the legs and the fetus. While in a side-lying position, special pregnancy pillows support the stomach, which allows the therapists to massage the back and hips. The belly is NEVER compressed by lying face down, nor is the belly left hanging through a hole in the massage table. These methods are less than ideal for the mother’s body and for fetal circulation.

Beautiful pregnant woman thinking of her babyPregnancy massage addresses the profound changes a woman’s body experiences during the entire childbearing year. During the first months, massage can help her body balance changing hormones, which often cause morning sickness. During the Second Trimester, pregnancy massage addresses the upper and lower back pain that develops from the weight of the new baby. At the end of pregnancy, massage can relieve swollen feet and hands, numbness, hip, low back and sciatic pain. Pregnancy massage is also intended for the three months after the delivery to help the new mother regain abdominal strength, reduce soreness and relax muscle tension, and to offer a brief respite from the new duties of motherhood and caring for an infant

If you are in a “High Risk Maternity” category, or having any complications, you may still be able to have a massage, but you should definitely get medical clearance first. You should also call your therapist before your appointment to make sure they have a good understanding of what it takes to keep you safe and comfortable. Most Certified or Licensed massage therapists get instruction on working with Pregnant Mothers as part of their entry level massage education. However, there are additional classes available, and each therapist has varying levels of awareness and experience. We recommend finding a therapist that has an additional certification in Pregnancy or Prenatal Massage. Don’t be afraid to ask questions about the therapist qualifications, and what they’re going to do during the massage. While you’re receiving massage, continue to ask questions as they come up. If at any time during the massage it feels worse than a “hurts good” sensation, then it’s too much, and you should speak up. Your therapist should never encourage you to suffer through anything you don’t like during a session.

The Medical Fitness Network can help you find a reliable, educated massage practitioner in your area to help you ease your pain, improve range of motion and reduce muscle tension. Let massage touch your life and add to your health and well-being!


  1. Field, T. (1999). Pregnant Women Benefit From Massage Therapy. Journal of Psychosomatic Obstetrics and Gynaecology, Mar;20(1):31-8.
  2. Field, T. (2004). Massage Therapy Effects on Depressed Pregnant Women. Journal of Psychosomatic Obstetrics and Gynaecology, Jun;25(2):115-22.
Pregnant woman doing yoga with a personal trainer

Prenatal Exercise Program Design: Exercise Duration

Exercise duration during pregnancy should reflect a woman’s current level of fitness and the type of activity she is doing. If you’re working with someone who’s just starting a prenatal exercise program the duration will be shorter (15-20 minutes) and progress slowly over time to 30-60 minutes. A pregnant woman who is already taking part in a fitness routine can continue with her current duration level, but exercise duration should be modified as needed to enable her to achieve a moderate to somewhat hard level of intensity without discomfort or undue fatigue.

Some exercise activities, such as swimming, may require a longer duration in order to achieve a moderate to somewhat hard intensity, so close monitoring of exercise intensity will help determine whether a longer bout is needed. As pregnancy progresses, pregnant women may find that they are able to tolerate a longer duration, lower intensity exercise bout better than a higher intensity, shorter bout, but avoid taking the intensity below the targeted zone of 12 to 14 on the 20-point scale or 3 to 4 on the 10-point scale.

In the case where a pregnant woman is having difficulty maintaining her normal exercise duration, try dividing the workout into two shorter sessions during the day. This is a helpful tool for enabling women to continue to exercise when she’s experiencing more fatigue in later pregnancy.

Want to learn more about how to develop a safe and effective maternal fitness program? The CE correspondence course “Prenatal and Postpartum Exercise Design” is available ppfconsulting.com

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.

Article reprinted from her blog with permission.


The Complete Guide for Exercising During Menopause

“Grab those hand weights and  get ready to go into a squat position,” a popular exercise guru cheerily calls out in her exercise video.  So a group of women, ages 16 to 52, dutifully get their weights and huff and puff their way through the routine  for 20 minutes three times a week.  The oldest of them, Maria, has been doing aerobics for a year. She firmly believes that the workouts have helped her avoid the hot flashes, headaches, mood swings, sleeplessness and depression that is commonly experienced by women as they go into their pre-menopause stage — and she may be right.

Why Exercise is Good

Numerous studies have shown that exercise can be an effective antidote to the rough days caused by  the hormonal changes when women hit their late forties or early fifties.

The most common symptoms, like hot flashes and sleeplessness, are associated with weight gain.  Exercising also helps prevent weight gain and loss of muscle mass that goes with menopause.

The many benefits of regular exercise may also include boosting your mood, strengthening your heart, and even promoting bone density.

While many women  opt for hormone replacement therapy (HRT) as a way to cope with the oftentimes debilitating physical and mental challenges of menopause,  HRT often puts women at risk for  blood clots, heart disease, breast cancer, Type 2 diabetes, osteoporosis, loss of muscle strength and dementia.   Those push-ups and crunches are looking better by the minute, aren’t they?

So, it’s on with the sweat pants and off to the gym we go!

What are the Best Exercises?

Dr. Alexis Abrahams, a gerontologist (a doctor specializing in the elderly), advises that exercising consistently is the key to getting the best out the exercises rather than the kind of exercise. Women in their 40s, 50s and 60s should aim to do any of these three forms of exercises:

  1. Aerobic/cardiovascular – these exercises strengthen the heart and lungs and can burn calories to help with weight management.  If you’re a beginner, start with 10 minutes a day and gradually increase as you get stronger.
  • Walking
  • Jogging
  • Tennis
  • Cycling
  • Working out on the elliptical machine, StairMaster
  • Dancing – ballroom, zumba, salsa
  1. Strengthening – When menopause hits, estrogen levels go down along with muscle mass. Working out on machines can help strengthen muscles and bones, burn body fat and rev up your metabolism. Choose a weight or resistance level  that will tire your muscles after 12 repetitions.
  • Hand weights
  • Dumbbells
  • Resistance bands
  • Exercise machines that strengthen muscles and bones and help manage weight
  1. Flexibility/stretching/range of motion – exercises that keep our aging bodies more flexible and helpful for improving (and maintaining) joint function if you have  arthritis.
  • Stretching exercises
  • Yoga, taichi
  • Pilates

Before You Start

Always check with your doctor before you consider any strenuous activity.  Ask what kind of exercises are safe and how much you can do without causing additional harm to your body.  If you have bad knees, avoid running or jogging or jumping which will put additional stress on the knees.  For women with osteoporosis, don’t do activities like biking or any sport that would put you at risk of impact that could break a bone.  Better scratch those  judo  classes from your list!

Whatever the activity, choose exercises that you enjoy and chances are you’ll continue doing them regularly.

How Much Should You Do?

According to the Centers for Disease Control and Prevention, women younger than 65 should spend at least 150 minutes a week on moderate-intensity aerobic exercises, like walking or 75 minutes of vigorous aerobic exercises. This can be broken down into 30 minutes, five times a week or smaller increments such as 15 minutes daily.

Do strength training at least twice a week, making sure to rest for at least one day between these sessions.  Do balance and stability exercises for 5 minutes every day, along with 1 to 3 minutes of stretching twice a day. If you choose to include yoga and meditation in your exercise regimen, do them on an as-desired basis, especially when you’re stressed and need something to keep you from throwing a brick at your loud next-door neighbor. Or your boss.

Here’s a sample workout schedule from the excellent book “The Ultimate Guide to Taking Control of Your Health and Beauty During Menopause” by Staness Jonekos.

  • Monday: Warm-up/Stretch, strength training, cardio
  • Tuesday: Warm-up/Stretch, cardio
  • Wednesday: Warm-up/Stretch, strength training, cardio
  • Thursday: Warm-up/Stretch, cardio
  • Friday: Warm-up/Stretch, strength training, cardio
  • Saturday: Warm-up/Stretch, cardio
  • Sunday: Rest

Doing your exercises right

Getting on the exercise bike or walking everyday just doesn’t cut it.  To reduce injury and to make the most of exercising, make sure you steer clear of these 6 common mistakes.

  1.  You only do cardio

Sure, you’re sweating after a thirty-minute power walk, but as menopause kicks in, you also need strength training to maintain your muscles and burn the calories.  Edna Levitt of 50+ Fitness recommends master squats and lunges to keep the big leg muscles strong and help people stay independent and active longer.

  1. Focusing on low-impact exercises like swimming to walking or running

Yes, your muscles might be moving but your bones get left behind.  Keeping your skeleton strong and healthy requires bone-jarring exercises like running and weightlifting to help ward off osteoporosis.  For postmenopausal women, brisk walking four times a week may be enough to lower the risk of hip fractures compared to women who didn’t walk as much.

  1. You take it easy

You can still do the exercises you did when you were in your 40s, says a JAMA Oncology study.  Postmenopausal women who did 5 hours of vigorous aerobic exercises per week lost more body fat in a year than women who exercised less.

  1. You eat the same

You were already eating healthy before, but when your metabolism slows down during menopause, you need to eat 200 calories less than you did during your 30s and 40s.  Choose protein sources from fish, chicken, and turkey and lots and lots of fresh fruits and vegetables.

  1. You forget to warm-up

Skipping the warm-up leads to injuries.   A 10-minute warm-up like arm circles, high knees or neck rotations can get the old bones and muscles ready.

  1. You think you can do it on your own

As always, check with your doctor about any of the intensive exercises you plan to do.  Get a therapist or a personal trainer for proper guidance especially with the strength training and vigorous exercises.

To keep yourself motivated, get your pals and family to exercise with you.  The more the merrier!

M is a happily married Filipino mother to three wonderful little daughters, ages: 8 years, 5 years, and 4 months old. Her daily life is a struggle between being the Executive Content Director for Project Female and deciding who gets to watch television next. She specializes in creating and editing content for female empowerment, parenting, beauty, health/nutrition, and lifestyle. As the daughter of two very hardworking people, she was brought up with strict traditional Asian values and yet embraces modern trends like Facebook, vegan cupcakes, and the occasional singing cat video.