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creatine (2)

The Benefits of Creatine Supplementation for Active Older Women

Loss of muscle and bone mass is arguably the greatest potential threat to vitality and independence in the aging female population. As ovarian estrogen declines during the menopausal transition, muscle and bone undergo significant changes.

Muscle mass and strength decline and loss of bone density accelerates after the onset of menopause. When these losses become severe, there is an increased risk of disabling falls and fractures and associated higher rates of medical comorbidities including high blood pressure, type 2 diabetes, depression, and cardiopulmonary disease.

Previously, in Athletic Aging, I posted about this very issue. Grip Strength as a Marker of Vitality in Mid-Life Women and Body Composition and Hormone Therapy – Truth and Tales are two articles that discuss the interplay among female reproductive hormones, muscle mass and function, body composition, and metabolism.

But it’s not just about muscles and bones! Mid-life women also struggle with sleep deprivation, brain fog, depression, and mood lability.

Today we continue this important conversation and take a deep dive into the science that explores the potential benefits of creatine supplementation in mid-life women that go beyond our muscles and bones!

How Does Creatine Work?

Creatine is a naturally occurring compound that is synthesized in the Human body by the kidneys and liver from the amino acids glycine and arginine. It is stored as phosphocreatine which supplies the energy that fuels muscle movement. Creatine is also found in animal proteins such as red meat, fish, poultry, and organ meats.

The phospho in phosphocreatine is a critical component for the production of adenosine tri-phosphate (ATP) found in tiny cell components called “mitochondria” that exist in every type of cell throughout the body. Think of the mitochondria as the “batteries” that power the cells within our tissues, and ATP as the “charge”. The “T” stands for tri -or 3 phosphates which is like 3 “bars” on your cell phone. When energy is used, ATP is converted to ADP – the “D” is for di- or 2 bars on your phone. So to recharge your phone to 3 bars (ATP), you need to plug it into the electrical outlet. Creatine serves as the source of energy to fully charge the mitochondria and replenish the stores of ATP.

What the Science Tells Us

Athletes have effectively used creatine supplementation for decades to support performance. Creatine is among the safest and most well-studied supplements in the sports industry.

Most of what we know about creatine was learned through the study of young, male athletes. Creatine has been shown to be effective in enhancing muscle strength, mass, and performance in strength-based activities. Because the aging population is particularly vulnerable to loss of muscle mass and function, attention has been turned toward investigating the potential use of creatine supplementation for preserving muscle mass and function in older individuals – particularly menopausal women.

A review of several randomized control trials and meta-analysis of studies investigating creatine supplementation in older female adults has discovered the following:

  • Women have 70-80% lower creatine stores and consume lower dietary amounts of creatine compared to men.
  • Declining estrogen levels are associated with increased inflammation and oxidative stress and may contribute to the reduction in protein synthesis and response to anabolic stimuli. Creatine supplementation has been proposed as a counter-measure to the inflammatory effects of declining estrogen.
  • Creatine supplementation with a high-dose load and maintenance of 3-5g daily in the absence of resistance training had minimal impact on muscle mass, strength, function, and bone density parameters in menopausal women.
  • Although studies have shown mixed results, the vast majority of research shows improvement of muscle strength, function, and bone density parameters with supplementation of 5g of creatine daily when combined with a consistent, long-term strength-training program of 3 months or more in menopausal women ages 50-65+.
  • There were no significant adverse effects of creatine supplementation in menopausal women across multiple studies.
  • Clinical evidence has reported positive effects of creatine supplementation on mood by restoring brain energy levels and balance. Evidence also suggests that creatine supplementation may favorably impact the dopamine and serotonin systems.
  • Creatine supplementation has consistently demonstrated improved cognitive performance and brain function, particularly in cases of sleep deprivation and mental fatigue. This is important given many mid-life women struggle with vasomotor symptoms (hot flashes) and disrupted sleep.

Summary of Recommendations for Mid-Life Women

  • Engage in a program of consistent (at least 2-3 times weekly) resistance/strength training as a permanent part of your long-term workout program.
  • Daily supplementation of creatine monohydrate may improve muscle strength, mass, function, bone density parameters, and body composition when combined with a consistent resistance/strength training regimen.
  • Dosing: Many experts agree a loading dose is not necessary. A daily dose of 5g/day (ideally in a shake, beverage, or with food) over time will achieve appropriate tissue saturation levels. *Vegetarians may require a dose of 5-10g daily.
  • Check out this podcast featuring Dr. Darren Candow, one of the leading creatine researchers for an incredibly informative review of how creatine works and the potential benefits of supplementation.
  • If you have chronic conditions involving your kidneys or liver, check with your doctor before incorporating creatine into your nutrition plan.

Article reprinted from Athletic Aging with author permission.

Dr. Carla DiGirolamo is a double Board-Certified Obstetrician/Gynecologist and Reproductive Endocrinologist who specializes in the care of reproductive age and mid-life women. Carla completed her residency training in Obstetrics and Gynecology at Brown University Medical School/Women and Infants’ Hospital and her Reproductive Endocrinology training at the Massachusetts General Hospital at Harvard Medical School. She is a North American Menopause Society (NAMS) Certified Menopause Practitioner and has been featured in multiple podcasts and speakerships at various events discussing the physiology of the hormonal changes of menopause, hormone therapy and functional fitness training.

 

References

Smith-Ryan, AE et al. Creatine Supplementation in Women’s Health: A Lifespan Perspective; Nutrients 2021, 13, 877. https://doi.org/10.3390/nu13030877Ellem

Pinheiro dos Santos, E et al. Efficacy of Creatine Supplementation Combined with Resistance Training on Muscle Strength and Muscle Mass in Older Females: A Systematic Review and Meta-Analysis; Nutrients 2021, 13, 3757. https://doi.org/10.3390/nu13113757

physical-therapist-and-client

Why Physical Therapy is Good for Women’s Health

Women’s health concerns are much more complex than men’s and with the help of physical therapy (also called physiotherapy in many parts of the world), many of these issues can easily be remedied or addressed. There are main factors that greatly differentiate men from women. Of these, it is important to highlight three: menstruation, pregnancy and lactation. These bodily changes in a woman are mostly influenced by hormonal fluctuations and can also be a reason for mood swings and differences in behavior.

woman lifting crossfit-534615_1280

Why Women Should Lift

Just a generation ago, women’s weight-lifting was largely isolated to professional athletes and competitive body-builders. Men have been lifting weights for years, but it has not come into the mainstream for women until the past 10-15 years. 

Some of the barriers to the barbell for women may include fear of injury, lack of accessibility to an environment where they can learn and lift weights safely, and even more compelling are concerns about body image: “I don’t want to get too bulky”. Today, we know so much more about the overall health and athletic performance benefits of weight training. As more women have flooded competitive and professional sports and with the emergence of CrossFit and other resistance based group fitness classes, weight training has become commonplace in women’s organized sports and recreational fitness programs. But still today, the barriers to the barbell still exist with many misconceptions about risk of injury and body image concerns. 

The Effect of Aging on our Muscles and Joints

Being a well-rounded athlete includes not only endurance, flexibility and agility, but also muscular strength.  Our muscles move our skeleton, protect our joints, are a major source of energy expenditure and play an important role in blood sugar management. Like our heart and lungs, our skeletal muscles need exercise to stay healthy so they can continue to carry out these functions for our entire lives. Over time, especially into the menopausal years, women begin to lose muscle mass and bone density. Decline in estrogen levels increases the rate of bone loss and joint laxity leaving us more vulnerable to injury and fractures. With the loss of muscle mass, our metabolism slows and activities may become limited. But it doesn’t have to be this way. One important weapon to combat these natural changes is the all-mighty barbell! 

Health Benefits of Weight Training

As young women, weight training helps performance across a spectrum of recreational and professional sports and builds a solid foundation of lean body mass, strength and functionality for the future. Starting from puberty, bone density increases until it peaks in our early 30’s.  Weight-bearing exercise, along with sound nutrition, optimizes bone density development to prevent osteoporosis and fractures later in life. Into our 40’s, 50’s and beyond, weight training and attention to nutrition and recovery can not only slow the loss of bone density and muscle mass that comes with menopause, but may even result in continued improvement– especially if weight training was not started until later in life. Increasing and maintaining muscle mass in this age group also affords stability to joints such as shoulders, knees and hips thus preventing injury. But what if I’m already in my 60’s and beyond and I have never lifted weights before? Is it too late to start? Absolutely not! At age 89, my mother started doing deadlifts and chair squats with gallon milk jugs. Weight training for beginners can start with weighted household items, progress to dumbbells and to group classes such as Boot Camps, Crossfit and other similar type classes. In all age groups, like with any new sport or activity, beginners should focus on strict technique and mechanics with an experienced coach or instructor before increasing load and intensity.

A Word about Body Image

When I started weight training in the mid-1980’s, skinny was in. I was always self-conscious about doing too much leg work because my legs became very muscular. So I stopped training my legs – for literally decades. And now I am paying the price. But through Crossfit I have regained a lot of what I could have developed in my younger years. Today, I very much regret surrendering to the societal ideal at the time. Because “society” doesn’t have to contend with my personal struggle to start rebuilding leg strength after age 45. Fortunately, today is different, “Strong is the new sexy”. But the body-shamers and the haters still exist and feel compelled to impose their beliefs and ideals on others. But the truth is that your strongest, healthiest, most confident self is your most beautiful self – not some societal ideal. So whether you are 18 or 80, grab those weights and give your body the gift of strength that will keep you healthy, active and living life to the fullest for years to come.


Dr. Carla DiGirolamo is a double Board-Certified Obstetrician/Gynecologist and Reproductive Endocrinologist who specializes in the care of reproductive age and mid-life women. Carla completed her residency training in Obstetrics and Gynecology at Brown University Medical School/Women and Infants’ Hospital and her Reproductive Endocrinology training at the Massachusetts General Hospital at Harvard Medical School. She is a North American Menopause Society (NAMS) Certified Menopause Practitioner and has been featured in multiple podcasts and speakerships at various events discussing the physiology of the hormonal changes of menopause, hormone therapy and functional fitness training.

mature-senior-woman-home-exercise-yoga

Menopause Exercise: The Depression or Well-being Determinant?

Wonder if your menopause exercise prescription makes a difference? It turns out your hormone ride during menopause deems exercise more necessary than ever. Your hormones reveal more than your likelihood to store belly fat or hot flash.

Research published in the Menopause Journal says your likelihood of being depressed or feeling positive lies in your physical activity level. The study addressed menopause, movement, and mental well-being.

One of 7 levels of physical activity was assigned to each subject:

  1. I do not move more than is necessary in my daily routines;
  2. I go for casual walks and engage in light outdoor recreation 1 to 2 times a week;
  3. I go for casual walks and engage in light outdoor recreation several times a week;
  4. Once or twice a week, I engage in brisk physical activity(eg, yard work, walking, cycling) that causes some shortness of breath and sweating;
  5. Several times a week (3-5), I engage in brisk physical activity(eg, yard work, walking, cycling) that causes some shortness of breath and sweating;
  6. I exercise several times a week in a way that causes rather strong shortness of breath and sweating during the activity;
  7. I do competitive sports and maintain my fitness through regular training.

Which level describes you?

Based on that you fall into one of these categories:

  • Low (1 to 3)
  • Medium (4 and 5)
  • High activity (6 to 7)

Subjects in the study with the highest level of activity had the lowest incidence of depression and the greatest sense of well-being.

That’s the bottom line.

What’s most interesting is that researchers measured not only self-reports of depression but hormone levels. So the study was both objective and subjective.

Given we’re in a time when positive mood, attitude, optimism are so important to how we get from day to day, this is just one more message to get moving.

There’s More

Menopause has historically been associated with negative feelings about aging and with greater incidence of depression than in younger women or same age men. The proper menopause exercise prescription, however clearly has the ability to change your well-being.

In fact, many women report that this is a time of great life satisfaction.

Menopause Exercise Rx

The high activity level word descriptions used in this study are exact descriptions of the High Intensity Interval Training and strength training to fatigue that are a necessity for women who want to flip 50 feeling not just well, but outright full of energy and vitality during and beyond COVID19.

Often when I talk about the After 50 Fitness Formula for Women, and a critical part of it — “Less Exercise, More Food” — inevitably an audience member will comment. She may say something like, “I’m so glad you said women over 50 need less exercise.”

I get nervous with that simple statement. Because like a recent podcast I created about “Moderate Exercise,” that is too open to interpretation.

So let me take some real estate in this post to get clear:

  • You are not a flower.
  • You are not delicate.

You absolutely need to push limits in your workouts – for seconds at a time. That’s true when you’re in good times and when you’re in COVID19.

You need moderate amounts of:

  1. High Intensity exercise that gets you breathless
  2. High Intensity strength training that takes you to muscular fatigue
  3. Fill in with low to moderate exercise that you love

It is #1 and #2 above that have the best opportunity to change your hormones for the better, and in doing so changes your mental well-being, your visceral belly fat, your hot flashes and night sweats, and reverses the effects of 179 genes associated with aging.

Careful Clarification

Advice to do less exercise is often interpreted as advice to do “light” exercise or following a doctor’s vague advice to “walk.” It’s not enough. And walking 3 or 4 miles a day as many women do in an effort to overcome weight or fat gains in menopause only makes matters worse. Greater volume of the same ineffective exercise will not get you better results.

Yes, you want less exercise. Less than you think, and of the right type (of intense exercise).

It’s true that if you’re just beginning you start with habits. We get you hooked and regular first. Yet, yes, you can do interval training when you start. COPD patients and asthma sufferers often do best with intervals. If they can you can. We simply apply a progressive plan for you.

Before you start intervals it may be appropriate for you to “restore before more.” If you’re already exhausted, suffering from mood swings, your first step is to restore yourself with rest, sleep, nutrients and movement, NOT exercise.

Menopause exercise is not a generic prescription for all women in menopause. It should be based on your unique condition now, your current hormone status (assessed by a fitness specialist by your signs & symptoms), and your personal preferences and schedule.

Yet, menopause exercise has the power to make this second half better than the first.

For Fitness Professionals: Offer Your Female Clients a “Hormone Balancing Exercise Prescription”

Gain the information, tools and resources needed to coach and train this steadily growing population with Debra’s online course with MedFit Classroom, Menopause Fitness Specialist.

Given the number of women who have not exercised previously, and the current void in proper hormone balancing exercise prescription, there exists numerous, lucrative opportunities for fitness professionals to positively impact the lives and health spans of a great many women still seeking answers.


Reprinted from flipping50.com with permission from Debra Atkinson.

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

 

Reference:

https://journals.lww.com/menopausejournal/fulltext/2020/04000/the_role_of_physical_activity_in_the_link_between.6.aspx

pregnancy-heart

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.

Pregnancy 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.


Kathy Flippin has been a Sports Massage Therapist since 1997 is the owner of Dynamic Touch Massage. Kathy’s passion is to offer excellent therapeutic massage, and educate her clients on how they can take the best care possible of themselves. Her clients include everyone from professional athletes to active grandmothers.

 

References

  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-at-gym

Building Strength is an Important Component in a Prenatal Fitness Routine

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

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

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

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

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

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


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

pregnancy-fitness-1

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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