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pregnancy-fitness-1

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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.

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.

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
senior fit

Hormone Balancing Fitness for Women in Midlife

Before hormone balance can be a goal you need a clear definition of what it or hormone imbalance looks like! It’s never just hormones though is it? For the majority of women in midlife and beyond, there’s also a special condition, a joint issue, or a crazy schedule that also needs to be addressed.

If any of these describe you:

  • You’re putting on weight lately no matter what you do
  • You have belly fat even though you’re weight is OK
  • You have cellulite on your thighs, belly, bum, or on your upper arms
  • You can’t seem to develop any muscle tone in your legs
  • You’ve got a saggy bum in spite of so many lunges and squats you can’t sit down
  • You’ve turned up the exercise and eat carefully but still no results
  • You’ve got saggy chest and neck skin

Plus:

  • You have touchy joints from prior or current injuries
  • You have had breast cancer surgeries
  • You’ve had other invasive surgery or joint replacement
  • You have a chronic condition

And potentially:

  • You can’t sleep well
  • Even if you do sleep you don’t wake up refreshed
  • You have high levels of stress right now
  • You’ve tested your hormones and you’re “normal” but don’t feel it
  • You still don’t have any idea how to exercise “normal” or not
  • You have depression or anxiety
  • You’re taking medications for the above or other things with side effects
  • Your digestion is off (even if you thought that was “just me”): You don’t poo every day at least once (more is better); You have rabbits or pudding instead of snakes, You have gas or bloating you just tolerate

And finally:

What you used to do doesn’t work any more.

Then this is definitely for you… if you want to change. Changing is the obstacle for a significant percent of women that express interest in change. If you aren’t willing to change habits, change beliefs, change what you eat and when, change how you exercise and when, then this will just be another blog. No set of exercises, videos, menu plans will ever help until you decide you are 100% in.

Throw Away the Textbook

Exercise for hormone balance is not your textbook exercise. “I’ve never heard that before,” is not a good excuse to dismiss something as true. How many research studies did you read last week about menopause, hormones, and exercise? They’re at anyone’s fingertips in today’s world. So holding onto old ideas without researching for yourself or finding a voice you trust instead of going by an outdated text is irresponsible. A published textbook is outdated by the time it goes to print. Research in this area is accelerating. Get help and get up to speed on research on hormone balance.

Approximately 6000 women a day go into menopause right now. That’s 2 million a year. Yet, 39% of all sports medicine and exercise research features females at all. It’s safe to say a small slice of that focuses on women in perimenopause, menopause, and post menopause and the hormones that influence and are influenced by her exercise.

It’s time to change the way we prescribe exercise during the change. If a woman begins perimenopause in her mid 40s and lives to her mid 80s she spends 40 years in menopause. Shouldn’t we be optimizing exercise for this large population of currently 38 baby boomer women, 25 million Gen X women and coming soon, an even larger number of millennial women? Fitness is either going to open a new level of health for women, who ultimately influence 80% of household decisions including health, or fail miserably. Conventional exercise prescriptions contribute to hormone imbalance.

Your hormone balance exercise

Start lifting weights focused on major muscle groups. Even if you swear by functional movement patterns, insulin, cortisol, and the half dozen more hormones that influence her fat and health are key for reducing risk of disease. Even if you want to tone those arms, you want to start with major muscle groups. Even if you want a flat belly, start with major muscle groups. Stop long slow exercise sessions and long endurance activity.

Increase your protein at every meal and eat regularly. Get to bed early and make sure you control your environment. If you love your wine or nightcap, you’ll want to stop that. All of these things kill testosterone, a key hormone for building lean tissue and libido. Testosterone gives you a kick of confidence too also important for libido.

These are but a few scenarios of exercise changes you can make for more hormone balance. Each woman has a unique set of health history, physical status, signs and symptoms that make her unique.

Want to learn more on this topic? Register for this FREE WEBINAR, presented by Debra Atkinson,  Dr. Michelle Maddux and Danielle Spangler.

Excerpt from the original blog post by Debra Atkinson for Flipping 50


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

postnatal exercise

Tips on Postpartum Exercise Programming for the Fitness Professional

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

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

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

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

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

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

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

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

Procede Gently

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

Get to Know Her Limitations

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

Establish Realistic Expectations

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

Create a Supportive Network

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

Teach Sustainable Lifestyle Habits

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

Want to learn more on this topic? Register for this FREE WEBINAR, presented by Danielle Spangler, Debra Atkinson and Dr. Michelle Maddux.


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

Meta Slider - HTML Overlay - Pregnant woman holding fitness dumbbells

Prenatal Exercise: Training for the Main Event

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

Current research continues to show that women can safely exercise and maintain their fitness level during the perinatal period.  The mom who laces up her sneakers instead of heading to the couch will be rewarded with a healthier pregnancy and a healthier baby.

Pregnant woman doing yoga with a personal trainerPregnancy is a time of excitement, uncertainties, fears, 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 this healthier lifestyle for herself and subsequently for her child.  With obesity on the rise in the US, it is important for everyone to increase their current 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 both mom and baby long term.

A Historical Perspective on Prenatal Exercise Guidelines

Moms today are inundated with information regarding 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 regarding their exercise programs. 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 <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 ACOG 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, ACOG published “Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion 267” (3). 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 brought the exercise guideline for pregnancy more in line with the 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 “ACSM 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. Some 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.

Beautiful pregnant woman thinking of her babyThe 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.

In 2015, ACOG released two new publications, “Obesity in Pregnancy,” Bulletin Number 156 (9) and “Physical Activity and Exercise During Pregnancy and the Postpartum Period,” Committee Opinion Number 650 (10).   Both publications emphasize the need for regular exercise to prevent or combat excess weight gain and /or obesity in the perinatal population.   Greater than half of the women of childbearing age in the US are overweight or obese. Obesity in pregnancy is associated with significant risks for both mother and baby.  Bulletin 156 authors wrote, “Optimal control of obesity begins before conception.  Weight loss before pregnancy, achieved by surgical or nonsurgical methods, has been shown to the most effective intervention to  improve other health problems.”  The updated Bulletin 156 recommendations include:

  • Behavioral interventions that utilize both diet and exercise can improve postpartum weight loss better than exercise alone
  • BMI should be calculated at the first prenatal visit and used to counsel women on diet and exercise utilizing the Institute of Medicine Guidelines for prenatal weight gain
  • Small preconception weight losses in obese patients can improve pregnancy outcome
  • Losing weight between pregnancies in obese patients may decrease the risk for a large-for-gestational-age baby in a subsequent pregnancy

Pregnant women doing squatting exercise.Pregnancy is an ideal time for maintaining or adopting a healthy lifestyle. Recommendations from ACOG Committee Opinion Number 650, “Physical Activity and Exercise During Pregnancy and the Postpartum Period” include:

  • Physical activity in pregnancy has minimal risks and has been shown to benefit most women, although some modification to exercise routines may be necessary because of normal anatomic and physiologic changes and fetal requirements.
  • A thorough clinical evaluation should be conducted before recommending an exercise program to ensure that a patient does not have a medical reason to avoid exercise.
  • Women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength-conditioning exercises before, during, and after pregnancy.
  • OB-GYN’s and other obstetric care providers should carefully evaluate women with medical or obstetric complications before making recommendations on physical activity participation during pregnancy. Although frequently prescribed, bed rest is only rarely indicated and, in most cases, allowing ambulation should be considered.
  • Regular physical activity during pregnancy improves or maintains physical fitness, helps with weight management, reduces the risk of gestational diabetes in obese women, and enhances psychological well-being.
  • 20-30 minutes of moderate intensity exercise per day, on most or all days, is recommended.
  • Exercise intensity should be monitored by RPE and the “talk test.” Suggested RPE is 13-14 on a 6-20 scale.
  • Women are encouraged to stay well hydrated, avoid long periods of lying supine and cease exercise if they have any warning signs (see below).
  • Women who were sedentary before pregnancy should gradually progress their exercise programming
  • Women who were regular exercisers prior to pregnancy and who have uncomplicated, healthy pregnancies should be able to engage in high-intensity exercise programs, such as jogging and aerobics, with no adverse effects. High-intensity or prolonged exercise in excess of 45 minutes can lead to hypoglycemia; therefore, adequate caloric intake before exercise, or limiting the exercise session, is essential to minimize any risk.\Contact sports, activities with a high risk of falling, scuba diving, sky diving and “hot yoga” are not recommended

Warning Signs and Symptoms to Discontinue Exercise (11)

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.

Join Sheila for her upcoming webinar:

 


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: ACOG, 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/2013-exercise-during-pregnancy-gives-newborn-brain-development-a-head-start.html
  9. ACOG. Obesity in Pregnancy. ACOG Practice Bulletin, No.156, December, 2015.
  10. ACOG. Exercise During Pregnancy and the Postpartum Period, ACOG Committee Opinion, No. 650, December 2015
  11. Watkins, Sheila S. “Healthy Moms@ Perinatal Fitness Instructor Training Manual.” 2013.
fdn-pregnancy-article

Pregnancy, Hormones and Mood Swings

Why are women hormonal when they are pregnant?  And are there different types of food that can help alleviate the symptoms?

By “hormonal”, we are referring to the severe mood swings that many women experience during pregnancy. Mood swings are also a common symptom of PMS, and in both cases, hormone imbalance is a likely cause. Unfortunately, hormone imbalance is quite common and is often a result of the unhealthy habits that our modern lifestyles promote. While there are many health factors that can cause moodiness, female hormone imbalance will be the focus of this discussion.

Female Hormone Imbalance

Estrogen and progesterone are the primary hormones involved in menstruation and pregnancy. In general, estrogen promotes tissue growth and progesterone regulates it. As such, when an imbalance between these hormones develops, serious problems can result.

Low progesterone is the most common form of female hormone imbalance and typically results in a condition called “estrogen dominance.” Even if estrogen levels are normal, they’ll still be high in relation to the low level of progesterone. This can cause mood swings, breast soreness, migraines, irregular menstruation, water retention, weight gain and much more. If left untreated, some of the major problems it can lead to include fibroids, infertility, endometriosis, cancer, heart disease and stroke.

Although the production of both estrogen and progesterone are dramatically increased during pregnancy, the severity of estrogen dominance can increase if the body is not able to meet the increased demand of progesterone. In extreme situations, this can even result in miscarriage.

What Causes the Imbalance?

The two primary factors that contribute to progesterone deficiency have to do with how it’s made and its involvement with stress.

Progesterone is synthesized from another hormone named pregnenolone which is created from cholesterol. Because we’ve been programmed to fear dietary cholesterol, many people follow a low fat and low cholesterol diet. This deprives them of the materials needed to synthesize important hormones such as progesterone. Furthermore, because cholesterol is important to the function of the brain and nervous system, the body will always sacrifice hormone production in favor of these more important areas.

Another dietary factor that contributes to estrogen dominance is the consumption of xenoestrogens and phytoestrogens. Respectively, these are chemical and plant based substances that mimic estrogen in the human body. Xenoestrogens are commonly found in plastics, pesticides, and other agricultural chemicals while soy products are notorious for containing phytoestrogens. This is just one of many reasons why it’s important to eat organic food, avoid storing your food or water in plastic, and minimize your consumption of soy products.

The Contribution of Stress

Finally, stress is a major contributor to progesterone deficiency. Cortisol, the body’s primary stress and anti inflammatory hormone, is derived from progesterone. As such, chronic exposure to stress will greatly reduce the availability of progesterone for other purposes. Furthermore, common sources of chronic inflammation such as infection and food sensitivities will do the same.

Many of us live with excessive stress, eliminate saturated fat and cholesterol from our diets, eat conventionally farmed foods that are laced with chemicals, and unknowingly eat foods that we’re sensitive to. In fact, this typically occurs on a daily basis. Each of these factors can cause estrogen dominance and modern society promotes all of them!

Adrenal fatigue is another example of how modern living promotes hormone imbalance and poor health. And it plays a role in estrogen dominance as well.

Regaining Balance

The question asked assumes that eating specific foods can resolve all of this. While diet is part of the solution, it’s far from being the complete solution. Searching for a particular food or supplement to resolve a specific problem is nothing more than a natural form of chasing symptoms. As always, the solution to all health problems begins with living a lifestyle that incorporates the 7 foundational factors of optimal health.

Because cholesterol is a precursor to many essential hormones, it’s important to get past the fear that dietary cholesterol and saturated fat cause heart disease. For further information about the fallacies of this belief, read The Cholesterol Myths by Uffe Ravnskov MD, PhD.

A few good sources of saturated fat and cholesterol include beef, pork, butter, ghee, and eggs. Be sure to get these foods from quality sources, and consider following the Metabolic Typing Diet to understand what quantities of these foods would be best for you.

In chronic cases of hormone imbalance where progesterone is used excessively to produce the cortisol needed to handle frequent stress and inflammation, the body’s preferred pathways of hormone synthesis can become altered indefinitely. In such cases, lifestyle improvements are still necessary, but often not enough.

Supplementation of bio-identical hormones is often needed to re-establish the proper pathways. However, for this to happen, any existing food sensitivities or chronic infections must be addressed as well. For this type of treatment to be effective, and also safe, proper testing is absolutely essential.

Hormone Balance is Just One Part of Functional Nutrition. 

Integrate Functional Nutrition Into Your Services. Functional Diagnostic Nutrition (FDN) offers a certification for professionals with a passion for helping others and who is willing to walk-the-talk. Helping others to regain health, regardless of their starting point, requires only the proper training and leadership. Click here to learn more about the FDN Certification course.


Originally printed on the Functional Diagnostic Nutrition blog. Reprinted with permission.

The mission of Functional Diagnostic Nutrition is to educate as many people as possible about how to get well and stay well naturally, so that they may, in turn, educate others. FDN founder Reed Davis is a Certified Nutritional Therapist and Founder of the Functional Diagnostic Nutrition® (FDN) Certification Course. Reed is known as one of the most successful and experienced clinicians in the world today, having provided functional assessments to over 10,000 clients for hormone levels, bone density testing, adrenal function, digestive problems, immune system and detoxification issues as well as testing for pathogens, food sensitivities and many related health problems.