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Preggie Fitness

You've heard about "eating for two" while you are pregnant. More and more women are now also "exercising for two". Women who have spent time and effort getting into shape, faithfully attending aerobic classes and gym sessions, naturally want to maintain their level of fitness while they are pregnant. Even sedentary women who don't exercise on a regular basis are curious about learning how to exercise during pregnancy because they don't want a repeat of their previous pregnancy experiences like excessive weight gain, an aching lower back, sluggishness, etc. MEGA presents "preggie" fitness guidelines for both the novice and the advanced exerciser.

Is it safe to exercise while you are pregnant?
No mother wants to jeopardize the life of her baby just to keep fit so the first question on your mind will be "is it safe to exercise while I am pregnant". Well, put your fears to rest. The American College of Obstetrics and Gynecology (ACOG) released a statement paper, Exercise During Pregnancy and the Postpartum Period, in February 1994 to guide obstetricians and gynecologists in giving advice to exercising moms-to-be. In it, the ACOG state that human data "indicate a pregnant woman can exercise safely with minimal risk to herself and her fetus". The American College of Sports Medicine (ACSM) also echoed this statement in 1994.

What exercise can do for you when you are pregnant.
Researchers have collected anecdotal testimony from thousands of exercising pregnant women who report a greater sense of well-being, increased self-esteem, less general aches and pains, less swelling, improved circulation and digestion, better sleeping patterns, higher energy levels, and a faster recovery to their pre-pregnancy figures. Researchers have to depend of these testimonies instead of hard scientific data because of the ethical constraints to doing experiments on pregnant women, which may endanger the life of both mother and fetus. Animal studies are also used but, many times, the data collected is not applicable to human beings.

No one has done more research on exercising pregnant women than James Clapp, M.D. director of research of the Department of Obstetrics and Gynecology at MetroHealth Medical Center in Cleveland, Ohio. He is also a professor of reproductive biology at Case Western Reserve University. His research shows that pregnant women who exercise gain less weight and have shorter labors, with fewer complications and fewer cesarean sections or forceps deliveries.

A 1990 study published in The American Journal of Obstetrics and Gynecology found similar results. Apparently, exercise per se does not shorten labor because there are other factors involved that are not affected by the fitness level of the mother like the rate at which the cervix (the neck of the uterus) dilates. But women who are fit are better able to push and relax during their deliveries thus shortening them. They also experienced faster recoveries.

First step: Check with your doctor.
The first step to starting an exercise program while you are pregnant is to check with your ob-gyn. No matter how fit you are, there are certain contraindications to exercising while you are pregnant. Your ob-gyn is the only person who knows the condition of your uterus, your blood pressure, your past medical history, etc. According to the ACOG, here are the contraindications to exercise during pregnancy:

In addition, women with the following conditions need to get their doctor's approval about whether exercise would be appropriate for them or not:

Warning signs to stop exercising.
If you experience any of these warning signs while you are exercising, stop and immediately go see your ob-gyn.

Exercise guidelines based on the American College of Obstetrics and Gynecology.
Consistent exercise is better than intermittent exercise.
During pregnancy, women can continue to exercise and derive health benefits even from mild to moderate exercise routines. Regular exercise (at least three times a week) is preferable to intermittent activity. Remember that "moderate" means one thing to a woman who is a triathlete and something quite different to a woman who hasn't exercised since high school days. Do the 'talk test" to see whether you are exercising moderately or not. If you can still talk (short sentences) while you are exercising, you are doing it at a moderate intensity. Just as non-pregnant women have different fitness levels, pregnant women also have different fitness needs so it is imperative that the exercise program be modified to fit your particular needs.

Women should avoid exercise in the supine position (lying on the back) after the fourth month.
During exercise, blood is diverted from the abdominal area (theoretically including the uterus) to the working muscles. Such a position is associated with decreased cardiac output in most pregnant women. Research is still not sure but the fetus may be affected. Until there is more data, it is better to play safe. Even at rest, in the supine position, the enlarging uterus can compress the vena cava, the major vein that runs up the backside of the abdomen. Compression of the vena cava decreases blood flow returning to the heart. Experts suggest not lying in the supine position at rest or during exercise for longer than five minutes. Besides, as your uterus gets bigger, it gets very uncomfortable to lie supine for long periods of time.

Modify exercise intensity according to how you feel.
Pregnant women should modify the intensity of their exercise according to maternal symptoms. Pregnant women should stop exercising when fatigued and not exercise to exhaustion. You may have different energy levels every day. On the days when you are feeling a little under the weather, either don't exercise or keep the intensity very low.

There is no clear cut guideline as to how long you should do aerobics because some women are very comfortable with 30 to 45 minutes while others are satisfied with 15 minutes. However, since the only fitness benefit to be derived from going beyond 45 minutes is to burn more calories, experts suggest setting this as the maximum limit. Weight-bearing exercises (aerobics, walking, running, etc.) may under some circumstances be continued at intensities similar to those before pregnancy throughout pregnancy. Non-weight-bearing exercises such as stationary cycling or swimming will minimize the risk of injury and facilitate the continuation of exercise during pregnancy.

It is normal to lessen exercise intensity as your pregnancy advances.
Do not feel guilty or feel like you are wimping out if you have to lessen your exercise intensity or duration as you approach your third trimester. This is a natural reaction of the body. If you were doing a treadmill workout, you would progress from an inclined position (in the first trimester) to a flat position (in the second trimester) to swimming or recumbent stationary cycling (in the third trimester). For step aerobics, you would go from a six-inch bench to a four-inch bench to no bench at all.

Avoid exercises or sports that may cause a loss of balance.
Exercises that have a high risk of loss of balance could be detrimental to maternal or fetal well being, especially in the third trimester. As your uterus gets bigger, your center of gravity will change and you may become clumsier. Therefore, exercises that are okay in the first and second trimester may no longer be appropriate in the third trimester. An example of this would be step aerobics. Further, any type of exercise or sport involving the potential for even mild abdominal trauma should be avoided.

Make sure you eat enough calories to balance out the calories lost through exercise.
Pregnancy requires an additional 300 calories a day in order to maintain metabolic homeostasis (stable body functioning). Thus, women who exercise during pregnancy should be particularly careful to ensure an adequate diet. Pregnancy is no time to diet to lose weight. You should eat good nutritious food to gain just the right amount of weight. However, just because you are exercising and you are pregnant, it is no excuse to pig out on junk food and rich desserts!

Watch out for signs of hypoglycemia.
Pregnant women are prone to hypoglycemia (low blood sugar) especially after exercise. You need to recognize the signs of hypoglycemia like fatigue, weakness, dizziness, fainting, and nausea. You can avoid post-exercise hypoglycemia by eating a pre-exercise snack that is high in carbohydrates and provides protein (example: nonfat milk and graham crackers). It also helps to eat another small snack after you exercise (example: nonfat yogurt and a banana).

Researchers have found that an aerobically fit woman enters pregnancy with an advantage over an aerobically unfit woman. The fit woman has an enhanced ability to metabolize fats during exercise. This means there is more glucose available for her and her fetus to maintain normal blood sugar levels.

Exercise can also be beneficial for women prone to gestational diabetes (diabetes that only happens during pregnancy). Exercise may help normalize maternal blood glucose and decrease the need for insulin injections.

Drink plenty of water and work out in cool surroundings.
Your baby's temperature is entirely dependent on your ability to cool yourself. The fetus is most sensitive to a high maternal core temperature during the first trimester. Drink plenty of water while exercising. A good guideline is to drink water every 15 to 20 minutes during exercise. Avoid exercising in hot and humid conditions. Never wear plastic or rubberized clothing! Stay away from hot tubs, steam rooms, and saunas. You can continue all that after you have given birth.

Studies have found that a fit person regulates heat better than an unfit person does -- another good reason to get in shape before you get pregnant.

Avoid stretching to the extreme.
You may find yourself unusually flexible during pregnancy. This is because of the hormone relaxin which "relaxes" your ligaments and other connective tissue so that your pelvic bones can widen to accommodate the growing uterus and prepare for the baby's passage through the vagina. Unfortunately, relaxin is not very specific about which ligaments to soften so all your joints (shoulder, knees, hips, etc.) are more prone to being over-stretched and injured.

Avoid exercises where you have to twist or change direction too rapidly.
The uterus is suspended in the pelvis by six ligaments. The round ligaments run diagonally on either side of the pelvis. These ligaments stretch as the weight of the uterus and baby increase. It usually takes two to three days for the ligaments to adjust to this stretching, which may cause an on-and-off dull, pulling sensation on either side of the pelvis during pregnancy. Twisting or changing direction rapidly can cause spasm of the round ligaments. Choose aerobic exercises that keep your hips facing forward even during lateral movements.

Have your doctor check you for diastasis recti.
Diastasis recti is a painless condition involving a separation of the abdominal muscles which affects about 38 percent of pregnant women. The relaxin and elastin hormones can also soften the linea alba, a connective tissue connecting the two halves of the rectus abdominis, the straight muscle of your abdominal wall. You'll recognize it as the vertical line running down the middle of your abdomen that may darken as your pregnancy progresses. As the uterus increases in size, the linea alba may separate like a zipper opening under too much pressure. Ask your doctor to check whether you have diastasis recti and how it will affect your exercise program.

Help! What do I wear?
The most comfortable exercise wear while you are pregnant is a unitard. You can either buy one specifically made for pregnant women or just a larger size than you would normally wear. Other good choices are pregnancy bike shorts and a big T-shirt (your husband's usually fits just right).

Aerobic or cross-training shoes are necessary if you are doing gym or aerobic classes. Good walking shoes are important if walking is your main mode of cardiovascular activity. Swim shoes are also a good idea when you swim to protect you from any chance of slipping as you get out of the pool.

Exercises every pregnant woman can do.
Whether you are fit or you are sedentary when you start pregnancy, one of the best exercise programs for pregnant women is the Maternal Fitness Exercise Program or the "Tupler Technique" by Julie Tupler, a registered nurse and personal trainer. Tupler's New York based company has been helping pregnant women exercise since 1991. Her program not only helps you to keep fit throughout pregnancy but it also helps you prepare for, as Tupler calls it, the "marathon of labor".

The cornerstone of her program is the BAKS Basics, an acronym for Belly breathing and dancing (allow us to explain before you raise your eyebrows), Aerobics and Abdominals, Kegels (exercises for the pelvic floor muscles), and Squatting, Strengthening and Stretching.

The BAKS Basics
Belly Breathing

  1. Expand your belly as you take air in through your nose and fill your lungs.
  2. Exhale through your mouth and empty your lungs as you bring your belly back toward your spine.

The belly breath improves circulation, promotes relaxation, prevents breathlessness, and gets the maximum amount of oxygen to you and your baby. It also gives you practice in the right way to breathe during labor, and works the abdominal muscles correctly, according to Ms Tupler. Spend at least ten minutes a day practicing relaxed belly breathing. Before going to bed is a good time.

Belly Dancing
In spite of the exotic name, belly dancing done the Tupler way is simply a small, controlled movement to bring the bottom of the pelvis forward and then return it to the center. In other words, a pelvic tilt. The movement relieves stress on the lower back. It prevents backaches by lengthening the lower back muscles which become shortened as the enlarging abdomen pulls them backward. There are four positions in which pelvic tilts can be done: standing, hands above knees, on all fours, and lying on your back (not longer than five minutes). The technique is the same for all four positions.

Abdominals
The muscle that expands and deflates your belly as you do your belly breathing is called the transversus abdominis. The transversus is the deepest of the abdominal muscles and has horizontal fibers, which wrap around your trunk. It is the muscle you use when you cough, sneeze, and go to the bathroom. It is also the muscle, which will help you push your baby out of the uterus during labor.

Tupler likes her patients to think of the transversus moving out and in, forward and backward, as if it were a sideways elevator. Think of your belly button as the engine that moves the elevator.

  1. Expand (take a belly breath). In this position, your belly button is at the first floor.
  2. Exhale slowly, and begin to move your belly button to the fifth floor - which is located near your spine. This doesn't mean that you are going to actually move your belly button to your spine (a physical impossibility!). It simply means you are going to consciously focus on the back-and-forth movement of the transversus.
  3. Your back must be supported and not move during the exercise. Keep one hand on belly, the other hand on the back to feel the transversus moving back-and-forth.
  4. Bring your belly to the fifth floor. Hold at fifth while you count to 30. Now press it back fifth to sixth floors as you count to 5. Counting aloud will force you to take a breath of air in between. Do 10 a day.

Aerobics
Follow the ACOG guidelines.

Kegel Exercises
The pelvic-floor muscles, called the Kegel or PC muscles, surround the urethra, vagina and anus. A woman contracts these muscles when she wants to stop the flow of her urine. During pregnancy, they have the extra burden of supporting the growing baby. After a vaginal delivery, these muscles are super-stretched and are often traumatized from an episiotomy (a surgical incision made in the lower border of the vagina to enlarge the vaginal opening). When these muscles are weak, women have bouts of incontinence (trickles of urine escape involuntarily). Kegel exercises are actually important not just for pregnant women but for all women over the age of 30 to prevent age-related incontinence.

  1. Sit comfortably with your legs apart and your back supported against a wall or a chair, and relax your abdominals.
  2. Pretend you have to urinate but you're going to stop the flow.
  3. Hold in the PC muscles as tight as you can as you count to ten. Then relax the muscle, feel it open like a flower, and hold it in again.

Try to do 20 of these ten-second holds at a time 5 times a day. That's at least 100 PC holds daily. As you get stronger, the kegel exercises can also be done standing up.

Squatting
This is not the kind of squat that is normally done in a gym. This is what is called a "primitive squat". Squatting strengthens the oblique abdominal muscles (they crisscross your waist), the knees, and the pelvic floor muscles. It also stretches the lower back, calves and the pelvic floor muscles. It is also a very good position to give birth in (more and more women in the United States are opting for this position when they push the baby out) because the outlet of the pelvis is opened up 27 percent in diameter. No wonder women in primitive societies give birth while squatting.

  1. Stand with your feet flat and wide apart.
  2. Hold on to an immovable object like a railing or doorjamb (sides of the doorway), and descend gradually and without bouncing into a squat, bending your knees and making sure your heels are on the floor. If your calves are tight, try doing it with short heels on.
  3. Shift your weight to the outsides of your feet; keep your arms straight and at shoulder height, and keep your head up.
  4. Hold the squat for fifteen to twenty seconds. Work up to holding the position for a full minute at a time. Then gradually work your way up to five minutes at a time 5 times a day.
  5. Important: to get out of the squat correctly without hurting your knees, do not try to stand up. Lower yourself to a sitting position one hand at a time. Before getting to a standing position, get onto all fours and then stand up by putting one hand on top of one knee. If your knees still bother you, modify the squat by not coming lower than past your knees. As you get bigger, open your legs wider to accommodate your growing abdomen.

Strengthen:
Strengthen your upper and middle back, chest, shoulders, abdominals (by doing the transversus exercise), pelvic floor (kegels), inner and outer thigh muscles.

Stretch:
Stretch your chest; lower back, shoulders inner and outer thigh muscles.

For serious gym buffs only.
If you have been doing gym for at least six months you can use this guide to modify your existing program (if you have never lifted weights, pregnancy is not a good time to start a serious weight program). Remember that it is normal to lessen the amount of weight you use as your pregnancy progresses. Show this guide (created by IDEA: The International Association of Fitness Professionals) to your gym instructor or personal trainer.

EXERCISES 1st trimester 2nd trimester 3rd trimester
LOWER BODY
Lunges - front, alternating, stationary yes
(with weights)
yes
(no weights)
(2nd half of the 2nd trimester: you should not go down as low as you normally can)
yes
(no weights)
(all of the 3rd trimester you should not go down as low as you normally can)
Walking lunges yes
(with weights)
yes
(same advice as above)
yes
(same advice as above)
Wall squats with or without stability ball yes yes yes
Plie squats(with the legs apart & the feet pointed outward) yes yes yes
Machines
Leg presses yes okay only for the
1st half of 2nd trimester
no
(valsalva maneuver)
Smith machine squats yes okay only for the
1st half of 2nd trimester
no
(valsalva maneuver)
Seated leg extensions yes yes yes
Seated hamstrings yes yes yes
Prone hamstrings yes no
(lying prone becomes impossible as abdomen enlarges)
no
(same reason)
Standing hamstrings yes no
(pressure on the lower back causes discomfort)
no
(same reason)
UPPER BODY
Biceps curl variations
(dumbbell curls, EZ curl bar, resistance with bands)
yes yes yes
(seated)
Tricep cable press-downs yes yes no
(enlarged abdomen will compromise proper form)
Triceps press-backs yes yes yes
Overhead tricep presses yes yes yes
(seated)
Lat pull-downs
seated, front pull downs only
yes no
(valsalva maneuver)
no
(valsalva maneuver)
Rowing movements seated, high/low elbow position yes maybe if range of motion is not compromised no
Lateral shoulder raises seated or standing yes yes yes
(seated)
Shoulder presses, overhead, seated yes yes yes
Supine dumbbell flyes yes no no
Incline dumbbell flyes yes yes yes
Seated chest (pec deck) yes yes yes
Seated chest press machine yes yes yes

Note: the valsalva maneuver is what happens when pressure builds in the chest due to exertion during some exercises. Blood pressure tends to rise.

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