There is certainly a lot of clinical research available on the topic of exercise and pregnancy. Some of it has used conditioned human subjects, such as Dr. James Clapp’s work, as discussed in Training the Pregnant Athlete, Part 1 , and some have examined the stress of exercise on sedentary individuals as well as animal models. These are all valuable sources of information. However, it is also important to seek guidance from professionals working in the field with pre-natal subjects. Fitness experts, physicians, naturopaths, and physiotherapists are a few of those types of individuals who have tailored expertise in particular areas of prenatal health, wellness and fitness. Part 2 of this article is an interview session conducted with these types of professionals to gain more insight into optimizing the health and well-being of the fit, mom-to-be.
Interview with Andrea Page (Pre- and postnatal fitness expert and founder of the FITMOM Company)
Andrea Page, a mother of 3, founded the FITMOM company 10 years ago after a 60-pound weight gain sparked by a doctor’s advice to not exercise despite a healthy pregnancy. As a certified personal trainer, Andrea has worked extensively with professionals like Physiotherapists & Obstetricians to develop the FITMOM™ coaching certification.
There are a lot of claims and myths out there regarding exercise and pregnancy. Can you give me your top five and some info on why it is a myth or a gross generalization?
Myth number 1: It is not safe to train during the first trimester.
For many years medical experts advised women not to exercise in the first trimester. The concern was related to first trimester miscarriage. A link was made despite no concrete evidence connecting the two. The reality is that 1 in 3 pregnancies are lost in the first trimester and are chromosomal in nature. Exercise in the first trimester has no links to pregnancy loss in the first trimester based on current research.
Myth number 2: Your heart rate should not go above 140 BPM.
Pregnant women have been told for many years to keep their heart rate below 140 BPM. The truth is heart rate is it is one area you absolutely cannot give a blanket statement. Without considering the age of the person, previous level of fitness and stage of pregnancy an absolute number is completely inaccurate. The "TALK TEST" is a more applicable guide. From a physiological stand point a well-trained women can have a higher heart rate and pass a talk test which means they are not compromising baby.
Breaking it down to simple application in this case also creates a more accurate form of monitoring. A person’s body will reserve oxygen to support cardiovascular function. Many women can work above 140 BPM without symptoms of breathlessness while some cannot.
Myth number 3: You cannot train your abdominals during pregnancy.
Many women are still cautioned by well meaning friends and even uninformed caregivers to avoid abdominals. Some people even believe it will hurt the baby which is ridiculous at best. Core strength is so important for expecting moms and in utero babies live in a cushion of fluid that protects them. Core strength is needed to support the lower back, support the pelvic floor and assist the uterus in the pushing phase of labor.
While core strength is safe for baby and crucial for muscular balance, preparing for labor and postpartum recovery it is also important to find a trained professional to do regular abdominal separation assessments. This assessment involves checking to see if diastasis recti has occurred. Diastasis recti is a disorder defined as a separation of the rectus abdominis muscle into right and left halves. Normally, the two sides of the muscle are joined at the linea alba at the body midline.
Regular monitoring and proper exercise prescription for diastasis will help prevent severe long term gynecological problems.
Myth number 4: You’re eating for two.
Anyone who loves to eat has no investment in knowing the truth here. The reality is pregnancy requires only minimal additional calories. The number quoted is 300 kcals extra per day. However that may be less or more depending on pre-pregnancy weight and energy expenditures. One can also add an additional 150 kcal to this figure if they are exercising regularly.
Myth number 5: Don't lift your arms above your head.
While lifting your hands above your head does in fact increase your heart rate this should not be an absolute contraindication as in active women this will be generally insignificant.
Interview with Dr. Julie Durnan (Naturopathic physician who specializes in women’s health)
Dr. Julie Durnan is a Naturopathic Physician and co-owner of Pacifica Naturopathic Clinic in West Vancouver, BC. After obtaining her degree in Environmental Science from the University of Guelph in Ontario, Dr. Durnan moved to the west coast and gained her Doctorate from the Boucher Institute of Naturopathic Medicine. Dr. Durnan has a family practice with a special focus on women's health and pediatric wellness.
You have some terrific nutrition and supplement recommendations for women who are pregnant. Can you discuss the importance of iron testing and the necessity for supplementation? Do you also recommend certain foods that are iron-rich during pregnancy?
Taking a good quality prenatal multivitamin is very important in pregnancy and there is very good research showing the importance of a multi in reducing complications in pregnancy. Nutritional requirements go up significantly when we're growing a baby, specifically our bodies' demands for iron. Iron is needed for proper placenta development and prevention of pre-term and low birth weight babies. A good multivitamin will contain approximately 45mg of iron in the daily dose. I always recommend that women eat a variety of iron-rich foods to keep their stores up. These foods include green leafy veggies, legumes, and occasional red meat if women are inclined. However, many women will require extra iron in addition to what's found in the multivitamin. Iron testing is important during pregnancy and possibly frequently if the mom-to-be is following a vegetarian diet or avoiding iron-rich foods due to nausea and food intolerance.
You do not recommend women do kegel exercises during their pregnancy. Instead you recommend they do their kegels postpartum. Can you elaborate on this advice?
That’s correct. I don't recommend doing kegel exercises for the pelvic floor during pregnancy. Contrary to what many women have been taught, doing kegels in isolation, will actually tighten the pubococcygeus muscles (PC muscles) and narrow the birth canal. Kegels are fabulous postpartum but in pregnancy, this is actually the worst time to be tightening these muscles. What women need to do is work all of their muscles in concert, that's by doing squats and activating their gluteal muscles (and calves and hamstrings) which will lift the sacrum and widen the birth canal.
You also recommend specific movement patterns during the pregnancy to help turn the baby. What are these patterns and what is the theory behind them?
It appears that in the past several years, there are more and more babies presenting and born in a posterior position (also called "back labor," which can be very painful for mom). One theory for this is that women have many more office jobs than we did in previous times. Many years ago, women would be on their hands and knees doing gardening and washing floors. Now women are often in a reclined or upright position for much of the day. Getting on hands and knees as much as possible is not only a fabulous way to lengthen the spine and stretch out sore muscles, but can also encourage baby to get into that desired anterior position.
What types of lifestyle advice do you offer to pregnant clients to make sure they are healthy and ready for child-bearing? Do you recommend exercise? Diet modifications? Certain amounts of sleep or downtime? Stress reduction strategies? Anything else?
Encourage women to remain active in their pregnancies. This generally means keeping up almost the same level of activity as women were previously enjoying prior to becoming pregnant. For women who were not exercising before getting pregnant, I recommend at least walking on a daily basis. There are certainly some foods to be watchful of during pregnancy, most notably raw fish and meat products which can contain Listeriosis (a bacteria which can cause miscarriage). I encourage women to avoid sugar and eat a well balance whole-foods diet. I also recommend acupuncture during pregnancy to keep stress levels down.
Next we feature interviews with two top coaches and athletes. These women did not follow the conventional guidelines of swimming and walking, but instead combined strength training with the use of kettlebells to stay pregnancy fit and functional!
Interview with Yoana Snideman
Yoana is a native Venezuelan, Russian Kettlebell Certified Team Leader and Physical Therapist, and mother of two. She is the co-owner of Revolution Fitness Center, co-author of the Kettlebell Fat Loss Series DVDs and Book, co-author of the “Kettebell Mommy” Staying Fit with Kettlebells During Pregnancy manual.
Yoana, what type of athlete are you? What are the typical training protocols you follows, sports you like, drills you do etc? How would you describe your pre-pregnancy activity level?
At the moment I would say I am primarily a kettlebell athlete with a strong leaning toward anaerobic activities such as sprinting and lower rep strength training. When I say Kettlebell athlete I am not referring to Girevoy Sport or competitive GS kettlebell competitions. I am an athlete that uses the kettlebell to become strong, powerful and mobile under the HARDSTYLE method of training that I have learned from Pavel Tsatsouline.
Whether I am training for a specific competition or just to be a fit mom, the focus of my exercise is on full-body compound lifts such as squats, deadlifts, pull-ups, presses, swings, cleans, snatches and more.
I have been training in this manner since 2002 and continued to train like this during both of my pregnancies (although at a less intense level).
You are a trained physiotherapist – what is your opinion on joint laxity and ligament changes during pregnancy and how did you change your workouts to accommodate these changes? Did you view these changes as a real “danger” or just something to keep in mind while working out?
As a physiotherapist, I am very aware of the changes that occur to the body during pregnancy. Having been pregnant twice, I can tell you that ligament laxity is a definite reality and there is a big increase in joint range of motion especially in the pelvic and hip region. The body is incredibly intelligent and obviously knows how to prepare the woman for the birthing process. I don’t view these changes as a huge danger as long as you continue to train for strength and stability throughout your pregnancy. One of the most important things to do is to go into your pregnancy as strong as possible. And by strength I am talking about being able to lift some considerable weight in a safe manner. This will help offset some of the potentially negative effects of ligament laxity. Of course some women are just naturally more loose in their ligaments and they have to be more intentional about limiting aggressive flexibility and mobility protocols.
During your pregnancy, what were your workouts like? What did you do with your volumes and loads? How often did you train and did you worry about keep your heart rate in a lower zone, or did you use more of an RPE to monitor your intensity and fatigue levels?
During both of pregnancies I really just listened to my body. If my body told me to rest, I rested. If it had energy, I took advantage of that and trained. I always tell women that they must listen to their body and put their baby’s health and safety as the top priority. Regarding volumes and loads, I gradually reduced both load and volume as the months progressed. Because everyone has a different training background, some people saw me snatching with the 16kg and 12kg kettlebell during my pregnancies and were very alarmed. They told me “how can you lift such heavy weight while pregnant? Isn’t that dangerous?” I would answer “NO.” It was not dangerous for me because I routinely snatch the 20kg and 24kg kettlebells, so to me lifting the 16kg and 12kg was actually a perfect step down that felt quite appropriate. At no time did I feel like I was pushing it too hard or that I was in a “dangerous” zone. I typically trained 3 to 4 days per week and my workout never last more than 40 minutes in total duration. Sometimes my workouts were only 10 minutes. I always emphasized QUALITY reps and sets over QUANTITY. And believe me, sometimes those 10 minutes were perfect for that specific day.
What I want to say is that everyone has a different fitness level and you must modify your training program during your pregnancy according to your fitness level (assuming that you have no pregnancy complications). That is why it is so important to have an open line of communication with your medical doctor during the entire 9+ months. Ideally you would find a doctor that is an athlete or fitness is part of their lives so they will understand the importance of exercise and be able to work with you during your entire pregnancy.
I used more of a RPE approach to monitor the intensity of my training. Blood pressure issues are common during pregnancy and it is essential to listen to your body. If you do not feel well during and after training, you have to ask yourself whether or not what you are doing is safe. Don’t overdo it! Once again, you must listen to your body!
Did you or your doctor feel that being as fit and healthy as you were going into labor and delivery helped you handle the stress and pain? What were the doctor’s comments?
The entire medical staff were shocked on how easy and fun both of my labors were. I was lucky enough to have two incredible doctors that delivered my babies. There is no doubt that my training played a huge role in preparing for the birthing process. Not only was it a fun experience for me but I recovered so quickly after both of my pregnancies. Forty-eight hours after my second child I was swinging kettlebells again at home. I must say that I was able to workout during my pregnancies because I went into both pregnancies super fit and super strong. I believe that the KEY in having an active pregnancy is to go into the pregnancy as fit as possible. I do not think that pregnancy is the time to start training hard when you have no prior training experience or do not have a decent level of conditioning. That is why I always stress that women MUST keep themselves in top shape at all times.
Interview with Maya Garcia
Maya is a CSCS, an accomplished kettlebell sport athlete and co-founder of Ice Chamber , a successful athletic training company in the San Francisco Bay Area, and Ice Chamber Kettlebell Girls. She is a Master of Sport, 9x Gold medalist, and the first American to win the Best Lifter Award in the International Union of Kettlebell Lifting. “Always listen to your body. If something doesn't feel quite right, it probably isn't. Avoid pushing though previous boundaries and just take it easy if you need to.”
Maya, what is your coaching and training background? What type of athlete are you?
I am a Certified Strength and Conditioning Specialist with the NSCA, a Master Coach with the World Kettlebell Club, and a Club Coach with USA Weightlifting. I also have a Bachelor’s in Sociology from the University of California at Berkeley so my perspective on health includes emotional and mental fitness as much as physical.
I am a Kettlebell Sport (Girevoy Sport) athlete and I compete in traditional kettlebell lifting events originating from Eastern Europe. The winner is determined by the most repetitions lifted non-stop, with one switch of hands, in a ten minute time period. Women competing at the professional level often lift 20-24kg kettlebells over 100 reps at a time.
How did you change your training during your pregnancy? Did you do different drills, less volume, lighter loads, etc.? Did you keep your heart rate in a certain zone or use RPE to monitor intensity?
I tried my best to use the same movement patterns I would use during my standard training regimen. Of course, I decreased loads and intensities to accommodate the growth of the baby. Other than that, I still moved like an athlete as much as I could. I never wore a heart rate monitor, however I did use RPE to monitor intensity.
Unfortunately in my second trimester I began to gain a lot of excess weight because I wasn’t managing my emotions and the stress of the pregnancy well. My training was extremely challenging once I began carrying an additional fifty pounds! That’s when I rediscovered kettlebell training. They allowed me to maintain my basic level of strength, while also improving my cardiovascular endurance. I found that the low impact movements associated with kettlebell training (i.e. swings and presses) were best suited for my pregnancy as well.
Were you ever “judged” or advised by the lay person not exercise so hard during your pregnancy?
Fortunately, all of my physicians encouraged me to exercise as I would normally. I was reminded to modify intensities based on how as I feeling that day. Of course, as I fell deeper into my pregnancy, there were many things that I could not do because of limited ROM and weight gain. However, I was always encouraged by medical professionals to continue aerobic and resistance training. Lucky me!
What all the experts interviewed shared with me: It all boils down to instincts!