Thursday, October 31, 2013

Basics of exercising while pregnant!

When life throws you curves…go for a run! 

Janae Richardson is a homemaker, runner, coach, and co-founder of UtahRunning.com. She graduated from Weber State University with a Bachelor’s Degree in History Teaching and PE/Coaching. Janae is a Level 1 Certified USA Track and Field Coach and recently completed a Master’s degree in Exercise Science at Utah State University and a Sports Nutrition Certification from the International Society of Sports Nutrition. She previously coached cross country at Davis High School (Kaysville, UT), but currently offers private coaching to runners of all levels.


Benefits of Exercising During Pregnancy
Mother
Baby
  • Improved cardiovascular function; head start getting back in shape after baby is born
  • Limited weight gain
  • Decreased musculoskeletal discomfort
  • Reduced incidence of muscle cramps and lower limb oedema (swelling in feet/ankles)
  • Lowers the risk of developing gestational diabetes and gestational hypertension (high blood pressure)



  • Decreased fat mass
  • Improved stress tolerance
  • Advanced neurobehavioural maturation (status of the body’s nervous system observed through behavior)


  • *Information from “Physical Activity and Pregnancy” (Melzer, Schutz, Boulvain, & Kayser, 2010) and Planning Your Pregnancy and Birth (ACOG, 2000)
    The curves of life that require us to change our course can come in all shapes and forms.  It could be a career change, a death of a family member or friend, a move to a new state/community, or an illness or injury.  For women, one of the biggest curves (literally) they’ll ever face is the baby bump of pregnancy.  Although pregnancy can drastically change our daily life and running routine, we should be grateful we aren’t living in the 1950s.  Back then the tradition and culture of the time encouraged a pregnant woman to continue performing her household chores (of course), but to avoid walking more than a total of 1 mile per day!  Even in the mid-1980s, the recommendations were to keep your heart rate below 140 beats/min and to avoid strenuous exercise that lasted more than 15 minutes.  We runners would have gone crazy!  Fortunately for us, the latest research is showing that continuing a running regime (even a vigorous one) during pregnancy is not only beneficial for the mother, but has added benefits for the fetus as well.  Keep in mind that continuing to run during pregnancy is safe only if there are no medical complications for mother or child and, as always, it is best to ask your doctor to make sure you have the green light to lace up those running shoes.  
    So the questions I believe many expecting mothers (who are addicted to running) ask, are: how intense and how long can my workouts be, how much mileage can I still put in, is core work still okay, and how can I mentally handle the weight gain, slower paces, and discomfort as the pregnancy progresses? 
    Warning Signs to Terminate Exercise While Pregnant
    • Vaginal bleeding
    • Dyspnea (shortness of breath) prior to exertion
    • Dizziness
    • Chest pain
    • Muscle weakness
    • Calf pain or swelling
    • Pre-term labor
    • Decreased fetal movement
    • Amniotic fluid leakage
    *Adopted from “The Pregnant Athlete” (Zaslow & Hame, 2011)
    Intensity
    I recently re-read an interview conducted by Runner’s World with world-class marathoners, Kara Goucher and Paula Radcliffe, when they were both expecting babies in 2010. They answered questions about their training, paces, and the changes they were experiencing during pregnancy.  They talked about how their intensity and mileage had decreased from their pre-pregnancy levels, but that they were still working out twice a day (second workout was sometimes cross-training), doing some short intervals (150-300 meters) on the track once a week, and a second harder workout during the week on the AlterG (antigravity treadmill that reduces the body weight of the runner).  They were still running 50-60 miles a week and their paces still sounded insanely fast, but what I gained most from reading this interview was that for them, the previously described training regime was scaled back from their pre-pregnancy workouts.  Their mileage was at about 50% of what it was before the baby bump.  This is definitely important for expecting mothers to recognize—the intensity and amount of mileage should decrease and it shouldn’t compare to pre-pregnancy workouts.  Just because it isn’t the same, doesn’t mean we should give up on running entirely, right?
    So we know what some of the elite runners are doing during pregnancy, but how intense should it be for us mere running mortals?  The answer to this question and many of the others addressed in this article can be very individual and really depend on what your training regime looked like prior to pregnancy.  Here are a few general guidelines for pregnancy intensity.        
    1) Moderate to hard intensity. Never to exhaustion.  Keep Breathing under control.
    A study out of Johns Hopkins University looked at the effects of moderate to vigorous exercise on highly active pregnant women, where most were runners who ran 4+ days/wk and were at about 30 weeks gestation. The study found that umbilical blood flow and fetal heart rate, measured immediately after moderate and vigorous exercise, stayed within a normal range.  
    2) Heart rate 60-90% of maximal heart rate.
    The American College of Sports Medicine recommends exercising at intensities of 60-90% of maximal heart rate for those who are regular exercisers and who want to continue to maintain fitness through pregnancy. However, there is a lot of variability in maternal heart rate responses to exercise, so target heart rates aren’t always the best determinant of appropriate intensity.  
    3) Use Ratings of Perceived Exertion (RPE)  
    RPE is a 6-20 scale that is a way of measuring physical activity intensity level.  You ask the question, “How hard does it feel like my body is working?”  Studies have shown that using RPE as an alternative to heart rate monitoring may be more useful in determining workout intensity.  RPE of 12-14 (somewhat hard) on the 6-20 scale would be considered moderate exercise.  
    Although there have been many advances in scientific evidence over the years on what is safe and appropriate exercise intensity for expecting mothers, an upper level of safe intensity hasn’t necessarily been established because there aren’t too many mothers out there who want to risk their baby’s health to find out (I don’t blame them).    
     Duration
    I don’t think there is a definite answer when it comes to the upper level limits of workout duration.  Some experts say ≤45 minutes of exercise per day is recommended, but I really think it comes back again to what you’ve been doing before your pregnancy.  For some runners, longer workouts may be fine, but for others, 45 minutes may be too much.  The American College of Obstetricians and Gynecologists recommends 30 minutes a day of moderate exercise most, if not all, days of the week for expecting mothers.  The main concerns with the duration (and intensity) of a workout is being able to safely regulate core body temperature and maintain an energy balance (consuming enough calories each day to meet the demands of mother, baby, and exercise fuel).  Heat is a bi-product of the metabolic demands during exercise and increases in body temperature during exercise are directly related to the intensity and duration of the exercise being performed.  If heat production exceeds the ability of the body to dissipate heat then the core temperature will continue to rise and could potentially cause problems for the fetus.  The main point here is to make sure you listen to your body and stay hydrated.  Playing it safe and leaning more toward the conservative side when it comes to the duration/intensity of a workout is always a good idea.  Keep in mind too that the duration/intensity and even the mode of exercise may change as pregnancy progresses.  Some people can run up to the day they give birth, while others become too uncomfortable and they switch to cross training (aqua-jogging, stationary biking, elliptical, walking, etc.) early on in their pregnancy.  Everyone will be different, so overall just do your best to stay active.  I usually adopt the motto “some is better than none” when it comes to the end of my pregnancies.      
    Core Work 
    If core work is something you’ve been doing before pregnancy then more power to you.  If core work has not made it on to your list of “Things to Do” then begin to add in a routine gradually.  Although modifications will need to be made to accommodate the growing bulge of your belly, continuing or adopting a core workout routine has many benefits.  It improves posture and decreases the chance of low back pain, it helps the body prepare for the hard work required for labor and delivery, maintains flexibility and muscle tone, and helps mothers return to activity sooner after giving birth.  Make sure toning pelvic floor muscles becomes part of your daily routine too.  These are the muscles that attach to the front, back, and sides of your pelvic bone and help control urination.  Pregnancy and childbirth can put these muscles under great strain and cause incontinence postpartum, so it is important to strengthen them.  Kegels are odd, but excellent exercises for strengthening pelvic muscles.  Here is the best description I found for how to perform Kegels:
    • close up your anus as if you're trying to prevent a bowel movement
    • at the same time, draw in your vagina as if you're gripping a tampon, and your urethra as if to stop the flow of urine
    • at first, do this exercise quickly, tightening and releasing the muscles immediately
    • then do it slowly, holding the contractions for as long as you can before you relax: try to count to 10
    • try to do three sets of eight squeezes every day: to help you remember, you could do a set at each meal
    Some words of caution to apply to your core workouts…avoid aggressive abdominal exercises at 12 or more weeks and avoid laying on your back after the 1st trimester because the weight of the uterus can press on the main blood vessel that brings blood back to your heart. 
    Here is a video with simple core exercises to do while pregnant:
     Video - Short and Effective Pregnancy Core Workout
    Nutrition
    As mentioned before it is important to make sure a mother-to-be is consuming enough daily calories to meet the demands of her body, the baby’s body, and the additional demands of exercise.  It is recommended that pregnant women consume at least an additional 300 calories to meet the demands of pregnancy and exercise.  An overall healthy diet is important with a variety of vitamins and minerals included.  To help ensure your baby is getting what he/she needs, a daily prenatal vitamin is also recommended.  One resource that may help give you an idea of what and how much you should be eating, is the Daily Food Plan for Moms at https://www.supertracker.usda.gov.  Although it is far from perfect, it does attempt to personalize some eating guidelines by having you enter in your age, gender, height, weight, physical activity level, and stage of pregnancy.  Staying hydrated before, during, and after a workout is essential during pregnancy.  Drink plenty of water to avoid getting dehydrated.
    The great thing about being pregnant is it truly does motivate you to focus on eating a healthy diet.  Something about knowing you are responsible for the health of another human being seems to do the trick.    
    Mentality 
    Being a pregnant runner definitely requires a shift in mental focus.  As runners, we are used to pushing our bodies to its limits in order to chase down a PR or another running goal.  During pregnancy, our mind set must change to a focus on maintaining fitness rather than trying to reach a peak fitness level.  It can be a great time to enjoy running without the added mental pressures of performing.  At times it will seem pointless as you put in the running time only to continue to get slower and slower and bigger and bigger. But constantly reminding yourself that it is good for you and the baby and that it will pay off on the other side of childbirth, will hopefully get you out the door each day.  It is a good idea to mentally prepare for the possibility that at some point along the way, running may become impossible and another form of exercise may need to be adopted to get your exercise fix and to reap the benefits.  Some of my “favorites” (read with sarcasm) are hiking, power walking (I’ve gained a new appreciation for race walkers during my two pregnancies), aqua jogging, biking – stationary is safest, and using the elliptical. 
    Good luck in the adventure of pregnancy and enjoy the miracle that this life curve will bring!   

    THANKS JANAE!

    Sources:
    Artal, R., & O’Toole, M. (2003). Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. British Journal of Sports Medicine, 37, 6-12.
    Melzer, K., Schultz, Y., Boulvain, M., & Kayser, B. (2010). Physical Activity and Pregnancy. Sports Medicine, 40 (6), 493-507.
    Neitz, K.M. (2010). Great Expectations: Interview with Paula Radcliffe and Kara Goucher. Runner’s World.
    Szymanski, L.M., & Satin, A.J. (2012). Exercise During Pregnancy: Fetal Responses to Current Public Health Guidelines. Obstet Gynecol, 119(3), 603-610.
    Zaslow, T., & Hame, S.L. (2011). The Pregnant Athlete. American Orthopaedic Society for Sports Medicine.
    (2011). Exercise During Pregnancy. FAQ. The American College of Obstetricians and Gynecologists.
    http://www.acog.org/~/media/For%20Patients/faq119.pdf?dmc=1&ts=20131024T0128515096
    Exercise in Pregnancy. http://www.nhs.uk/conditions/pregnancy-and-baby/pages/pregnancy-exercise.aspx#close
    Neitz, K.M. (2010). Great Expectations: Interview with Paula Radcliffe and Kara Goucher. Runner’s World.
    Image: Pregnant Woman http://pinterestpicks.com/wp-content/uploads/2012/10/a-125.jpg



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