Pre-& Postnatal Training Q &A - Part I

Exercise during pregnancy - good or bad? I was having a conversation with a friend recently who just found out she was pregnant. During her first doctor’s appointment her doctor told her to avoid elevating her heart rate above 140 bpm and adapt a low intensity exercises routine (yoga, walking).  “Hmm…” I thought. While there are contraindications to exercise throughout pregnancy, for women who’ve previously exercised (especially at high intensities like my friend), the 140 bpm restriction is based on old research. My friend’s experience got me thinking - what other types of common questions do pregnant and postpartum women have around training? There is a lack of quality information available, and often conflicting information that causes confusion for many. Can I lift heavy? Can I run? It is safe to exercise at all, especially in the first trimester when risk of miscarriage is high? How soon can I exercise after baby?The truth is (assuming no contraindications) prenatal exercise can set mom up for a speedy postpartum recovery, and get her back to feeling strong in the gym and activities of daily life as a mom. Exercise after pregnancy has been shown to reduce depression, increase self-esteem, and minimize the risk of chronic disease. 

Pregnancy Training Questions

Is it safe to continue strength training?

Research shows that the outcomes for moms and babies are better with prenatal exercise. Moms who train throughout their pregnancy have shorter labors, decreased risk of preterm labor, fewer complications, and shorter hospital stays. Staying active can also help you sleep better, reduce your likelihood of suffering from some common pregnancy complaints, and reduce stress.That being said, pregnancy is not a great time to push yourself, or try an extreme sport with a high risk of falling :) Many athletes (myself included) receive a ton of advice on how to modify training as their pregnancy progresses. The first thing I like to discuss with anyone is risk vs. reward. Training in pregnancy does come with risks. With every movement or activity we want to ensure the benefits outweigh the risks involved. Can you lift x weight? Potentially, but should you? Some women may choose to stay away from strength training with these added risks. But, I would argue that there is a greater risk to mom physically and mentally with not exercising at all.  https://www.instagram.com/p/B9uSKlOg1Dw/

Can I “do what I’ve always done”?

This is a well meaning piece of advice often given to moms from their doctors, midwives, and friends. But, “do what you’ve always done” is not setting mom up for long-term success. The advice doesn’t consider the mom’s long-term health, function, and return to sport postpartum. How can we do what we’ve always done when the entire structure of our body is changing, during both pregnancy and postpartum? Exercises are going to feel different as the body adapts to changing demands week to week. There is opportunity for higher intensity exercise and metabolic conditioning work in pregnancy, but it must be programmed strategically. We need to work the body in a way that supports you and baby. The more we can honor and embrace new strategies for exercise and mindset the better off we will be for long-term sustainable health and performance. The course I took with Brianna Battles really shifted my perspective on this.

Can I elevate my heart rate above 140 bpm?

From personal experience, I hit 140 bpm climbing the stairs in my home :) The cause for concern around a high heart rate has to do with the muscles pulling all the oxygen and not enough going to the fetus. However, 140 bpm comes from outdated research. I recommend using a Rate of Perceived Exertion (RPE) on a scale of 1-10 or the “Talk Test” to guide you. If you’re feeling appropriately challenged, breathing hard but not totally out of breath, and allowing yourself ample recovery time during and between workouts, then that’s a great start. 

Can I train my core during pregnancy?

Proper abdominal and core training is vital during pregnancy because of the postural changes and additional weight being added to the anterior (front) side of the body. Many women experience abdominal separation in pregnancy, called Diastasis Recti (DR). DR occurs because the growing fetus puts pressing onto the abdominal wall. The rectus abdominals will then stretch because the connective tissue holding them together gets very thin and soft. DR is a normal process in pregnancy. A stronger core can help reduce the size and severity of diastasis recti and set you up for a speedier recovery postpartum. There are specific core exercises typically avoided as pregnancy progresses to help minimize diastasis recti, such as sit-ups, crunches, front planks (front loaded movements), and exercises that result in doming of the abdomen.Some pregnancy friendly core exercises can be done from half and tall kneeling positions, as well as pallof pressing, dead bugs, farmer’s walks, diaphragmatic breathing, side planks, slow mountain climbers from an elevated surface, to name a few. Check out this post with more on training your core in pregnancy. https://www.youtube.com/watch?v=oSKtRFjUfgM

Is it OK to run during pregnancy?

I hear this question discussed a lot. Many women fear harming themselves or the baby. But, not being able to run can also be concerning to them. Most international guidelines state that running is safe in uncomplicated pregnancies. According to ACOG, pregnant women who engage in vigorous-intensity aerobic activity or who are highly active “can continue physical activity during pregnancy, provided they remain healthy and discuss with their healthcare provider how and when activity should be adjusted over time.”  https://www.instagram.com/p/BWIZdIXjduy/**Daisy is one inspiring mother runner from San Diego :) To answer this question fully though, I’m going to pose a question: just because you can run, should you? Below are a few questions to consider first. 

1. Are you a regular runner? 

If you are not someone who is used to more intense levels of cardio, adapting to the increased demands may be too much given all the changes in your body. You might find yourself breathless and fatigued. A regular runner may also have muscles and joints used to frequent impact, and may cope better with the increased load on the pelvic floor and abdominals as pregnancy progresses.      2. Has your doctor cleared you for exercise?Has your doctor given you the “ok” to continue?    3. Do you have any pelvic floor or musculoskeletal issues?Do you experience any leaking when you cough, sneeze, laugh, or run? Do you have any heaviness around the perineum? Did you have any birth trauma in a previous pregnancy?I highly recommend all women visit a pelvic floor physiotherapist during pregnancy for assessment and guidance. They may recommend reducing or removing running from your program if pelvic floor risk is high. However, this is always your choice. From personal experience, running became uncomfortable around ~18 weeks pregnant. But, you know your body best. Some pregnant women (runners and non runners) may experience pelvic girdle pain, low back pain, knee pain, and other musculoskeletal conditions throughout pregnancy. There may be treatment options to help manage the pain so you can continue to run (e.g. pelvic support belts, massage, reducing running speed/distance), but ultimately you’ll have to make a decision. Risk vs reward?     4. Are you aware of signs and symptoms that you need to watch out for if you do decide to run while pregnant?Don’t be afraid to reduce your speed, frequency, or distance as your pregnancy progresses. You are not a failure if you slow down. One study showed that only 16% of runners ran in their final trimester. Below are some of the signs and symptoms you want to be aware of: 

• Pain (pelvis, low back, knees, or anywhere in the body that feels new)
• Pressure in the pelvic floor / perineum
• Peeing - Incontinence 
• Peaking - Bulging or strain along the linea alba (connective tissue that connects the two sides of the rectus abdominis). You may notice this looks a bit like a football along your belly. 
• Leaking of blood or clear fluid - call you doctor immediately
• Chest pain, headaches, dizziness, extreme calf pain or swelling, shortness of breath - call your doctor immediately

For the most part, you’ll find you self-limit running during pregnancy because at some point it may not feel good anymore. Provided there are no medical conditions that put you and the baby at risk, you should be able to continue with the doctor's OK. 

What exercises should I avoid?

Rather than giving you a list of exercises in a “No” or “Yes” category, I’m going to describe specific physical sensations. These will better help you tune into your body and safely enjoy exercising throughout your pregnancy. 

1. Exercises that cause pain or discomfort

Feeling pain during or after an exercise is a sign that the body needs some additional support, or a change in strategy (body alignment, breath/press distribution, reducing the load). You may experience pain in the front of the pelvis (symphysis pubic dysfunction), back of the pelvis (sacroiliac joint pain), general low back pain, in your knees, or somewhere else in the body.      2. Exercises that cause leakingLeaking may be common during pregnancy, but it is NOT normal. Leaking can show up during any movement, but more commonly during high-impact (running, jumping) or exercises with high intra-abdominal pressure (deadlifts, squats, chin-ups). Leaking doesn’t mean you can never do the exercise, but it does mean we need to adjust your strategy. Example: Leaking during running. Try shifting your body forward a bit more at a slight angle. Incline walking works great for this as well. This will allow your core and pelvic floor more opportunity to respond to the pressure from high impact.      3. Exercises that cause doming through the abdominal wallThe focus here is avoiding exercises that make you feel constant outward pressure along your abdominal wall. This might feel like straining in your abdominal muscles. You may experience this while doing push-ups, planks, or a twisting movement. I recommend taking your planks or push-ups to an elevated surface to minimize the downward pressure. Also of note is that this sensation could happen at any stage of pregnancy.     4. Exercises that cause pain or bulging in the perineumThis is extremely important, as it’s directly related to long-term pelvic floor health. This is a sign that your pelvic floor may not be coordinating properly with the amount of pressure it’s working against. Focusing on breath can make a huge difference. Example: Squat. First check, are you holding your breath? One breath strategy is an inhale on the way down into your squat, then, just before you reach the bottom of your squat, start your exhale breath and continue through the range of motion to the top of your squat. This provides a bit more support for your pelvic floor.    5. Exercises where you feel you need to “prove something”Can you do this exercise? Perhaps. But, should you? It’s ok to slow down. It’s also ok to continue exercising, as long as you tune into your body and what it’s telling you. If you experience any pain or signs to back off, don’t ignore it.  Do you have any questions about training through pregnancy? Drop them below and I’d love to answer them! Tune in to Part II where I’ll discuss common postpartum fitness questions :)