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Are There Risks to Working Out During Pregnancy?

Some research shows that standing for a long time or lifting heavy objects is associated with pregnancy complications (such as preterm birth), but exercise is more of a protective factor for women during pregnancy. If you’re in good health with no pregnancy complications, the American Congress of Obstetrics and Gynecologists (ACOG) approves a “regular, moderate intensity” exercise program for all fitness levels, even for previously inactive women.

weights, weight lifting, exercise, exercise and pregnancy, fit and healthy pregnancyYou can continue activity as long as your pregnancy stays healthy and you feel good doing it, but it’s important to regularly discuss the type and intensity of your workouts with your health care provider. Be willing to make adjustments in response to changes in how you feel over time.

Despite the misperception that exercise during pregnancy is risky for women and their babies, studies consistently show that those who work out when they’re expecting tend to have better health outcomes during pregnancy and delivery.

So are there any cautions besides not pushing yourself too far?

Anecdotal evidence suggests that women already at risk for preterm labor might trigger labor with exercise, but those moms didn’t experience the healthy, typical pregnancy that we’re primarily focused on here. Exercise does not increase your risk for preterm labor, and additional research finds that women who are considered “heavy” exercisers actually show lower rates of preterm birth than do women who exercise less often or with lower intensity. After 37 weeks, active women deliver 6 days earlier, on average, but these deliveries are not considered preterm.

More intense exercise is associated with an increase in blood glucose in pregnant women, but there isn’t a known impact on insulin level. It’s thought that the glucose is produced in response to the need for it as a result of intense exercise, so there isn’t likely to be a surplus that would cause a risk to you.

runner, woman running, running and pregnancy, working out and pregnancy, fit and healthy pregnancyExercising during pregnancy does seem to make a difference, with the best outcomes reported for women who maintain a consistent workout practice from early pregnancy through the third trimester, even if they adjust the intensity and type of exercise as they near delivery.

For example, overall discomfort in late pregnancy appears to be lower in women who exercise more during the first trimester, and researchers have found that women with a history of vigorous workouts who continue to be highly active in pregnancy have lower resting heart rates and a better maximal oxygen consumption (VO2max) throughout pregnancy than do moderate and nonexercisers.

There’s a slight increase in VO2max postpartum even among recreational athletes if they maintain just a moderate level of exercise throughout pregnancy. However, while you can maintain (or even improve) your VO2max, your anaerobic working capacity may be reduced in late pregnancy even if you’ve stayed active.

Still, the takeaway message is that maintaining a consistent, moderate fitness program throughout pregnancy is good for you, your athletic body, and your baby’s healthy development.

Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MDFit & Healthy Pregnancy is a friendly, comprehensive guide to exercising during pregnancy from athlete-moms Kristina Pinto and Rachel Kramer, MD.

Find Fit and Healthy Pregnancy in your local bookstore or online and learn safe ways to exercise for two!

Please consult your doctor before embarking on an exercise program during pregnancy.

How Exercise Affects Fertility

cycling, cyclist, endurance sports, exercise, exercise and fertility, fit pregnancy, fit and healthy pregnancyOf course you won’t exercise while pregnant until you first get pregnant! Athletic women can have particular concerns about conception and fertility because the reproductive system responds to how much energy we expend by working out. We’re not talking about how you get through a triathlon during your period or the nuances of core work with severe menstrual cramps. And we’re not talking about the tricky business of using up so much energy at the gym that you have zero interest in sex.

Yes, conception is closely tied to energy, to the extent that your body needs enough nutrition, particularly fat, to compensate for your activity and stay in a healthy zone for conceiving and supporting the growth of a fetus. But while exercise intensity and volume are often held responsible for how easily an athletic woman conceives, there are several factors in menstrual regularity that can play out in fertility issues:

  • Balance of energy use and fuel intake (calories)
  • Body weight and composition
  • Disordered eating habits
  • Psychological stress
  • Individual variation among women

swimmer, swimming, female swimmer, female athlete, exercise, exercise and fertility, pregnancy, healthy pregnancy, fit and healthy pregnancyWhen you have missing, infrequent, or irregular periods as a result of any of those factors, you might experience trouble conceiving, which is known as ovulatory infertility. It’s like trying to make an omelet without eggs. Although working out is something of a scapegoat, exercise at high levels of training volume, particularly in endurance sports, can change the frequency and regularity of menstruation, making it hard to predict your ovulation. For example, one study of distance runners found that an increase in mileage from 30 to 42 miles per week was associated with the rate of amenorrhea (missing a period for at least 3 months in a row) going from 2 percent to 31 percent.

The thing is, statistics like this can create the false belief that exercise causes ovulatory infertility, which isn’t the case. Amenorrhea associated with exercise has to do with food intake and energy use and maintaining the balance between them. Exercise simply affects that balance, which wobbles when a woman isn’t getting enough calories from fat to support her energy use. The result is a disruption in the hormones that direct her ability to conceive and may change her body mass index (BMI), which influences menstrual regularity.

For more on BMI and getting pregnant, check out our other articles: Exercise BMI and Getting Pregnant and More on Exercise, BMI, and Getting Pregnant.

Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MDFit & Healthy Pregnancy is a friendly, comprehensive guide to exercising during pregnancy from athlete-moms Kristina Pinto and Rachel Kramer, MD.

Find Fit and Healthy Pregnancy in your local bookstore or online and learn safe ways to exercise for two!

Please consult your doctor before embarking on an exercise program during pregnancy.

The Benefits of Exercising During Pregnancy

running, exercise, fitness, fit and healthy pregnancyDespite the misperception that exercise during pregnancy is risky for women and their babies, studies consistently show that those who work out when they’re expecting tend to have better health outcomes during pregnancy and delivery.

Here are some of the benefits of exercising while you are pregnant:

  • yoga, exercise, fitness, woman doing yoga, exercise and pregnancy, fit and healthy pregnancyBetter cardiovascular function
  • Less weight gain
  • Lower musculoskeletal discomfort, especially in the lower back
  • Better posture
  • Fewer muscle cramps
  • Better mood and self-esteem
  • Lower risk of gestational diabetes
  • Fewer instances of hypertension
  • Better circulation throughout the body and to the placenta
  • Less constipation and bloating
  • Improved muscle support for the pelvis
  • Lower rates of incontinence
  • Stronger muscles, bones, and ligaments for labor and delivery
  • More energy and better sleep

Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MDFit & Healthy Pregnancy is a friendly, comprehensive guide to exercising during pregnancy from athlete-moms Kristina Pinto and Rachel Kramer, MD.

Find Fit and Healthy Pregnancy in your local bookstore or online and learn safe ways to exercise for two!

Please consult your doctor before embarking on an exercise program during pregnancy.

Cheerios, the Boston Marathon, and the Seeds of a New Book for Active Women

cheerios, babies, baby food, moms, motherhood, pregnancy, fit and healthy pregnancyOur book Fit & Healthy Pregnancy has been a long time coming, both for me and for the topic of exercise, pregnancy, and new motherhood.

In 2006, my boy planted the seeds for this book with the Cheerios he threw in my hair while we watched the Boston Marathon on TV. As I made lunch for him in his high chair, I watched athletes whose afternoon was looking pretty different from mine and welled up with tears as the exhausted people ran across the yellow line on Boylston Street.

marathon, marathon runner, athletes, athlete momsI wanted to be one of those people. I decided the marathon was within reach, since I knew how to run and my baby already had me exhausted anyway. And with a Cheerio to my temple, the seed was planted. My love of marathoning became a love of coaching, which was the perfect venue for merging my doctorate in women’s psychology with my dedication to sport. Fit & Healthy Pregnancy is the result of that extensive work with other women and my experience as an athlete mom.

I’ve met many women who find strength and sustenance in sport and fitness, and this book is meant to underscore that they don’t need to give up athletics when they decide to grow a family. The need for activity translates into a habit of the most awesome self-medication, whether it’s running, biking, swimming, yoga, or some other cathartic activity involving your body—and pregnancy doesn’t mean you must quit that healthy vice. Mother’s Little Helper isn’t a pill; it’s a good sweat.

This website is a guide to helping you find that zone of wellness as your body performs its ultimate feat of stamina and endurance: creating, growing, and delivering a baby.

Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MDFit & Healthy Pregnancy is a friendly, comprehensive guide to exercising during pregnancy from athlete-moms Kristina Pinto and Rachel Kramer, MD.

Find Fit and Healthy Pregnancy in your local bookstore or online and learn safe ways to exercise for two!

Please consult your doctor before embarking on an exercise program during pregnancy.

An Introduction to Your Fit Pregnancy

London Olympics, Olympians, Athletes, Female Athletes, Female Olympians, Pregnant OlympiansThe 2012 London Olympics seemed like a baby shower for fit pregnancy, a watershed for sport and motherhood. At the 2008 Beijing Games, swimmer Dara Torres had opened a door for women in sports to be highly visible moms, and the London Olympics picked up where she left off by placing mothers front and center. In no other Olympic broadcast had athlete moms been more celebrated, or perhaps more decorated. Beach volleyball star Kerri Walsh-Jennings took home her third consecutive gold medal, having become a mother of two in the years between the Athens (2004) and London Games. The 2012 medal favorites in the women’s high jump included three moms of toddlers. Several of the most promising marathoners were also moms, including Kara Goucher of the United States and Romanian Constantina Dita, a 42-year-old mother of a teenager. No longer just waving flags tearfully from the stands, mothers were high-profile in the action and on the podium.

London was also a groundbreaking Olympics for expectant women. In no prior Games had a competitor participated at 36 weeks pregnant. Malaysian riflewoman Nur Suryani Mohammed competed in the 10-meter air-rife event, saying later in a press interview that she talked to her baby daughter in utero every morning, asking permission to shoot without being kicked. “If the baby kicks, I have to breathe easy and let her calm down before shooting,” said Nur. Now, that’s good advice for moms everywhere.

As a Muslim woman competing in Olympic air rife while 8 months pregnant, Nur might have broken through several layers of ground in elite sports. At the same time, she represents the modern age in women’s athletics. Today, many women are more likely to register for baby joggers and bike chariots than rock- ing chairs, and they’re inclined to stay fit and active throughout pregnancy. As Nur put it, “I am the mother. I know what I can do. I am stubborn.”

healthy body and mind, mind and body, wellnessAnd yet many of us don’t know how much we can do, and we encounter raised eyebrows and voices of concern that Nur and other expectant mothers also face as they strive for a fit pregnancy. This book offers answers to clear up that confusion, and it will help empower you for a healthy, active 40 weeks and beyond. It covers your mind-body wellness as well as the health and safety of the baby you’re growing. And by presenting the most current knowledge on pregnancy and exercise and the advice and experiences of countless expectant women with active lifestyles, this book will equip you to navigate what can seem like the ultimate 9-month endurance sport.

At the same time that you’ll learn about fitness that is safe and healthy for women with pregnancies that are progressing normally, reading this book will help you focus on yourself. The central tenet of a fit pregnancy is that you value your own experience and heed your individual body’s cues in order to be strong, active, and healthy. This is your body and your pregnancy—no one else’s. You’re creating an ecosystem of flesh and blood, and your fit pregnancy won’t look precisely like that of any other woman. This book reminds you to trust your body and focus on a balance between mental and physical health in order to be fit and healthy while you grow a baby.

Designed for veteran and recreational athletes as well as general fitness enthusiasts, the book digs deeply into each trimester, including the often neglected “fourth trimester” of postpartum adjustment. Each of these chapters covers the essential information you need to cultivate a healthy pregnancy and start toward motherhood.

You’ll be able to read about such key topics as:

  • Whats happening to my body?
  • How do I fuel each trimester?
  • How do I exercise safely throughout my pregnancy?
  • How do I keep a fit mind during pregnancy?

Swimmer, Swimming, Female Swimmer, Woman Swimming, Female athlete, fitness, fit and healthy, Fit and Healthy PregnancyYou’ll learn about fitness options for each phase of pregnancy, focusing on running, biking, swimming, stretching, and strength training. Chapters feature simple and efficient exercises to enhance your fitness routine as well as advice on building mental strength and finding calm during this period of change, both for yourself and for your relationships.

A distinctive feature of this book is the insight offered by the many moms who have been there before you as well as the expert contributions of coaches, trainers, midwives, and doctors. What’s more, the book is rooted in the medical expertise of athlete OB-GYN Dr. Rachel Kramer, who offers current, balanced advice to guide you through a safe and rewarding pregnancy experience that honors your need for fitness and your care for your growing baby. You’ll find her expert contributions highlighted throughout the book. Simply put, this book offers you the best of all sources: sound medical advice, a mind-body fitness guide, and motivation from other women who have walked—or worked out—in your shoes.

Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MDFind Fit and Healthy Pregnancy in your local bookstore or online:

 

 

Please consult your doctor before embarking on an exercise program during pregnancy.

Olympian Is 8 Months Pregnant and Runs the 800M

davetrendler:

Olympian Alysia Montano recently ran in an 800m race while 8 months pregnant. Running coach Jeff Horowitz offers a few thoughts and links to the story on Washington Post.

Originally posted on Jeff Horowitz Running and Triathlon Coach:

In case you missed this, Olympian Alysia Montano recently ran in an 800m race . . . while 8 months pregnant. Her goal was just to be back on the track and enjoy participating, and, as she put it, to not be the first person ever lapped in the 800.
She sets a great example with this run. The idea that pregnant women have to be sedentary is a myth. Unless there are complications, a woman experiencing a normal, healthy pregnancy can maintain an active exercise regimen. The key work here, though, is “maintain”; this would not be the time to start up a new, more aggressive training schedule or routine. Also, it’s important to watch for signs of overheating.
For more on Alysia’s run, go to http://www.washingtonpost.com/blogs/early-lead/wp/2014/06/27/olympian-alysia-montano-runs-an-800-meter-race-while-34-weeks-pregnant/

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More on Exercise, BMI, and Getting Pregnant

Pregnancy, Healthy Pregnancy, Fit & Healthy PregnancyWith many women having babies later in life, fertility struggles aren’t uncommon, and many women who are frustrated and emotionally spent from trying to conceive say they cut back on exercise as a way to feel some control over a situation that even doctors have trouble explaining with certainty. This is a normal coping response to a stressful and difficult experience. Ultimately, though, fitness activity is your ally because it relieves stress and helps you maintain a healthy body that can support the growth of a baby. When you think about your workouts, strive to find the mental space between exercise as a stress-buster and workouts that cause anxiety about your fertility. Whether you’re a recreational athlete or an elite competitor, exercise jeopardizes your fertility only when it is the reason that your body doesn’t have enough fat to ovulate and, therefore, conceive.

Most women likely will not have fertility trouble that is exercise-induced. Fertility might become more difficult for those who train at the elite level because their bodies have so little fat, but you can safely maintain a moderate to vigorous fitness program of 4 to 7 days of cardio and strength building exercise per week without concern about conceiving as long as you get enough calories from fat to menstruate. Such a program includes 30- to 45-minute workouts and longer sessions of up to a few hours for endurance athletes. It’s all about fueling to replenish what is burned. However, as mentioned previously, new exercisers should always begin a program gradually, particularly if they’re trying to conceive. As you think about planning your 9-month ultra-event, try to establish a realistic sense of your fitness habits and physical baseline, whether you’re concerned about fertility or looking to determine your pregnancy fitness goals. Print out a calendar and write down your physical activity for the month before conception to get a real idea of your workout baseline.Biking, Bike Riding, Woman Bike Riding, Fitness, Healthy, Exercise, Cardio, Fit & Healthy Pregnancy

Establishing your BMI is another good frame of reference for understanding your fitness and health baseline, but keep in mind that the formula and results rely on your height and weight without taking into account your aerobic capacity, genetics, bone mass, or ratio of fat to muscle. Nonetheless, your bodyfat percentage is important information to consider. A healthy woman is 20 to 25 percent body fat, and a specialist can give you a reliable measurement and analysis of your particular case using skinfold calipers, which might look like a torture device but are actually more like tongs.

Your individual body and fertility will probably have different needs and patterns for metabolizing food depending on the type and intensity of your different activities. If you’d like a specific dietary plan for your fertility and fitness routine, get the input of a nutritionist, fertility expert, and/or exercise specialist who can address the specifics of your lifestyle and health. When it comes to your cycle and fertility, individual variation is as important as the energy intake–use relationship.

See the first article on this topic: Exercise, BMI, and Getting Pregnant

Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MDFit & Healthy Pregnancy is a friendly, comprehensive guide to exercising during pregnancy from athlete-moms Kristina Pinto and Rachel Kramer, MD.

Find Fit and Healthy Pregnancy in your local bookstore or online and learn safe ways to exercise for two!

Please consult your doctor before embarking on an exercise program during pregnancy.

Exercise, BMI, and Getting Pregnant

You might be thinking, “Hold up; I thought pregnancy meant the freedom to gain weight. Why measure my body fat?” Body-mass index (BMI), is calculated from a formula based on your height and weight and can be factor into fertility and healthy nutrition for supporting the growth of your fetus.

fertility, pregnancy, pregnant, healthy pregnancy, fit and healthy pregnancyIf your BMI is either too high or too low, your periods can be disrupted, affecting conception. Specifically, a BMI that is below the 10th percentile, meaning your body fat is less than 22 percent of the total, means you could experience irregular periods or amenorrhea. Eating fewer calories than you use during the day can disrupt your body’s ability to produce estrogen and progesterone, which regulate your menstrual cycle and by extension your ovulation and fertility. However, when your diet includes enough fuel to support your exercise routine and energy use, there will be no change in the hormones responsible for fertility.

If you’re having house guests, you buy more groceries. If you’re going to house a baby in your body, you need enough nutrition for both of you. Your kids won’t just raid the fridge as teenagers—they’ll do it in the womb, too.

On the whole, medical experts agree that there is no real evidence that exercise intensity threatens fertility—as long as you get balanced nutrition to maintain a healthy fat store. In fact, research shows that overweight women experience a higher rate of infertility than those who have lower BMIs, with 12 percent of cases attributable to being underweight and 25 percent to obesity.

What’s more, vigorous exercise actually lowers your risk for ovulatory infertility, as long as you maintain a healthy BMI. Every hour that you exercise each week is associated with a 5 to 7 percent lower risk of infertility related to ovulation.

If your doctor or midwife is concerned about your BMI being too low, you might be advised to decrease your workout intensity or training volume temporarily while you boost your calorie intake to meet your body’s demands (based on what you’re burning). If that’s the case, don’t fret about lost workouts. Consider replacing one calorie-sucking cardio workout per week with a yoga or dance class. You might not tap into your aerobic endorphins, but you can still achieve the delicious feel of a sweaty workout.

archery, low-impact exercise, exercise during pregnancy, fit and healthy pregnancyThis is a great time to try a new fitness activity you haven’t been able to fit into your regular routine or specific training regimen. It could be your chance to try belly dancing and archery—just don’t do them together. Fitness isn’t a threat to pregnancy; it’s an asset. As long as your training or exercise program increases gradually in intensity and volume, it will be less likely to jeopardize your menstruation because the reproductive system adapts to changes in exertion and metabolism. Older studies that linked exercise and infertility sampled women who started very intense programs or who had other complicating factors, such as stress or nutritional deficits. More recent research that compares exercisers of various levels of intensity with nonexercisers finds that the rate of conception is similar between groups and that approximately 5 percent of women in both groups experienced infertility.

Check back soon for the next article: More on Exercise, BMI, and Getting Pregnant

Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MDFit & Healthy Pregnancy is a friendly, comprehensive guide to exercising during pregnancy from athlete-moms Kristina Pinto and Rachel Kramer, MD.

Find Fit and Healthy Pregnancy in your local bookstore or online and learn safe ways to exercise for two!

Please consult your doctor before embarking on an exercise program during pregnancy.

General Medical Guidelines for Exercise During Pregnancy

stretching, toe touching, exercise, aerobics, health, fitness, fit and healthy pregnancyIn Fit & Healthy Pregnancy, Dr. Kristina Pinto and Rachel Kramer, MD, offer guidelines for women who would like to exercise during pregnancy. They suggest:

  • Warming up for 5 to 10 minutes is important to ease into a workout and determine how your body is feeling that day. Start slowly and build to more effortful exercise during a session.
  • Exercising regularly on most days of the week is better for your fitness than a burst of exercise that’s followed by days or weeks of no activity.
  • A moderate workout of 30 minutes on most days of the week will be beneficial for most women.
  • hydrating, hydration, woman drinking water, drinking water, healthy, fit and healthy pregnancyGenerally speaking, if you’re able to hold a conversation while you exercise, your exertion is in a safe zone. Use Borg’s Rate of Perceived Exertion scale (see Chapter 2) to monitor your effort level, and don’t exceed a 16 on the scale.
  • The extra weight you carry as you progress through pregnancy will make easy exercise feel harder. Stop if you feel dizzy or exhausted.
  • Drink a glass of water before and after exercise and drink based on thirst while you work out.
  • Avoid exercise with a risk of falling or blunt force to the abdomen, such as downhill skiing or soccer.
  • Be careful with any exercise that might strain your back, such as overstretching to touch your toes or the floor in yoga.
  • Avoid sit-ups or any exercise while lying on your back after the first trimester.
  • Always inform the instructor, trainer, or coach that you’re pregnant.

Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MD

Fit & Healthy Pregnancy is a friendly, comprehensive guide to exercising during pregnancy from athlete-moms Kristina Pinto and Rachel Kramer, MD.

Find Fit and Healthy Pregnancy in your local bookstore or online and learn safe ways to exercise for two!

Please consult your doctor before embarking on an exercise program during pregnancy.

Warning Signs You Should Stop Exercising During Pregnancy

woman running, happy woman, well-balanced lifeYour fitness practice will be most healthy for mind and body when you can see it as your individual plan without holding it up against an ideal. Try not to compare your own activity with what your best friend did when she was pregnant.

Your body will tell you how it feels; attend to those cues. Strive for balance when it comes to the reproductive process and your exercise routine, and be willing to adapt to factors in your lifestyle such as stress, work, and family dynamics. If you can avoid being rigid with your fitness program, your pregnancy and your workouts will do you much more good in body and mind.

Exercise, even vigorous exercise, is healthy for a growing fetus, provided your body is accustomed to that level of exertion. Monitor your level of effort because overexerting yourself in a workout can be problematic. If you experience bleeding, hyperventilation, blinding headache, nausea, vomiting, or dizziness, stop immediately and contact your health care provider.

warning sign, warning, dangerThere are a few conditions that point to drastically reducing or eliminating exercise, and these are nonnegotiable. If you experience any of these symptoms, stop exercising and talk to your doctor:

  • Relentless vomiting
  • Abdominal or pelvic pain
  • Severe illness (e.g., flu)
  • Vaginal bleeding
  • Injuries

Other circumstances that could influence your workout efforts should be discussed with your provider at your initial visit. These conditions include:

  • Anemia
  • Arrhythmia
  • Bronchitis or asthma
  • Diabetes that isn’t well controlled
  • Morbid obesity
  • Severely low weight or BMI
  • Intrauterine growth restriction in this pregnancy
  • High blood pressure
  • Orthopedic problems or sports injuries
  • Epilepsy
  • Hyperthyroidism
  • Smoking
  • Any other medical condition that makes you unsure whether exercise is okay

Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MDFit & Healthy Pregnancy is a friendly, comprehensive guide to exercising during pregnancy from athlete-moms Kristina Pinto and Rachel Kramer, MD.

Find Fit and Healthy Pregnancy in your local bookstore or online and learn safe ways to exercise for two!

Please consult your doctor before embarking on an exercise program during pregnancy.