Printed July
1 2002
The Cincinnati Enquirer
Prenatal workout helps mom
improve well being
By Lee Sivitz
Enquirer contributor
It has been decades since being pregnant meant
being treated like an invalid. But just this year,
the American College of Obstetricians and Gynecologists,
the guiding force of prenatal care in the United
States, published a landmark opinion that, “In
the absence of either medical or obstetric complications,
30 minutes or more of moderate exercise a day
on most, if not all, days of the week is recommended
for pregnant women.”
One way to follow this recommendation is a program
called Fit to Deliver, developed in Canada in
1996 and available in Greater Cincinnati through
a company called Fitness for Women.
“We offer the program through group classes
or in personal training appointments,” says
Renee Jeffreys, an exercise physiologist who owns
Fitness for Women and runs the Fit to Deliver
program at New Body's Personal Training Fitness
Center in Blue Ash.
“For habitual exercisers, I will set up
a (individualized) program and act as a resource
as they need it (usually over the phone or by
e-mail).” she says.
The program also includes a manual that outlines
stretching and strength training routines and
gives exercise guidelines for the first, second
and third trimesters of pregnancy.
One of Ms. Jeffreys' Fit to Deliver participants
is 32-year-old Tamara Cline of Hamilton, who is
seven months pregnant.
“Remember your transverse,” Ms. Jeffreys
reminds Ms. Cline, who was warming up on the treadmill.
“The transverse is that muscle you suck
in when you see a good-looking guy walk by,”
Ms. Jeffrey says. “But a lot of times, people
contract it and hold their breath. And that's
what we don't want you to do.”
One way that Fit to Deliver is different from
many other prenatal programs is that it focuses
on the core muscles, such as the transverse abdominals
and muscles in the back. This helps strengthen
the back to reduce discomfort and strengthen the
muscles that carry the baby's weight.
Also, Fit to Deliver uses a team approach. A
physician, physical therapist and exercise physiologist
advise each client.
“When we design a program or add or make
modifications to exercises we are looking at it
from those three disciplines,” Ms. Jeffreys
says.
Ms. Cline joined the program early in her pregnancy,
hoping for a shorter and more energetic labor,
and a quicker rebound after the baby is born.
“I did not do this with my first (child),”
she says. “I wasn't as self-aware body wise.
I had a really long labor . . . I was aiming for
natural childbirth, but I couldn't do it.”
Ms. Cline feels the Fit to Deliver program has
made a difference.
“It's helping boost my energy, self-esteem
and self awareness,” she says. “I did
not expect that at all.”
Daniel Bowen, an OB-GYN with a practice in Springdale,
says exercise during pregnancy is nothing new
for his patients.
“I have a fairly high percentage of patients
who are either already in an established exercise
program or want to be because they got pregnant
and want to do what's best for the baby,”
Dr. Bowen says.
Although there are no scientific studies documenting
the benefits of exercise on delivery, he says
his patients who exercise report “they sleep
better, eat better and generally have a better
sense of well being (throughout their pregnancy).”
Studies have indicated that continuing exercise
after pregnancy can minimize post-partum depression
in patients who may have a greater risk for that
condition.
But what if you weren't exercising before you
became pregnant? Is now a good time to start?
Ms. Jeffreys believes it is.
“When women are pregnant, they are more
likely to do positive things for themselves,”
she says. “So if you can get a woman to exercise
during pregnancy and she can maintain that after
pregnancy, she is going to have a much healthier
life over the long term.”
Exercise tips
Dr. Daniel Bowen, a Springdale OB-GYN, offers
these tips for exercise during pregnancy:
- Due to increased blood volume, your heart
is working harder at rest and with every (movement).
For cardiovascular exercise, you will reach
your target heart rate faster and should maintain
it only for 20 minutes.
- Keep muscles stretched and do a good warm-up
and cool down every time you exercise.
- Your physical space changes during pregnancy
as your belly gets bigger. There is some higher
risk of falling, especially on stairs, or of
turning the wrong way. Pay attention and be
attentive to the mechanics of what you do.
- The hormone relaxin is released early in
pregnancy to soften the joints and allow easier
delivery of the baby's head. It affects ankles,
knees, hips and the lower back as muscles work
harder to maintain posture. Look for less jarring
exercises that will give cardiovascular benefit
without causing joint or back pain.
- If you were not an exerciser before pregnancy,
start slowly. Try swimming or walking rather
than running. The frequent changes in your center
of gravity makes it difficult to recognize and
keep a proper running form if you were not a
runner before pregnancy.
About Fit to Deliver
Location: New Body's Personal Training
Fitness Center, 11142 Luschek Drive, Blue Ash.
Group classes: Meet three times per week,
for cardiovascular and conditioning work. Fitness
testing and individual exercise prescription included.
Cost: $150-$400 (based on weeks pregnant when
registering).
Personal training: Individual one-hour
sessions with a personal trainer who specializes
in prenatal clients. Includes fitness testing,
individual exercise prescription, Fit to Deliver
book, two one-hour sessions. Basic package: $170.
Exercise prescription for pregnancy:
Designed for the experienced exerciser and includes
fitness testing, personalized exercise prescription,one-hour
personal training sessions, access to trainer
to answer questions throughout the pregnancy.
Cost: $200.
Information, registration: Contact: Renee
Jeffreys of Fitness for Women, (859) 291-4354;
e-mail renee@fittodeliver.com.
The Fit to Deliver manual is available separately
from Ms. Jeffreys.
|
 Dive
in and go with the flow with
these five workouts
by Astrid Van Den Broek
IN THE SWIM
Crunching on stale popcorn in dark
theatres is a job hazard Anita Herczeg, 35, has gotten
used to. For the producer/host of Flick, a film/review
and celebrity-interview show on the Life Network, "dinner"
often gets jammed in when she's reviewing the latest
movie. So it's completely understandable when this mom-to-be
says her workout schedule has to be flexible. "I
like exercise routines that I can just go and do and
it's up to me when I start and finish," she says.
A seasoned runner (she's run the New York City Marathon)
Herczeg found it difficult to continue running when
she entered her second trimester. Her solution was to
head to the pool. "I miss running, but I really
do enjoy swimming," she says. "I find it stretches
me out along my stomach and chest. It's also a nice
weightless feeling."
Aquatic exercise is ideal during pregnancy,
says Dr. Karen Nordahl, a Vancouver doctor and the coauthor
of Fit to Deliver.- An Exercise Program for You and
Your Baby (Sandhill Publishing). "The water supports
a woman's body weight, reducing stress on her hips,
knees and ankles," she says, adding that it also
helps relieve water retention by pushing the fluid back
UP through the body. And, best of all, you don't have
to be a marathon runner like Herczeg or a marathon swimmer
like Marilyn Bell to start this program: anyone at any
fitness level can swim during pregnancy.
On the page below, Dr. Nordahl and
personal trainer Susi Kerr outline the swimming program
they developed for pregnant women.
suit up
- Look for nylon/Lycra swimsuits
that are also chlorine-resistant, suggests Bess Hilpert,
founder of Round Rock, Tex.-based Mothers in Motion,
which produces active wear for athletic moms-to-be.
"Lycra moves and stretches with you and the shoulder
bands won't slip."
- Avoid cotton swimsuits because
they absorb water, making you heavier.
- Look for maternity swimsuits that
contain breast and abdominal support. "You want
enough coverage so you don't feel as though your breasts
are falling out," says Hilpert. For the fuller-figured,
a supportive bodysuit such as a unitard can be used
in the water.
five water - jogged workouts
Depending upon your energy and fitness
level, select one of, these five workouts. Aim for at
least 3-5 swims a week, with a day of rest in-between.
Instead of monitoring your heart-rate (during pregnancy
your heart-rate is elevated due to increased blood flow),
Dr. Nordahl and Kerr recommend the Borg Scale, which
lets the woman decide the intensity of her workout.
This scale, which runs from 0 to 10, measures one's
rate of perceived exertion (RPE). An RPE of 0 means
your body is at rest, while 10 means you're running
an Olympian-like sprint. For these swim workouts, pregnant
women should aim for an FIFE of 3-5. (it's best to judge
your RPE by how much you can talk while working out.
For an FIFE of 3, you should be able to talk comfortably
the entire time. At an RPE of 5, you should be able
to say at least a few sentences and, by the time you
reach an RPE of 6 or 7, it's difficult to talk while
exercising.)
warm up
Begin with some stretches in the pool. Start by lifting
one knee at a time to your chest, then swinging one
leg forward and back through the water while holding
on to the side of the pool for balance. Finally, do
some arm circles above the water. Aim for, 10-15 repetitions
per limb. Now, swim or water-jog for 5-10 minutes, keeping
your RPE at 1-2. If you're a regular swimmer, stick
with the stroke you normally prefer. If you jog, Kerr
recommends you do it in the deep end, where your feet
aren't touching the ground. It's more like dog paddling
than jogging, but Kerr says you'll get a better workout
and it's easier on your joints. For extra support while
jogging, particularly for your lower back, try an adjustable
aquatic jog belt. With its foam backing and nylon belt
that clips at the front, it gives you a bit more buoyancy
and provides stability. Finish your warm-up with more
of the stretches described above.
- This workout is pretty basic. Simply slip into
the pool and swim or water-jog nonstop for 5-30 minutes.
Keep your RPE around 3-4. To track time and the number
of laps you've completed, slip a Speedo Lap Counter
on to your finger.
- swim or water-jog for five three-minute intervals
at an FIFE of 4-5, with a 1-2 minute recovery period
between each set. Recovery minutes can be spent easy
swimming or light jogging, but you can also rest at
the side of the pool. Protect your hair from chlorine
damage by applying conditioner before you put on your
swim cap. Try Speedo's cap (above) for a snug, yet
lightweight, fit. After your swim, remove chlorine
with Aveda Hair Detoxifier or Joico Resolve Deep-Cleansing
Shampoo and Joico Phine Conditioning Chelating Treatment.
- For this entire workout, aim for an RPE of 4-5.
Start by swimming or water-jogging for five minutes,
then rest for 1-2 minutes. Do another four-minute
workout, then rest again. Continue your workout in
descending intervals of time (three, then two, then
one) with rest periods in-between.
- Swim or water-jog for six two-minute intervals
with an RPE of 5. Between sets, allow for a 1-2-minute
recovery. To further strengthen your upper arms, back
and shoulders, try swimming and jogging with resistance-increasing,
webbed aqua fitness gloves.
- Swim or water-jog for 10 one-minute intervals with
an RPE of 5. Give yourself a one-minute recovery between
sets. There's nothing like tunes to keep you revved
and motivated. Turn the dial to your fave station
with Speedo's Surf Runner 2000 radio.
cool it Finish
your workout by water-jogging or swimming for 5-10 minutes
at an RPE of 3, followed by these light stretches, which
you should hold for 20-30 seconds. Calves: lean
against the side of the pool, placing one foot in front
with your knee bent and your heel off the ground. Place
the other foot behind, keeping it flat. Now, slowly
lean your hips into the side of the pool. Hold, then
switch legs. Quads: bend one leg, pulling your
heel into your buttocks. Hold, then switch legs. Upper
body: place your right arm across your chest and,
with your left hand, gently push on your right elbow
until you feel the stretch. Hold, then switch arms.
Triceps: lift your right arm up and bend it back
at the elbow so that the forearm falls diagonally behind
your head. Push down gently on your elbow with your
left hand until you feel the stretch.
To do these stretches outside the
pool, wear a pair of rubber aquatic fitness shoes with
nonslip soles for added stability. Also, see Aqua Yoga:
Harmonizing Exercises in Water for Pregnancy Birth and
Beyond (Lorenz Books), by Francoise Barbira Freedman
fit tips
- Check with your doctor or caregiver, before beginning
a fitness program.
- Listen to your body. If you feel fatigued, experience
abdominal pain, cramping, vaginal bleeding, dizziness,
shortness of breath or contractions or notice less
than three fetal movements in the 30 minutes immediately
post-exercise after about your 18-week mark, consult
your doctor.
- Dr. Nordahl recommends drinking two additional
eight-ounce glasses of water for each hour you exercise
and consuming an additional 120 calories for each
hour of exercise. Kerr recommends a small carb-based
snack, such as a banana or yogurt, at least half an
hour before your swim.
- Keep it consistent. Sporadic exercise, which Dr.
Nordahl defines as high intensity for prolonged periods
once or twice a week, can actually be harmful. "The
stopping and starting tends to cause dramatic changes
in the blood flow in the placenta," she explains.
"As a result, the baby can become a little bit
distressed." Her advice? Aim for 3-5 low-to-moderately
intense workouts per week, keeping your RPE between
3 and 5.
Shape's Fit Pregnancy
Article:
July 15, 2001
Check out Fit to Delivers article in "Shape's Fit Pregnancy"
magazine Aug/Sep issue.
Post Partum Exercise
Chart:
May 15, 2001
Below is Fit to Deliver's Post Partum exercise chart
in "Shape's Fit Pregnancy" magazine Jun/Jul issue.
Back
on the bike(or running trail...or stair-climber...)
The following chart, created
by the folks at Fit To Deliver (a prenatal-fitness program
developed by health care professionals in Vancouver
Canada), is a guide to what's safe to do when. Some
general rules-of-thumb from these experts:
- The period immediately after childbirth isn't the
best time to start a new exercise program. In general,
stick with the same activities you did before or during
your pregnancy.
- You may find that you fatigue faster because of
nursing, lack of sleep and your new parental responsibilities.
Listen to your body and slow down if you are tired.
- Drink lots of water, especially if you are breastfeeding.
- You may have increased vaginal flow for a few hours
after exercise. This is not cause for concern unless
you experience gushing or cramping or pass blood clots.
- Always get your doctor's approval before starting
or resuming strenuous activity, especially if you
had a Cesarean section.
| HOW SOON CAN
I...? Before resuming any exercise, check with
your doctor. If you were at a high fitness level
before and during your pregnancy, you may be able
to start exercising sooner than if you were at
a low or moderate fitness level. But no matter
what level you were, remember to start exercising
slowly.
|
| ACTIVITY |
AFTER
VAGINAL DELIVERY |
AFTER
A C-SECTION |
| Do
Kegels |
From
day 1 |
From
day 1 |
| Walk
around the block |
As
soon as you feel comfortable |
As
soon as you feel comfortable |
| Do
yoga |
2
weeks, with doctor's OK |
4—weeks |
| Do
ab exercise |
2
weeks, with doctor's OK |
weeks |
| Lift
weights |
2
weeks, with doctor's OK |
weeks |
| Jog |
3—4
weeks |
10—12
weeks |
| Ride
a bike |
Wait
for doctor's approval |
10—12
weeks |
| Kick
box |
Wait
for doctor's approval |
10—12
weeks |
| Do
low impact aerobics |
6
weeks |
8—12
weeks |
| Use
the stair-climber |
6
weeks |
8—12
weeks |
| Run
a 5k |
6—8
weeks |
12—16
weeks |
| Run
a 10k |
12—16
weeks |
12—16
weeks |
Lobbying Capital Hill:
May 29, 2001
Fit to Deliver will be lobbying on Capital Hill. The
Fit to Deliver team will be in Washington DC presenting
to congress the need for changes in fitness study funding.
If you are in the area come and meet the authors on
the mall and in the Senate.
Live Chat:
April 24, 2001
Live Chat at 12:00 noon PST with the authors of Fit
to Deliver at Fit
Pregnancy.Com. Chat on line with the authors of
Fit To Deliver at Fit Pregnancy’s Web Site. If you would
like to join in go to Fit
Pregnancy.Com and click on “Chat”.
Sun Run:
April 22, 2001
Congratulations to all
the Moms who participated in the 2001 Vancouver Sun
Run, making it a huge success. Hope to see you and a
lot of other Moms next year.
SHAPE'S FIT, October 2000
 Recognizing
the uniqueness and progressiveness of the Fit to Deliver
program, SHAPE'S FIT Pregnancy magazine is featuring
the Fit to Deliver team and its prenatal exercise program
in its October 2000 issue, available on newsstands starting
September 15.
Get a copy today and see how you and
your baby can benefit from these easy-to-do and safe
preventional exercises.
Fit At Any Level
(as seen in the October 2000 issue of
Shape
Fit Pregnancy Magazine)
WHETHER YOU RUN MARATHONS OR JUST
WALK DAILY, HERE'S A SAFE PRENATAL WORKOUT FOR YOU.
STAYING ULTRAFIT during pregnancy
was a given for Juliana Nievergelt, 39, an elite triathlete
in Medfield, Mass. "It never even occurred to me
to quit exercising." She says. "I felt great
and I found it fascinating to see what my body could
do."
Although Nievergelt raced in a swim meet and a 5k early
on in her second pregnancy, she stopped competing after
eight weeks because she didn't feel like pushing herself.
Still, she swam, cycled on a stationary bike and ran/walked
an hour at a time four days a week. Plus, she weight
trained right up until her delivery. Nievergelt, who
won a major triathlon 10 weeks after giving birth, says,
"Much of society still thinks that [pregnant] women
should severely restrict and limit their activities.
But I really doubt that I would have felt so healthy
and strong if I hadn't kept active."
Even women who don't enter pregnancy in top-notch condition
report that being active helps make them feel good.
Naiomi Raimon, a 40-year-old elementary reading teacher
from Ithaca, N.Y., who is pregnant with her first baby,
hadn't worked out seriously for several years before
she became pregnant. Pregnancy inspired her to walk
briskly for an hour at least three times a week and
take a prenatal yoga class twice a week. "The exercise
kept me feeling energetic and limber," she says.
"At work I spent a big part of my day sitting on
the floor or in tiny chairs with kindergarteners - I
doubt I would have been able to get up and down like
that if it hadn't been for my yoga stretching and walking
workouts."
Even though they worked out at vastly different intensity
levels, Nievergelt and Raimon are convinced that exercising
helped keep them healthy during their nine months of
pregnancy. Can they both be right?
There's little dispute that moderate exercise is beneficial
in a healthy pregnancy. According to a variety of studies,
recreational exercisers are less susceptible to common
pregnancy discomforts such as swelling, nausea and leg
cramps. Their risk of gestational diabetes, preterm
delivery and Caesarean delivery is lower, too.
But are high-level workouts safe? Yes, says Karen
Nordahl, M.D., associate clinical professor of family
practice at the University of British Columbia Faculty
of Medicine and founder of Fit
to Deliver, a prenatal-exercise program. "The
studies haven't documented adverse effects," she
says, "which suggests that pregnant athletes can
safely maintain pretty intense levels of training, providing
certain guidelines are followed."…http://www.fitpregnancy.com/
All materials Copyright 2004 by Fit to Deliver Inc. except where indicated.
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