IN THIS CHAPTER
Making your healthcare provider a partner in exercise
Recognizing the four components of exercise
Keeping close tabs on your body
Modifying your routine throughout each trimester
Knowing when to take a break and when exercise is off-limits
Think of this chapter as the fine print — all the information that you need to know but that exuberant friends, trainers, and fitness book authors may have glossed over. This chapter helps you get your healthcare provider on board with your prenatal fitness goals so you don’t ever put your baby at risk. It also tells you how to continuously monitor — and modify — your and your baby’s responses to your exercise routine. You discover some key signals that indicate you should call or visit your physician immediately. Safety may not be the most exciting topic you’ll ever read about, but this chapter is jam-packed with tips and advice.
Consulting Your Healthcare Provider
Here’s the bottom line on your healthcare provider’s role in your pregnancy fitness goals: Always consult with him or her before starting an exercise program. Discuss your goals and the type of activity you plan to do, making sure it’s safe for you to get started.
Your number-one goal for your pregnancy is to deliver a healthy child — that has to take precedence over your fitness goals. If your healthcare provider feels that your exercise routine will put your baby at risk, don’t push it. In nine months, you can pick up your fitness regimen and work out wholeheartedly, knowing that you have a healthy baby at home.
The American Congress of Obstetricians and Gynecologists (ACOG) has devised guidelines for exercising during pregnancy and after delivery, and that advice serves as the basis for this and every other book on fit pregnancy. Go to www.acog.org for info on ordering these guidelines. In addition, ACOG issued a set of contraindications (medical conditions and complications) and put them into two categories:
· Relative contraindications: These conditions may indicate that something’s amiss and may mean that you shouldn’t start or continue your exercise program. We cover these contraindications in the later section “Knowing How Much May Be Too Much.” That section also includes some potential warning signs that may indicate a problem is developing and that you should stop exercising and check with your healthcare provider.
Keep the relative contraindications in mind whenever you exercise, and if you ever experience any of them, stop exercising and call your healthcare provider right away. Together, you can decide whether continuing to exercise is appropriate for you.
· Absolute contraindications: These contraindications are listed in the last section of this chapter, “Understanding Conditions That Make Exercise Off-Limits.” If you began your pregnancy with any of these conditions or if they develop during your pregnancy, your healthcare provider will very likely tell you that exercise isn’t an option during your pregnancy. And if you are cleared to exercise but begin to develop any of the absolute contraindications, call or visit your healthcare provider as soon as possible.
Developing an Exercise Plan
Exercise has four main components: intensity, duration, frequency, and type. By putting these components together, you build strength, cardiovascular fitness, and flexibility without injuring yourself or being uncomfortable. All four pieces of the exercise puzzle fit together, though, so you need to think of each as you and your healthcare provider develop a workout plan.
As Book 1, Chapter 4 points out, when you’re pregnant, your body goes through a number of changes, some that are so subtle you may not be aware of them. These changes are important to keep in mind as you develop and engage in your pregnancy exercise program:
· Shifts in your center of gravity: As your uterus pushes your abdomen up and out, your center of gravity may also change, and you may find that you can’t balance as well as you used to, which can result in falling down. This is why, as your pregnancy progresses, many healthcare providers urge you to stay away from activities that require excellent balance.
· Joint instability: During pregnancy, your body releases a hormone called relaxin, causing your joints to loosen slightly and allowing the joint in front of the pelvis to widen so that your baby’s head can pass through that region during birth. Be cautious with activities that require quick movements or a lot of balance.
· How much heat you generate: Throughout your pregnancy, you’re like a little furnace, generating far more heat — and therefore raising your body temperature faster — than you did before you were pregnant. Both you and your baby can suffer if you overheat, so take extra care during these 40 weeks to stay away from situations that can raise your body temperature too high, like exercising outdoors in high heat or in a hot, unvented gym.
Intensity
The intensity of your workout is the effort you put forth as you exercise — hard, moderate, or easy. With some sports, you measure your intensity in miles per hour, revolutions per minute, per-lap time when swimming, and so on, so that you know empirically whether you’re working harder or easier than the day before. In other sports, you can’t measure intensity directly.
Regardless of what the speedometer is telling you, the important measure of intensity is how hard you think you’re working out, based on how you feel (for example, saying, “Whew, that workout was hard” versus “Today’s workout felt easy”). A specific tool, called the Borg Rating of Perceived Exertion (RPE) Scale, lets you assign a number to your response. The scale ranges from 6 (no effort at all) to 20 (maximum effort), with 13 being somewhat hard.
You want to feel challenged and slightly winded while exercising, so keep your workouts in the 12 to 14 range or at a level that feels moderate to somewhat hard (you can talk while exercising without feeling exceedingly short of breath).
A rating of 12 on the RPE Scale won’t always correlate with the same mile-per-hour rate throughout your pregnancy. One day, you may give a 12 rating when you’re walking at a pace of 16 minutes per mile. On another day, later in your pregnancy or as a result of not sleeping well, you may give the same 12 rating when walking at a pace of 20 minutes per mile. Even though you’re walking more slowly, you may feel that the two efforts are equally hard. And that’s what’s important — how the workout feels to you, not what the clock or speedometer says.
Duration
Duration refers to the amount of time you spend exercising each day. When you’re exercising at a 12 to 14 rating on the RPE Scale (see the preceding section) and you don’t feel any discomfort or fatigue, you can begin to gradually increase the duration of each workout from 15 or 20 minutes up to 30 minutes or more.
Duration and intensity are super-glued together: You may be able to exercise without discomfort or fatigue for 45 minutes at a level of 12 on the RPE Scale but for only 30 minutes when you’re exerting yourself at a level of 14. If, during a workout, you have trouble exercising for a longer duration, scale back your intensity from a 14 to a 12. If you still experience fatigue or discomfort at 12, reduce the duration by 5 or 10 minutes.
Frequency
Frequency refers to how often you work out — that is, how many days per week. Most experts agree that exercising for three to six days per week at a duration of 30 to 60 minutes per workout keeps you in good shape. How many days per week you can comfortably exercise depends on the following:
· How fit you are right now: The fitter you are, the more days per week you can work out without experiencing discomfort or fatigue.
· How your pregnancy is progressing: Is your baby growing normally? Are you gaining weight normally? Do you feel good? If you answer no to any of those three questions, cut back on the number of days you’re working out each week.
· The intensity and duration of your workouts: If you’re working out at a 14 on the RPE Scale for 45 to 60 minutes, you may find that three or four days per week is a more comfortable frequency than five or six days per week.
You need one day off per week while you’re pregnant, even if you’re convinced that you can work out seven days per week. You can, however, stretch your muscles seven days per week. And if one of your days is only a strength-training day, seven days is okay. But doing cardiovascular workouts all seven days will cause you to experience too much fatigue. Enjoy that day and the extra time you have as a result of not working out, and you’ll be better prepared for the days that you do work out.
Type
The type of exercise refers to what activity you choose as your workout. Book 4, Chapter 3 helps you pin down the activities that tend to work best during pregnancy, and if you’re new to exercise, Book 4, Chapter 4 asks you some questions that may help you decide what sort of exercise routine you’re looking for. Ultimately, you want to choose activities that meet the following criteria:
· You enjoy the activity.
· The activity doesn’t put your baby at risk (see Book 4, Chapter 3).
· You can still do the activity as your center of gravity changes throughout your pregnancy.
· The activity makes sense as one to do during pregnancy. If you’re doing an activity that you can’t easily modify, or if your RPE Scale rating is more than 14 and modifying the duration and frequency doesn’t lower the intensity, consider changing to a different type of activity.
Monitoring Your Body
The key to safeguarding your and your baby’s health is to monitor your body while you’re working out and throughout the rest of your day. This is the time to notice details about your body and to keep tabs on how you feel. Along with your healthcare provider, you need to closely monitor telltale signs:
· Whether your baby is growing normally
· Whether you’re gaining weight normally
· Overall, whether you feel good (you have energy and would tell others that you feel “good”) or bad (you’re tired all the time, seem to be getting sick pretty often, and so on)
If your baby is growing as scheduled, you’re also gaining weight normally, and you feel great, you can continue your workout routine. If any of the preceding three signs are negative, you need to modify your routine until you’re feeling good, gaining weight, and helping your baby gain weight again.
In addition, try to stay aware of other body signs, including pain or discomfort, your weight after a workout, the amount you’re sleeping, and the color of your urine. Here are specific tips on what to watch and measure:
· Hot bod: When you’re pregnant, you produce more heat, so you need to closely monitor whether you’re overheating. You can avoid overheating by working out indoors (in an air-conditioned area) during times of high heat and humidity and by staying well-hydrated all day long. If you become lightheaded, feel faint or nauseated, sweat more than usual, or feel uncomfortably hot, stop exercising, hydrate, and rest until you feel better. Avoid hot yoga classes (Bikram) and hot tubs or saunas, as these activities don’t allow your body to effectively regulate heat.
· Finger on the pulse: Although your heart rate is no longer considered an adequate measure of how intense your workout is, checking your heart rate is an effective way to determine how rested you are and how your body is handling pregnancy overall. Check your heart rate every morning, before you get out of bed (but not directly after your alarm goes off, when your heart may be racing). Take your pulse for one full minute. Keep a daily record of your pulse, and if you find that one morning it’s significantly higher (for example, you go from 70 beats per minute to 90), your body may be fatigued, you may be getting sick, or you may be training too much. Whenever your morning resting pulse is elevated, consider taking that day off from your workout routine.
· No pain: Although you may feel some initial soreness when you begin an exercise program or increase the duration or intensity of your workouts, you shouldn’t feel pain as a result of exercising. The later section “Knowing How Much May Be Too Much” explains some common types of pain that may indicate you’re overdoing your exercise program, but the general rule is this: If exercise hurts, stop your workouts and call your healthcare provider.
· Talk time: Pregnancy isn’t the time to exercise to or past the point of exhaustion. You should always be able to carry on a conversation while exercising; if you can’t, you need to reduce the intensity or duration of your workout.
· Toilet test: If you aren’t getting enough fluids, you can get dehydrated, which is bad for you and your baby. The color of your urine is an excellent indicator of whether you’re drinking enough fluids. After you urinate, take a peek at the color of the water in the bowl: If your urine is light yellow or nearly clear, you’re drinking just the right amount. If the color is orange, dark yellow, or a medium yellow, you need to drink more fluids, and you may want to curtail your exercise routine until the color lightens.
· Too tired: You’re bound to feel a little tired as you’re exercising, but how do you feel the rest of the day? Do you feel overly tired, fatigued, or downright exhausted? If so, pull back — take a day or more off, reduce the total time you’re exercising each week, and/or reduce the intensity of the workout.
When monitoring your health throughout your fit pregnancy, keep in mind that if your exercise routine feels good to you, you’re probably doing everything right. If the routine feels too intense or your body’s not responding well after you finish exercising for the day, you need to reduce the intensity and/or duration of your workouts or take a short-term break from exercising. Whenever something just doesn’t feel right, contact your healthcare provider for advice.
Modifying, Modifying, Modifying Your Routine
During pregnancy, whenever something isn’t quite right, you need to modify your exercise routine to keep it safe and effective. Your baby’s health is your most important priority right now, and if modifying your exercise regimen ensures a safe, healthy baby, that’s the only healthy course of action to take. No matter how much you want to continue your current routine, you shouldn’t do anything that compromises your baby’s health.
You may need to modify your routine monthly, weekly, or even daily according to your body’s response to both your pregnancy and your exercise routine. Pregnant women generally make certain modifications throughout each trimester, as the following sections discuss.
First trimester (weeks 1–13)
During the first trimester, you want to continue whatever physical activities you’ve been doing. If you’re new to exercise (see Book 4, Chapter 4), get into exercise very gently. Either way, consider the following potential modifications and tips during this trimester:
· If your breasts are sore, you experience morning sickness (or nausea/vomiting any time of day), or you’re experiencing extreme fatigue, cut back on your routine or forgo exercise until you feel better.
· After 12 weeks, you can modify supine exercises by using a wedge or pillows to raise your upper body off the floor.
· If you were exercising before you got pregnant, you can probably wear your sports bras throughout much of the first trimester. You may find, however, that at the end of this trimester, you need a larger size. If you haven’t yet invested in a good sports bra, go to a sporting goods store, running store, or fitness store and try on several until you find one that’s comfortable. Don’t buy too many: You’ll quickly outgrow them, and because sports bras are made of fast-drying material, you can quickly wash one or two out, as needed, and wear them over and over.
Second trimester (weeks 14–26)
During the second trimester, you may feel better than at any other time during your pregnancy. Continue to monitor your body’s reaction to exercise, and if you feel good enough to do so, consider increasing the duration or intensity of your workouts. Also keep the following potential modifications and other tips in mind:
· Sometime during this trimester, you want to shop for a new sports bra, because your existing one is probably getting too tight.
· If you feel unbalanced during these weeks, consider discontinuing any activity that can throw you off balance, like gymnastics, tennis, downhill skiing, skating, horseback riding, trail biking, and hiking in the woods over rutty trails. Replace with swimming, water aerobics, or a stationary bike, which doesn’t require excellent balance.
· Because your baby is growing and becoming more vulnerable if you fall or are hit in the abdomen, your healthcare provider may ask you to stop ball sports (soccer, basketball, racquetball, and so on), contact sports, and outdoor biking. (Note that because of your expanding abdomen, you may find a recumbent bike more comfortable than a traditional stationary bike.)
· If you’re doing step aerobics, make sure that your step is no higher than 4 inches off the ground, unless you feel absolutely stable and balanced with a higher step.
· If you’re rowing, you may find that this super-intense sport is too fatiguing for the rest of your pregnancy. Pay careful attention to how you’re feeling and how well you and your baby are gaining weight.
· If you’re weightlifting, don’t overwork your thigh muscles, because machines that work the thighs also tend to place stress on the ligaments around the pelvis and cause discomfort.
· After the fourth month, avoid lying on your back for long periods, or you run the risk of feeling faint from the pressure your uterus puts on the vena cava (the large vein that sends blood from your lower body to your heart). If you feel faint while on your back, roll over on your side to reestablish blood flow.
· If you’re doing yoga, remember to modify poses for comfort and avoid any moves that cause pain. After the first trimester, use a wedge or pillows to raise the upper body when doing supine exercises.
· Many healthcare providers recommend that you stop competing in sports events during the second trimester, although this depends on your sport and how you’re feeling. If you’re in your second trimester and want to continue participating in a competitive sport, ask your healthcare provider for advice.
· Be careful not to overstretch or make sudden moves during this trimester (and the next and for about five months after you deliver). While you’re pregnant, a hormone called relaxin gets you ready for childbirth by relaxing all your ligaments and joints. Use extra care to make sure you don’t overstress your joints with fast and ballistic movements.
Third trimester (weeks 27–40)
In the third trimester, depending on how you feel, you may need to switch to low-impact activities, such as walking, swimming, and indoor cycling. In fact, some women are so fatigued and have so much difficulty moving around that they aren’t able to exercise at all during the third trimester, but if you can, keep it up: Studies show that women who exercise during the third trimester achieve the greatest benefits from that exercise: reduced fat gain, shorter and less complicated labor and delivery, and shorter recovery after delivery from exercise.
As you go through your third trimester, keep the following potential modifications and tips in mind:
· As with the second trimester, avoid overstretching. And if you haven’t already discontinued outdoor cycling, now is definitely the time to begin cycling indoors.
· In addition to needing a new sports bra, you may need a support belt or belly brace.
· If you’ve been running, you may decide to stop that activity and walk instead. If you’re doing aerobics, avoid jumps in the last trimester. If you’ve been cycling indoors on a traditional indoor bike and didn’t switch to a recumbent bike in the second trimester, you may need to do so now.
Knowing How Much May Be Too Much
Following is a list of symptoms that may mean something’s wrong. Only your healthcare provider can determine whether exercise is causing these symptoms and whether the symptoms are anything to worry about. If you experience any of the following, however, stop exercising and call your healthcare provider immediately:
· Contractions: Contractions are a positive sign only if you’re within a week or two of your due date. Otherwise, contractions may indicate premature labor.
· Dizziness: This can be a sign of anemia (a low red blood cell count that results in weakness and fatigue) or other conditions.
· Shortness of breath not during exercise: Shortness of breath is normal during exercise but may signal a problem if you experience it when you’re not working out.
· Headache: Although many pregnant women report an increase in headaches during their pregnancies (often brought on by fatigue and stress), if you experience a severe headache or a less severe one that doesn’t seem to go away, contact your healthcare provider. Headaches can be an early sign of preeclampsia (pregnancy-induced high blood pressure).
· Increased swelling in your legs: This can be a sign of preeclampsia, which is characterized by high blood pressure and fluid retention in the extremities. It can also indicate deep-vein thrombosis, a blood clot that develops in a vein.
· Muscle weakness: Muscle weakness can take a couple of different forms: total-body weakness (in which you feel weak all over) or specific muscle weakness (such as weakness in your right arm or the left side of your body).
· Vaginal bleeding and/or leaking of amniotic fluid: Leaking blood or other fluids can be the result of several complications, including placenta previa (in which the placenta blocks all or part of the cervix), placenta abruption (separation of the placenta from the uterus before delivering your baby), premature labor, and miscarriage.
· Not feeling your baby moving: Your baby will probably be calm during exercise, but you should start to feel several movements again within 20 to 30 minutes after you stop. If your baby’s normal movements have diminished or stopped, your baby may be experiencing problems. (Keep in mind that fetal movement isn’t expected until around 20 weeks.)
Review this list with your healthcare provider, and ask him or her about any other symptoms you should watch for, based on your own medical history and circumstances.
If you’re asked to reduce or completely cut out exercise as a result of one or more of these symptoms, keep in mind that this period of rest may be temporary. Ask your healthcare provider to reevaluate your condition at each prenatal visit and see whether you and your baby are now in a safe condition and can return to some level of exercise.
In addition, the following physical conditions may mean that you won’t be able to successfully work out while pregnant. If you’ve experienced any of the following contraindications, take extra time with your healthcare provider to ensure that exercising during pregnancy is right for you:
· Irregular beating of your heart that hasn’t been explained
· Intrauterine growth retardation (IUGR), which means that your baby isn’t measuring up to what’s normal for her gestational age
· A history of a sedentary (nonactive) lifestyle
· Orthopedic (bone, muscle, joint, ligament) limitations that exercise may worsen
· A history of heavy smoking
· Being extremely overweight or underweight
· Severe anemia
· Chronic bronchitis
· Type 1 diabetes that isn’t well controlled
· Hypertension (high blood pressure) that isn’t well controlled
· Hyperthyroidism (overactive thyroid) that isn’t well controlled
· Seizure disorder that isn’t well controlled
Understanding Conditions That Make Exercise Off-Limits
A few medical conditions usually — although not always — make exercising during pregnancy an unwise choice. Your healthcare provider is the only one who can verify which conditions make pregnancy workouts off-limits for you, and many physicians ask their patients not to exercise during pregnancy if they’re diagnosed with or have a history of any of the following:
· Carrying multiple babies who may be delivered early
· Heart disease that restricts activity
· Incompetent cervix (the cervix dilates prematurely)
· Lung disease that restricts activity
· Persistent vaginal bleeding in the second or third trimester
· Placenta previa after 26 weeks
· Pregnancy-induced hypertension (high blood pressure along with edema and increased protein in the urine)
· Premature labor during this pregnancy
· Ruptured amniotic membranes
A WORD ABOUT UNDERGARMENTS
Although undergarments aren’t visible, they’re extremely important for your overall comfort. If you’re wearing an uncomfortable sports bra, the most comfortable T-shirt or pair of shorts in the world isn’t going to overcome the discomfort you feel because of that bra. So make the first layer you put on your most important.
The principal element to look for in your undergarments is comfortable support, not fashion. After all, no one’s going to see these articles of clothing except you. Also keep the following in mind as you shop:
· Size: Don’t buy anything that feels too tight or too short. You’re always better off with slightly loose clothing than gear that’s too tight.
· Chafing points: While standing in front of the dressing room mirror, move around to see where underwear or a sports bra may rub (chafe) your skin. You don’t want your skin to be raw after you work out.
· Fabric: The most comfortable fitness clothes have at least a percentage of polyester, sometimes under brand names like CoolMax and DriFit. The rest is usually cotton or Lycra, a fabric that makes clothing stretch and give a little.