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FITNESSParenting, the ergonomic way
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------ Parenting, the ergonomic way Besides the anatomical and physiological changes that happen during pregnancy, the actual movements of motherhood can cause aches and pains. Fitness professionals often teach clients the proper ergonomics to with regard to office space and typical everyday movements. However, the movement patterns of mothers are quite unique and can cause serious distress on the body if not done functionally. The spine is subjected to abnormal stresses which over time can lead to injury or degeneration of spinal structures Pushing Stroller Purchase a stroller that fits. Some are inappropriate for especially tall or short people. Make sure you can take a full, comfortable stride when walking with a stroller. Carrying Baby Keep your spine in neutral alignment and to bring baby your body’s centre whenever possible. Your spine should be kept neutral and shoulders pulled back. Because of swelling, carpal tunnel is prevalent in the pre and postnatal population. A neutral wrist position is essential to avoid exacerbating a problem. Nursing/Feeding Carrying Car Seat The best thing you can do is to carry the car seat as little as possible. It’s better to take baby out of car seat and hold him close or put him in a stroller than to drag this awkward object around. According to a study presented at this year’s Annual Meeting of the American College of Sports Medicine, it is better to manually hold an infant and lift an object than to perform a lift while the baby is in an infant carrier. If you’re going to pick it up, find a neutral spine before picking the car seat up. Just as in lifting any other heavy object, you should stand in front of the car seat, with the seat centred to your body. Bend down by bending your legs and bring the seat in towards your body. Engage your core as you stand back up. Ideally, use the strength of your bicep to hold the seat, rather than let it hang from the shoulder girdle. A best-case scenario is to hold it in the centre of your body like a laundry basket. Front Pack Carrier Changing Baby Sample Exercise Program Dynamic Warm-Up Begin with a low-level cardiovascular activity (traditional warm-up), then follow with dynamic stretching exercises like leg swings (front and back, side to side) This type of dynamic stretching helps improve balance to the joints and improves relaxation and contraction coordination of the muscles Once you have achieved a light glow, you are sufficiently warmed up. During the cool-down, stretches should be done for the following areas: hip flexors, hamstrings, quadriceps, gluteals and pectoral muscles. Strengthing the Upper and Lower Core Hip Bridges (with baby) Squats(with baby) Side Plank Opposite Arm and Leg Lifts Rear Fly (resistance band) Standing Rows (resistance band) Reverse Crunch (with baby) It becomes especially important during pregnancy to pay attention to the muscles of the abdominals and pelvic floor (PF-Core) because they are the most often stretched and weakened. Strengthening the PF-Core gives you a strong, stable base from which to work and move. If you don’t have a strong base, certain parts of the body must absorb extra stress to compensate for the weak foundation. The problems caused by this extra stress can continue long after childbirth unless the entire core, including the pelvic floor, is strengthened. Strengthening the entire muscle system helps alleviate pain and makes simple tasks – such as carrying a baby, getting in and out of the car, and lifting and reaching – much easier. ------ Gestational diabetes: the exercise link Did you know that regular exercise is a major factor in preventing and treating gestational diabetes? In fact, the Canadian Diabetes Association recommends pregnant women do 10 to 30 minutes of aerobic exercise most days of the week. What is gestational diabetes? What causes gestational diabetes? Gestational diabetes starts when your body is not able to make and use all the insulin it needs for pregnancy. Without enough insulin, glucose cannot leave the blood and be changed to energy. Glucose builds up in the blood to high levels. This is called hyperglycemia. What does this mean for my baby and me? This can lead to macrosomia, or a “fat” baby. Babies with macrosomia face health problems of their own, including damage to their shoulders during birth. This can also make a Caesarean-section more likely. Because of the extra insulin made by the baby’s pancreas, newborns may have very low blood glucose levels at birth and are also at higher risk for breathing problems. Babies with excess insulin become children who are at risk for obesity and adults who are at risk for type 2 diabetes. Gestational diabetes usually goes away after pregnancy. But once you’ve had gestational diabetes, your chances are two in three that it will return in future pregnancies. Many women who have gestational diabetes go on to develop type 2 diabetes years later. There seems to be a link between the tendency to have gestational diabetes and type 2 diabetes. Gestational diabetes and type 2 diabetes both involve insulin resistance. How can exercise help? What kind of exercise is safe to do? If you have already been diagnosed with gestational diabetes, you will have been prescribed an exercise routine that supports your nutrition plan. The following guidelines are recommended for enjoying a healthy pregnancy: Previously Inactive Pregnant Women: Previously Active Pregnant Women: Find something that you enjoy doing and always seek your healthcare provider’s approval before beginning an exercise program. ------ Postpartum fitness tips: get back to fit In addition to the sleep deprivation of new parenthood, diaper changes and feeding schedules, you may wonder when on earth you are going to find time for yourself. These exercises are designed to require very little time and should fit into your new busy schedule. They can be initiated as early as possible, even in the hospital. Do them at home when you have a few extra minutes to help yourself feel better and avoid some postnatal complications. Do not focus on weight loss; that will come later. The following exercises can be done when you feel up to it, even as early as day one. They are designed to improve muscle awareness in the lower abdominal and pelvic floor area. These muscles were taxed during pregnancy, labour and/or a Caesarean section. All the exercises can be done in a back lying position or seated if you do not have too much discomfort. Start slowly with one exercise and add others as you feel your strength increasing. Start off with four to five repetitions of each and gradually work up to 12 to 15. Important note: Always check with your doctor or caregiver before attempting any of the exercises. Kegel Exercises: Exercise 1 (Slow Hold) 2. Close your eyes, imagine that you want to “hold on” and stop yourself from passing urine or passing wind. 3. Now squeeze the muscles around your front passage (vagina) and back passage (anus) as strongly as possible and hold tightly for three seconds. You should feel the pelvic floor muscles lift up inside. 4. Repeat this “squeeze and lift” movement, holding the contraction for three to five seconds. If you can hold longer do so up to a maximum of 10 to 15. Ensure that the squeeze stays strong and you can feel the ‘let go.’ Allow at least a five-second rest in between each exercise. Repeat up to 10 times. Now rest for one minute. The quality of the exercise rather than quantity is most important. Exercise 2 (Quick Squeeze) Do not try to hold on to the contraction, just squeeze and let go. Allow a three-second rest in between each exercise. Repeat 10 times. Do this routine twice a day. Gradually increase the speed of each contraction and number of repetitions before the muscle tires. Quality of the exercise is more important than quantity. Exercise 3 (Pelvic Tension) Practise Proper Breathing Lateral Costal Breathing Supine Upper Back Stretch • Gently pull your elbow across your chest toward the opposite side. Ankle Pumps & Leg Slides This can be done lying or sitting. While maintaining pelvic tension, do 10 ankle toe wiggles and ankle rolls with each foot. Next, keeping heels down, inhale through your nose and exhale through your mouth as you slide one heel out until the leg is almost straight. Slide the heel back and repeat with other leg. These exercises increase circulation and keep the legs moving. Having a new baby in the house is an exciting and exhausting time and it is natural to forget about looking after yourself. It is important to spend a few minutes a day on exercise as soon as you can. These few “stolen” moments will enhance your long-term health and your overall feelings of well-being. -------- How to get fit before conception As a woman prepares her body for conception, she will often make the necessary lifestyle changes during the year prior to conceiving. These can include quitting smoking, discontinuing alcohol and if inactive, beginning an exercise program. Most women already know that a simple intervention like taking folic acid prior to conception can make their pregnancy a healthier one. But exercise? Current studies are indicating that exercise may in fact improve fertility. It has already been demonstrated that a woman who is active before her pregnancy receives the most benefit from her exercise program. Encouraging fitness in the preconception stage is prudent in a woman of reproductive age. For the habitual exerciser, no modifications are needed during the preconception period unless fertility issues present themselves. For the non-exerciser, a moderate program of exercise, which includes cardiovascular, strength (functional) and flexibility components, should be started. The program should progress slowly with conservative increases in intensity, duration and frequency of exercise. Women should be counselled that it takes the body approximately four to six weeks to adapt to a training program, and during that adaptation time, it may be difficult to conceive. Ideally women would conceive once the fitness program is firmly established, approximately three months after beginning a new program. It should be stressed that improving their fitness is one of the easiest and cheapest means to support a healthy pregnancy and healthy child. Where to Begin If you have previously been sedentary or never active on a consistent basis (meaning at least two times a week for a period of three months or more) then start with a gradual walking program. Start off walking on alternate days for anywhere from 15 to 30 minutes and increase up to 10 percent per week. Use soft trails, the beach or grassy areas to minimize the shock to the joints. Avoid slippery conditions and steep uphills, which may tempt you to push your intensity level too high, and steep downhills because of the increased stress on the knee joints. If you have been previously quite active continue with your program. But at the same time can you start some non-weight bearing cross training activities like swimming, pool running, cycling or elliptical trainer to help improve your overall fitness and work different muscle groups. Always start slow with new activities, perhaps 7 to 10 minutes and increase gradually as your fitness improves. Warm Up Well Doing a good dynamic warm-up before any activity is common sense. Warm up the joints for the activities ahead with leg swings front and back and side to side and in figure eights. These work on balance, hip strength and flexibility so you get a lot of value for your time spent. Always keep the knee your standing on soft (slightly bent) and ‘fire the core and sustain’ (keep your tummy tight), Try two sets with 10 repetitions in each set. How hard should you work? Most people are familiar with taking and monitoring their heart rate during and after exercise. As well “perceived exertion” is an ideal way to determine how hard you are working especially once your pregnant. Use the 10-point BORG scale in determining “perceived exertion,” the scale goes from 0 to 10, with 0 being no work at all to 10 being very, very heavy work such as sprinting. During your walks you should be able to carry on a conversation throughout your workout. If you start pushing the intensity a little as you get fitter, you may move into the range of working somewhat harder. Cool down & stretching Ensure you cool down slowly and add some stretches at the same time. Focus on the areas that tend to be short and stiff. Stretch the hips flexors and hamstrings. Do two to three stretches holding to the point of tension for 30 to 40 seconds. ------- Running
your way to delivery fitness One of the most common inquiries pregnant women have is whether or not they can continue their running program. Running and walk-run activities can be a great adjunct to any fitness routine that a women continues throughout pregnancy, as long as she follows sensible guidelines. Always check with your physician or caregiver before beginning this or any other exercise program. Training
tip Warm up
Stability
Smarts Terrain
Smarts Intensity
Smarts Find Your
Level Trimester
1 Beginner:
Intermediate:
Advanced:
If at any time you feel overly exerted doing the same run you would have done prior to pregnancy, don't worry. It is your body's way of telling you that it is busy using up your energy with different things right now! Trimester
2 Tips: Intermediate:
Tips: Advanced:
Tips: Trimester
3 Tips: Intermediate
& Advanced: Tips: Common Sense
Tips: Following the advice in this program should allow you to run smoothly throughout your pregnancy. Each woman's response to pregnancy and exercise are different, so modifications must be made accordingly. Your current goal is to stay fit to deliver and have a healthy pregnancy and baby. Happy running! The Borg
scale of perceived exertion Can you talk the talk while you're walking the walk?
-------- A
postpartum workout for maximum results Now that you have had your baby, it is time to think about getting back into shape. Most women find that the joy of motherhood leaves them with little extra time for themselves. This workout is designed to give you maximum results. Before you begin, you must be aware of a few simple things. Remember that the changes that occurred during your pregnancy can persist up to one year postpartum, so be patient with yourself during this process. If you have had a Caesarean section, it will take longer to get mobile afterwards - take that into consideration as you begin your workout program. While you are breastfeeding, it is important to stay well-hydrated during and after your exercise program. A good guide is to monitor the colour of your urine; it should be clear for at least two hours after your workout. Despite all the controversy surrounding the topic, exercise does not impact the quality of your breast milk. Our advice is to start the workouts below only when it has been at least two weeks since your vaginal delivery or six weeks since your C-section. Note: before starting any exercise, always consult with your doctor first. Principles
first o Rest and recovery. This is important to allow your body time to recover from the fatigue caused by exercising. o Flexibility. Remain flexible in your planning. Training plans can be modified. Be in control of your plan not a slave to it. o Keep it fun. Training should be fun and stimulating. If it's not, change the way you train or your attitude toward it. Quick
calorie burners Treadmill Walking: A 10-minute walk at a 15-minute-per-mile pace with a 10 percent incline burns off approximately 70 calories. Using a treadmill on the incline maximizes your calorie expenditure and causes less stress on the joints. The uphill walking burns about 70 percent more calories than level walking. Start easy and gradually increase the speed and the grade. If you have to hang on to the rails, the treadmill is going too fast and you're burning fewer calories. Cross Country Ski Machine: Ten minutes at a moderate level burns approximately 90 calories. As your technique on this machine improves, you will burn more calories from your increased range of motion. To help improve your glide motion, lift your heel at the end of the stride. Vary your routine between short quick steps and long smooth glides to vary the intensity. Rowing: Ten minutes using a setting that is somewhat hard burns approximately 70 calories. Initiate the move from your legs and buttocks, not your back and arms, and keep a smooth continuous stroke with no stopping or hesitation. Stationary Bike: Keep your pedal speed high (80 to 90 RPMs) for the full 10 minutes but alternate the resistance setting to increase the intensity of the workout. Try a ladder climb of 30-45-60-60-45-30 seconds hard, following each one with an equal amount of time just spinning at a high RPM. This burns approximately 80 calories. Try cross-training
Core and
pelvic floor strengthening Cool-down
Dr. Nordahl and Carl Petersen are authors of the book Fit to Deliver, and will publish their second book Exercise and the Childbearing Years in 2004. They also offer prenatal and postnatal fitness classes in Vancouver. For information call 604-612-9585 or www.fittodeliver.com. -------- Prenatal
yoga guide What is yoga? The word yoga is translated from Sanskrit, and means "union," that is, union of the body, mind and spirit. From a yogic point of view, life is to be enjoyed and experienced fully. And with pregnancy, there is more joy. So what is prenatal yoga? Prenatal yoga is the nurturing activity undertaken when time is spent (a little or a lot) to gently relax, release and attune to your body and your rapidly growing baby within. The natural, vital and restorative energies of the body and mind are enhanced through gentle yoga postures. When pregnant, moms-to-be feel the strains of the ever-changing body, particularly the new demands on the back. Yoga work counterbalances the growing abdomen and maintains good posture. Stretching while strengthening helps to release the pelvic opening in preparation for birth. Toning the pelvic floor allows for a more controlled birthing, lessens complications, and enhances postnatal healing. General guidelines
you should follow in your prenatal yoga class: Poses that
require you to lie on your back: Squatting
poses: If you can't
continue with your yoga class: Don't push
yourself: When looking to attend a prenatal yoga class, ensure that the teacher is a certified and experienced. Janice Clarfield teaches prenatal yoga and couples workshops for birth preparation, as well as yoga for adults of all bodies and ages. Janice trains and certifies professionals to teach prenatal yoga. 604-739-6664; janice@urbanyoga.ca; www.urbanyoga.ca -------- Getting
fit after baby: exercises mom can do with baby Returning to fitness postpartum is a challenging task. Between sleep deprivation and a significant decrease in your free time, it is not hard to see why so many women find it difficult to get back into an exercise routine. Fortunately, there are many simple exercises that can be done with your baby at home. Exercising with baby provides interaction for the mother and baby, and will improve the strength and conditioning of the mom. Immediate
postpartum exercise After a C-section or a traumatic vaginal birth the return to exercise may be delayed. The main factor when considering a return to activity is pain. If the activity is painful, stop. Joint laxity seen in pregnancy can continue postpartum. If you suffered from any joint-related problems during your pregnancy you should consult your health professional before getting back into aerobic and strengthening exercises. A physical examination is recommended before returning to vigorous exercise. In the first six to eight weeks the best exercises to do would be your pelvic floor exercises, for example, Kegel exercises. Squeeze the muscles that would stop the flow of urine. Try different techniques like elevators and speed-ums. Elevators consist of pulling on a pelvic floor contraction and then increasing the strength of the contraction up to a maximal contraction. You can also do descending elevators by starting with a maximal contraction and gradually letting off some of the strength in small amounts, like an elevator going down. Speed-ums are progressively quicker contractions with complete release of the muscles in between contractions. Together, these exercises improve the tone and coordination of the pelvic floor muscles. Postpartum
exercises six weeks and beyond By six weeks postpartum, women may gradually resume the normal exercise routine that they were doing prior to becoming pregnant (pre-conception). Their first goal should be caring for their newborn and themselves. They should resume exercise slowly. If you ran prior to pregnancy, start with a brisk walking program and progress to a walk-jog program. The number of repetitions and sets you perform should be based on your fitness level. In general, one to two sets of 10 to 15 repetitions is a good start. The following is a list of exercises that can be done at home with your newborn close by: Baby sit-ups
Modification: If your abdominals are too weak or inhibited to lift the shoulder blades safely off the ground, do a sit back instead. Start seated upright with your baby as described above and sit back with your torso until you feel a tensioning in your abdominals. Hold and then return to sitting upright. Baby push-ups
Split
Squats Mini Squats
Remember, these exercises are only suggestions. After baby is born, remember that even a quick stroller walk can be beneficial. Try to use exercise as a means to feel like your old self again, rather than a way to lose the 'baby fat.' If you cannot motivate yourself, try to exercise in a group or with a buddy - it will help you make the effort. Karen Nordahl is co-author with Carl Petersen of the book Fit to Deliver, and will co-publish their second book Exercise and the Childbearing Years in 2004. Karen and Carl also run postnatal fitness classes. Info: 604-612-9585, www.fittodeliver.com. Martha Sirdevan is a physiotherapist practising in Vancouver. -------- Stretching
through the childbearing years What changes do you make to your warm-up now that you are pregnant? A hormone called 'relaxin' is manufactured by your ovaries and placenta early in your pregnancy (about week six). Relaxin acts on the ligaments of your pelvis, allowing for expansion during birth. The problem with relaxin is that its actions are not specific to the joints of your pelvis - it in fact affects every joint in your body. As a result of this 'looseness,' pregnant women often find that they can stretch much farther than in their non-pregnant state. This can predispose you to injury and subsequent discomfort. As a general rule, the exercises below should never be performed past your pre-pregnancy stretch point. Warm-Up
Warming the body up slowly helps prevent injuries caused by going too hard, too fast with cold, non-lubricated muscles and joints. Warm-ups vary depending on the type, duration and intensity of activity you are going to do and should include a dynamic stretching component like leg swings, crossovers, side shuffles, high knees and heel drills or skips. A good 20- to 30-minute warm-up can also help contribute to your general conditioning especially during your pregnancy and post partum. Smart
Stretching Guidelines Dynamic
Stretching Examples
of this are: If your flexibility is already good, the warm-up routine should focus on dynamic stretching or general movements of gradually increased intensity. Dynamic stretching used as a warm-up helps normalize joint mechanics, increases the dynamic range of motion (ROM), improves joint position sensors (proprioception) and improves the "relaxation-contraction" coordination. Pregnancy is not the time to gain flexibility, but rather to maintain what you already have. Slow,
Static Stretching Again, pregnancy is not the time to gain in flexibility but rather maintain what you have already. Key Stretching
Areas o Work with your physical therapist to determine which stretches are best for you to focus on. Training
Tips Rules
of Stretching: Karen Nordahl is co-author with Carl Petersen of the book Fit to Deliver, and will co-publish their second book Exercise and the Childbearing Years in 2004. Karen and Carl also run postnatal fitness classes. Info: 604-612-9585, www.fittodeliver.com. -------- How
to regain your pre-pregnancy shape Losing weight and regaining your pre-pregnancy physique after delivery requires patience and persistence. You have experienced nine months of pregnancy, watching your body grow in new ways and go through some unbelievable changes. Your body does not resume its original shape immediately after labour. This article addresses some of the guidelines as well as some practical and realistic advice around a postnatal weight loss program and tummy thinning program. When can
I start? However, when it comes to resuming exercise, remember that bodies don't like big surprises. You will need to ease into activity on a gradual schedule, and regularly challenge yourself to make progressions. It is best to initially set reasonable goals and progress from there, rather than to expect too much from yourself, and fail. Patience is important. The other perspective that needs to be considered is time management. Learning to take care of a newborn is stressful, and you need to make sure that your exercise helps to decrease your stress, rather than add to it! Incorporating your baby into your exercise program can be a great way to interact with your baby, as well as get in shape at the same time. Remember that keeping yourself healthy and happy is an essential priority to achieving balance in your life. Jotting down your goals on a calendar can be helpful and motivating. Finding a partner to exercise with you is also a good way to keep on track. Always check with your caregiver before resuming this or any other exercise program. What exercise
should I do?
This can be achieved through a brisk walk, walk-jog, run, stationary bike, treadmill, elliptical, swimming or water running. Always start with a five to seven minute warm-up and finish with a five to seven minute cool-down and gentle stretches. You should aim to do some cardio exercise five days per week. Remember to progress. You can challenge yourself by increasing the duration of your activity, the speed or the resistance. So, for example, if you are currently walking, and your goal is to start jogging, try including one minute of jogging every five minutes for one week. The following week, do two minutes of jogging and three minutes of walking. Then three minutes of jogging and two minutes or walking, etc., progressing gradually on a weekly basis until you are jogging. Other ways to progress are to add hills, or to add five minutes of extra aerobic exercise every week. Tummy
tune-up The transverses abdominis (TA) is your deepest layer of abdominal muscles, and the most important abdominal component of core stability. It is a flat deep muscle that works in conjunction with the pelvic floor, diaphragm and back muscles to provide a stable base during all activity. Getting
Started: o The muscles above the navel should not be contracting, the ribs should not move and the abdomen should not bulge. o Master this exercise with normal breathing before moving on. Fire the
core and sustain + leg slide, fall out and march Hip bridges
Remember that it took nine months to gain your tummy, and it will take some time to get rid of it as well. Consistency, persistence, patience and goal-setting is important in the process of regaining your pre-pregnancy shape. Wendy Foo is a fitness instructor and physiotherapist practicing in Vancouver. Karen Nordahl is co-author with Carl Petersen of the book Fit to Deliver, and will co-publish their second book Exercise and the Childbearing Years in 2004. Karen and Carl also run postnatal fitness classes. Info: 604-612-9585, www.fittodeliver.com. ------- Cross the finish line to postpartum fitness Virtually every conversation with new moms involves the topic of baby fat – not the cute, cherubic kind found on newborns – but those annoying, post-partum bulges that just seem to hang around like that lazy roommate you had in college. Gloria Clark remembers those conversations. Born and raised in East Vancouver, Clark was an active young woman who excelled at track and field. But as she got older, there seemed to be less time for sports as the demands of work and family crept in. By the time Clark had her first child at the age of 32, she found fewer hours for exercise between the demands of motherhood and her career. After the birth of her twins in 2001, Clark decided it was time to stop talking about getting into shape, and start doing something. She made a New Year’s resolution to take up running. “My main motivation was to get my post-maternity body back in some shape that was recognizable,” explains Clark. “It had been a little over a year since I had had my twins, Renée and Aidan, and I really wanted to rid myself of the additional layer of ‘stuff’ that still occupied space on my abdomen.” Clark had never run more than 15 km. Determined not to lose her motivation, she joined a running club in January 2001, and set a goal to complete a half-marathon. Clark chose the Scotiabank Half-Marathon. Then a friend suggested she try a full marathon. Clark recalls, “I wasn’t very confident that I would be able to complete the training but I thought I’d give it a try.” The Road to 26 Miles As always, life presents obstacles. “I would often race home from work, make dinner, and have it on the table before I went on my run. And if there was the slightest objection to me going then I wouldn’t go. I realized that this wasn’t the best way to approach training as I was often late and stressed to the max by the time I left home.” Injuries and illness can get in the way of training. “I twisted my ankle snowboarding. After the accident I was off running for two weeks and then I caught a head cold which took me out for another week or two,” says Clark. In May 2002, Clark was one of 2,051 runners who registered for the Vancouver International Marathon. Cheering her on was her husband, Jeff, her one-and-a-half year-old twins, Renee and Aidan, her 10-year-old son, affectionately nicknamed “Q,” and the rest of her family and best friends. “The pain was very real,” describes Clark of her first marathon. Most distance runners have experienced muscle cramps at some point, and Clark was no different. “The race went very well until my first leg cramp set in at 25 km. I stopped, stretched and carried on, but continued to cramp for the remaining 17.2 km.” Despite the pain, Clark completed the marathon in a time of 3:54:48 – under four hours – an amazing accomplishment for a first-timer. She describes the feeling she got in the last mile, seeing familiar faces as she reached her goal. “There isn’t anything that will motivate you more than to see your most precious fans cheering you on.” What was the first thing Clark thought of as she crossed the finish line? “I can stop running!” But Clark had caught the bug. Next, she set her sights on Boston. The Boston Marathon There are specific events where runners must qualify for Boston and New York. In BC, one of those events is the Victoria International Marathon. Clark needed to achieve a time of 3:50:59 in order to qualify in her age category. Admittedly, she was slightly overconfident, having already completed one marathon, and didn’t train as often as she should have. Only 19 km into the race, Clark began to feel ill and got progressively worse. She missed qualifying for Boston by 30 minutes. The experience was a setback that caused Clark to re-focus. By the time she entered the Vancouver Marathon the following year, she was ready. But it was going to be tough – both physically and mentally. As she ran the marathon, Clark watched her time erode away. With the help of her running mate, Dario, she managed to get up the Burrard Bridge hill, and then knew she could make it. Clark remembers, “I knew that if I ran as fast as I could with no cramping I still had the slightest chance. I said my last prayer and ran.” Clark crossed the finish line in a time of 3:50:58. She had qualified for the Boston Marathon. Since deciding to ‘lose the baby fat,’ Clark has competed in four marathons: Vancouver (2002), Victoria (2003), Vancouver (2004), and Boston (2005). She has also run four half-marathons. “Initially I started running to get back into shape. Now I run because of the incredible group of running friends that I have,” says Clark. “I truly love the running but it is my friends that make the journey worthwhile. Boston was very special to me as I had my best running pals with me, Stacey Burgess and Suzanne Johnson.” And what about the future? “My goals are Vancouver (2006), New York (2006) and Boston (2007). I’m praying for my body to hold on until I’m done.” Be realistic about your fitness level. Make an appointment with your family physician before starting any rigourous exercise program. ------ Postpartum depression: can exercise help? You may have noticed that the subject of postpartum depression has made its way into the mainstream media. Brooke Shields has written a book (which brought several of my own patients into the office), Oprah has discussed the issue, and although I do not agree with his comments, Tom Cruise did help publicize the condition. But what does this all mean? How can you tell if you are depressed when you have little time for anything except for the care of your baby? You are not sleeping as well, not eating properly and at times overwhelmed by the new arrival. When does it get serious? The ‘baby blues’ usually occur about the third day after delivery, and can last until the 10th day. The condition is characterized by tearfulness, anxiety, irritability, mood lability, increased sensitivity and fatigue. For most women the blues are short-lived, and usually resolve. Some of the blues can be attributed to the isolation women experience during the early newborn period. It is important to ask for help when you need it, and do not try to be Supermom, at least not right away! A group exercise program where you can be with other moms has been found to be effective in reducing some of the symptoms of the baby blues. If there are no group classes in your area, you can try to create one with family, friends or prenatal class participants who may be interested. Postpartum depression is a different matter entirely. Part of the difficulty in making the diagnosis is that so many of the symptoms of postpartum depression can be confused with the normal emotions surrounding birth. The symptoms of fatigue, difficulty concentrating, sleep disturbance, and depressed mood often accompany the birth of a newborn. It is important as physicians to determine what is normal and what is not in the postpartum period. For example, a woman who worries excessively about her infant’s weight gain two weeks after birth is normal. Worrying excessively about the same when your child is four months old and thriving is not. If a diagnosis of postpartum depression has been confirmed, the standard treatment consists of medication and psychotherapy. Some early results from a study in Australia have suggested that a stroller walking program has helped alleviate the symptoms of postpartum depression when combined with medical and psychotherapy. So what does this all mean? If you are feeling sad and depressed for a prolonged period after birth (after the first two weeks) talk to your doctor or midwife. You may not have postpartum depression at this stage, but you may be at risk for the condition. Your doctor will likely advise you to increase your support network (if possible), start some type of exercise program (this can be a simple walk outside with the stroller for ten minutes per day) and recheck with her in a few weeks. If you or your family members are concerned about the possibility of postpartum depression, check with your doctor. Remember, is it sometimes very hard to sort out what is normal and what is not, so do not be afraid to task for help. Medication and/or psychotherapy are the mainstays of treatment, but an exercise program may help reduce the duration of your symptoms. The workout below gives you an example of what may help. Walking Program Increase by one minute per day until you reach 40 to 60 minutes. Web resource: www.wellmother.com: An excellent website developed by Vancouver’s own postpartum depression expert, Dr. Shaila Misri. ------ Managing weight gain in pregnancy We don’t need research to show us that Canadians are weighing more. All we need to do is walk down any street. But it has presented new challenges for health professionals who see pregnant patients in their offices. In the 1950s, when pregnant women were eating less, the medical profession developed an ‘eating-for-two’ policy. Today, with 34 percent of the pregnant population starting out moderately overweight or obese, eating for two can be dangerous to both mom and baby. An overweight woman is defined in the research as any woman weighing over 88 kg. (194 lbs) at any time during pregnancy. This weight (or higher) has been associated with an increase in the incidence of gestational diabetes, pregnancy-induced hypertension, blood clots in the leg, induction of labour and Caesarean section. If the mother weighs over 210 lbs, the incidence of anaesthetic complications increases, as does the rate of post-Caesarean section wound infections. Research has also demonstrated that childhood obesity control starts in the uterus. What we do for our children when we are pregnant can influence the rest of their lives. In my practice, pregnancy is a significant motivator to changing habitual behaviours. What we may not do for ourselves (eat healthy, exercise) we will often do for our baby. Provided being overweight is not due to an underlying medical illness (thyroid disorders, depression) there are ways to help you through this difficult time. You need to remember that your baby will take what it needs from you, but you still need to feed yourself in a healthy way. I will often have patients attempt to achieve a lower overall weight gain during their pregnancy if they start out overweight. Instead of the usual 25 to 35 lbs, I have the goal decreased to 18 to 25 lbs of total weight gain. Research also suggests that the more sweets you eat early in your pregnancy, the more weight you gain during your pregnancy. So we try and make the appropriate lifestyle changes as soon as we can. Here is some simple advice I give my patients: 1) Avoid all processed food. A good rule of thumb comes from dietitian Patricia Chuey, who advises her clients not to eat anything that will not rot on your counter after one month. I go a bit further with my patients, telling them not to eat anything that comes from a package in their cupboard. I am hopeful they will take my advice at least half of the time! 2) Eat more fruits and vegetables. Mother was right on this one. This can mean eating more salads, or sneaking vegetables into your meals. 3) Do not double the Canadian Food Guide. 4) Get access to a dietitian. Resources include: www.eatingforenergy.com or Dial-A-Dietitian at 604-732-9191 (Greater Vancouver) or 1-800-667-3438, www.dialadietitian.org. 5) Quick snack foods from a package are not your friend. 6) Get some exercise. This can be as simple as 30 minutes of walking per day, in 10-minute intervals. You may be able to do this on your lunch hour. Walk with a group of friends to make it more enjoyable. Here is a simple walking program that you can follow on your lunch hour or after dinner. • Do a walking routine up to 30 minutes. Finally, pat yourself on the back…you are doing a wonderful thing for yourself and your baby. ------- Exercising when you’re pregnant Does any mom-to-be still believe that the next 40 weeks are a time for putting up her feet and indulging every craving? These days pregnant women are working full-time jobs right up until their due dates and multitasking to get things squared away before baby comes along. Today’s expectant mothers are as busy as before they got pregnant, if not more. And the trend is amplified in the fitness sector. Everywhere, pregnant women are grunting through squats with stability balls and sweating on the treadmill, balancing in yoga poses and strengthening their abs in Pilates classes. Even women who were previously inactive are seeking out prenatal fitness classes now that more expectant moms are recognizing the benefits of exercise during pregnancy. But even with this shift towards physical fitness, there are still lingering myths surrounding pregnancy and exercise. For instance, how much is too much, and how little too little? There are misconceptions on both ends of the spectrum. Many active women believe their fitness regimen will be unaffected by pregnancy while others believe they’ll have to stop their routine entirely. Women that were inactive before getting pregnant tend to think it’s safer to stay inactive. But the reality is that regardless of where you start, your fitness program must take your pregnancy into account. Aside from the usual benefits of a fitness program, prenatal exercise minimizes the aches and pains associated with pregnancy. Exercising through your pregnancy can reward you by: Timing – Too Late? Intensity – Out of Shape? Age Heart Rate Range Duration – No Pain, No Gain? Type – Thrill Seekers Need Not Apply! This doesn’t mean that currently active women should stop running, lifting weights, swimming laps or doing yoga! If you’re paying attention to your body response as your pregnancy progresses and are careful not to overexert, it’s perfectly safe to continue within the abovementioned guidelines. Beginners should stick to simple, lower-impact activities like walking, stationary cycling and swimming. Nutrition – Eating for Two? Continuity – Keep on Truckin’! Keep in mind that physical fitness is meant to enhance your pregnancy, labour and delivery – not cause added risks. Exercising in moderation can bring great rewards to you and your baby, both during and after your pregnancy! |
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