I am so excited to present this guest post by Pelvic Floor Physio Julie Bagshaw from Vital Physiotherapy.
Finding out you are pregnant is an exciting time! It is also a time where you will experience many changes in your body, your emotions and……. your workout routine.
Despite my background as a pelvic health physiotherapist and Crossfit athlete, I still felt unclear about how and when I would need to modify my workouts through my pregnancy. This is because every woman starts their pregnancy at a different fitness level, every woman experiences different symptoms and every woman’s body changes and grows differently during their pregnancy. Also, every woman has different fitness goals during their pregnancy and this results in a lot of ‘grey’ area about how and when to adapt exercise. Given the lack of clarity on how to make changes to your fitness routine throughout pregnancy, especially for those like me who enjoy high intensity and high impact activities such as Crossfit, I wanted to share my top tips on navigating the ‘grey’ and staying fit throughout my pregnancy!
Currently, I’m 34 weeks pregnant and (*knock on wood*) I really haven’t had symptoms such as nausea, reflux and fatigue affecting my ability to keep exercising. I also don’t have any contraindications to exercise- if you are unfamiliar with this please read more here. Keep this in mind as you read through my tips, as all women and all pregnancies are different. If you are ever unclear on how to be adapting your workout routine and don’t have the confidence or background to do it alone, please consult your local pelvic health physiotherapist or trainer educated in pregnancy & postpartum fitness!
1) BE INFORMED
Let’s start with the question: What is the recommendation on exercise during pregnancy? After 15 years, (finally!) new Canadian guidelines were published in fall 2017 that indicated that all pregnant women without contraindications should be getting 150 minutes of moderate intensity exercise over a minimum of 3 days each week. This includes both aerobic and strength training. This level of exercise showed no increase in miscarriage, preterm birth or stillbirth and can even contribute to a 40% reduction in major complications such as gestational diabetes and hypertension, to name a few. This makes it pretty clear that we should be exercising in pregnancy. Actually, one of my favourite things to remind women is that ‘you are pregnant, not sick…of course you should exercise!’
But, what about exercising at high intensity and with high impact, such as Crossfit? Evidence specifically about Crossfit and its effects on mom and baby is slim at this point and consists mostly of case studies of women who refuse to stop these workouts! Outcomes on both mom and baby in these studies sound promising but given how difficult (and unethical) it is to ask pregnant women to perform Crossfit workouts to properly study the outcomes, we likely won’t see any concrete guidelines in this area for some time. Welcome to the ‘grey’ area! My personal journey on adapting my training mainly consisted of my own personal and professional knowledge base and reading as much as I could about pregnancy fitness from some well known fitness professionals and physiotherapists such as Brianna Battles, Nikki Bergen and Julie Wiebe. I’ve included an entire list of these at the end of this blog for your reference!
My first trimester included very little change with the exception of making sure I was not getting too hot, as it was August at the time I found out I was pregnant. The Canadian pregnancy exercise guidelines suggest that avoiding excessive heat (as to not allow core temperature to rise above 38.9 deg. C) is important, which is certainly a consideration for Crossfit. With this in mind, I:
switched to lighter clothing
worked out near a door or fan and
although an outdated guideline, I wear a heart rate monitor to keep my intensity at a level that allowed me to keep moving and breathing moderately hard but not be gasping for air or overheating (my actual target was about 80% of my maximum heart rate or 150 beats per minute)
I’ve been exercising at a high level of fitness for the better part of 3 years and, as such, my body was used to both the impact and intensity that comes along with it and I found that these modifications worked well.
In my second and third trimesters I began to modify high impact movements such as burpees, box jumps, pull-ups and running. I was also not pushing myself to lift weights above 75% of my 1 rep max (my own target). These movements started to become a lot more difficult and I felt that I was not able to maintain good control of my inner core (see #6 below for more on this). My personal thoughts are that high impact exercise, such as jumping and running, is not the most beneficial during pregnancy. These types of exercise require more motor control, stability and ability of the body to absorb force. In pregnancy, our central stability system (aka inner core) is not functioning optimally due to the internal pressure from the growing uterus. This, among many other changes related to hormones, balance etc.., can compromise our ability to handle impact and can lead to a higher likelihood of pelvic floor and core dysfunction, such as diastasis, incontinence, pelvic pain and prolapse. As with all ‘grey’ areas, each woman will need to determine when to start modifying these types of movements, but know that signs such as doming or bulging at the midline of your stomach, pelvic pain, leaking and pelvic heaviness are NOT normal and should be a sign to modify your movements and seek help from a pelvic physiotherapist.
2) KEEP REVISITING YOUR TRAINING GOALS
In physio school I was taught that pregnancy is a time to ‘maintain not gain’. However, in my first trimester I had no obvious changes to my body and so there was nothing reminding me that I was pregnant. As my belly grew, my intra-abdominal pressure increased and my clothes stopped fitting, I was constantly reminded that I was carrying a tiny human inside of me. More naturally, my training goals shifted to maintaining my training frequency (Crossfit 3-5x per week) but with modifications of specific exercises or to the amount of weight I was lifting to ensure I maintained good form. One thing I had to keep reminding myself is that making modifications is NOT ‘giving up’. It is just smart training. If you are faced with an exercise that you likely ‘could’ do (e.g. Toes to bar, handstand pushups), ask yourself ‘should I do this’ and what am I trying to achieve? If you’re just trying to prove to yourself or others that you still can – it’s likely not worth it.
3) DO WHAT YOU ENJOY
Finding out that you are pregnant does not mean that you need to attend only ‘prenatal’ classes. Don’t get me wrong, there are a lot of really wonderful places in the city that offer prenatal fitness classes (e.g. 889 yoga, Evymamma, Toronto Yoga Mamas, and soon right here at Vital!) but after trying them out, I realized that it simply wasn’t what I enjoyed! Rather than limiting yourself to these classes, my suggestion is to work with a pelvic physiotherapist or trainer educated in prenatal fitness to help you modify the type of exercise you actually enjoy doing! Chances are, you will stick to it more easily.
I work with a lot of high intensity athletes in my practice and, in my experience, most of them have had a tight pelvic floor and hip region – myself include. Your growing baby accommodates the space it has and so creating a more relaxed environment can give your baby more room to get into an optimal position. Some options for improving flexibility include prenatal yoga, spinning babies poses (see link below) and, if you’re comfortable with making your own modifications, I’ve really enjoyed ROMWOD, which is a Crossfit focused mobility routine.
5) BE PROACTIVE ABOUT YOUR BODY
Having some insight into all of the changes that occur in the body in pregnancy and being exposed to pregnant women every day with varying levels of pelvic floor dysfunction, I was not about to wait to ‘see how it goes’ – especially since I knew I wanted to keep up with my high intensity exercise through my pregnancy. Any of the muscle or strength imbalances in your body tend to get amplified in pregnancy as your body grows and is put under more stress on a day-to-day basis.
Since my first trimester, I’ve been seeing a chiropractor, pelvic physiotherapist, osteopath, naturopathic doctor and massage therapist. I’ve certainly experienced many symptoms in my pregnancy from constipation to low back pain to pelvic girdle pain, but I haven’t let anything of get to the point that I needed some urgent care or couldn’t function. Don’t feel like you need to include all of these health care practitioners into your pregnancy team, but consider which ones seem right for you and don’t wait until you need help- be proactive!
6) MAINTAIN A CONNECTION TO YOUR INNER CORE
If you don’t know what your deep ‘inner core’ means, please check out this post and this post to better learn about these 4 muscles- the diaphragm, transversus abdominis, pelvic floor and multifidus. Understanding how to activate your deep inner core is critical to your body functioning more optimally in any pregnancy, but especially for those wanting to continue high intensity workouts. Our core muscles stretch, carry more load and are more difficult to engage as we grow in pregnancy and spending even a few minutes a day maintaining a connection to these important muscles can help you maintain balance, continue to have better form, avoid obvious signs of diastasis, have an easier pushing experience and allow for a quicker postpartum recovery.
7) DON’T STOP MOVING
Unless you have a contraindication to exercise, don’t stop moving! In physiotherapy we love the saying ‘motion is lotion’ and it’s no different when you are pregnant. There are so many benefits to mom and baby related to exercise – improved digestion, better sleep, improved mood, reduction in risk of gestational diabetes, high blood pressure and depression – to name a few.
8) SUPPORT YOUR GROWING BODY
If your goal is to continue higher intensity exercise its important that you support your growing body such as your breasts and belly! I had good luck with the Cadenshae nursing bras- they work well for those even with larger breasts who need good support for higher intensity fitness and allow for a nice transition to breastfeeding and activity postpartum. Additionally, I really liked the supportive hug from the Bao Bei Pregnancy Belly Support Band, which is created by a women’s health physiotherapist and pilates instructor. This band doesn’t negate the need for your to maintain a connection to your deep core (see #6!) but it allowed me to more comfortably continue higher impact exercises such as burpees and double-unders into the start of my second trimester and felt like a nice support during weightlifting.
As mentioned, all of my favourite resources to help guide modifications in pregnancy, maintain flexibility, support your growing bump and feel informed about the evidence of fitness during pregnancy are listed below. This is just a sample of information that I’m sure is available, but are all ones that I feel comfortable endorsing and sharing! Found another amazing resource? Please email me at: Julie@vitalphysiotherapy.com and let me know! Happy exercising!
1) Pregnancy Belly Support Band: https://www.baobeimaternity.com/
2) Brianna Battles
Free resources: http://www.briannabattles.com/resources/
Pregnancy & Postpartum Athleticism Facebook Group: https://www.facebook.com/pregnancyandpostpartumathleticism/
3) Julie Wiebe Blog
5 Things To Do Before You Get Pregnant: https://www.juliewiebept.com/fitness/five-things-to-do-before-you-get-pregnant/
Safe Exercise for Pregnancy: https://www.juliewiebept.com/fitness/safe-exercise-for-pregnancy/
Running + Pregnancy: https://www.juliewiebept.com/pregnancy/how-long-can-i-keep-running-while-pregnant/
4) ROMWOD: https://romwod.com/
5) The Bump Method: http://thebellemethod.com/uncategorized/the-bump-method-exercise-during-pregnancy/
6) Spinning Babies: Daily Activities for Pregnancy https://spinningbabies.com/start/in-pregnancy/daily-activities/
7)CSEP/SOGC Pregnancy Fitness Guidelines: https://csepguidelines.ca/wp-content/uploads/2018/10/4208_CSEP_Pregnancy_Guidelines_En_P2A.pdf