Women’s Health & Fitness Programs
Many important health issues for girls and women involve matters of reproductive
health, childbearing, fertility and aging. Research informs us that an active, healthy
lifestyle provides a number of benefits throughout a woman’s life span:
reduced discomforts from pregnancy, labor, birth, recovery & menopause
reduced risk of hypertensive disorders of pregnancy and premature birth
potentially shorter active labor and reduced risk of cesarean delivery
more rapid return to joyful activities, less excess weight following birth
mother-infant interaction, leading to infant psychomotor enhancement
reduced rates of obesity, cardiovascular disease, and type 2 diabetes
reduction of some cancers, osteoporosis, falls and loss of muscle mass
improved social support, networking and stress management skills
greater belief in one’s ability to be strong and capable (self-efficacy)
In the generations since birth moved from the home to the hospital setting, it has become less and less frequent that women in developed nations see birth first hand and accept it as a natural part of life prior to their own first birth experience. The “epidemic” of fear surrounding birth may well be partly a result of this phenomenon. In a recent post published in Midwives magazine, a publication of the UK’s Royal College of Midwives, DTP director Ann Cowlin wrote a blog entitled ‘Exercise and Body Trust in Birth.’ The post addresses the confidence in one’s body that accompanies training specific exercise and how this applies to pregnant women and their preparation for birth. Here is the link to the blog post: http://community.rcm.org.uk/blogs/exercise-and-body-trust-birth
DTP: When did you first work or study with DTP? HSB: We first discovered DTP in 2011 while researching evidence-based exercise programs for pregnant women. DTP was exactly what we were looking for! So in January of 2012, Healthy Start Brooklyn trained three former clients and one staff member to teach free DTP classes to low-income pregnant women in Central Brooklyn. It took some time for us to get the program up and running, but we have been offering classes since March of this year and they have been continuing successfully ever since.
DTP: Describe the focus or mission of your work. HSB: Healthy Start Brooklyn is a federally funded program that seeks to improve the health and wellness of women, infants and families in Central Brooklyn. Rates of infant death, premature birth and illness in the neighborhoods of Bedford-Stuyvesant, Brownsville, Bushwick, East New York, and Flatbush are far higher than elsewhere in New York City and the U.S. as a whole. HSB provides support services, education and training to reduce these inequalities and improve the lives of Central Brooklyn residents. Our DTP classes, as with our childbirth education and doula programs, are aimed at trying to offer our clients free services that are available to more affluent women to help offset some these inequalities that can have a negative impact on birth outcomes.
DTP: What do you most enjoy about your work? HSB: We enjoy seeing our clients coming back to class every week. Some of them have very little support systems in their lives, and it is extremely rewarding to see them participate in class each week and stay after class to talk to each other and share stories. It is our hope that the class not only positively affects their physical health, but also their mental health as well, serving as a place where they can de-stress and socialize with other women in similar situations. We also really enjoy receiving pictures of the babies that our class had some part in helping enter the world healthy!
DTP: What is the most important or interesting thing you have learned from working with moms, moms-to-be, or other women clients? HSB: Pregnant women can move! In the beginning, we were nervous about making our class routines too high intensity for some of the women who were further along in their pregnancies. We were surprised to find that they could all keep up and were even requesting the higher intensity routines.
To learn more and see more photos, go to the DTP Blog:
It’s time to hit the main theme again: Aerobically fit women are at reduced risk for things that go wrong in pregnancy, improve their tolerance for labor and birth, and recover more rapidly in the postpartum period.
Moving into Motherhood
The arrival of the holidays provides a good reason to bring this up, yet again! Pregnancy is a gateway time in women’s lives…we become more aware of our bodies, our sensations, our feelings, our needs, and how versatile and amazing our bodies are. We can make people with our bodies! During pregnancy, we often take precautions…we eat more carefully, avoid toxins, try to avoid stress. When the holidays arrive, we see indulgent behavior in a different light.
Yet, even with all this focus on behavior, we sometimes miss the biggest aid to a healthy pregnancy: physical fitness. Research clearly demonstrates that fit women do better, are healthier and happier. More and more in the U.S. we see disorders of normal organ function that accompany sedentary pregnancy.
Let’s look at this a little closer (yes, I am going to repeat myself some more, but it is an important concept to spread). We live in a body model that rewards an active lifestyle.
Being sedentary causes things to go wrong
Not moving creates biochemical imbalances because the cardiovascular system atrophies and molecules created in the brain or brought in through the digestion may not get where they need to go for a healthy metabolism.
Your cardiovasculature is the highway that brings usable substances to the place they are used. You have to help it grow and develop, use it to pump things around and give it a chance to be healthy. Aerobic fitness does all these things.
Advice for young women of childbearing age
If you are thinking of pregnancy, have recently become pregnant, or work with women of childbearing age, we encourage you to open avenues of activity for yourself or others in this population. You can learn more from our blog dancingthrupregnancy.wordpress.com. You can seek out local pre/postnatal fitness experts on this site. Yoga is nice…we use some of it in our work, along other specific exercises for which there is a direct health benefit. But, we also see yoga converts who come into our program in mid pregnancy unable to breathe after walking up a flight of stairs. How will they do in labor? Not as well as those who have been doing aerobic dance or an elliptical machine 2 or 3 times a week.
The AHA/ACSM guidelines for the amount of aerobic exercise needed to improve cardiovascular status hold true for pregnant women just as they do for the rest of the population – a minimum of 150 minutes of moderate, or 75 minutes of vigorous, or a combination of these levels of intensity, per week. If you are not getting this level of activity, you are putting your health – and that of your offspring – at risk.
What is fetal programming? Every person living on earth was first exposed to a uterine environment that helped determine their lifetime health and development. The term for this phenomenon is fetal programming. It is a hot topic and deserves attention.
Accepting the importance of fetal programming places responsibility on the mother-to-be to do all she can to insure her body provides nutrients and oxygen to her growing infant while avoiding possible risks and toxins. At the same time, genetic and environmental factors contribute greatly to the potential for some disorders and problems that arise. Thus, we must be careful in assigning guidelines for acceptable behavior or blame for poor outcomes to pregnant women.
On the one hand, we can all see the negative consequences of something like fetal alcohol syndrome…clearly the result of maternal behavior. Is a pregnant woman whose baby has been damaged in this way guilty of abuse?
But, what if a mother is obese, eats poorly and ends up with an infant with a disturbed metabolism. Is this abuse? What if the mother has an infection that results in cerebral palsy? Or what if she lives near a highway and involuntarily inhales fumes that negatively affect the placenta?
How do you get a healthy baby? Of course, there are no guarantees. There remain many unknown factors that can affect the course and outcome of a pregnancy. Some factors we are aware of, such as avoiding certain fumes or chemicals. There are some behaviors we know can maximize the potential for a good outcome, such as eating adequate protein, aerobic conditioning and strength training. [Note for new readers…lots of these factors have been covered in our previous posts.]
But, what about all the things we don’t know about?
If these goats eat the wrong grass, will they go into labor?
Here is a cautionary tale: There is a species of goat that, if they eat a certain type of skunk grass on day 14 (and only day 14) of pregnancy, will not go into labor. Why? Plant toxins in this grass interfere with the development of a small portion of fetal brain, the paraventricular nucleus. This nucleus is involved in the signaling cycle of labor. Without it, the mother will not go into labor!
What are the take-home messages here?
Probably no one is ever a perfect fetus…too many possible threats.
There are some threats we can avoid…being lazy, over-eating, smoking.
There are some threats we cannot avoid, so we do the best we can.
Do the best you can by your baby…aerobic fitness, good nourishment, sleep, good hygiene and de-stressing your life.
MORE?!! You didn’t think that was it? Only a few comments on evidence as to WHY moving around, burning calories, being strong and learning to relax while pregnant is beneficial? No, of course not. You know there is more to it, like WHAT movement is safe and effective during pregnancy?
So, what is safe? Well, first, unless you have a very few conditions that your health care provider considers unsafe, every woman — fit, currently sedentary, young or a little older — can exercise safely in pregnancy. How much of what kind depends on your fitness level and exercise history. Get medical screening first.
If you are fit, you can do vigorous exercise
If you are fit, you just need to learn how to modify some movements to accommodate your biomechanics. As your body changes, stress on the joints and tissues means a little less jumping or ballistic motion will be more comfortable and safer. If you are fit, you can continue with vigorous exercise and it will be of benefit to you and your baby.
If you are not so fit or are sedentary, find a certified pre/postnatal instructor and join a group where you will have fun, get some guidance and be monitored for safety. How do you find such a person? Try our Find A Class or Trainer page.
What is effective? Don’t spend your time on things that may be nice to do but don’t help you focus and prepare for birth, relieve discomforts or have the stamina for birth and parenting. There is substantial scientific evidence and information from large surveys that these things are helpful.
Cardiovascular or aerobic activity is the most important activity you can do. Already fit? Keep working out; join a class if you want support or new friends. If you are sedentary or somewhat active, you can improve your fitness by doing at least 20 — 30 minutes of aerobic activity 3 times a week. Work at a moderate pace — somewhat hard to hard — so that you can talk, but not sing an aria! If you are more than 26 weeks and have not been doing cardio, you can walk at a comfortable pace. Aerobics is key because it gives you endurance to tolerate labor and promotes recovery.
Strength and flexibility exercises that do not hurt and are done correctly are also safe. There are some special pregnancy exercises that actually help you prepare for birth. Essential exercises that aid your comfort, alignment and birth preparation include:
• Kegels (squeezing and relaxing pelvic floor muscles) — squeezing strengthens them and thus supports the contents of the abdomen, and learning to release these muscles is necessary for pushing and birth.
• Abdominal hiss/compress and C-Curve® - contracting the transverse abdominal muscles reduces low back discomfort and strengthens the muscle used to push and later to recover abdominal integrity after birth.
• Squatting — getting into this position strengthens the entire leg in a deeply flexed position; start seated and use arms for support, stability and safety. Leg strength improves mobility and comfort in pregnancy and postpartum; plus, deep flexion is a component of pushing in almost all positions.
• Strengthening for biomechanical safety — strengthening some parts of the body helps prevent injury to bone surfaces, nerves and blood vessels within joints re-aligned in pregnancy. This can be done using resistance repetitions (weights, bands, calisthentics or pilates) or isometrics (yoga or ballet). A responsible class will focus on upper back (rowing), push-ups, abdominals, gluteals, hamstrings, and muscles of the lower leg.
• Stretching of areas that tend to get tight — relieving some discomforts through flexibility helps you maintain a full range of motion. Static stretches, used in combination with strength exercises or following aerobics, is most effective. Stretching prior to exercise tends to produce more injuries than not stretching. Areas needing stretching include the chest, low back, hamstrings and hip flexors (psoas).
Mind/Body skills are very important. There are two activities that exercisers constantly tell us are a big help in pregnancy, birth and parenting.
• Centering employs a balanced or neutral posture, deep breathing and mindfulness to help you work in a relaxed way. Athletes and dancers call this “the zone.” Starting your workout in association with your body establishes economy of motion, something very useful in birth and parenting, and reduces risk of injury.
• Relaxation is another key activity; it relieves stress, promotes labor in the early stages and helps you enter the zone!
How lucky is this? Just a few days ago, yet another study was released and has been circulating on Medscape and other medical sites that indicates exercise is beneficial in pregnancy, whether the mother is a previous exerciser or not. Just in time for this entry!
Behavior Affects Pregnancy Outcome
Physical exertion (we call it “exercise” nowadays) is a normal state for healthy humans. Only in the last century has the desire to rest or the need to store extra calories as fat become more possible to achieve than our need to move about to survive.
Pregnancy is a state in which both of these factors (resting and storing calories) are enhanced through organic changes in body chemistry, adaptations that favor fetal survival. The current sedentary lifestyle exaggerates these metabolic changes and results in syndromes that increase the risk for a number of metabolic, cardiovascular and immunological disorders of pregnancy.
When confronted by the idea that it is counterintuitive to think exercise in pregnancy might be safe (let alone beneficial) I am dumbfounded. To me, it is counterintuitive to think that a sedentary lifestyle in pregnancy might be safe!
Burning Calories in Pregnancy Improves Outcomes!
What is the evidence that exercise in pregnancy is beneficial? Keep in mind that some studies have been executed more expertly than others. But, what is compelling is that numerous well-respected researchers have sought to test the hypothesis that exercise is not safe, but come away with results that indicate the opposite!
Here are some of the major findings:
• The placenta is larger and has more transport surface in exercisers than sedentary women
• The fetuses of (aerobic) exercising mothers make beneficial cardiovascular adaptations
• Women who do aerobic exercise are less likely to develop severe preeclampsia or gestational diabetes, and the long term health problems that accompany these disorders
• Women who are aerobically fit recover from birth 10 times faster than sedentary women (as measured by time needed to metabolize free radicals produced in labor)
• Women who exercise in pregnancy are more likely to be physically fit in midlife
• Babies of aerobically fit women are at reduced risk for prematurity and low birth weight
So, we have arrived at the take-home message: MOVE!! Pregnancy works best when you move and burn calories in a moderate to vigorous fashion. But, alternate this activity with rest and good nutrition, and be sure to stay well hydrated.
If you want more specifics and resources on this topic, try these:
Let’s start at the beginning…in the first trimester you feel sick and tired, right? Three things:
1) your immune system is pro-inflammatory (causing nausea and fatigue), 2) your body is protecting your fetus from some toxins (if you eat something not so great for the fetus, you throw up), and 3) you have extreme swings in blood sugar levels so that after you eat, the level soars and you feel sick.
Number 3 can be fixed with behavior, but you may have to wait out 1 & 2. To fix number 3 eat very small meals frequently (6 or 8 times a day) and be sure to eat protein, that is, eggs, meat, fish, fowl, cheese, nuts, rice & beans, soy, etc. with each small meal. This stabilizes blood sugar and prevents dramatic elevations that can cause nausea.
In most healthy pregnancies, the immune system will rebound in the second trimester so that you feel good; it is protecting you again! But, those wicked toxins and infections are still out there in the environment, so the message is beware bad air (smog, smoking, industrial air pollution), highly processed foods (lunchmeats, things with names you can’t pronounce), any drugs or meds not prescribed or okayed by your ob or midwife, alcohol, and dangerous bacteria, viruses and other microbes!
Exercise wisely…no sky-diving or scuba diving! Eat healthy food and get enough sleep. De-stress through relaxation and meditative techniques. Don’t take risks with your health, but do stay active and start to prepare for birth and bringing home a baby (or two?).
Third trimester & the immune system goes on the fritz again — can’t keep this baby in here forever; must expel! You may feel sick and tired again. BUT, keep your prenatal care appointments, keep moving, get good nutrition, rest and stay focused. Before you know it the real work begins, not to mention the 18 years of sleep deprivation.
Getting from here…
Being Fully Present in Your Pregnancy…
Being Fully Present as Mom.
…is a journey like no other. The adaptations of your body to the demands of pregnancy are amazing. If you pay attention, you will learn more about the meaning of existence from this than from anything else.
BE HERE NOW!!
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Please refer to February 5 entry for entire graphic. Today: Environmental Preconditions to Pregnancy.
Our environment is with us all the time. Even if we think we are preventing or controlling environmental factors that impinge on our bodies and minds, they are lurking here, there, everywhere, and they are myriad. Our environmental influences are everything from the air we breathe to the persons who raise or teach us, from the food available to our housing, from our job stresses to cultural forces or even the weather in our part of the world. These things help shape who we are physically and mentally, over the long term and from moment to moment.
Are you prepared to become a parent? One way to tell is to look at your environment…is it healthy? Are you living in a situation that you can count on? What about clean air, safe paint or safe food? What about water? What about people around you? Are they supportive? Does your environment help you stay healthy?
What about your body? Factors in the environment that affect fertility (or lack of it) may determine if you can even become pregnant, or when you can become pregnant. Think about this: Women who work together often cycle together. What if you work alone, say at home…does this affect your ovulation? One factor identified in the lowering age of menstruation in girls is the increasing number of hormones in various meats. Another factor is the presence of non-biologically related older males in the household. If these things are known, imagine what is not known about situations, chemicals or people in our environment that affect our reproduction!
There is not an absolute separation of genetics, environment and behavior. If we are genetically predisposed to certain disorders, for example, we may or may not develop them, depending on environment. Some persons are inclined toward autoimmune disorders, but they may do well or poorly depending on the air pollution where they live. Some individuals may develop immune disorders. And, this situation may adversely impact inflammatory responses during implantation.
People who strive to take care of themselves even if they live in horrible conditions can use their behavior to improve their chances for success in everything from a healthy pregnancy to a meaningful existence. Even if genetics and the environment are against the process, behavior can sometimes overcome the odds. Granted, it’s not likely you can produce 6′5″ offspring (see last post on genetics!) if the egg person is 5′2″ and the sperm person is 5′7″, but much is possible beyond that.
So, what do you do about your environment if you are thinking about becoming pregnant? Take stock. Ask yourself what, if anything, might have to change. Ask what you can or can’t accept for your offspring, if you know there are environmental factors that aren’t perfect. Fetuses are amazing creatures; the placentas that supply and defend them are ruthless and will protect a fetus at all costs. But, you can give your body and potential baby a good chance to do well by providing a six month span of a healthy environment leading up to conception. And, healthy for mind as well as body.
When your baby comes into the world, a door opens in your heart to a room you didn’t even know was there. In that room is a certain kind of love and caring that cannot be described. It is love for this being who is and isn’t you. As a mother, you have been her/his environment for nine months or however long you have shared. The womb is a small, protected, organized environment, one that reflects your larger environment. So, take stock now, ahead of time.