SUNDAY MAGAZINE

Stay fit for two

DR. SHEELA NAMBIAR M.D

Exercise during pregnancy can help prepare you for childbirth; exercising after can help you get back in shape.

We’ve heard the age-old counsel to “eat for two” in pregnancy that, although said with the best intentions, is not truly necessary for the mother or the growing foetus. As we all know Indian society, more often than not, revolves around food.

Pregnancy is an opportunity for mothers and grandmothers to pamper their little girls who are ‘to-be-mothers’ with the most indulgent recipes handed down through generations. Indian parents travel across the globe to be with their daughters during their pregnancy, to keep them “safe” (which often translates as “immobile”), and to help them with their life changes post-delivery. It is a brilliant practice but one that might require some modifications to accommodate today’s lifestyle.

Pregnancy is not a disease that needs to be treated or cured. There are symptoms like dreadful nausea and vomiting as well as the dizziness and fatigue; the mood swings that don’t seem to let up. The backache, peripheral oedema, insomnia, heartburn and sheer exhaustion in the latter months are, for many, a critical component of being pregnant. Being well informed, equipped, mature and, sometimes, just plain accepting might prove to be the only sensible way to get through what might not be the most comfortable nine months in your life.

So what can you do to ease your symptoms and perhaps transform these months into an odyssey that could prove to be more meaningful than traumatic and empowering than simply painful and trying?

Planned exercise

Getting “Fit for Two” before a planned pregnancy requires more than just an amorphous plan. While a positive attitude in looking forward to a joyful pregnancy and easy delivery goes a long way to keep you optimistic, it is not sufficient to ensure that you have the emotional and physical endurance, the training and knowledge to adapt to unpredictable developments during pregnancy.

According to ACOG (American College of Obstetrics and Gynaecology), exercise during pregnancy can help prepare you for pregnancy and childbirth; exercising after can help you get back in shape.

Being pregnant is only the beginning of a long journey into motherhood. The journey does not end with the delivery of the baby; instead, as I often tell my patients, it’s only just getting started!

It is crucial to understand that you need to train your body to accommodate another living being and adapt to the various physiological, hemodynamic and structural changes that it undergoes during those nine months. This training should ideally begin well before getting pregnant. If it has not been initiated already, then it is never too late to begin in pregnancy under the vigilant supervision of a qualified professional.

Having the option of planning a pregnancy allows women time to train optimally for the marathon of pregnancy and labour. This is especially the case for the urban women today who choose to have children later in their lives.

Although being older brings about a greater level of emotional maturity (most of the time!), it can be harder physically, not to mention the statistically higher incidence of bringing forth children with chromosomal anomalies. Training to stay strong and gathering the resources required for a healthy pregnancy becomes even more imperative in these cases.

There have been some concerns about the safety of exercise in pregnancy and the weight of the child at birth. However most studies show that well monitored exercise can benefit the mother provided the necessary precautions are heeded.

Fitness in pregnancy, delivery and after requires a thoughtful consideration of Exercise and Fitness; Diet and Nutrition, One’s Emotional/ Mental status.

Exercise in pregnancy is also categorised into the Aerobic component, Strength training and Flexibility.

Aerobic component

Walking is an ideal exercise during pregnancy. It is low impact and chances of injury are minimal. The cycle, elliptic/cross trainer or stepper are all available in most gyms and can be used as alternatives for a low impact cardio workout. Twenty to 30 minutes of a cardio workout five days a week is ideal.

In the early stages of pregnancy, you may be just too exhausted, nauseous or ill-tempered to exercise. Slow walking, yoga, deep breathing with relaxation techniques are usually better alternatives to a vigorous cardio workout at this point. In the last trimester, it may be required to break up the workout into two separate sessions during the day to counter fatigue. Enthusiastic exercisers may be tempted to push themselves to the 70 per cent or even 80 per cent intensity that they are accustomed to. While this is ideal in the non-pregnant state, it is not recommended while pregnant. Stay at 50-60 per cent of your intensity (where you can have a comfortable conversation with your exercising partner, but not be able to burst into song) During pregnancy the centre of gravity of the body shifts due to the growing uterus. This, in addition to the instability of the joints of the feet and knees and hips can lead to a compromised balance and a higher risk of strains and sprains.

Higher work load on the heart during pregnancy (in the form of higher cardiac output and stroke volume) can cause higher intensity workouts to be detrimental to pregnancy. Staying at 50-60 per cent intensity is sufficient to sustain cardiovascular endurance.

The objective of aerobic training in pregnancy is not weight loss but optimum health. It has been shown to prevent and control gestational diabetes, improve mood, prevent oedema, help you sleep better, regulate bowel and generally make your pregnant months easier to deal with.

Strength Training and flexibility

Pregnancy brings about muscle imbalances and undue stress on certain parts of the body due to the enlarging uterus and weight of the breasts. Increased lumbar Lordosis (curvature) causing the pelvis to tilt. The shoulders round forward and droop. The wide paced, rather awkward, walk adopted in the later months, swollen feet, indigestion, backache, sleeplessness and fatigue can make these months hard to endure, leave alone exercise.

However, if the proper exercises to strengthen the over stretched muscles of the upper back (the trapezius, Latissmus dorsi, and Posterior deltoids) and stretch the tightened muscles of the chest (pectoralis and serratus anterior) and anterior deltoids are executed, a large part of the pain and discomfort can be relieved. Strengthening the legs, back and abdomen, stretching the inner thigh and hamstrings, exercising the pelvic floor muscles and working the calves will go along way in aiding the support of the extra weight in pregnancy without developing varicose veins and cramping. Relief for the stretched round ligaments by ‘hip flexion’ exercises or the tense pyriformis muscle by the deep gluteal stretch will relieve most of the common ‘aches and pains’ of the pregnant months. An easier and quicker labour has been found to prevail in women who exercise regularly. They are stronger, capable of withstanding pregnancy and labour and also recover at an incredible pace after the delivery.

Strength training exercises can be done in 15-20 minutes twice or thrice a week as time permits. There are several simple exercises which can be easily learnt.

Stretching

Stretching tightened muscles is imperative if you want to avoid the pain associated with the progressing pregnancy. It can be done everyday after warming up the muscles. Stretching the contracted muscles eases the tension and allows for a feeling of relaxation and calm especially when combined with the appropriate breathing.

A stretch routine can be used as a sole mode of exercise, especially towards the last few weeks, when any other activity seems intolerable. The synchronised breathing allows for some introspection and calm at a time when it may be impossible to do anything else.

Learning how to breath rhythmically during delivery, (although sometimes not a totally feasible exercise), can help you gain a sense of control of a situation that seems so hysterical.

Finally, exercise in pregnancy is not just about ‘staying in shape’ (as that is hardly possible!), but about staying in some semblance of control at a demanding time, finding tranquillity and inner strength, and about preparation for the foremost challenge of your life.

Diet and nutrition and emotional wellness during pregnancy and after call for another commentary at another time.

The writer is a practising Obgyn, a Fitness and Lifestyle Consultant NAFC (U.S.A) and Director, TFL Fitness Studio, Chennai. E-mail: >drsheela@tflinc.net

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A few exercises that are specifically designed to combat muscle imbalances:

Lateral raise/Shoulder press.

Bent over lat raise/Seated Cable rowing.

Flyes/Pushups, depending on the stage of pregnancy, followed by chest stretches.

Hip extensions

Quadreped Arm/Leg reach to stabilide the ‘core’.

Abdominal crunches and Side Plank on the Swiss ball.

Squats, lunges and calf raises to strengthen the lower body.

Kegels exercises and pelvic Bridging for the pelvic floor muscles.

Seated Cobbler, Spinal twists, Downward dog and Child’s pose are some of the yoga poses that can be incorporated into your routine.



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Precautions to take while exercising: (ACOG Guidelines)

Exercise in a cool environment to avoid over heating of the body. Warm up and cool down adequately before and after exercise and stay well hydrated.

Avoid exercises that call for lying on the back for prolonged periods of time after the fourth month of pregnancy. Strengthening the abdominal wall can be done on the “Swiss ball” however.

Always use the appropriate clothing and foot wear that allow for sweat to be absorbed and stability while moving.

Avoid exercises that call for significant test of balance like the one legged poses of Yoga, running/skiing downhill and martial arts based exercises. The hormone Relaxin and Progesterone released in pregnancy lead to a certain degree of instability in the joints which present as loss of balance. It is not advisable to test this balance inordinately and incur accidents.

Avoid high-impact exercises or contact sports, like horseback riding and high impact aerobics, tennis, kickboxing during pregnancy; the early months allow for a runner to continue running if that is your preferred mode of exercise, but as pregnancy advances it may be wise to change to a lower impact activity like walking. (Although I must admit, Indian women don’t need to be convinced of this, as they are already extremely cautious about any activity in pregnancy).

At the first sign of any untoward symptoms like cramping, bleeding, loss of fetal movements, fall or injury, consult your physician.

There are some relative contraindications to exercise in pregnancy like pregnancy induced hypertension, a low lying placenta, bleeding in pregnancy etc which your obstetrician should be able to warn you about.

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