Written by Ives Hot, ACE-Certified Group Fitness Instructor
Wow it's been a minute since we shared a post. A lot has happened in the past couple of months. Kaila Jae is turning ONE this month, we have both ran and PR'd races, and I am joining the FIERCE club of mamas in May 2020. Oh yes, pregnant and THRIVING. Thrive is my word for 2020 and my goal is to be a resource for women in Seattle that are embarking on this journey, are thinking of pregnancy in the future, or are post-partum.
Let me preface this by saying that as a fitness instructor one of the first concerns I had when I found out I was pregnant was how will I need to adapt my workouts. I was in the peak of my marathon training cycle and initially my worry was how do I need to adjust my training and nutrition to run a successful race. As I started my web search for pregnancy and running, I quickly realized that I would also need to adjust my HIIT strength training. My goal here is to share helpful modifications to make other women feel comfortable in strength training classes as they embark on this wild pregnancy journey! I am going to talk about some of the science behind what is happening in your body, break down moves by trimester, and give you confidence to keep showing up in class for YOURSELF and that BABE.
This post serves as a guide based on expert opinions and guidelines that are available. However, you should always check in with your OB/GYN and listen to their advice about exercise and pregnancy. Pregnancy is also not the time to suddenly become a workout fiend, if you weren't active at baseline.
WHY SHOULD I MODIFY MY CORE EXERCISES?
If you're new to pregnancy, you may be wondering why you should change what you're doing before you have a big old belly in the way. Even if you aren't showing, in the first trimester your uterus starts to grow and expand to make room for baby -- this means your abs start to stretch. Towards the end of your first trimester, beginning of the second trimester you will want to check for diastasis recti (DR).
Diastasis = separation
Recti = abs
DR describes the abnormal separation of your left and right abdominal wall, which appears as a gap between the two sides. It is normal for your abs to separate slightly during pregnancy to make room for baby, but a separation greater than 2 centimeters is thought to be abnormal. When you have DR and crunch up, you may notice "coning" or a ridge that occurs in the center of your belly. But why is DR bad? Generally, DR is bothersome because it can cause lower back pain, urinary incontinence, constipation, and at times makes vaginal delivery more difficult. In rare cases DR can lead to hernia formation due to there being a thinner layer of tissue allowing the organs to poke out.
DR can happen with any pregnancy, but is more common when women carry twins, have had multiple pregnancies, or are shorter in stature. Based on "What to Expect," if you develop a 3 finger width separation between your abs, you definitely need to modify your core exercises. Modify does not equate to STOP exercising. A strong core supports a strong pelvic floor and you definitely want that for delivery.
You may be one of the lucky mamas and not feel any symptoms (nausea, aversions, fatigue) until halfway through the first trimester. If you are experiencing those symptoms --it's okay, you aren't alone and hopefully that all improves in the second trimester. In regards to adjusting exercises this early on there are lots of expert and not-so expert opinions. Again, please be aware that most of the articles that are available are written based on expert opinion and don't necessarily have strong data supporting them.
There is a camp of individuals that feels strongly that you should not "do crunches." The reasoning behind this strong stance is that a "sit-up" or crunch motion places more pressure on the rectus abdominus (left and right more surface layer ab muscles). There is also some conflicting data from the Journal of Orthopaedic and Sports Physical Therapy, that demonstrated how abdominal crunch exercises performed during pregnancy actually shortened the inter-rectus distance from gestational week 35-41 through 14 weeks post-partum. If you don't want to stop traditional ab exercises, you can modify them by placing a wedge or ball behind your back for additional support. Ultimately, unless any exercises are causing discomfort or pain you do not need to modify during the first trimester. However, if you are more apprehensive about developing DR, you can focus more on oblique and transverse abdominus strengthening exercises.
Example 1: Side Plank
Example 2: Bird Dog
By now you may be starting to look pregnant, especially if you are having twins or this is your second or third (or more) babe. If your bump seems small, don't stress either. We all grow and show differently in this phase of pregnancy and it can be hard to hear comments from friends, family or strangers about your body. For Christy and I, we both did not show until later into our second trimester. Try not to compare yourself to other mamas or if you aren't pregnant yet, try not to mom shame. Whether you outwardly look preggers or not, chances are that YOU have noticed a change in your abdomen by now. It's wild to think of everything going on inside your body. Your uterus has grown much larger to make room for baby, amniotic fluid, and the placenta and clothes feel tighter (hello stretchy pants #BLESS).
Because your body is changing, you may start to feel differently about your typical exercises and in turn need more modifications. Personally, at about 18 weeks is when I started to modify my abdominal exercises. I am now at 22 weeks and continue to exercise 6 days per week, including running, cycling, HIIT, and strength work. I still do Barry's classes about 4x per week and although I am a bit more breathless, I continue to hit sprints on that treadmill albeit a bit slower. (For perspective: My baseline is an endurance athlete and I ran the NYC Marathon at 13 weeks pregnant.)
I no longer perform abdominal exercises that involve a full range sit up, v-up, jack knife, or bicycle crunch. Basically, any fast tempo or quick diagonal ab exercise I view as off limits and I rather focus on slow-controlled exercises that allow for breath to be connected to movement. You can also continue traditional or side planks and the bird dog mentioned above if it feels good.
Exercise 1: Knee Hover or Mountain Climber March
Exercise 2: Deadbug or Heel March
Exercise 3: Heavy Lifting Moves i.e. Deadlift, Squat, Lunge
You are in the final stretch mama! Things are feeling really REAL as you feel baby moving daily, don't sleep as comfortably, and probably start to move a bit slower. You are not alone in how you feel and can always reach out to Christy and I with questions, concerns, or stories. There is no such thing as TMI when you're growing a human!
This is also when you really start modifying exercises to feel more comfortable and to try to reduce DR. The pressure from intra-abdominal flexion can cause that "coning" or ridge to appear. You are going to want to avoid traditional ab exercises by this point if you have been hanging on to them.
Exercise 1: Plank
Exercise 2: Modified Bird Dog
Exercise 3: Heavy Lifting Moves i.e. Deadlift, Squat, Lunge
Alright we have covered A LOT. I hope you feel empowerd to show up for yourself and that babe in the gym or your next group fitness class and have some tools to adjust ab exercises when they come up. Don't worry you're not alone on this journey. Just remember to notify the instructor that you are pregnant and will be modifying! This post is based off literature searches on PubMed, Lexicomp, as well as opinions from fitness experts that wrote for Shape Magazine, Parents website, What to Expect, and Bump. Another great resource I found in my research was the Pregnancy Guide from Expecting and Empowered.
CONQUER YOUR SUMMIT,
Christy here to talk about exercise and lactation. Most mamas are eager to get back into a regular workout routine postpartum and I was totally in that same boat, but the other question that comes up is whether exercise impacts breastfeeding and milk supply/quality. I personally did a little research when I started working out more vigorously postpartum, but I wanted to dive a little deeper to ensure I was sharing the best knowledge. Ives was kind enough to pass on some scholarly literature she has access to, to aid in my research.
I also know that this is a sensitive subject and I by no means am an expert in this area, so please consult your doctor for medical advice before beginning exercise postpartum. I’m simply a new mama sharing my journey and research along the way in hopes of helping others in the same boat. As a reminder, it is typically recommended to wait 6-8 weeks before beginning regular exercise. This will look different for everyone based on their individual recovery.
When I first began researching exercise and lactation, I was happy to learn from various sources and studies that participating in regular, moderate to intense exercise postpartum does not impact milk supply, quality, or a baby’s growth once a woman’s milk supply is established (through supply and demand) and in fact has so many benefits! The caveat being that every woman is different and in scenarios of extreme diet restrictions and/or high levels of exercise intensity that vary drastically from what the woman was doing prior or during pregnancy, it is possible to experience milk drop off.
In general, breastfeeding typically shouldn't be a time to cut back on calories and personally, I'm not focusing on any specific goals besides feeling as good as I possibly can with all of the changes and challenges a new mom is up against. The postpartum phase is such an important time to nourish your body and ensure you are not only adequately fueling yourself but also finding the time to move or more importantly, find time for yourself.
According to KellyMom.com, a website developed to provide evidence-based information on breastfeeding and parenting, “Moderate exercise improves a mother’s health and has a positive effect on her emotional well-being”. So mamas, I'm a huge advocate of letting go of the mom guilt in order to spend some time giving back to yourself!
As ultra runner Sophie Power put it, when a picture was snapped of her as she breastfed her son Cormac during the 105-mile Ultra-Trail du Mont Blanc race, “It has highlighted something that women feel really unable to talk about. There is this huge mother’s guilt that all the time you need to be 100% focused on your baby, and I’m saying that by not focusing on your own physical and mental health you can’t be the best mother. For me, personally, I need to be physically fit and have those mental breaks. Women really struggle to be open about saying that.”
I couldn't agree more and is yet another reason I wanted to research and shed light on exercising while nursing. Let's dive into some of my key findings which include milk composition changes, lactic acid in milk, and calories/nutrition needed during exercise while nursing.
Milk Composition Changes:
Although research has shown that exercise does not impact lactation as noted above, I want to give you all sides of the story.
According to KellyMom.com (also noted above), “Exercising to exhaustion may have a short-term effect on IgA content of a mother’s milk”. This is based off a few small studies. If you don’t know what IgA is, like yours truly… after Googling it, I learned that it is one of the most common antibodies in the body. We need IgA to fight bacteria, viruses, and toxins. The decrease in IgA after intense exercise is however very short lived, 10-30 minutes and levels return to normal within the hour. Also, a decrease in IgA in one feeding per day is very unlikely to make a difference on your infant’s health.
Lactic Acid and Milk Taste:
The other worry some mamas have is lactic acid in breast milk. Lactic acid does not harm your babe, but can change the taste of your milk. Apparently there was a highly publicized study in 1992 indicating that a baby may refuse expressed milk from a mom that has been exercising at 100% intensity. Please note that the babies in this study were fed milk by a dropper and not from the natural source, the nipple.
I personally have had no issues with this and there are times where I do workout at a high intensity, but it’s still something to consider as you begin to increase your workout intensity.
If you notice an issue, the advice is to wait an hour after intense exercise before feeding/pumping. Simply pay attention to whether your baby consistently rejects your milk after exercise, talk to your doctor, and make adjustments as needed.
Okay, so now that we can assume it’s okay to exercise and breastfeed, let’s talk hydration. Hydration is key for keeping up your milk supply, even if you aren't exercising. Exercise causes you to sweat (we love this), and lose water that then needs to be replenished following exercise. Everyone is going to be slightly different with the amount of water they will need to drink, but a good rule of thumb is to ensure your urine is clear.
If you are a numbers person, The Institute of Medicine says that on average a breastfeeding mother should consume 3.1 liters which equates to 13 cups, compared to 2.2 liters or 9 cups for non-pregnant/lactating women. These are just guidelines and remember, you know your body best.
A personal tip is purchasing a hyrdoflask tumbler with a lid and straw! Having cold water nearby that was easy to sip from a straw (and didn't spill, because it was knocked over often) seriously made a world of difference. My Hyrdoflask tumbler was 22 ounces, so my goal was to fill it up 4-5 times a day!
Calories in Vs. Calories out:
I don’t count calories or weigh myself, but it's important to touch on and based on my research your caloric intake should not fall well below the amount of calories you are burning in a day (less than 20-25%). Keep in mind, on average, you are burning 300-500 extra calories per day when breastfeeding/pumping.
My personal advice and what has worked for me is to eat when you are hungry and to eat nutritionally dense foods. I breastfeed approximately 3X a day and pump 2-3X during the work week. I typically eat 3 meals a day and 3-4 small snacks. This includes fresh fruits, vegetables, healthy fats, whole grains and legumes, and lean proteins. Having easy, healthy snacks easily accessible is key! Chopping up veggies to eat with hummus, making my lactation energy balls, or having nutritionally dense bars stashed away, such as RX, Lara, or PerfectBars are great options.
Want to lose weight post pregnancy?:
Based on my research, if you are trying to lose weight the key is to not drop more than 3/4 a pound to a pound per week. Drastic weight loss could impact milk production. Just like exercise during pregnancy, however you were eating prior or during pregnancy will not have a major impact on your milk supply. So what this means is that with any calorie deficit changes, the key is to start slowly. It took almost a year for your baby to grow inside of your changing body, so keep that in mind and be kind to yourself as you try to meet your goals.
When it comes to nutrition both postpartum and to help with lactation, there is a lot of information out there, but some key takeaways I learned specific to exercise and lactation were around protein and calcium intake.
In regards to protein, it's recommended to keep your intake up to prevent loss of muscle mass (Recommended Intake of protein for nursing mothers is 65 grams/day for the first 6 months and 62 grams/day between 6 and 12 months). Below are some practical foods guidelines.
For calcium, it is recommended to get at least 1,000 mg a day, "especially if you’re training at a high intensity,” recommends Diane Spatz, P.D., professor of perinatal nursing at the University of Pennsylvania and manager of the lactation program at the Children's Hospital of Philadelphia. From an article pulled from Runnersworld.com, "Women can lose 3 to 5 percent of their bone mass while breastfeeding, according to the National Institutes of Health: “This bone loss may be caused by the growing baby’s increased need for calcium, which is drawn from the mother’s bones,” says the NIH. Low estrogen, which protects bones, may also play a role.
Don't think you have to go chugging milk... dairy products are obviously rich in calcium, but here are a few other sources outside of the dairy family, rich in calcium:
There is no such thing as a perfect diet and sometimes it's just ensuring you are eating enough, never deprive yourself. Your body is working hard to produce milk and it's okay to treat yourself even if it doesn't fall into these guidelines. As they are just that, guidelines that I found interesting and helpful as I continue to stay active and especially as I plan to pick up my exercise intensity now that I feel my body has healed from birth.
Whether it's adding more protein or calcium into your diet or maybe just letting go of the mom guilt you may be feeling when you leave the house to get a work out in, I hope you found this information helpful! Whether you are a breastfeeding mama or planning to breastfeed one day while staying active, let me know your thoughts and/or experiences below!
THE WEEKS FOLLOWING RACE DAY AND GLYCOGEN REPLENISHMENT
It's been three weeks since Ironman 70.3 Coeur d'Alene and I am a couple of weeks into marathon training. If you are new to endurance training (or you are my husband) you may roll your eyes and think, "this biish is crazy." Truly, I never thought I would be the person to finish a race of any kind let alone be hopping from one to the next. But they are addicting. I'm not even close to NYC Marathon and I am already thinking of what will be my next marathon or Ironman. That being said, recovery between races is SO important.
After my first marathon, I heard from other runners that you should take ~30 days off after you race and let your body recover. I didn't do much research, but that sounded good. I was so sore the first week and I also missed cross training, so it wasn't that difficult to hold off on running and fill my time with my favorite group fitness classes. A handful of races later, I am actually interested in understanding why recovery is important and how to recover appropriately. Reminder every human and race is different. This is meant to provider more details and look at what evidence if any is out there. Always feel free to share your perspective below or email us!
When Should I Start Running Again?
There are lots of opinions and recovery plans out there. As a clinical pharmacist, I have access to scholarly literature searches (Pubmed and UpToDate), which I used to help delve into some of the later details on this topic. However, I decided to start my search like many of you would, by surfing the web to see what comes up when you type in "marathon recovery plan."
If you have ever looked up running plans, then chances are you have come across a Hal Higdon plan. Hal Higdon is a runner and a best-selling author. He has developed training plans for everyone from novice to advanced runners, half marathons and full marathons, and even has a week by week guide for the month post marathon. He refers to the time frame post marathon as, "Mile 27" in his book. I will be the first to admit that I have not purchased any of these plans, so I cannot vouch from personal experience, but I do think they create a great framework. My spark notes summary of his recovery program for advanced runners is below:
I wanted to compare the Hal Higdon post-marathon recovery plan to other internet plans. My next web search brought up and article from Runner's World. Pleasantly, Runner's World broke down the recovery post marathon week by week as well. They didn't provide as much detail on when to run or incorporate speed work, but encouraged adding on to intensity and duration as week's progressed.
At this point, I want to look into the science behind the recovery. Most plans are recommending a similar amount of time to recover, but why? What is going on in your body after a marathon?
In a study by Tsai and colleagues, massive aerobic exercise i.e. running 26.2 miles led to un-repaired DNA base oxidation. "This oxidative DNA damage correlated significantly with plasma levels of creatinine kinase and lipid peroxidation metabolites, and lasted for more than 1 week following the race." WHOA...what does that actually mean?? Creatine kinase is a muscle enzyme that lives within your mitochondria and is usually elevated in response to muscular damage, which in turn is a marker of the degree of muscle injury. It is also involved the storage and transfer of energy. In elite athletes or in marathoners the concentration of this particular enzyme increases within skeletal muscle and is usually in response to regenerating muscle fibers.
So basically, running a marathon = elevated creatine kinase for ~1 week = wait a couple weeks to resume vigorous aerobic exercise.
Runner's Connect is another great blog with a wealth of information, including a post on overtraining. In this post, the recommendation is to wait 2-3 weeks post marathon to allow ample time for recovery of both creatine kinase and myoglobin (myoglobin acts as oxygen storage for mitochondria). Based on my research, there are limited studies and data on the physiologic changes that occur after prolonged aerobic exercise; however, it appears that at least 2 weeks of light or minimal exercise is recommended before the athlete resumes rigorous training. One of the other topics that intrigued me was nutrition after the race. We all have heard of carbo crams before aerobic sporting events, but what about replenishing our glycogen stores after crossing the finish line?
Carbo-loading Post-Race: Glycogen Replenishment Facts
Disclaimer, the pic above is part of the dinner my husband an I enjoyed before my Ironman 70.3. It has absolutely nothing to do with building back glycogen stores after the race. I wanted to share this pic to spark some intrigue --everyone's pre-race rituals and nutrition vary. That is normal and I don't encourage you to suddenly change your diet the day before a race to reflect what works for me. However, a part of training involves using the months prior to race day to figure out what food fuels YOU best. I don't change my nutrition drastically the days leading up to my race. I don't eat pasta often in my regular life because it makes me feel heavy so you probs won't see me eating pasta the day before a marathon. I do love sushi and fries. So you can bet my pre-race meal always includes sweet potato fries and either sushi or an alternative lean protein source (baked fish is great if the city doesn't have great sushi). I also drink one, no more than two glasses of wine or a margarita in my normal week. PAUSE. Yes, you read that right. I am an athlete who enjoys fries and alcohol. Pre-race jitters would be so much worse if I also forbid myself from enjoying the foods and draaanks I love. Again, I don't binge drink while training so I definitely don't binge the day prior to the main event but a glass of wine is the perfect way to unwind. But enough about pre-race carbs, let's chat about what comes after.
Massive aerobic training does not just impact your muscle fibers and enzymes, it also depletes your glycogen stores. But what is glycogen? An article in The Sport Journal, titled "Glycogen Replenishment After Exhaustive Exercise," delved into awesome detail on this topic.
Glycogen is made up of long chain polymers of glucose molecules which are stored in liver and muscle and used by the body during exercise . At higher exercise intensities, glycogen becomes the main fuel utilized. When liver glycogen is depleted it can reduce blood glucose levels which results in volitional exhaustion. The concentration of muscle and liver glycogen prior to exercise plays an important role in endurance exercise capacity. It is actually typical for glycogen to be more depleted in the liver than muscle following intensive training, 85-95% versus 65-85%, respectively. Although you did a stellar job building up your glycogen stores before the race, now you have used all that energy and need to refuel.
Think about it, your body is like a race car. You fueled it with premium fuel leading up to race day and you won because you competed and completed by crossing that finish line. Now I don't know about you, but my bodice is even more of a temple after that race and I definitely want it running smooth quickly after. So fuel up! The two hour window immediately after exercise cessation is optimal for carbohydrate (carb) ingestion. Your glycogen resynthesizes at a rate of 2% per hour after this two hour window, but this rate rises to 5% when 50 grams of carbs are consumed. Another lit search led me to a great read titled, "Fundamentals of Glycogen Metabolism for coaches and Athletes," which states that 1-1.2 g carbs per kg of body weight per hour should be consumed to take advantage of the improved glycogen synthesis that can occur immediately post massive aerobic exercise. The overall goal is to ingest 10 g of carbs per kg of body weight in the first 24 hours.
For example, I weigh 63 kg (or ~140 lbs) so my goal is 630 grams of carbs post marathon and I should ideally try to eat 60-75 g of carb per hour. Let me put that in perspective, a banana has ~30 g of carbs and a slice of bread has ~15 g of carbs. So it takes WERK to eat all those carbs. Work smarter, not harder people! Help your bod recover by capitalizing on improved glycogen synthesis occurring immediately after the race and start ingesting those carb dense foods shortly after crossing the finish line.
Below are some examples of carb-rich foods from that article:
P.s. you can bet I looked up grams of carbs in my two fave foods (because research duh)... a side of sweet potato fries at a restaurant is ~50 g and the average sushi roll is anywhere between 50-60 g. Unfortunately, a pour of wine is only 4 g of carbs. Soo I guess I will stick to eating my carbs ;).
OKURRR... I know I hit you guys with a lot of science and knowledge bombs, but hopefully this helps you understand the importance of recovering the right way after your next big race. I know I have personally failed at glycogen replenishment in the past and feel fatigued the evening and day following the race. I will definitely be making some big changes to nutrition after NYC Marathon and am hoping this helps with energy. I also need to SLOW DOWN after races and allow more than 5 days before revisiting vigorous physical activity. Guilty of starting back up again too quickly! I promise to be more patient after the next race and respect my body if you all do, k?