Transcription:
Exercise During Pregnancy

Melanie Cole (Host): Today's special episode of Kids Health Cast comes from our Back to Health series. This conversation features Dr. Zhanna Fridel and we discuss what expecting parents should know around exercise and fitness during pregnancy.

Welcome to Back To Health, your source for the latest in health, wellness, and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back To Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine. I'm Melanie Cole, and I invite you to join us as we discuss exercise and fitness during pregnancy.

Joining me is Dr. Zhanna Fridel. She's an assistant attending obstetrician gynecologist at New York Presbyterian Hospital Weill Cornell Medical Center, and an Assistant Professor of Clinical Obstetrics and Gynecology at Weill Cornell Medical College Cornell University. Dr. Fridel, it's a pleasure to have you with us. I'm so glad we're talking about this. I'd like to jump into this by asking you, what would you tell a woman right now that she can be doing as far as exercise before she gets pregnant to help ensure a healthier pregnancy?

Dr Zhanna Fridel: Good morning. Pregnancy is a perfect time to get healthier and more fit. And I see patients for preconception counseling, that is before they get pregnant, and I always advise them in addition to doing some necessary blood tests and taking their prenatal vitamins, that exercise is a very important part of preparation for the pregnancy. Anyone can exercise. It does not have to be expensive. They don't have to join a gym and one of the best exercises anyone can do, and it's available and affordable, is walking. Walking involves all muscle groups. It is easy and it can be modified to any fitness level. So I would tell someone who hasn't exercised before, go outside and start walking.

Melanie Cole (Host): Well, that certainly is great advice and something that really anybody can do, right? So, let's talk about some of the things that fitness does help with and ways that it can help you to get ready for that pregnancy. So, we all know that exercise helps with being overweight. How does being overweight affect a pregnancy or even underweight? And so, as we're setting these goals and trying to exercise before we get pregnant, how can that preconception healthy weight and exercise goals help us in the long run.

Dr Zhanna Fridel: So, both pregnant and non-pregnant individuals can benefit psychologically and medically from exercise, because exercise helps to improve cardiorespiratory endurance, muscle strength, flexibility, body composition, coordination, power, balance, speed. Two-thirds of Americans are currently either overweight or obese, so exercise helps those people to avoid excessive weight gain during pregnancy and it helps people feel better. It improves people's mental state. It makes people happy. So being overweight certainly has consequences in pregnancy and being obese especially, because it increases the risk of diabetes in pregnancy, preeclampsia in pregnancy, large for gestational weight infants and exercise helps to modify those risk factors.

Melanie Cole (Host): So what exercise specifically are we talking about? As women are pregnant, if they have not been somebody who's exercised before and maybe they want to start slowly, you mentioned walking. But what else can they be doing? Can you please speak about some specific exercises? And then we will talk about red flags and things they need to watch out for. But what are you talking about when you mean specific exercises?

Dr Zhanna Fridel: So a certain set of exercises that are considered safe to either initiate if they've never done that before or continue. So I've already mentioned walking. Swimming is a great exercise, because it helps to reduce any stress on the joints. It's easy, but it does provide a lot of cardiovascular benefits. Spinning bikes are very common and very popular right now, so any stationary cycling is good. Low impact aerobics, modified yoga and Pilates. People can do some jogging or running, and certainly some light strength training. And again, you don't need to join a gym. You could get basic exercise equipment for home, some light dumbbells, and there is a lot of different programs that people can join online on social media and do these modified yoga or maternity Pilates classes and certainly some pelvic floor muscle training like Kegel exercises. So all of those exercises are easy, accessible, and it does not require previous training experience.

Melanie Cole (Host): Can you tell women how long if they're going to go walking, if they're going to cycle, if they're going to go swimming? Because a question that I received just so many times was how long should I be doing it? Is 10 minutes enough? Is three 10-minute sessions enough? Should I be doing it all in one? Answer those questions for women, Dr. Fridel, if you would.

Dr Zhanna Fridel: Absolutely. So if a woman has never exercised before and a woman is leading a sedentary lifestyle, I would start off with just 10 to 15 minutes of these exercises two to three times a week. And as the woman feels that there is progress, then I would increase those exercises to about 30 minutes, anywhere from five to even up to seven days a week, depending on the strength and intensity of the exercise. So if someone is going to walk or cycle, they can start with 10 to 15 minutes of activity, two to three times a week and increase it to 30 minutes up to five to seven days a week. For someone who has been exercising before, they can start off with doing 30 minutes of moderate exercise five days a week. And that is what's recommended by American College of Obstetrics and Gynecology.

Melanie Cole (Host): Dr. Fridel, I remember when I was pregnant and as I told you off the air, I'm an exercise physiologist and, at the time, I was, you know, a personal trainer and very heavy into that. So I was a big exerciser. What do you have advice-wise for women that are big exercisers? I mean, I was told, and my doctor had to drill it into me, to cool it a little bit and to calm down on some of my exercise so that I wasn't doing too much. How do we know if we're doing too much?

Dr Zhanna Fridel: So for someone who is either an elite athlete or a person who just loves exercising and has been in great shape and exercised their whole life, certainly I recommend using something that's very easy and it does not require any equipment or money commitment, simply a talk test. So if a person can have a conversation during the exercise, then that activity is not strenuous enough and they can continue that during pregnancy. If someone is unable to speak during the exercise, then probably during pregnancy, that's a little bit more vigorous than we recommend.

And certainly for weightlifting, I have a lot of powerlifters as my patients, patients who do professional bodybuilding, there is a lot of controversy about how much a person can lift. So I usually recommend lowering the amount of weight. So for someone who is doing dead lifting of 200 pounds, we usually don't recommend doing it in pregnancy because it increases the intraabdominal pressure and there's potential concern for preterm delivery or placental abruption. But certainly, I don't tell people not to work out or not to lift weights, but I recommend limiting the amount of weights a woman lifts to no more than 20 to 40 pounds. And for someone who's been exercising for a long time, they could make those exercises strenuous even with that weight, even if it seems light to them. So I would definitely do the talk test. I think that's one of the easiest to do.

Melanie Cole (Host): No, that's great advice. And that's a good way to kind of keep track of how hard you're working. Now, there are certain exercises that as a pregnancy continues become a little bit contraindicated. Can you speak about things like abdominals? If women are taking a class and everybody gets down on the floor to do crunches and things, sometimes those are contraindicated for women in their ends of their second trimester and into their third. Can you speak just a little bit about some exercises that you feel are just really not as safe for women as they move along in their pregnancy?

Dr Zhanna Fridel: Absolutely. So there are certain exercises that all patients should avoid irregardless of their previous activity levels. And that's anything that can potentially hurt the woman and result in abdominal trauma. So I usually tell patients to avoid contact sports, so ice hockey, boxing where they're sparring with a partner, basketball, because if a ball hits the abdomen at high speed, it can increase the risk of placental abruption, where the placenta separates from the uterus. Also if there is a high risk of falling or hitting the abdomen, like skiing, that I usually do not recommend, same thing for skateboarding. Scuba diving, skydiving, those things can cause significant issues, they can cause decompression sickness. And for someone who hikes more than 6,000 feet, it can make someone have high altitude sickness, which is very dangerous. So those exercises are prohibited like acute mountain sickness that people who hike really high up over 6,000 feet can cause. So those exercises, no matter of the previous activity levels, are contraindicated in pregnancy. So I definitely ask to avoid that.

The question you asked about crunches. I prefer that my patient do standing ab work. After the first trimester, I don't recommend doing crunches on the floor because as the woman is laying down, it could cause a compromise and decrease flow into the uterus. So those exercises I don't recommend, but there is a lot of standing exercises that people can do lifting their knees, and that, can help with abdominal and in general core strength.

Melanie Cole (Host): Do you have any red flags? Before we get ready to wrap up, things that you want women that are exercising, whether they're new exercisers or they've been around a while. Taking your advice about tapering down, whatever, but red flags, if we're in an aerobics class or we're swimming or biking, any of those things that you want women to take notice of and say it's time to stop exercising and/or call their doctor.

Dr Zhanna Fridel: Absolutely. So I tell people to listen to their bodies because our bodies will tell us when things are not going well. So if someone is exercising and they feel extreme lightheadedness, or if they're bleeding, they feel nauseous, they are sweating profusely, they cannot continue conversations, those things are even for elite athletes signs that we should be stopping the exercising and contacting the doctor, slowing down. Heated exercises are not recommended, but let's say someone is cycling in a studio and it's very hot, I think it's time to stop that exercise, leave the studio and cool off. So certainly anything that, you know, if someone's feeling decreased fetal movement, cramping, pain, those are some warning signs that this is not safe and they need to contact their doctor.

Melanie Cole (Host): Very good advice. And what about postpartum, Dr. Fridel, are there some specific recommendations for when a woman can get back into her routine or start exercising again? I remember right after I had my first child, I took a walk the day I got home, not a big long walk, but I threw a blood clot. And my doctor said, I meant you could walk to the end of the driveway, not go on a half a mile walk. And I mean, I guess I didn't even realize it, but there are some things. You know, women's bodies need to kick back in a little bit, right? So give us some of your best postpartum advice.

Dr Zhanna Fridel: Absolutely. And I'm a mother myself, and I know that I have overdone at a time and I definitely felt it. I've had patients who were admitted to the hospital two or three weeks after the delivery, because, since walking is okay, they decided to do a seven-mile hike and came to the hospital with severe pain and bleeding.

So I usually recommend that when someone gives birth, it's almost an equivalent of running a marathon. So you have to give yourself some grace. You have to give yourself some time to recuperate. You're dealing with a newborn, you're dealing with either perineal repair or recovering from a surgical scar, and those are some major changes. So our bodies need time. They need rest. They need sleep. They need good hydration. So while exercise is extremely important, immediately postpartum, I think is the most beneficial to get the extra nap in, to take that warm shower, to drink that extra bottle of water. But as someone is feeling better, I usually recommend starting to take short walks. So for example, one to two blocks. We don't need to go from zero to 60. So someone does not need to return immediately to their level of previous activity because our bodies have gone through a lot of changes. So I would say gradual beginning of return to normalcy.

So in the initial weeks from the delivery, I would say in the first zero to three weeks from the delivery, I actually recommend minimal straining, very short walks, gentle stretching, and certainly Kegel exercises, which help to strengthen the pelvic floor. After three to six weeks, I would say a longer walk depending on how someone is feeling and I would leave it at that. They can maybe do very, very gentle, very low-weight arm exercises, but nothing more than that. And certainly concentrating on the Kegel exercises, which help to support the pelvic floor. After they get the clearance from their doctor at six weeks and beyond, then they can slowly increase their endurance and go back to their pre-pregnancy level of activity of 150 to 300 minutes of moderate intensity physical work. But again, that should be done slowly. It doesn't have to be done immediately.

Melanie Cole (Host): Well, I think that's great advice and that we women have to be kinder to ourselves and more patient with ourselves after we've just given birth. We have to know that our bodies will get back there, maybe not quite exactly the way that they were, but they will. And we just have to be kind to ourselves and patient. And as you say, take our time because it'll happen. Give us your best advice as we wrap up. What would you like women to know about exercise and fitness during and after pregnancy?

Dr Zhanna Fridel: So remember exercise is great. It's great for your mind. It's great for your body, but it doesn't have to be long. You don't have to hire a personal trainer. You don't have to join a gym. Anything is better than nothing. So no exercise is bad within pregnancy limitations. Be gentle, listen to your body. Do the best that you can every day. Be kind to yourself. Remember there's always tomorrow. Set short-term goals and continue them and you will see that you will progress and you will feel better.

Melanie Cole (Host): One-hundred percent agree. Thank you so much, doctor, for joining us today and sharing your expertise for women that are out there wondering what and how much exercise they can do as they're pregnant or post-pregnancy. Thank you again.

And Weill Cornell Medicine continues to see our patients in person, as well as through video visits and you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Back To Health. We'd like to invite our audience to download, subscribe, rate, and review Back To Health on Apple Podcasts, Spotify and Google Podcasts. For more health tips, go to weillcornell.org and search podcasts. And parents, don't forget to check out our Kids Health Cast. I'm Melanie Cole.

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