- Lisa Grossman, RN, BSN, PHN, OCN
Perinatal Fitness and Exercise
I had the pleasure of chatting with Danielle Spangler of Core Mom and who many of you may know as “Bionic Mommy.” Danielle teaches workout classes that are safe for expectant mamas and mamas in the postpartum period that have been cleared by their OBGYN for exercise. She provided some great advice about how to safely exercise during and after pregnancy. If you have any questions for Danielle, she can be reached at firstname.lastname@example.org and you can visit her website at www.daniellespangler.com. Q: What is your advice in terms of working out during pregnancy? If someone has never worked out before, is it okay for them to start exercising? A: If someone has never exercised before they can always start fresh. In 2015 ACOG stated that unless there is a major preexisting medical condition, women should be physically active during pregnancy. According to the CDC, the standard is 150 minutes per week. Q: For those who were already working out before becoming pregnant, can they continue with their current workouts or should they modify? A: I would advise them to veer away from traditional strength training classes at the gym because they are not usually taught by somebody who has a prenatal fitness certification so they may not be able to help them modify. I would advise them to seek out exercise classes that specifically meet their needs. Most doctors tell their patients to walk. Walking isn’t necessarily bad, but, especially during the third trimester, the relaxin hormone produced by the body during pregnancy coupled with the expanding hips during pregnancy can cause the legs to externally rotate. When external rotation of the legs occurs, the feet also turn out and this can change a woman’s gait. The change in gait can cause her to compensate with different muscles which can create injury. In addition, walking in the third trimester causes the hip flexors to tighten and shorten, putting more pressure on the back and also throws the body into a forward “rounding” position (especially in the region of the upper back, which places pressure on the pelvic floor). I tell women that walking isn’t bad; however, they should be mindful about the way that they are walking. The hips and shoulders should be lined up and the head should be straight. Be careful not to turn your toes out and carefully keep your feet forward. Q: Tell me what you know about the condition called diastasis recti. What is it and can it be prevented? A: Diastasis recti (DR), to put it simply, is a separation of the abdominals. The connective tissue that binds the left and right side of the abdominal wall is called the “linea alba." When pregnant, this connective tissue stretches to accommodate the growing pregnancy with the help of the relaxin hormone. As as a result micro tears can develop creating a “gap” in the abdominals. Diastasis recti is considered problematic when the gap is more than 2 cm wide. You can get screened for this by your doctor, pelvic floor PT or someone who specializes in pre and postnatal fitness (like myself). A few examples of risk factors for DR include age, multiple pregnancies, women with a narrowed torso and I’ve personally noticed it with women who have hyperextensive joints. Usually after birth everybody has a little bit [of DR]. What happens is that a woman’s doctor releases her at a postpartum check-up and says it’s okay to continue what she was doing prior to pregnancy. The woman will go back to her old workout routine and do crunches or start running but that intraabdomnial pressure is too much for the connective tissue. For some women, they may have already been at risk for DR and then the activity after pregnancy can send it over the edge. I’ve seen that a lot. The best way to prevent DR is to be cautious during and after pregnancy. Avoid movements that create extra “intra-abdominal pressure” like getting up by using your abdominal muscles or any exercises like crunches, static planking, etc. My goal is to try to screen as many people in class as possible for DR but, at the same time, I feel like it is almost irrelevant because most postpartum women have a little bit of abdominal separation and I don’t want to dwell on that. I want to teach them how to properly strengthen and activate their muscles and they will eventually start to bring the gap a little closer together. Q: Is every exercise that you focus on in your class safe for postnatal mamas? A: Yes! Every exercise I use is with consideration that every woman that walks into my class has a fragile linea alba. I choose my exercises as if everybody has some sort of pelvic floor dysfunction whether it be pain, urinary incontinence, prolapse… all of my exercises would be safe for any of those pelvic floor dysfunctions. Q: To summarize, what are your recommendations regarding perinatal exercise? A: Exercise during and after pregnancy is a must; however, how you exercise is something that you need to be cautious about. Make sure that you do not jump right back into activity that you did prior to pregnancy and do not push yourself. What you are doing now is going to effect you for years after your pregnancy. I’ve seen it on the other side with my peers. My peers are in their 40’s and 50’s and some of the things that they are still experiencing can be traced back to pregnancy and childbirth. It is never too late to seek proper exercise techniques. Inquire with a physical therapist or someone like myself who understands this population. The earlier you do it the better you are going to be for the long term. We are trying to set you up for success not just for right after the baby is born but for years to come when you are an older woman to prevent you from having leakage, pelvic pain or anything else that we have been told is a normal “side effect” of having a baby. To read more about ACOG’s current recommendations relating to exercise during pregnancy please visit: https://www.acog.org/Patients/FAQs/Exercise-During-Pregnancy. Danielle has a Bachelors of Science in Kinesiology and over a year of credits toward a Masters in Exercise Physiology. She has earned many certifications through various organizations such as The Grey Institute in Applied Functional Science, The National Academy of Sports Medicine, The American College of Sports Medicine and The Cooper Aerobics Institute of Dallas. Danielle has completed multiple continuing education courses focused on pre/postnatal fitness. She is currently writing her own pre/postnatal specialty certification. She has completed many courses focusing on the female kinetic chain & female anatomy. She also worked at Sports Club LA for 5 years and worked specifically with pre/postnatal clients, which is where she got most of her hands-on experience.