Tuesday, January 21, 2014

The 40-Week Training Plan - Phase II

Second trimester – week 14 to week 26

The second trimester seems to be the honeymoon of pregnancy for most women. Everything says it’s the time when you have the most energy, and for most women, the nausea also goes away. Sounds perfect, right? Well…there’s still indigestion, constipation/diarrhea, and the fact that none of your running clothes fit anymore to make this trimester still a bit of a challenge ;)

The guidelines that are out there for this trimester:
1. No exercises on your back.
2. No kettle bells or jerking movements (maybe).
3. No core exercises (maybe).

The Challenges:
1. Indigestion
2. Fatigue
3. Growing girth/weight gain

What I learned this trimester:
1. Listen to your body!
2. Rest is golden.
3. Triathlete GI symptoms get even worse when you're pregnant. You just have to roll with the punches and alter workouts accordingly.
4. Running is amazing...even when you're big.

*No exercises on your back*

Just reviewing those guidelines that I put for the second
Inferior Vena Cava Syndrome
trimester, I think we need to add some stipulations. No exercises on your back is true, and it relates to anatomy. In so-called Inferior Vena Cava Syndrome, the weight of the baby in the 2nd and 3rd trimesters compresses the inferior vena cava which supplies blood back to the maternal heart. For those cardio-phys enthusiasts out there, this decrease in venous return to the heart leads to decreased cardiac output and eventually decreased blood flow through the aorta and to the baby. Basically, lying on your back evenutally leads to decreased blood flow to the baby. The sudden rise in venous pressure can also cause placental separation (YIKES!) and decreased renal function (not good). Symptoms of inferior vena cava syndrome are intense pain on the right side of the body, muscle twitching, decreased blood pressure, and retention of fluid. 

So, maybe just listen to your doctor and don't lie on your back. Definitely don't do exercises on your back because during exercise you are already making valsalva maneuvers that increase internal abdominal pressure and working to increase your cardiac output. 

*No kettle bells or jerking movements (maybe)*
There is soooooo much info out there on kettle bell
workouts for pregnant women. Do your research,
listen to your body, and go with what you were doing
prior to pregnancy...as long as it still feels right.
An uncredited source that I read mentioned no kettle bells after the first trimester. I think most MDs aren't very specific about the exercises that you're allowed to do other than the specifics of no exercises while lying on the back. The idea behind this concept of no kettle bells refers to the premise of doing more controlled movements. I have still done kettle bell swings during the second trimester, but I have not done any cleans. I'm sure elite athletes are still doing cleans while pregnant, but they have professionals to monitor their form, etc. Most pregnancy books recommend no heavy weights or power lifting. The most important thing is to breathe and perform your strength training movements in a controlled fashion. I think that's more important to keep in mind than to eliminate any one form of exercise.

Most workouts for pregnant women are made up of high repetitions and low weight. This is not necessary and often not effective depending on what certain women have been used to doing prior to pregnancy. A better idea is to lift lighter weights for a similar volume. Meaning, choose a weight at 65-70% of your 1 rep max and lift in a controlled fashion 3 sets of 10. Also possible is more sets of smaller reps, but controlled movements are key. 

*No core exercises (maybe)*
Okay, so my ACOG certified what-you-need-to-know-about-your-baby-and-pregnancy book says no core exercises during 2nd and 3rd trimesters. But, squats, lunges, running, sitting on a theraball, standing with good posture--these are all examples of "exercises" using core muscles. So, I think within reason, this is one of those flexible guidelines. It is true that performing core exercises that are extremely difficult (and they may not have been that difficult prior to pregnancy), that cause you to valsalva, or that strain abdominal muscles are not safe during pregnancy because they can worsen an abdominal diasthesis, or separation in the muscles of the abdominal wall. If you feel like your diasthesis is worsening, it is best to have your obstetrician check it at a visit before continuing with core exercises. Modified core exercises are great too. You don't have to do crazy abs when your belly is loosening up and preparing for carrying a baby! That comes after you give birth ;) 
Doing planks with a theraball may be more
comfortable and less strenuous during pregnancy.

It is always best to go with how your exercises make you feel. I was doing planks and push-ups into the early second trimester, but as my abdominal muscles started separating to make room for my growing uterus, it started feeling weird to me. I wasn't sure if it was uncomfortable, but it was enough to make me lay off planks and traditional floor push-ups. One of the reasons it was difficult and weird-feeling for me was probably because I wanted to plank for as long as I had pre-pregnancy, which isn't the best idea I suppose. You also have to keep in mind that any gravity exercise you are doing is now more weight than most women have ever carried in their lives. This is the case for me. I have never had to push up this much weight before, and it makes a difference. Obviously, bench press is out of the question because it is done while lying on the back. Incline press is questionable. TRX, light saddle-bag lunges and squats, and light kettle bells have been my strength training exercises of choice during the second trimester, and I've also added bar push-ups (they're easier). 

*Other General Considerations*
-avoid repetitive intense isometric exercises
-avoid heavy resistance weight lifting
-avoid any exercises that result in a marked pressor effect during pregnancy
-avoid or modify exercises that cause excessive joint stress (due to increased joint laxity during pregnancy)

And with what frequency?
This article from 2001 http://www.ncbi.nlm.nih.gov/pubmed/11228494 found that women who exercised greater than or equal to 5 times per week had lower birth weight infants compared with women who had exercised 3-4 x per week. Interestingly, they also found that women who exercised less than 2 times per week had lower birth weight infants but not as low as the excessive exercisers. But, what gives, ACOG? No new studies on this stuff since 2001? That was back when they were writing articles about whether VBAC (vaginal birth after cesarean section) was safe or not. So I'm reluctant to lend any weight (HAHA...weight) to this article, structure my workouts around it, or recommend that others exercise only 3-4 x per week as well. I will say that later stages of pregnancy tend to make you cut back and slow down on workouts just naturally. So even people running 30 miles a week in the first trimester are running less mileage, jog-walking, and/or running fewer times per week by the end of the pregnancy. The same kind of seems to go for all forms of exercise. And now ACOG says 30 minutes of moderate activity a day, so doing something every day, if that's your thing pregnant mammas to be, go for it. Your body will tell you what is right for you. Isn't nature smart?

So, how's it going? 
24 weeks, 5 days, still running
So, this week marks week 25, and I'm not loving the second trimester as much as everyone said I would. And, be it pregnancy or residency exhaustion, I'm not feeling as good as I thought I would...on some days. I'm feeling more and more pregnant and definitely bigger than I have ever been in my life. I can feel my running form changing, but in a way, running is more comfortable than it was in the late first and early second trimesters when I wasn't used to running with a belly. Be it my bigger form or the work of growing a baby, my shifts working in the pediatric ICU and elsewhere are a lot more physically taxing than I feel like they should be, but I guess that's what being a pregnant resident is all about. The other surprise is that I'm not exercising as much as I thought I would. I'm averaging somewhere around 4 workouts per week, still with 10-15 miles of running total per week, some swimming, some biking. I feel super pregnant and gross some days with very little energy, and other days I think, "Wow, this is the energy people mentioned." That energy fades in like 1-2 hours, though. I will say that whenever I go for a run, as soon as I am moving, it feels like the best idea in the world that I decided to go for a run. It's the closest thing my pregnant cranky self gets to feeling human these days. So, in a way I think it would be helpful if I could do it every day, but that's just not feasible with my work schedule and with the extra rest I have realized that I need. The good news is that I am starting to appreciate more and more full-on rest days. They make me appreciate the days that I exercise even more, and they help me re-charge from work/pregnancy. That must be why my pregnancy app is always saying, "Make sure you are getting plenty of rest," and I always roll my eyes and think, "This totally wasn't written for residents." The best news is that our baby is doing well, and that makes me happy, no matter what O:-)

Stay tuned for
-maternity workout gear
-running form changes during pregnancy
-third trimester updates
-post-partum fitness

More Info:

On Strength Training

On kettle bells during pregnancy
There are a ton of workouts online, but I would be weary of just finding one if not put together by a certified trainer.

Uptodate Info on Exercise during Pregnancy:

Also see original "The 40-Week Training Plan" blog for further resources