Exercise in My Pregnancy
I wanted to write about the training I did through my pregnancy, there is a lot of misinformation about exercise and pregnancy. Even more so with CrossFit and pregnancy. I think it’s because there’s a tendency to think it involves snatching 100 kilos whilst walking on your hands. Sometimes it only takes for people to hear that you’re training when you’re pregnant for them to impart their uninvited opinions on what you should or shouldn’t be doing. Ultimately this comes from a good place! As annoying as it may seem society perhaps views pregnant women as delicate and needing to be protected. Growing a life is an incredible thing to do and I think people are phobic about things they don’t understand. This includes women who choose to exercise to a moderately high intensity whilst pregnant. Many times I had lovely members of the public rush over to lift things in or out' of my car whilst I was pregnant, I just smiled and accepted it. I could have started ranting about being a strong independent woman whilst tearing the sleeves off my jumper and flexing but ultimately sometimes it’s nice to have the help! One thing I do feel strongly about however is a woman’s right to train during pregnancy.
I was lucky to have an uncomplicated pregnancy my feet got a bit puffy towards the end of the second trimester but that was about it. I trained five days a week and was lucky to do most of it at Commando Training Centre (CTC) in Lympstone. With my husband being in the Marines I could use their gym. Once it had warmed up a bit in late spring I went pack to my old Crossfit gym, Crossfit Pi. I think this was a big part of the reason I managed to train for the entirety of my pregnancy right up to 40 weeks. Being in Lympstone I was away from the public and I could just get on with things. There was no “oof should you be doing that love?” One thing I did get on a semi regular basis were marines looking a little nervous but giving me a thumbs up or saying how nice it was to see a pregnant lady still training. I completed the CrossFit Open workout 19.1 when I was just shy of 23 weeks pregnant. Nothing was scaled at that point and I felt good hitting depth for my wall balls which I had to throw to the male target height because there were no female targets (that started to grate on me by round 4). This is the beauty of CrossFit, on that particular day I felt great but say the next week if I was starting to become symptomatic with PGP (Pelvic Girdle pain) I’d cut out all unilateral work and not go below parallel. I could still do the same workout as the person next to me but scaled. Below is a scaled workout I completed at 39 weeks pregnant, I dropped the weight of my dumbbell thrusters and didn’t go below parallel. I just ticked through the workout in no particular rush.
Being a physiotherapist certainly helped me to stay safe when training but there are literally millions of women training and doing what they enjoy whilst pregnant. You don’t have to be a genius to work out that sometimes you are going to be tried and feel wobbly. Don’t get me wrong there are also women who will push through and have difficulty mentally adjusting to a change in their training whilst pregnant but that’s another post for another day. Ultimately for me it was about risk verses reward. Do you need to be kipping or going upside down? If the answer is yes then great discuss things with your coach and find ways of checking in and making sure you continue to be safe. Elite gymnasts are not going to stop handstands when they are pregnant! Some ladies want to keep doing box jumps throughout their pregnancy, I didn’t although I physically felt fine doing them I’m horrendously clumsy when it comes to box jumps, just ask my shins. That doesn’t mean the woman next to me who has an athletics background is going to stop box jumps. This movement may have formed an integral part of her power training for the last 10 years. With risk versed reward it’s important individual’s are honest with themselves and their coaches, this relationship works both ways. If coaches just say no to specific movements without rationalising and giving appropriate challenging scaling options the likely hood is the individual may just go and do it anyway potentially injuring themselves. There is absolutely no shame in scaling. Ever heard the phrase regress to progress? Well it’s true. The CrossFit website Crossfit.com is full of scaling ideas to keep you doing the movements you want but potentially reducing that risk. Nichole Christensen has compiled a table of scaling options for the pregnant athlete and written an article for the CrossFit Journal. You can find the website for the table and Journal in the references below (I did A LOT of sled pushes when I was pregnant)!
Your coaches will (hopefully) be a wealth of knowledge. You can still push yourself just in different ways. Anybody who suggests scaling handstand push-ups for seated strict press with dumbbells is an easy option, is a very bad liar! Remember risk vs reward. Your shoulders will still be on fire with those seated strict press but your midline will be less taxed and you’re not upside down reducing the risk of a fall under fatigue. BUT if you’re a gymnast, have been playing CrossFits for a long time or even if you are super confident and feel comfortable with no pain or contraindications then go ahead. You do you.
Don’t get me wrong I’m a very average Crossfitter! Pre pregnancy I had strict pull ups, butterfly pull-ups my weightlifting was ok(ish) on the weak side strength wise. Rx handstand press-ups were fine and I had a decent engine which I think comes from years of competitive swimming. Nothing develops your engine like thrashing yourself in a mildly hypoxic state for two hours a day 6 days a week for the best part of 10 years! I didn’t have any of the jazzy muscle up stuff but I was improving all the time and very much enjoyed my training. I found moving and getting out of breath was important for my mental health. I know that’s the same for a lot of other ladies too. I can’t really put my finger on why. I feel a bit on edge if I don’t find the time to be active or train so it’s something I’ll always try and prioritise. That was why I knew it was important that I kept training through my pregnancy if I could. I was fully aware my body would change and I made the adjustment in my head to switch from pushing for PB’s to maintenance and enjoyment.
I say that but I had to overcome some real demons to do that. As I say I was hardly going to the games but one thing I was exceptional at was being hyper critical of my performance. This does not translate well into pregnancy! I’d always have a little devil on my shoulder telling me to push harder rest less go heavier. Judgement and ego. Those things really have to be left at the door and better still not be picked up on your way back out of the gym. It took for one of my close friends to remind me that maybe people are looking at me thinking “crikey she’s very pregnant and still pushing through workouts, good on her!” Rather than “Ooof check out her pregnant ankles, her husband’s gym t-shirts are not doing her 8 month bump any favours!”
The no judgement extends from self judgement to judgement of other pregnant ladies. Some women will continue to hit full depth in their squats right the way through pregnancy others will go to where they feel comfortable. Some women will choose to olympic lift or use a barbell through their pregnancy. It’s very easy to judge by your standards. Please don’t! I won’t ever judge a woman but I will advise on best practice if they are symptomatic or if they want to change the way they train. Everybody is different with varying abilities. You have elite athelets and people who just want to see what it’s all about. Really unless I have assessed a pregnant lady watched her move and taken a full subjective assessment I can’t and won’t advise. What was right for me through my pregnancy might not be right for the lady next to me. That’s the beauty of sport and exercise, we’re all plodding away at our individual goals. The video below is me scaling my wall balls to not break parallel, I’m 8 months pregnant at this point. Not symptomatic but just finding the grind out of the bottom position with wall balls a bit too much (I blame my long femurs).
I did totally stop a couple of things because I felt pressure or uncomfortable doing them. The biggest change for me was stopping rowing at week 28 which broke my heart a little. I could still row perfectly fine but I was aware of some coning down my midline and I didn’t see the point in keeping on pushing so I scaled downing to either sled pushes or the airdyne. I stopped all olympic weightlifting super early well before I had a bump mainly because I know in my mind my bar path would have been all over the place and I didn’t need any help sabotaging my lifts, I was perfectly capable of doing that pre pregnancy. I substituted the barbel for dumbbells and I stopped strict pull ups around week 20 as they were starting to become uncomfortable on my midline. All kipping went out the window after about 20 weeks and all time favourite workouts like Mikko’s triangle were scaled in terms of calories. Pre pregnancy I’d do an hour of 12 calories every minute and just about survive, while pregnant I’d do 9 calories for half an hour. As a general rule I’d use the talk test. Am I able to hold a short conversation whilst I’m working out? If I was going full physio I’d get the Borg Scale of Exertion out, laminate it and lanyard it to myself promising not to go above a 6, I favour the talk test for obvious reasons. Below are a couple of things to keep in mind when you’re pregnant and training.
Things to look out for;
Coning or doming down the midline. Have someone observe you doing a specific movement if you’re worried or record workouts and look back. I was coning on rowing so I scaled at 28 weeks.
General fatigue levels. The first trimester and towards the end of the third fatigue plays a big role. On these days it’s good to move and slowly tick through it’s also good to go home and go to bed. Entirely up to you!
Are you eating/drinking enough?! I sound like an annoying relative here I know but growing a baby takes a fair amount of energy. We all know increasing calories is unnecessary until the second trimester when you can add an additional 340 calories. In the third trimester it’s increased to 450 calories. I know where are the tubs of Ben and Jerries you were promised?! Add to that a bit of training and some serious heat in May/ June last year and I had to seriously up my intake of fluids throughout the day and especially during and after training. This follows nicely on too…
The heat. Crossfit gyms and for that matter gyms in general can be like little saunas. Pre pregnancy training in the heat was bliss. Mid pregnancy it was hell. I was much warmer in general because of the increased blood volume, add to that 28 degrees with no breeze and a 30 minute EMOM and you have the perfect recipe for a mass scale of weight/ time/ reps, you name it.
Avoiding lying on your back for any part of the workout past 16 weeks of pregnancy. The weight of your uterus can weigh heavy on your Vena Cava.
Feelings of wobbliness, yes that is a technical term. I’m alluding to one of the many beloved pregnancy hormones, Relaxin. I could go on forever on this topic, it’s hotly debated. There isn’t just one straight answer to how it affects pregnant and post part women. As I’ve said before ALL pregnant and post part women are different, relaxin affects different people in different ways. Being mindful of exercises that create impact (box jumps, double unders) and moving to the bottom position or end of range be it flexion or extension.
Exersion, we discussed this previously. I personally felt comfortable exercising to a level 6 on the Borg Scale of Exertion. This is an individual choice and based on my pervious levels of fitness. The POGP (Pelvic Obstetric & Gynaecological Physiotherapy) recommend exercising to be woking at levels 3-5 in Fit and Safe To Exercise in the Childbearing Year (2013)
A brief look at the research
Beetham et al found no significant difference existed in birthweight for infants of mothers who engaged in vigorous physical activity. Findings from this meta-analysis indicate that vigorous intensity exercise completed into the third trimester appears to be safe for most healthy pregnancies. Further research is needed on the effects of vigorous intensity exercise in the first and second trimester, and of exercise intensity exceeding 90% of maximum heart rate.
Wang and Apgar reviewed studies on the dynamic of blood flow between mother and baby; Measurements of the effect of exercise on fetal heart rate demonstrate either no significant change or short-term increases of five to 15 beats per minute. Two studies have detected fetal bradycardia during vigorous exercise in untrained women performing near maximal capacity. All episodes of fetal bradycardia resolved in less than two minutes. In the same women, submaximal exertion to 70 percent of maximal aerobic power did not cause fetal bradycardia. Pregnancy outcomes in the subjects with transient fetal bradycardia were not significantly different from those in the other subjects.
Nascimento et al conducted a systematic review of literature on evidence concerning exercise during pregnancy. They found exercise during pregnancy is associated with higher cardiorespiratory fitness, prevention of urinary incontinence and low back pain, reduced symptoms of depression, gestational weight gain control, and for cases of gestational diabetes, reduced number of women who required insulin. There is no association with reduction in birth weight or preterm birth rate. The type of exercise shows no difference on results, and its intensity should be mild or moderate for previous sedentary women and moderate to high for active women.
To be clear, I would never prescribe CrossFit or high intensity exercise to any of my pregnant patients. I advise ladies to continue with the form of activity they were doing preconception and then assess movement patterns and subjective history. I have highlighted this research to assist individuals who already train pre pregnancy, in making a decision about the way they train through their pregnancy in addition to guidance from their midwife and other allied health professionals. This is only a very brief touch on some of the research. Highlighting one of the main issues with these studies is that none of them were specifically conducted on the effects of CrossFit on mother and baby. Potentially because it can be so varied, it’s not as simple as a random controlled trial with a group of ladies walking at x- pace x- times a week and for x- duration of time. There are unique physical factors that may predispose pregnant women to injury which is why it’s so important to remember risk versus reward. Speak to your coach, physiotherapist and midwife for further guidance if you have concerns. Below is an infographic from the department of health, “Listen to your body and adapt.” It has some really useful information to keep in mind.
The World Health Organisation and Public Health England recommend weigh training twice a week. Did you know that? No, neither did I until recently. The benefits of CrossFit are quite clear, I’m not talking about injuries or some of the crazy things people do, one arm snatches etc. I’m talking about a group of people completing the same exercises together scaling and or Rx’ing (completing at the prescribed weight/distance/reps/time/movement). It builds a sense of community and accountability to exercise which is a brilliant thing. Community includes all genders, all races and nationalities, young and Old(er), disabled, pregnant, fit, able bodied and unfit. Wouldn’t the CrossFit world be an exceptionally boring place if it only consisted of 20-30 year old fit able bodied men wearing bandannas, high-fiving each other with their tops off getting drunk on pre workout? If you see a pregnant lady in your gym smile! Encourage her, she’s about to complete the most important/amazing workout of her life, birthing that wall ball she’s been carrying around under her t-shirt! V x
References;
Beetham, K.S., Giles, C., Noetel, M. et al. The effects of vigorous intensity exercise in the third trimester of pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth 19, 281 (2019). https://doi.org/10.1186/s12884-019-2441-1
Crossfit Scaling options; https://www.crossfit.com
Nascimento. S., Surita., Fernanda. G., Cecatti, José G., 2012. Physical exercise during pregnancy: a systematic review. Accessed on 27/03/2020. Can be found at; https://cdn.journals.lww.com/co-obgyn/Abstract/2012/12000/Physical_exercise_during_pregnancy___a_systematic.6.aspx
Nichole Christiensen., 2017. Pregnancy, A Practical Guide for Scailing. Accessed on 24/03/2020. Can be found at; https://library.crossfit.com/free/pdf/CFJ_Pregnancy_Christensen_Table_5.pdf
POGP., 2013. Fit and Safe To Exercise in the Childbearing Year. Accessed on 25/03/2020. Can be found at; https://pogp.csp.org.uk/system/files/publication_files/POGP-F%26S%28Mums%29%202016.pdf
Wang. T. W, and Apgar. B.S., 1998. Exercise during pregnancy. accessed on 27/03/2020. Can be found at; https://www.aafp.org/afp/1998/0415/p1846.html