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Exercise During Pregnancy

April 10, 2020
exercise pregnancy naturopathic doctor toronto

Now that you’re pregnant, you’re probably wondering about exercise during pregnancy. I’m summarizing the Canadian guidelines for physical activity throughout pregnancy set by the SOGC.

By exercising during pregnancy, you’re positively affecting your and your baby’s health. If you don’t have any contraindications to pregnancy (which are posted below), now is the time to start doing something. Especially if you were previously inactive and/or considered overweight or obese.

How much and what type?

Ideally you should aim for about 150 mins of moderate-intensity activity over the week (think: 30 minutes, 5 days a week).

If you’ve been previously inactive, you may want to begin gradually at a lower intensity, and increase the duration and intensity as your body gets used to it.

Aerobic and resistance training, with a pinch of yoga are great options. And in terms of improving health outcomes for you and your baby, you should aim to do all of them within the week.

Some activities do carry a higher risk and are considered contraindicated during pregnancy – like scuba diving, any activities with physical contact, danger of falling, and non-stationary cycling. Avoiding high-heat activities like hot yoga – as it may cause dehydration.

What the F is DRA?

DRA, known as diastasis rectus abdominus, may occur in some people. Essentially, your abdominal muscles may begin to separate. If you’re noticing that this has happened, book a visit with your pelvic floor physiotherapist to see what you can do. This means that you may also want to avoid ab strengthening exercises for the time being.

One of my colleagues filmed a video about DRA a few years ago. Check it out if you’d like more info

What about the first trimester?

Studies show that exercise in the first trimester doesn’t increase the odds of miscarriage or congenital anomalies. In fact, not exercising during the first trimester increased the odds of pregnancy complications like gestational diabetes, gestational hypertension, excessive gestational weight gain and depressive symptoms.

Let’s keep it real though, most people are exhausted in their first trimester – so the idea of anything besides walking is absolutely not appealing. But, if your energy hasn’t taken a nose dive, or if you’ve reached the point in your second trimester where you feel like you can start your routine again – let’s get to it!

Should ALL pregnant people exercise?

Exercising during pregnancy can provide many health benefits, but there are women who shouldn’t engage in strenuous exercise as its contraindicated. Keep in mind, this doesn’t mean they’re not allowed to move and continue their activities of daily living.

Absolute contraindications to exercise include:

  • Ruptured membranes
  • Premature labour
  • Unexplained or persistent vaginal bleeding
  • Placenta previa after 28 weeks
  • Preeclampsia
  • Incompetent cervix
  • Intrauterine growth restriction
  • High-order multiple pregnancy – like triplets
  • Uncontrolled type 1 diabetes
  • Uncontrolled hypertension
  • Uncontrolled thyroid disease
  • Other serious cardiovascular, respiratory or systemic disorder

Relative contraindications to exercise include:

  • Recurrent pregnancy loss
  • Gestational hypertension
  • A history of spontaneous preterm birth
  • Mild/moderate cardiovascular or respiratory disease
  • Symptomatic anemia
  • Malnutrition
  • Eating disorder
  • Twin pregnancy after week 28
  • Other significant medical conditions

Obviously, if you fall into any of these categories you’ll want to check in with your OB/Gyn or Midwife to see about your specific health situation – especially if you fall into the ‘relative’ category. You’ll want to figure out the advantages and disadvantages of exercise with your care provider before you start to exercise.

Tell me about KEGELS

During pregnancy, you may start noticing some urinary incontinence – perhaps some leaking will occur when you’re running, jumping, and laughing. Although this is common, it’s not considered normal. Many books or other professionals will tell you to start doing kegels. Do NOT do this. Instead, visit a pelvic floor physiotherapist so they can assess your pelvic floor. The reason being is that your pelvic floor may be “tight” yet weak (hence the leaking), and doing kegels can cause your pelvic floor to become tighter, not stronger. However, sometimes kegels can be helpful – but it’s super important to get a professional assessment before starting these.

Never heard of kegels before? Check out this video filmed by one of my colleagues!

Final Thoughts

Exercise during pregnancy is a great thing if you don’t have any of the above absolute/relative contraindications – but always speak to your care provider if you have any questions.

If you’ve been a bit sedentary in the first trimester (that’s okay, pregnancy is tiring!), start slow with low intensity and shorter durations and increase as you go.

If you happen to notice any abdominal separation or even leaking while jumping/running/laughing, be sure to book an appointment with a pelvic floor physiotherapist. I’m writing this post during the COVID-19 pandemic and a lot of health care practitioners have transitioned to virtual visits, so there’s still an opportunity to see a pelvic floor physiotherapist or naturopathic doctor if you have the ability to do so.

References

Mottola, M., Davenport, M., Ruchat, S., Davies, G., Poitras, V., & Gray, C. et al. (2018). No. 367-2019 Canadian Guideline for Physical Activity throughout Pregnancy. Journal Of Obstetrics And Gynaecology Canada40(11), 1528-1537. doi: 10.1016/j.jogc.2018.07.001

PCOS and Exercise

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September 24, 2018
PCOS and exercise, toronto naturopath, naturopathic doctor toronto

We all know that exercise is helpful in general, and that is especially true for those living with PCOS. Exercise may improve ovulation, insulin resistance and promote weight loss. Yet, it’s hard to say which type of exercise, the intensity, and how much PCOS-ers should be doing.  

Types of Exercise

Resistance Training

Resistance training (also known as weight or strength training) requires the body (muscles) to push against force that is practised against it. This includes bodyweight exercises, plyometrics, use of resistance bands, free weights or machine equipment. Resistance training is thought to be beneficial to PCOS-ers because it can improve insulin resistance, glucose metabolism and resting metabolic rate, lowers body fat and increases lean muscle mass. 

One study looked at progressive resistance training in women with PCOS. Women in the intervention group exercised for 1 hour per day, 3 times a week for 4 months. Exercises included: bench presses, leg extensions, front lat pull-downs, leg curls, lateral raises, leg presses (45 degrees), triceps pulleys, calf leg presses, arm curls, and abdominal exercises executed in alternating segments. At the end of this study, the women with PCOS experienced weight loss and increased muscle mass, lowered androgen levels, increased reproductive function, but no significant changes to insulin resistance.  

The 2015 Almenning study also evaluated strength training compared to HIIT in women with PCOS, and also found that at the end of the study while there was an improvement in body composition, there were not any changes to insulin resistance. 

Aerobic Exercise

A 2018 study looked at aerobic exercise in women with PCOS. Participants performed 40 minutes of exercise (including 5 minutes of warm up and 5 minutes of cool down), 3 times a week for 16 weeks. The exercise group completed their supervised exercise outside on a track. Interestingly enough, the study does not explicitly state what exercise the control group did, however it may have been unsupervised exercise for 150 minutes per week (this is what I am guessing).

Results demonstrated that there was an improvement in the health-quality of life score, an improved cardiometabolic profile, reduced BMI and waist circumference, and overall positive response doing exercise. However, no changes were seen in fasting glucose or insulin or HOMA-IR values in both control and exercise groups. 

High Intensity Interval Training (HIIT)

In men with insulin resistance, studies have shown that HIIT has had a positive impact overall, compared to continuous training (think walking or running). 

One study looked  at HIIT in women with PCOS. These women participated in a 10-week program where they would do HIIT three times a week. Two sessions were 4×4 minutes of HIIT at 90-95% of their maximum heart rate, separated by 3 minutes of moderate intensity exercise around 70% of their maximum heart rate. The last session was 10×1 minute of maximum intensity HIIT separated by 1 minute of rest or low activity. Mode of exercise was dependent on the individual, but could be the treadmill, outdoor walking/running/cycling. The control group were simply advised to do at least 150 minutes of moderate-intensity exercise per week.  

The primary outcome of this study was to measure the change in insulin resistance (via the HOMA-IR value) from baseline to post-intervention. In the group who did HIIT, IR values significantly improved (specifically fasting insulin), as well as overall body composition. 

PCOS and yoga, toronto naturopath, naturopathic doctor toronto

Yoga

So far the only studies looking at the effect of yoga on PCOS, have been done in adolescent girls. In previous studies, yoga has been studied in men and with poor insulin sensitivity as well as in people with obesity and diabetes.  

A 2012 study looked at adolescent girls and the effects of yoga on glucose and insulin levels. Girls were divided into 2 groups – 1 which practiced yoga (1 hour a day for 12 weeks), and the other which practiced conventional physical exercises. At the end of the 12 weeks, there was reduction in fasting blood glucose in the yoga group as well as a drop in the HOMA-IR score of 0.38. The control group actually had an increase in their HOMA-IR score of 0.29. 

A 2013 study by the same authors looked at the effects of yoga in adolescent women, but this time specifically looking at endocrine parameters (Anti-mullerian hormone (AMH), luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone, prolactin, body–mass index (BMI), hirsutism, and menstrual frequency) before and after 12 weeks. Adolescents in the yoga study practiced for 1 hour per day for 12 weeks, while the other group simply practiced conventional physical exercises. At the end of the 12 weeks, they found that yoga was better at reducing AMH, LH, and testosterone and improving menstrual frequency. 

Final Thoughts

You obviously have your pick when it comes to exercise. I would choose something based on what you like to do (if you hate yoga, don’t do it) and what your goals are. I personally want to decrease my HOMA-IR value, so choosing HIIT and yoga might be the way to go for me. 

Something important to keep in mind is that exercise is not the be-all and end-all of treatment. In fact, doing too much exercise may impair your adrenal glands, causing more inflammation, thereby causing more insulin resistance. Sometimes taking it easy is key, and doing gentle exercises (ie. walking, yoga) will your best bet in your path of healing. 

Exercising Tips

One of my favourite authors, Gretchen Rubin, has some tips when it comes to sticking with exercise. Some of my favourites are:

  • Plan exercise with a friend who will not be happy if you don’t show up

  • If you’re travelling, figure out how you will schedule in some exercise

  • Keep track of how much you exercise (ie. I put stickers on my recycling calendar)

  • Pair activities (ie. Watching Netflix? Exercise at the same time)

If you found this information helpful, please sign up for my monthly newsletter called The Flow for great and informative content like this!

References

KOGURE, G., MIRANDA-FURTADO, C., SILVA, R., MELO, A., FERRIANI, R., DE SÁ, M. and REIS, R. (2016). Resistance Exercise Impacts Lean Muscle Mass in Women with Polycystic Ovary Syndrome. Medicine & Science in Sports & Exercise, 48(4), pp.589-598.

Almenning, I., Rieber-Mohn, A., Lundgren, K., Shetelig Løvvik, T., Garnæs, K. and Moholdt, T. (2015). Effects of High Intensity Interval Training and Strength Training on Metabolic, Cardiovascular and Hormonal Outcomes in Women with Polycystic Ovary Syndrome: A Pilot Study. 
PLOS ONE, 10(9), p.e0138793.

COSTA, E., DE SÁ, J., STEPTO, N., COSTA, I., FARIAS-JUNIOR, L., MOREIRA, S., SOARES, E., LEMOS, T., BROWNE, R. and AZEVEDO, G. (2018). Aerobic Training Improves Quality of Life in Women with Polycystic Ovary Syndrome. Medicine & Science in Sports & Exercise, 50(7), pp.1357-1366.

Nidhi, R., Padmalatha, V., Nagarathna, R. and Ram, A. (2012). Effect of a yoga program on glucose metabolism and blood lipid levels in adolescent girls with polycystic ovary syndrome. International Journal of Gynecology & Obstetrics, 118(1), pp.37-41.

Nidhi, R., Padmalatha, V., Nagarathna, R. and Amritanshu, R. (2013). Effects of a Holistic Yoga Program on Endocrine Parameters in Adolescents with Polycystic Ovarian Syndrome: A Randomized Controlled Trial. The Journal of Alternative and Complementary Medicine, 19(2), pp.153-160.

Improving Period Pain with Yoga

May 7, 2018
period pain and yoga, dysmenorrhea yoga, period cramps, toronto naturopath, naturopathic doctor toronto

Whenever clients come to my office with period pain complaints, they usually expect to have some dietary and herbal recommendations. As I’ve been doing more research to see what other therapies would be helpful for this all too common condition, I’ve come across some research investigating yoga as a therapy for period pain. 

What the research says about period pain and yoga

There have been three studies looking at the effects of yoga on period pain. All studies looked at three specific poses – practiced alone or with others and results have shown an improvement in pain duration, pain intensity, and quality of life.  

The three specific poses that were studied were: cobra, cat, and fish pose. The duration of the yoga practice ranged between 20 minutes a day to 60 minutes once a week, and length of treatment ranged between 2 to 3 months respectively. Unfortunately, there wasn’t a follow-up in any of the studies to determine the lasting effects. Also, the studies did not keep track of any pharmaceutical use between the yoga groups and controls. 

yoga period pain, toronto naturopath, naturopathic doctor toronto 

Cobra Pose

This energizing pose, helps to increase circulation within the lower back and pelvic, and provide them with a fresh supply of blood.  

How do do this pose

Start by laying facedown with your forehead on the mat. Your feet should be close together with pointed toes. Place your hands beneath your shoulders, palms down and elbows tucked next to the your body.

Inhale and curl your upper body off the floor 2 to 3 inches as you slowly raise your forehead, nose, chin, shoulders, and chest. Your pelvis should remain on the floor.

Return to a neutral position by, slowly releasing your upper body back onto the floor.

Cat Pose

Often seen as a warm up stretch (paired up as cat-cow pose), this pose helps to increase the flexibility and strength of the spine and improve circulation overall. 

How do do this pose

Kneel in neutral “table position,” with your knees under hips and arms beneath the your shoulders. Your back should be flat, and face should be looking down at the floor. 

Exhale and slowly drop your head and tailbone. Arch your back and exhale further as you pull your navel up toward your spine

Fish Pose

This pose helps to stimulate the pelvic organs (like your uterus!). 

How do do this pose

With your legs extended and closed together, lie on your back. Your hands should be palm down, underneath your tailbone. 

On an inhalation, lift your upper body onto your elbows and bend your neck backward. You can rest the crown of your head on the mat. At this point, your back should be arched. Ensure your weight is mainly on your elbows, not your neck. Press both sitting bones firmly into the floor.

Return a neutral position by pressing your elbows onto the floor. Gently lift your head, tuck your chin, and lower your upper body

Note: This pose may be a bit more labour intensive than the others, if you practice yoga at a studio, you may want to ask your teacher to help you achieve the proper position of this pose, or how to modify it. 

Final Thoughts

When it comes to period pain, there are so many tools available to help alleviate pain. My go to recommendations are usually going dairy-free as well as acupuncture (my favourite!). But incorporating yoga is an easy at-home treatment. You can likely start to practice these poses before and during your cycle! 

Of course, if you’re finding that you need some additional support or guidance, certainly feel free to contact me to see how I can I help with your period pain!

References

Rakhshaee Z. Effect of Three Yoga Poses (Cobra, Cat and Fish Poses) in Women with Primary Dysmenorrhea: A Randomized Clinical Trial. J Pediatr Adolesc Gynecol. 2011;24(4):192-196. doi:10.1016/j.jpag.2011.01.059.

Yonglitthipagon P, Muansiangsai S, Wongkhumngern W et al. Effect of yoga on the menstrual pain, physical fitness, and quality of life of young women with primary dysmenorrhea. J Bodyw Mov Ther. 2017;21(4):840-846. doi:10.1016/j.jbmt.2017.01.014.

Yang N, Kim S. Effects of a Yoga Program on Menstrual Cramps and Menstrual Distress in Undergraduate Students with Primary Dysmenorrhea: A Single-Blind, Randomized Controlled Trial. The Journal of Alternative and Complementary Medicine. 2016. doi:10.1089/acm.2016.0058.

Miller O. Essential Yoga. Chronicle Books; 2014.