Tania's Tips:  Running and Pregnancy

Guidelines for Exercise during Pregnancy by Canadian Academy of Sport Medicine. 

Pregnant Runner Products 

Baby on Board

By Sonia Mendes

When she was pregnant with her first child, Marian Coke continued doing training runs right up until the day she gave birth, much to the shock of a few of the people who saw her running with a rounded belly on the paths of Ottawa.
“I did get some strong reactions because I was very visibly pregnant – I was still running at 40 weeks,” says Coke, 41. “During one run, a lady called out ‘What are you doing? That’s child abuse.’”

It's nothing new that some people think it's dangerous for women to run while pregnant. After all, it wasn't so long ago that the prevailing wisdom was that even women who weren't pregnant could damage their reproductive organs by running anything further than 800m. That's why Kathrine Switzer was almost tackled by an organizer when she became the first woman to run the Boston Marathon in 1967 - five years before women were officially allowed to compete in it. And why there was no Olympic marathon for women until 1984. In those shockingly-recent dark ages, adding a bun to that supposedly-fragile oven would have been deemed, pardon the expression, inconceivable.

Obviously we've come a long way since then as far as women's running is concerned. But many people still wonder: Is running while pregnant bad for the baby? Does it constitute child abuse? No, say the experts. In fact, the thinking has evolved by leaps and bounds since the '60s. Today, physical activity - including running - is not only permitted during a healthy pregnancy, but usually deemed as highly beneficial. Many women, like Coke and 29-year-old Evelyne Gionet of Ottawa, have been able to continue running well into their pregnancies.

"My midwife has been very encouraging in terms of keeping fit," says Gionet, who ran three 10k races in the first two trimesters of her pregnancy this year. "She believes that it's good to be active during pregnancy, for so many reasons. I couldn't agree more - I've found that it has helped my energy level, and has improved my sleep and mental health."

Coke says the uninvited comment caused her to reevaluate what she was doing. But in the end, it only affirmed that she had made the right decision. "Sometimes there's a stigma (about running while pregnant), like how the occasional person doesn't like to see breastfeeding in public," she says. "But I would remind people that I was pregnant, not sick - it's not an illness but rather a natural state."

Just a Twinkle: Running Before Baby

Obviously, being able to train safely and effectively while you're carrying a baby starts with running before you get pregnant. Most medical recommendations suggest that women who are thinking of becoming pregnant and want to run or exercise during the pregnancy should get started prior to conception.

"I started running longer distances back in 2001," says Gionet. "It was addictive and my distances just kept increasing." Gionet, a New Brunswick native, ran her first marathon in September 2007.

As a result, with years of running experience, Gionet felt comfortable continuing her regime during the pregnancy, although she toned down her pace and distances considerably.

"When advising a pregnant woman about exercise, it's really determined by her previous level of activity," explains Dr. Julia Alleyne, Medical Director with Sport C.A.R.E., a multidisciplinary clinic at the Women's College Hospital in Toronto with a unique expertise in the area of women and physical activity. "If a woman hasn't been active for three to six months prior to the pregnancy, then I would advise her not to start exercising until the second trimester. It's not a good idea to introduce new athletic activities at the start of a pregnancy."

For some women, planning to start a family can really inspire them to improve their health and lifestyle. Heather Lisa Carson of Edmonton says she wanted to shed excess pounds before getting pregnant.

"I didn't feel good about myself," says Carson, 38. "I had gained a ton of weight and I had high cholesterol. I even received warnings from my doctor."

Carson completed an intensive, eight-week fitness training program, then took on a personal trainer. After working with him five days a week for nearly eight months, she lost 35 pounds and worked her way up to running a 10k.

"I was really buying motivation, that's what I had lost," says Carson. "My weight loss improved my back pain and cholesterol, and gave me more energy."

After she had her health issues under control and had improved her lifestyle, Carson felt ready to begin a family. Today, she is a proud mom to a baby boy, Cruise, born in March.

Bun in the Oven: Running During Pregnancy

For the competitive runner, pregnancy doesn't necessarily need to change your regimen very much at all. Coke says she felt great while running through two pregnancies. Her training went so well, in fact, that she even inspired her husband to pick up the pace.

"I actually beat my husband in a 10k race while I was six months pregnant with my first child," says Coke. "He ran a personal best (of 44:10) that day and was encouraged along the race course - to hurry up and try to catch up with his pregnant wife!"

Now a mother to four-year-old Megan and two-year-old Michael, Coke says she recalls the frustration of her running pace getting consistently slower as her pregnancies progressed. As a seasoned athlete who completed three Ironmans before starting a family, Coke was able to maintain an impressive schedule of running, swimming and biking throughout her first pregnancy. Even on the day of her daughter's birth, she swam 2,500m and ran 10k.

But for some, the symptoms of pregnancy itself can override training goals. Shona Moss Lovshin, a 39-year-old mother from Chelsea, QC, recalls the overwhelming nausea and dizziness she experienced for the first 18 weeks of her pregnancy.

"They say that you can do all this exercise, but the reality is that when you're puking your guts out it's pretty hard," says Moss Lovshin, who was a very active runner prior to having her first child. "I could hardly stand up half the time, let alone think about exercising."

Moss Lovshin, who holds a BSc and MSc in exercise physiology, cautions that women should not beat themselves up if they're not able to keep up their usual running or exercise routine during pregnancy.

"There's a whole lot of pressure on women to be able to do all of this," warns Moss Lovshin, who has studied and attended conferences on the subject of athletic overtraining. "But it's not necessarily the gold standard for everyone. You really have to listen to your body and do what feels comfortable. Be easy on yourself - everyone is different."

Dr. Kerry Telford, a family doctor with the South Community Birth Program in Vancouver, echoes the sentiment. "The caution I would give would be to do it in moderation," says Telford. "Don't overheat your body, since raising core body temperature increases the risk of neural tube defects in the first trimester, and can possibly lead to other neurological damage later in pregnancy. Also, remember that pregnancy hormones loosen your ligaments and make you more prone to injury."

Creating a Program

Recommendations on exercising while pregnant have changed a lot over the last three decades.

"In the 80s, guidelines were much more conservative and lacking in scientific support," says Alleyne, who was the main author of a recent position statement on the subject for the Canadian Academy of Sport Medicine. "Today, there is a wider ability to exercise within a healthy pregnancy, and new guidelines are now providing 'exercise prescriptions' that offer suggestions of how exercise might change from trimester to trimester.

"The hardest thing about the guidelines is that women will find them too conservative and too cautious, but we do have to heed what we know," says Alleyne. "Right now, research indicates that a marathon runner should not run for two hours during pregnancy; some studies show it is just too long for the body to continue and other research is still inconclusive."

In planning a program for running or other exercise during pregnancy, talking to your healthcare professional is the first step. One well-established resource to help the pregnant woman to do just that is the PARmed-X for Pregnancy tool. Approved by Health Canada and widely available online, this screening tool consists of a series of questions for a pregnant woman to answer. Using the completed form, a midwife, nurse or physician could then apply risk factors to the pregnancy and make suitable recommendations for exercising.

Still, there are no hard and fast rules as to what's right and wrong in terms of exercise. Heart rate, for example, has been used in the past as a measuring stick for exertion. "In the '80s, it was quite arbitrary - they just told women not to go above 140 beats per minute," says Alleyne.

But it's no longer quite that simple, and Alleyne argues that for many women, using a heart rate monitor and looking at numbers in such a narrow fashion - rather than looking at the broader picture in terms of how the individual feels and her symptoms - can cause unnecessary anxiety.

Runners especially can be very analytical about their training patterns, so putting heart rate in context can be very helpful for them," says Alleyne. "More recently, researchers have looked at heart rate in relation to age, and created target zones based on age."

Mix it Up: Altering your Regime

While new physical activities are not usually recommended during the first trimester, many women opt to try something new during the remainder of their pregnancies.

After her early nausea and dizziness backed off, Moss Lovshin found that cross-country skiing felt more comfortable than running. "It was less pounding for my tired body, although I did have to be careful to watch out for icy conditions," she says.

Gionet decided that her final run would be a 10k at the Ottawa Race Weekend, held annually in late May. "It was an amazing experience - people were cheering me on and encouraging me," she recalls. Since then, her workout routine has shifted to swimming and prenatal yoga.

For Carson, continual running was comfortable until around the seven-month mark. At that point, she began doing a combination of running and walking to bring the pace down a notch. She also modified her weight-lifting regime by sitting down, under the careful eye of her trainer.

How Mama Got Her Groove Back: Running After Baby

You've done it - you've survived the ups and downs of pregnancy and brought a brand-new, little person into the world. Congratulations! So now you can get back to running just like you did before, right? Not so fast - medical and anecdotal evidence alike suggest it's best not to rush it.

"Even in the context of a low-risk, healthy, vaginal delivery, there are a lot of things going on in a new mother's body that makes it reasonable to wait," cautions Alleyne. She points out a number of postnatal factors to consider, including: lactation and the proper establishment of breastfeeding; the effects of blood loss during delivery, which can last from 10 days to three weeks postpartum; and the overall lack of sleep experienced with a newborn baby.

First-time mothers, in particular, must remember that they are still undergoing new, unchartered waters in terms of physical change.“Personally, I experienced serious (breast) engorgement after the birth of my first child,” says Moss Lovshin. “It was highly uncomfortable and not an ideal time to resume exercising. What you have to remember is that all of this will resolve itself in time – wait until you actually feel like you want to go out (exercising) instead of pushing yourself.”

The six to eight-week mark postpartum is often referenced as a major milestone for the recovering mom. This is because the uterus should be fully involuted, or back to normal, by then, explains Telford. "If there was any laceration or episiotomy during labour, this should have healed by that point, allowing for a return to normal exercise and activity."

One Step at a Time

For women who are keen to return to running, the key is to ease back into it. Alleyne suggests a walking program, starting at around three weeks. A walking program is different than just walking because it involves setting a goal, then increasing it by 10 per cent. Start with 15 minutes at a brisk pace, continue until you can walk for up to 30 minutes (with or without a stroller). When you're ready to challenge your intensity, try five minutes of walking and five minutes of running. Using this method, the healthy, postpartum mother could resume a running program around six to eight weeks, says Alleyne.

Most of all, keep in mind that life will change with baby on the outside. Some women find it's just not realistic to run as hard or as often as they did prior to pregnancy, or they may realize that there are other exercises and activities to do that are more appropriate, even more fun, with their kids.

"Just remember that your kids are only little babies once, so you have to look at what's best for both of you," says Moss Lovshin.