Christina: Being pregnant and having a baby and being postpartum is hard. Being pregnant and being postpartum deconditioned is harder. And so we need to change the messaging from being fear focused to being empowerment forward and saying, here are your buoys. Here’s what I want you to be paying attention to. But these hard caps that we’ve had, we’re starting to slowly and incrementally push back against and It’s taking some time, but we are starting to see the pendulum swing a little bit.
Mike: Hello. Hello. Welcome to muscle for life. I am Mike Matthews. Thank you for joining me today for a new episode on the topic of high intensity exercise and pregnancy. both during and after pregnancy, but mostly during pregnancy. That is going to be the focus of today’s talk. And when I say high intensity exercise, weightlifting, high intensity, weightlifting, not warmup workouts, as well as endurance training, cardiovascular training, high intensity cardiovascular training.
And in today’s interview with Dr. Christina Previtt, you are going to learn. What you should and shouldn’t consider doing with your exercise when you’re pregnant as well as after pregnant. And, spoiler alert, you can do a lot more than you might think. A lot more than most quote unquote experts would recommend.
And in this interview, Kristina explains why that is. She explains why so many experts say that you should do very little, if any, high intensity exercise while pregnant. And also explains why you probably should be doing a fair amount of high intensity exercise while you’re pregnant. For your own sake, as well as your baby’s sake.
And in case you are not familiar with today’s guest, Dr. Christina Previtt is a physiotherapist with a PhD in geriatrics from McMaster University. She has over 10 years of clinical experience. She specializes in pregnancy and aging research. She teaches at the Institute of Clinical Excellence. She speaks internationally on women’s health and fitness and also Has a background as a national level weightlifter.
Oh, and last but not least, she’s a mom herself. So she is coming at this not only from her deep clinical experience, but also from her first hand experience. But first, If you like what I’m doing here on the podcast and want 125 of my favorite quick, easy, and delicious fitness friendly recipes, you want to get a copy of my flexible dieting cookbook, The Shredded Chef, because here’s the deal.
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I’m really
Christina: excited for this
Mike: conversation. Yeah. Yeah. This is a good topic. Something, as I said, Offline I’ve written and spoken a bit about and just basically shared my understanding of relevant literature, but I was excited to speak to somebody who knows a lot more about it and speak to a woman who also has personal experience.
And I think there’s value in that as well, in addition to what’s in the literature. So here we are. And I thought a good place to start would be if you could talk about some of the common misconceptions about high intensity exercise, particularly weightlifting, but I’ll let you go wherever you want with that during pregnancy.
Christina: Yeah I guess first and foremost, it’s that A lot of the recommendations that people are given they think are based on research, and they actually aren’t. They are based on the fact that we don’t have any research. So if I can go a little bit down, a history of where we’re at from a research perspective in pregnancy is.
In the female lifespan, pregnancy is probably one of the most protected times, right? And it is marked by a lot of feelings of insecurity and uncertainty about what to do, how to do anything, should you do something, like you’re questioning everything. And from the medical system perspective, if we don’t know, The answer is no.
And what that has led to is now that we’re in this space where women are wanting to lift heavy and they are running marathons before they’re pregnant. They want to get back to sports after their pregnancy. They’re going to their doctors and they’re saying, Hey I have a 315 pound deadlift. Is it okay for me to lift any weights?
And they’re like let’s stop lifting. And let’s only lift 25 pounds. That can work for some people, but it’s not based in. In a research study that shows that this is harmful. It’s based in the fact that we don’t have any research studies at all.
Mike: It’s like asking, it’s like asking a lawyer in business if you should do anything.
The answer is no, always.
Christina: Yeah, because there’s a liability piece to it. Like we really don’t have a ton of data. I have a PhD in geriatric rehab. I never thought I would be doing a postdoctoral fellowship and it was. Purely because, from my own experiences, I was a national level weightlifter going into my pregnancy.
I was finishing up my PhD and the internet showed up when I was pregnant and lifting, right? They were telling me my baby was going to die and that my uterus was going to prolapse and I just got so unsettled and frustrated by the fact that this wasn’t based on harm data, but we also didn’t have any benefits data.
And so that’s where some of my research study that studies that have gone, cross sectional and now we’re trying to accumulate some retrospective and prospective data. We are trying to build that evidence so that, we feel really comfortable as a medical community in low and moderate intensity exercise.
We get a little squeamy and uncertain and high intensity exercise. And so what we’re trying to do is push that risk tolerance zone for our providers. So that those people who want to lift heavy, or they want to keep running, or they want to keep cross fitting or working out at high intensity are not going to be actively told that they shouldn’t be doing it.
Mike: And can you speak to some of the details of what you just mentioned, specifically some of these ideas of the horrible things that are going to happen if women Are going on social media to look for information or going elsewhere really any anywhere online to look for information. They are going to quickly come across claims like those.
Christina: Yeah, so let’s talk about like weightlifting and pregnancy. So there’s a couple of things that people are told. One, they’re given a hard cap. They’re told. don’t lift over X amount of weight. So it’s usually between 20 and 30 pounds through any part in their pregnancy. And I’ve had clients who have even said to their doc I have a toddler at home and she’s 35 pounds.
Are you telling me that I can’t lift my baby? And they look them point blank in the face and they say, yes. And you’re like, okay, as a parent that doesn’t really make much sense. Oh, and it’s because none of our research has gone over those thresholds, right? So we have research in under 25 pounds. We don’t have research above it.
And so that’s number one. Number two is that individuals get told, your core and your pelvic floor is under so much strain already in pregnancy. We don’t want to strain it more with resistance training. So back off. And I am like adamantly against that because if we think about our rehab principles and I have a painter who has a sore shoulder.
My messaging isn’t, you already put a lot of strain on your shoulder, let’s never strengthen it because you need to do more work. The messaging is the exact opposite, like you’re putting your body under a lot of strain. You need that muscular reserve around your shoulder in order to be able to meet the demand of your day.
Let’s build up your capacity. In pregnancy, it becomes the exact opposite messaging where we say, your body’s under a lot of strain. Let’s decondition you. And I say to my moms, I was like, being pregnant and having a baby and being postpartum is hard. Being pregnant and being postpartum deconditioned is harder.
And so we need to change the messaging from being fear focused to being empowerment forward and saying, here are your buoys. Here’s what I want you to be paying attention to. But these hard caps that we’ve had we’re starting to slowly and incrementally push back against them and it’s taking some time, but we are starting to see the pendulum swing a little bit there.
The last one is around bracing and proper bracing during lifting in pregnancy. And so some individuals will say not to hold your breath with lifting or not because of the blood pressure.
Mike: Which is essentially impossible. If you’re going to squat, for example, any amount of weight, you’re going to valsalva almost by default because you have to.
Christina: Yeah. And yeah. And if you’re under, if you’re putting your body under any amount of load, you’re going to at least transiently valsalva. So at least transiently hold your breath in order to create inner abdominal pressure and pressure isn’t bad. It’s that your body needs to be ready for it. And some of our work has started to, to really, again, push back on that with, systematic acute point of care studies on fetal and maternal hemodynamics by other individuals in my research lab.
And then my work has been focused on pelvic floor and the Valsalva maneuver with lifting during pregnancy.
Mike: And I definitely want to get into more of the programming details later, but before we get to that, so what about then some of the. Some of the benefits and some of the evidence based benefits that you’ve been uncovering in your work and the reasons why women should consider weightlifting.
Maybe even taking it up if they’re not doing it or if they are doing it to continue to do it with. Some of the asterisks that you’re going to provide later.
Christina: Yeah. Awesome. So a couple of the camps that we’re starting to look at strength training and pregnancy around one is around pain. So we know that many women experienced some amount of pain, usually around the pelvis, but.
pregnancy related pelvic girdle pain, SI joint, low back pain, pubic symphysis pain during their pregnancy. And what our research is starting to show is that those who are more active going into their pregnancy have less significant pain. Those who decondition less during their pregnancy, there was a recent study that showed that they had less severe pain.
And those who have more strength around, have a higher fitness score in their pregnancy tend to have less severe pain. So there seems to be some protective effect and that makes a lot of sense, right? When we have hormones going through our body that make it so that we don’t have the same static support or our ligaments aren’t as strong because they’re lengthening to prep for labor, we have to rely more on our muscles to help give us that support and give us that strength that we need to do all of the tasks that we need to do in our day.
And It’s a lot of work to be pregnant, just existing as a pregnant person, right? So the more reserve you have, the better. So we’re starting to see some literature in the pain space around that. The second space is around complications in pregnancy. So the two big camps being cardiometabolic health. So gestational hypertension and preeclampsia, which could be really significant complications in pregnancy and then gestational diabetes.
So in our general non pregnant research. Our evidence is really strong that strength training keeps your blood pressure more regulated, makes you less likely to have high blood pressure, and helps control your blood sugar so that you’re able to better manage your diabetes. And our research in pregnancy is starting to go that way as well.
I did a cross sectional study with a group of collaborators that looked at individuals who self selected to lift more than 80 percent of their one rat max. in their pregnancy. And then we said, how did your birth go? How did your pregnancy go? Did you have any complications? And what we saw was that rates of gestational diabetes, gestational hypertension, and preeclampsia were well below national averages.
And so overall, like really positive initial findings for us to keep, pushing into some of that research on higher dosing of string training.
Mike: And that’s what you would expect, at least what you would hope for, like you mentioned, if you look at If you look at also research on strength training and the perception of pain, I did an interview with, I forget his name, pain science.
com. Anyway, it was a couple of years ago, a deep dive on pain and some of the mysterious elements of pain and how some people can have certain conditions have basically no pain. Other people can have no condition and have significant amounts of pain. And just that the research, at least at the time is when we were having that discussion clearly showed that.
People who strength train regularly, just. They just experience less pain for whatever reason. At that time, I know one of the proposed mechanisms was that it may be that it’s just raising our pain tolerance basically. And pain has to get over a certain threshold for us to become aware of it. And strength training seems to raise that threshold.
And so anyway, if you. have an effect like that generally, then you would hope that it holds in pregnancy and then some of the cardio metabolic benefits as well. So that’s cool though, to have specific evidence, again, to your point of then making it acceptable for, again, you think about doctors to make recommendations where they can point to highly specific evidence to, even if it’s just a point of feeling good about their recommendations and not causing harm.
Christina: Yeah, absolutely. And we’re starting to see this shift right towards promoting exercise more regularly, even in lieu of having some complications. Like for example, we see that individuals who are starting to show signs of preeclampsia, which is High blood pressure plus protein in the urine. Those who are more active, and this is aerobic research, but they tend to be pregnant longer.
And that is really important for a baby, right? The longer you can stay in mom’s belly, every single day matters. And so we even have some of that research now that And this is largely in the aerobic space because that’s unfortunately where the bulk of our research is showing that, it helps even with the primary prevention of these conditions, but also the management of them if they’re established.
And so now we’re seeing a lot more advice away from bed rest with different complications and they’re moving more towards pelvic rest. And we’re even starting to see that, there’s pro inflammatory cascades that happen when individuals are going into complications so that activity may not actually be.
Something to be contraindicated, but actually encouraged in a lot of those situations, which again, makes a lot of sense.
Mike: What about after delivering the baby? I’m sure there are some significant benefits there too.
Christina: Yeah, so that’s a good question. The amount of deconditioning that an individual experiences can definitely make the postpartum journey.
Harder. Our research on reconditioning in the postpartum period, very poor and very minimal. I wish it wasn’t. But for example, I am a person who is very adamantly against the six weeks of do nothing. I think that blanket statement is actually really harmful. I teach a lot and I coach a lot of athletes who are in the United States.
We would never tell a person to have a sling on for six weeks. Then you’re going to have full range of motion, full function, full capacity. If you have any pain, you’ve messed up and go back to full work duties. And right now, like that’s the state of some individuals where individuals are going back four to six weeks after having a baby and we’ve done no reconditioning.
And then from an exercise perspective we know in that early postpartum piece, not only just physical healing, But from a mental health perspective, the do nothing can actually really negatively impact mental health. And so what we’re seeing too is can we encourage some movement? And we’ve had some research on individuals who have started earlier exercise programs and their depression scores are lower.
in that postpartum period. So as we want to focus on, we don’t have a ton of research on the early recovery phase. A lot of our stuff is in, over 12 weeks postpartum. I wish we had a little bit earlier. Clinically, I can give some insights about where I counsel, but we really want to think about our reconditioning period.
And then also think about the mental health side of things. So there are certain people who will say, and some of this is cultural, so I want to be, cognizant of that. But they’ll say, five days in the bed, five days around the bed, five days around the house. And postpartum hemorrhage is a really important complication that movement is a modifiable risk factor for.
Some of our evidence on cesarean section in hospital is that those that walk more. in hospital after a c section are less likely to have post operative complications, which tracks with so much of our other you have your knee replaced or your hip replaced, and we take a black and decker to your joints and put in a new one, and you’re standing up that day because we know that it reduces complication risks.
And so it’s how do we be mindful of where mom is? She’s going through a really big transformative piece. We don’t want to shame or blame if people need more time to rest. But we don’t want to be the reason why they’re resting longer than they feel like they want to. And so a lot of it is about meeting individuals where they’re at, respecting their healing.
And then I oftentimes will give navigational buoys of saying, Hey, moving after baby, think about this, and this. These are signs that You probably need to rest now, like if you can rest and then, reengage again, once you’ve had a little bit of a rest window,
Mike: and I’m assuming that postpartum period is generally going to go smoother if mom was exercising regularly with a moderate to high degree of intensity throughout her pregnancy, the emotional, psychological, as well as physical.
Or no, am I wrong?
Christina: Yeah, no, you’re not wrong. It’s just so the, that blanket statement can be so helpful, but it can also be harmful in some ways. So in general, yes, the more active you are in your pregnancy, you are going to stack the deck in your favor. When it comes to potential labor and delivery and birth outcomes, but what I also see happening is people are like, you are so active in your pregnancy labor and delivery.
It’s going to be a breeze. You’re going to have no problems postpartum. And then people do have a complication that happens or they do
Mike: and then they think maybe something’s wrong with them or whatever.
Christina: And they’re like, what did I do wrong? It’s my fault. So I always talk about it as stacking the deck versus really dictating outcomes because labor and delivery is a wild ride and we can’t control what baby’s going to do.
We can’t control if baby gets stuck. We can’t control if baby goes into distress. We can’t control some of those things. Like even some of our gestational diabetes and stuff. preeclampsia. I’ve had competitive athletes who are like, how do I have gestational diabetes? I do everything right. And some of it is just how the placenta embeds, which is what we’re seeing in some of our research in gestational hypertension and preeclampsia.
And it’s just genetics. Like it just happened. So we can stack the deck. And in general, we see that people do really well when they’re active during their pregnancy. It makes it a little bit easier to cope in that postpartum period, but we never want to like, again, sweep and generalize in the other direction.
Mike: Yeah, which of course would apply to really any benefit of any type of exercise that we’re talking about probabilities and they take cardiovascular benefits. Yes, exercising regularly. It’s going to reduce your chances of dying from a heart attack. Is it going to bring them to zero? No, it’s not for other reasons.
And so we do what we can and then we accept what the outcome is because what else are we going to do?
Christina: Exactly.
Mike: Exactly. Let’s talk about now program. Let’s get into. Modifications, considerations for how women should approach this if you want to speak to women who maybe would be just getting started during pregnancy, that’s probably one crowd and then there would be another crowd of women who are coming into it in a regimen and are fairly Thank you.
intense in their training. It’s training. It’s not just exercise and how they should be thinking about programming throughout their pregnancy.
Christina: Yeah. So I think, so let’s talk about that. I’ve never lifted a weight in my life, but I’m pregnant and I want to be really healthy for my baby.
I’m very motivated to get into the gym. So those are going to be individuals that one, I’m going to tell them you absolutely can start a new exercise program to right? Everyone says don’t start anything new. Don’t do anything new in pregnancy. That’s not true. But we would start slow and progress in more like how we would for a beginner lifter, right?
Like we would do a linear periodization where we would start with lower volume. Lower weights. Focus on the mechanics. Make sure we’re getting that right. And then gradually add weight. And then as individuals get into the second half of their pregnancy and baby bump start to get a little bit bigger then we can make modifications to range of motion reps and sets and load from there.
I do not think that we can’t do any type of progression through our pregnancy. Some people will say this isn’t the time for you to progress your weights and that type of thing. Yes. To try and remove some of those expectations. But also if I have a person who’s not very conditioned in strength, they’re going to PR all of their movements, whether that’s a PR bicep curl, because they’re doing bodybuilding style workouts.
Or, it’s somebody coming in doing squats and deadlifts. And so going into that other crowd and speaking to our newbies as well, is we don’t have any exercises that are pregnancy safe versus unsafe. And I think this is a really important concept is People will say, oh, here’s an exercise that’s safe during your pregnancy.
That doesn’t exist, and the messaging is harmful because then it makes it seem like other exercises are unsafe, and that isn’t true. We have exercises that our body is ready for and exercises that our body isn’t, and heavier loads for somebody who isn’t used to it. They may not be squatting and deadlifting really heavyweight yet because their body just isn’t ready for that.
I am not a runner. I wouldn’t sign up for a marathon this weekend because my body’s not ready for that, right? That is the same if you’re pregnant or not.
Mike: Or even a 5k. Trying to go from zero to that is, is crazy. It’s going to be painful
Christina: for me, right? And for, and then that, that speaks to our trained athletes as well, because then people say when do I have to train differently during my pregnancy?
When do I have to remove? my loading. When do I have to bring my load down? How do I have to change my brace strategy? And what we have realized is that so much of that is individual, right? So much of that is individual. And it can be based on your training volume, how your body is feeling, your previous injuries going into your pregnancy.
If you have another kiddo at home, that second pregnancy hits different because I can’t sleep on the couch after I’m done work and have, been at the gym because I have a toddler who’s mom let’s do all this stuff. So all these life events are going to dictate when you choose to ease back or you choose to change your exercises.
But what I will say is that when it comes to how you are bracing, holding your breath for bracing, you can do that all the way up until delivery, which is not what I would have said five years ago, right? We used to say, Hey, Strain on the pelvic floor, breathe out when you’re on the hardest part of your lift.
I don’t say that anymore. I say here are choices of how you can breathe and you can choose what works for you. And then we see individuals generally when we’re describing their progression or modification is that they tend to scale their weights back so that they’re, if they’re generally working at 80 to 85 percent, they’re in that 60 to 65 range as they’re getting up.
Towards delivery. That being said, I’ve had plenty of my pregnant athletes who like mass moves mass and they PR their deadlift every They’re using that extra body weight to their advantage and they’re stronger than they’ve ever been. And we actually don’t have a set time when you have to modify things Where we will modify things is around pain, where we may change range of motion and scale down load.
If individuals are peeing when they don’t want to be peeing during lifting or feeling heaviness. During their lifts, then we may modify how they’re breathing and the load that they’re having because of fatigue considerations and any other feelings of like dizziness or being unwell, especially if we’re doing things like exercising on our back.
So it is safe to exercise on your back so you can bench press all the way up until delivery. But some people are very sensitive to that because of compression of the uterus on the inferior vena cava. And so they will start to feel unwell, like dizziness, just general, like they get like nauseous. They don’t feel very good.
Those are individuals that all prop their heads up so that they’re not having that compression in late pregnancy. But again, some people can go right up until delivery. I’ve had some people who, as soon as they warm up with a glute bridge, they’re like, I feel like I’m going to throw up. So there is a lot of variability within that.
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Something between a warmup set and a working set. But at least at some point in your pregnancy, it’s no longer appropriate to push even close to failure within one or two reps of failure on a. on a compound exercise, for example.
Christina: We’ve seen people do powerlifting meets now, eight months pregnant. So really we don’t know.
And that’s a lot of conservative recommendations because if we don’t know, we scale back or if we don’t know, we freeze. And again, that’s going to be so individual. I PR’d my snatch at a weightlifting meet using a weightlifting belt, 10 weeks pregnant with my daughter. And everybody is going to be slightly different.
Sometimes giving athletes with athlete brain permission that they can go sub max, if they’ve been in it and they’re like, I have to push, I have to push, I have to push, they get a lot of fear and anxiety that I’m going to lose my fitness and I’m not going to be able to get back. Sometimes the conversation isn’t that you can’t do this is that you don’t have to push it if you don’t want to like depending on how you’re feeling and your fitness will come back after baby.
And so I think it’s catering that conversation that we don’t know you can if you want to keep lifting heavy. You can. The only thing that I would say for people who are lifting really heavy and they are hold breath bracing is that I’m going to prep them for birth a little bit differently. So what we do see is that those who hold their breath to lift and especially those who are really good at it because they’ve been doing it for a long time, they are very good at closing their holes when they hold their breath.
to increase pressure in their belly so that they get that spinal stiffness and they can lift heavier weights. You have to do the exact opposite to birth a baby. That pelvic floor that you were trying to close that hole, you have to let it go and let it open for baby’s head to descend. And what we see is that Some of our barbell athletes are very bad at doing that because they’re so used to holding their breath and closing their sphincters and they have to do the exact opposite for birth and what we know in the research is that those who have a longer stage of pushing tend to also have pelvic floor co contraction on a breath hold delivery strategy and so we want to teach them here’s what you do when you’re lifting Here’s what you’re going to do in birth.
And so if I’m programming for an athlete who’s pregnant, I get, I give them like birth prep workouts, right? Essentially say, okay, here’s your working sets. And now I want you to completely reverse it and try and get into this different frame of mind so that when you are. In your big delivery day that you’re not actually working against yourself because I’ve seen some athletes who have had failure to progress and part of that is likely because when they are used to holding their breath and pushing, it’s with everything contracted.
Mike: Have you found that any sort of pelvic floor exercises have helped with that where you’re contracting and then relaxing muscles just to even get a sense of how that feels?
Christina: Yeah I will put them into pelvic floor lengthened positions. So the three positions exercise wise that lengthen the pelvic floor the most is a deep supported squat, a happy baby position and child’s pose.
And then I will get them to hold their breath and think about pushing down a little bit. And feeling. So usually your pelvic floor will come together and lift up when you’re doing like that Kegel contraction. So you want it to come down and spread. And so I’m trying to get them to feel that sensation.
And it’s something that you need to practice and don’t, you don’t think that I. I don’t want them to think that it’s just going to come really naturally and it’s okay that it takes some time to unlearn and then it can prep them for that feeling. And so I’ve had some athletes who have had different kids and I’ve seen them for their subsequent pregnancies and they’ve come back after Oh yeah, I fought myself the entire time my first delivery and it was a totally different experience.
This time through, and so it makes sense with the current research we have, of course, we don’t have a ton of research and high level lifters and how their birth outcomes are coming in terms of length of time for different stages of labor, but
Mike: random thought and comment just comes to mind. I wonder if so female lifters can run into this issue.
I wonder if male lifters are more likely to experience premature ejaculation for the same reason. because the pelvic floor muscles are just so used to being so tight. And then that’s that the relationship between that and ejaculation is well established. Random thought, but just occurred to me.
Christina: Not what, but you know what?
So we talk about leaking with lifters, like 50 percent of women who, who lift heavy weights. Pee, when they don’t want to be peeing under heavy loads. So we talk about a lot in the peeing on the platform, like all that kind of stuff. But men, they get hemorrhoids, hernias, and testicular pain too, is another one where like they can maybe have like hip tightness and their pelvic floor tightness.
and then it comes into the side of the testicle or they have anal incontinence where they’re farting in the bottom of the squat and that can be all signs of pelvic floor hypertonicity or their pelvic floor is super jacked up and they can have that or they’re not bracing appropriately and this is where I see hernias and hemorrhoids, right?
Because so often they get told to inhale with a big inspiratory breath and then push out against their belt which essentially puts them to end range of static structures versus trying to rely on that dynamic support and reinforcing with the belt. So then I see them with TLJ L5 S1 back pain that’s referring into the hip or they’re experiencing hemorrhoids and bleeding out the butt.
Isn’t that fun? We talk about this kind of in that female space, but it’s in the guys too. We just don’t talk about it as much. And so anytime I post about the male lifters, I’d always get so much attention because I can always see that there’s people who are like sending it being like, see look, that it’s like those private.
500 people have shared it to somebody and you’re like, Oh, I know where this, I know that it was.
Mike: Yeah, I’ve made that mistake myself that just relying too much on the belt in that way, like not getting that feeling for people listening. I like the cue that I like is to get the feeling that you’re going to get punched in the stomach and that you’re bracing for taking that punch.
And you’re not pushing your stomach out, but there’s a brace. And when you’re using a belt, you’re still doing the same thing, but like you said, you’re using the belt to support that. But I’ve made that mistake too. Sometimes it’s just you’re in your last rep or two or three of the set.
It’s really hard. You are just trying to not get stuck in the hole. And you have a fair amount of weight on your back and you just let it go a little bit and you rely a little bit too much on the belt. And I’ve had minor hemorrhoids a couple times over the years and it’s happened. It’s just
Christina: For sure.
And so the way that I will coach my athletes is the same thing. I’ll use that exact same cue. If they’re pregnant, I’ll tell them to, to hug the baby. And then my third cue that I use that’s exactly the same way is pretend that your toddler is about to jump on your belly. And the first thing that people do is they knock that rib cage down over their pelvis and they tighten up through their abs.
And then when I add the weightlifting belt, I tell them to tighten it on an exhale. And then when we know we’re in our max brace, we go to max inspiratory volume. And what that’s going to do is it’s going to seal that belt around beautifully. You don’t have to push out against it. You’re going to feel it.
And then you brace the exact same way.
Mike: That’s a good, that’s a good point on tightening on an exhale. That’s actually something that I. I’m gonna, I’m gonna make a mental note of that to make sure I recommend that specifically because that alone probably resolves most of it.
Christina: Yeah. Yeah, it does. And it’s cleaned up so well.
Mike: I guess you could force it, but it’s even harder to force it if you do just that.
Christina: Yeah, exactly. And then you also, you get that, that feeling of support and stability, but you also do it by getting that good co contraction of your core canister. And so that’s where I wish that we could get in front of, as much as From a rehab perspective, I can help the females who are lifting.
I really wish that I could get in front of coaches and teach those, bracing mechanics and then speak to some of the female specific considerations. Cause we don’t really have even a ton of research on bracing mechanics on a female pelvis. Like I’m extrapolating most of my research from, or most of my clinical teaching from male bodies or hemodynamics for individuals who are pregnant.
And we just have so much work to do, too, in terms of, if we would have said that 50 percent of lifters have pain, people would probably be really upset about it. Might be true for some of our high level athletes, but, we say 50 percent of females are leaking, or 50 percent of adolescent athletes pee in sport, and it’s just glazed over.
We spent millions of dollars in FIFA because there’s a slightly increased risk of ACL tears in our female soccer players, which we should, but 50 percent of them are also leaking. And so we’re not talking about Their pelvis and you need considerations for them to make them perform better because they’re not thinking about, Oh, I’m going to pee myself here on this platform.
Mike: You think there’s a little bit of a stigma or it’s just uncomfortable to talk about? I haven’t seen, I’ve seen some strange social media clips. Where it’s celebrated, which is fine, but it’s a little bit odd or it’s almost like a weird, it’s like a fetish or something, not for the woman.
But it’s like guys that are wanting to find this footage and they find it erotic or something. But aside from that, I don’t see it. I don’t see it being talked about much.
Christina: I have been around powerlifting gyms that say if you aren’t peeing, you ain’t PR ing that type of thought around normalization for incontinence, because it is so common, and I understand the reasoning of saying, I don’t want you to be embarrassed about this is something that happens guys can have nosebleeds and, Guys have vomited because of inter abdominal pressure issues when they’re doing your max deadlift or whatever.
But when we use the word normal, it means that we shouldn’t seek care to fix it or that it isn’t something that can be fixed. And so it’s difficult because it’s definitely something that is common, but it is something that We can manage in most situations, and sometimes you just don’t know that it’s going to happen.
Just like you don’t know if you’re going to tweak your knee on a really heavy squat. You don’t know if you’re going to accidentally going to pee on a PR attempt. Like sometimes it’s just at a threshold that your body’s ever been exposed to, and you don’t know how your body’s going to respond. And injuries happen under higher amounts of impact, fatigue, and load.
That doesn’t mean that we don’t approach those. It means that we just recognize that we’re pushing the resiliency of our tissues, which means that tissues can break down, which includes the pelvic floor, which is a group of muscles.
Mike: Let’s come back to pregnancy. And are there any activities that you would not recommend?
Any things that maybe you would normally do if you weren’t Pregnant. But when you are pregnant, you would stop doing or you would change significantly
Christina: in a gym setting.
Mike: And that could be broad or specific wherever you want to go.
Christina: Yeah. So it’s really interesting because. I truly believe that we’ve put way more buoys on people around exercise and pregnancy than is probably necessary.
And one of them is around no contact sports. That is around risk of falling. But even that so that would be recommending things like don’t downhill ski, don’t snowboard, don’t get on a horse. But I’ve also treated people who are equestrian riders. They have a horse that they trust more than anything.
And they believe that they’re not going to get bucked off that horse. And they think that they’re going to be okay. And so then they ride their horses or do equestrian all the way up until delivery. You can tell with my terminology that I do not partake in equestrian horses. I don’t know.
Mike: It’s actually funny you bring that up.
Cause my wife is into horses. I’m not but she’s into it.
Christina: Yeah, so we’ve had more people, but they feel a lot of shame and blame because people are like, Oh my gosh, you shouldn’t be riding a horse, but they feel a lot.
Mike: Yeah. Yeah. If you, if they just if you’re seen doing that, people are going to start talking.
Christina: Exactly. And the same thing with, snowboarding and downhill skiing, like it’s the, how much risk colors you have about the fall and how confident you feel on. your skis and then so obviously like contact related sports like rugby where you are falling and that type of thing is generally contraindicated because obviously blunt force trauma to the abdomen is not recommended.
That high altitude we’re have conversations about and deep scuba diving is where like our absolute no’s are. Don’t go in a sauna. Heat stress is something that we’re having some research on around like how much It’s harder to regulate heat when you’re pregnant. So be mindful of exercising in high heat.
Mike: So that would apply to hot yoga and hot Pilates and that type of stuff.
Christina: Yeah, saunas, those types of things. It can put a lot of stress on baby. So those are generally the ones that are like, do not pass up. go. Other than that, it’s all around like a sliding scale of modification based on how comfortable you are with those movements, your fitness and conditioning going into your pregnancy, and what your thoughts, feelings, desires and goals are in your postpartum period.
So it’s really a lot less.
Mike: Yeah. So if I’m hearing you right, then I’ve also heard claims around impaired recovery. And sometimes even giving specific, like you should not lift weights more than three hours per week or do three workouts per week. And so it, it sounds like those are bunk.
Christina: Yeah. The other one that a lot of people talk about is heart rate considerations around, you shouldn’t let heart rate go over. I think they all say 150 or 160. That’s based on a study on six elite level athletes who are on a treadmill test. And when they approached a hundred percent of their VO two max, they were elite level runners.
They saw hints of baby’s heart rate going down. That was a really small study. It was, there was no control group. There was no normalization of what. baby’s changes in rhythms are. And my research group just published a crossover study that looked at high intensity intervals where they had mom’s heart rate going up into the late high 170s or like low 180s.
And they didn’t see any changes to mom or baby’s hemodynamics that would have any indication that baby was injured on in distress. And so with higher rigor in some of our study designs. ’cause that was exploratory in nature. We’re starting to see that. There doesn’t seem to be that concern outside of max out 100% maybe.
And even that’s maybe it does.
Mike: And who wants to do that anyway? Unless you’re an elite. Unless you’re an elite athlete. ,
Christina: it’s like a max echo sprint. Nobody wants to do it.
Mike: Correct. Correct. And so then that, of course, then reply to any sort of cardiovascular exercise that, that is okay.
When pregnant you’re not going to want to go out and run sprints on the concrete at eight months pregnant, but
Christina: yeah. And and again, this was like a bag. case of telephone where some of these recommendations came from because in general, the bulk of our research is around moderate intensity aerobic training.
So if you think 220 minus your age is a rough like calculation of max heart rate, most people are getting pregnant around 30. That’s average median of first pregnancy. Now, 1 90 you take, 0. 6 to 0. 7 and you’re roughly at between 135 and 150 beats per minute, right? Depending on age. And that would put you roughly in a moderate intensity zone.
But people took that and said, that’s our cap. Mhm. But really what it’s doing is that’s a heart rate zone that you would be in for moderate intensity. And then I get moms who are like my resting heart rate went from 50 to 70 when I was pregnant. And so even going upstairs, I’m pushing, 130 beats per minute, just because of the heightened blood volume, my hematocrit changes, my plasma volume changes.
during pregnancy. So again, like we’ve really started to debunk some of those considerations and heck, we see some of our CrossFit athletes are endurance athletes who are really pushing those intensities and just feel really good doing it.
Mike: Can you talk to us about what research you are doing now and maybe what you’re looking forward to over the next X number of years and where you would like to see the research go?
Christina: Yeah, that’s my favorite thing to talk about. So I am doing a postdoctoral fellowship with Margie Davenport’s lab looking at high load resistance training in pregnancy. So I mentioned my cross sectional study with our group where we we asked just under 700 women who self selected to lift more than 80 percent of their one rep max in their pregnancy.
And we looked and described How they modified, when they modified, did they scale or modify certain exercises? And we asked about Olympic weightlifting and lifting on your back and Valsalva maneuver. And then we took a look at some of their labor and delivery outcomes to try and describe what they did.
And if you’re thinking about levels of evidence, not to get too nerdy, like that’s level five, that cross sectional data. So what we’re trying to do now is build from there. So we now have two studies that are open for enrollment. We have a retrospective study where we are taking individuals who are less than a year postpartum, and they tracked their exercise during pregnancy, like they wrote it down, and we’re asking them to give us their training logs and then tell us about their experience during pregnancy and their labor and delivery outcomes.
to build on that cross sectional data. And then we are following individuals from the first trimester of pregnancy. Coming into the study if you are less than 20 weeks pregnant, and we are following you each trimester, and then 3, 6, 12, and 18 months postpartum, where we’re getting you to answer a variety of surveys, and then give us your training logs, so that we can see how did you modify, did any complications come up, is there anything that we need to be considering for resistance training, As much as, of course, my bias is that I want resistance training to be good for you during pregnancy and I have seen clinically that it is, I also need to know if there’s an asterisk sign in certain groups that we need to worry about, right?
We want to know all of that data. And so that’s going to take me probably, two or three years to, because we have individuals who are now just at labor and delivery they’re getting close to their due dates, but we have a lot of people who haven’t even approached it yet. And so we’re going to follow them.
them forward. Where I really want to go, and this is like my dream, so now we’re like building to level three evidence, is the next step from there is okay, now we have all this evidence that’s showing that people are self selecting, and those who are self selecting to lift heavier seem to be doing okay, hopefully, fingers crossed.
Next, it’s doing randomized control trials that actually have appropriate dosing, because I’m not going to go on a full rant, but our interventional researchers, oftentimes the loading and dosing schema for resistance training outside of the strength and conditioning research is very poor, right? Like I had, there was a randomized control trial on pregnant women who were using yellow TheraBands and they were calling.
Cat cow and posterior pelvic tilt’s resistance training. And they were talking about seated ankle dorsi flexion and plantar flexion as their resistance training. And then we’re thinking that’s going to meaningfully change how they’re feeling in their pregnancy.
Mike: And then come the headlines about how resistance training actually doesn’t do anything or
Christina: Rage.
Face goes red. Yeah, but yes. And then if the bulk of our research is there, it’s really hard when we have these breakout studies that do appropriately load people. And then the reporting of resistance training and study methodology is very poor. And there’s just so many things that we need to work on in the resistance training literature space.
But that is one space where I want my research to go. And then one of my dreams is to also get bracing research in people who have had kids, pregnant individuals, and postpartum individuals to see what’s going on at the pelvic floor. So what does EMG look like in the core canister when you haven’t had kids and you’re not leaking versus you are if you’re pregnant and you’re not leaking versus you are in your postpartum you are leaking versus you aren’t and can we cue the brace does that change what’s happening at the pelvic floor so we have better distribution of pressure versus downward displacement of pressure so that we can reduce Risk of leaking in pregnancy, postpartum, but also in individuals who have never given birth who are leaking.
So trying to bridge some of the interventional work with some of our physiology work is where, like my dream of like where this research studies are gonna go and maybe showing my hand, but that’s where I would really love to see some more research come
Mike: And then I would suggest a comprehensive book.
Christina: Yeah. Yeah.
Mike: Really for to make it just. very accessible to the many women who would read such a book, but who wouldn’t be able to go through your research, because they’re laymen.
Christina: I also have a podcast called the Barber Mamas podcast that is meant for individuals who are like, I’m pregnant.
Or I just had a baby, how can I lift or how can I exercise? And it’s been great, like I’m a pelvic floor physical therapist and an orthopedic therapist and I’m still in clinic once a week. And most of the times I’ll be like, okay, I want you to listen to these episodes and then let’s have a conversation about your questions.
Because there’s so much, there’s so much conflicting data out there. There’s so many individuals who are pregnant and then, they’re telling about their experiences and they’re not meaning to, but they’re becoming like the expert that people are listening to. And they’re not, they’re not.
As informed in those spaces as they need to be speaking to large platforms of, and it’s difficult. It’s difficult because then it works against me when I’m trying to educate.
Mike: And the same is true. The same is true in the book space as well. Unfortunately, you have a lot of really bad information and you have a lot of books.
This would apply to. Every genre I’ve ever read in, but it certainly applies to health and fitness that do very well because of their marketing, but not because the information is true or even workable, but if you have the right marketing, you can sell a lot of books and you can get a lot of good reviews and people will say a lot of good things, but you’re, It’s obviously doing a disservice to mostly a disservice to the people who are looking for solutions.
So that’s again, why I bring up a book, cause I would guess that certainly a job to be done here. There’s a lot of women. I would bet right now on Amazon looking for a book along these lines and who knows what they’re finding their way to, there may be some good material. This isn’t a space that I’m familiar with, but anyway.
I like books, so I’m just throwing that out there as something to, that there might be an opportunity at some point if you wanted to pursue it.
Christina: Yeah, that would be, I think that would be great. I think we just need more research before I always feel comfortable putting it out into a book format.
Mike: Yeah, that’s what I was saying.
Just keep it in your mind in the future, maybe.
Christina: Give me five years and then maybe we can, I can loop around to some of that research space. And you’re absolutely right, like even I have a PhD, but that does not mean that I’m an expert in everything, right? Like my spaces are in rehab, specifically around strength training and resiliency, that doesn’t mean that I’m the expert in everything.
And so sometimes when we extrapolate too far, we can lose the context and nuance that it takes when you’re really deep in the trenches of spaces. And that’s why I’m on social media a lot as well, because I’m in this space. I have competed pregnant postpartum or both in CrossFit powerlifting weightlifting.
I have a 12 year barbell history. I’ve coached athletes for many years, but I’m also. a PT and a PhD. And but I’m not using the flashy slogans. There’s a lot of nuance, right? I didn’t say anything that was like definitive today, which is probably going to frustrate some of your listeners being like, I just want you to tell me that I stopped snatching it.
Yeah, it’s just that doesn’t exist, right? The blanket statements oftentimes are catering to people with lower levels of fitness, and it’s because they have to apply to everybody. And so that’s why we want context. We want the nuance because it allows us to serve individuals well.
Mike: And for what it’s worth, I think that you’ve shared a lot of great information, very practical.
And if I think that. Women listening who have a good basic understanding of strength training and a good basic understanding of programming, they should take a lot away from this discussion because they have an understanding of even a lot of what is. Being implied, they can listen between the lines, so to speak, and understand then what that means for them.
And of course, if they have specific questions, this is one of the questions, the last questions I’m gonna ask you is where people could find you and find your work. And if you do any sort of coaching or anything, because I’m assuming you have a lot of women who reach out and they have questions.
Christina: Yeah, absolutely. So one of the best messages that I ever got on my social medias, which I’ll tell you where they are in a second is you made me less afraid. I was so happy that I found you. Because I wasn’t afraid anymore about these things, and you told me what to listen for. And that will bring, those messages will bring a tear to my eye every single time, because for me, that’s the point.
Our medical system makes people afraid, and it creates barriers to exercise, where oftentimes, We would do better removing those barriers and encouraging movement rather than making people afraid to move. And yeah, that’s why I’m on social media a lot. So if you are an athlete who is looking for programming around pregnancy, postpartum, I run a company called the Barbell Mamas.
So we do pregnant and postpartum lifting programs that have filters for different pelvic floor considerations and different pregnancy considerations. So just like I said, it’s You can’t say at this week, you’re going to do this. What we have is we have our base program and then saying, if you’re feeling incontinence with this, switch to this, if you’re experiencing pain, switch to this, if you’re feeling core pressure or belly button pain, switch to this.
And that allows you to figure out how you’re feeling within your body. And we run a podcast for pregnant and postpartum women to get understandings of different things that are being thrown at them. in this stage of their life. If you’re looking for more, if you’re an exercise professional or a physical therapist who’s looking for continuing education I do a lot of research focused work on my social media pages, doctor.
christina underscore private. And then I teach pelvic health courses through the Institute of Clinical Excellence and Pelvic Health. And in geriatrics. And if you are pregnant and you are listening to this or early postpartum and listening to this, if you would consider being in one of our two research studies, I would be forever in your debt.
Mike: It’s good. I was going to bring this up too. I was going to make sure that because I know how much of a pain it can be to recruit.
Christina: Oh yeah. So I am just so thankful for all my social media followers because they have been pushing it far and wide. And I’m so thankful to podcasts like you to let me try and bring this research out because.
Our guidelines are not going to change unless we have the data to support us, which means that I rely so heavily on all the amazing women who are, taking their time to, to come into our study. So my Instagram Dr. Christina Previtt. The links are in my bio and all the information for my research studies are there and I would just be forever grateful if you guys could come into those studies because it’s going to move the needle.
Mike: Love it. Love it. This was a great interview, Christina. Thanks again for taking the time and maybe we can think about a follow up topic in a few months when it’s out.
Christina: Sounds great. Thanks so much. Bye.
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