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It’s no secret that exercise is good for us.
But here is the thing not a lot of people are out there saying but I am SURE you are probably feeling or thinking.
How the EFF do you exercise when trying to conceive or in early pregnancy?
And that is keeping people stuck.
Because so many women aren’t sure how to do it safely, they err on the side of caution and don’t do anything, which isn’t ideal. Then we have another group of women who are potentially over-doing it, which also isn’t ideal.
So in this podcast episode, I’m sharing my fast and furious tips on how to exercise during that preconception window when you might be wondering if, when and how you should be exercising; as well as how to exercise safely during early pregnancy and the first trimester.
Movement is an essential component of pre-conception care and pregnancy. Not only does establishing a regular exercise routine now set up healthy habits for life, it optimises your fertility, improves outcomes for a healthy pregnancy and prepares your body for the physical demands of labour, birth and post-partum recovery.
We know that exercise is good for our bodies, but it seems that too many women are at opposite extremes of the spectrum. Either they’re completely sedentary and not getting nearly enough exercise, or they’re gym junkies and putting their bodies through excessive stress during their workouts; neither of which are great for our hormone balance. Regular, moderate intensity exercise is essential for maintaining a healthy lifestyle, but only around 30% of the population does enough exercise to actually gain health benefits, and 20% of adults are entirely inactive. Current World Health Organisation guidelines recommend that adults aged between 18 and 64 years should be doing at least 150 minutes of moderate intensity aerobic physical activity throughout the week, as well as strength training on at least two days.
Women who are mostly inactive are at increased risk of being overweight. Fat cells contribute almost one third of total oestrogen in the body, which means that body fat has a significant effect on oestrogen levels and therefore the menstrual cycle and overall hormone balance. If body fat percentage is too high, there will be a greater amount of fat cells in adipose tissue, producing excess oestrogen. This can lead to an imbalance between oestrogen and progesterone levels and may present as oestrogen dominance. This reduces the ability of oestrogen to bind to its receptors and communicate with other hormones throughout the body. Excessive adipose tissue will also have an effect on egg quality and contribute to irregular menstrual cycles and reduced fertility, as well as other long-term health effects such as heart disease, stroke and diabetes.
Conversely, if percentage body fat is too low, the body perceives that it is in a stressed state. While progesterone is mainly produced by the ovaries, a small amount is also produced by the adrenal glands. This progesterone is then converted to other hormones, including the hormone cortisol. Cortisol helps to manage digestion and regulate hunger and food cravings, as well as regulating blood pressure, sleep and wake cycles, and most importantly, our ability to cope with stress. Cortisol is a glucocorticoid, meaning its main job is to raise blood sugar levels, regulate inflammation, and increase blood pressure so that our heart can pump blood to our muscles to ultimately protect us from danger, or perceived danger in the form of stress. Cortisol is also a catabolic hormone, and it breaks down muscle tissue. Consistently elevated levels of cortisol will negatively impact muscle mass and strength, metabolism and body shape, as well as contributing to increased weight gain.
The adrenal glands are very sensitive to any stress that the body is exposed to, and will adjust the body’s response to stress by producing cortisol in whatever amount is required. Excess cortisol production puts the body into “fight, flight or freeze” mode and switches off any non-essential activities to prioritise survival. This includes the communication pathways between the hypothalamus, the pituitary gland and the ovaries (called the HPO axis) which means that sex hormone production will not be prioritised and ovulation is unlikely to occur, leading to conditions such as hypothalamic amenorrhea.
Unfortunately, in the world that we live in today, we are constantly under pressure, highly stressed, and almost continually in “fight, flight or freeze” mode. The body is designed to be in a stressed state for only short bursts of time. Chronic stress therefore impacts our hormone balance and contributes to irregular menstrual cycles, PMS symptoms and weight gain. Maintaining hormone balance in the body is a delicate balancing act, and any disruption to one hormone will influence another.Under stress, the body will convert progesterone to cortisol, therefore reducing progesterone levels relative to oestrogen levels and once again creating oestrogen dominance. If ovulation does not occur in a menstrual cycle, or the body attempts to ovulate multiple times before it is successful, the follicular phase becomes longer than what is typical, and further contributes to high oestrogen levels as the body prepares to ovulate. Relatively low progesterone levels mean that when ovulation does occur, the luteal phase is often too short for the cycle to be considered fertile. If the luteal phase is less than 10 days, there is insufficient time for a fertilised egg to travel to the uterus and implant into the endometrium, reducing the chances of implantation and increasing the risk of miscarriage.
So, how can we use movement and exercise to our advantage while also keeping our stress response and cortisol levels under control? Funnily enough, moving your body can have positive effects on your cortisol levels, but only if you’re exercising in the right way. The time of day will influence the type of movement that is appropriate, as will the phase of your menstrual cycle that you are in on a given day.
Moving your body first thing in the morning has been shown to help get your stress hormones to their peak and then flush them out of your body. Later in the day and before bed can spike your cortisol and leave you feeling “wired”, leading to difficulty sleeping. Walking is the very best form of movement that is suitable for all fitness levels and can be continued into pregnancy. Walking outdoors in nature is preferable to a treadmill or similar gym equipment, with the added benefit of a Vitamin D boost. If you want to work up more of a sweat, aim for short, sharp, higher intensity workouts earlier in the day which can help to manage mood, stress, sleep and overall hormone balance. Later in the day, switch to lighter exercise, yoga and stretching for recovery. The key to protecting your hormones is to avoid long workouts at high intensities, such as endurance running. Instead, opt for shorter, high intensity workouts or longer workouts at lower intensities. Your recovery is just as important as your workout. Make sure you schedule recovery between days of high intensity exercise. Avoid doing high intensity workouts every day, no more than around four days a week. Give your body time to rest.
Changing how you exercise according to each phase of the menstrual cycle can further support hormone balance. Acknowledging that your menstrual phase is a time to rest and recover can initially be difficult if you are conditioned to consistently high intensity workouts. Consider that you are losing blood during this phase, often experience lower energy, and oestrogen and progesterone levels are both quite low. Slow down, make time to rest and recover and listen to your body. This is the phase to reduce the intensity of your workouts and choose gentle walking, yoga, stretching and recovery.
As bleeding finishes and your body enters the follicular phase, you will start to feel good! Your energy will increase, you’ll feel generally happier and less likely to experience the mood changes that can be common during menstruation. You can now increase exercise intensity and work up a sweat with cardio or high intensity interval training. Use your extra energy to challenge yourself.
Your mood and energy will continue to improve as you approach ovulation. After all, the body is programmed to improve our chances of pregnancy, so we need energy to look for a mate and reproduce! We’re also likely to be more socially outgoing around ovulation and experience increased libido. This is the time to enjoy a high intensity workout, and your body will actually be more efficient at burning calories and using fats for energy. Take care however, as all this added energy and motivation can lead to over-doing things, so pay attention to your technique to prevent accidents and injuries.
After ovulation you will enter the luteal phase, which is the longest phase of the menstrual cycle. As menstruation approaches, this is the time when many women will experience traditional PMS symptoms, such as headaches, breast tenderness and cramping, as well as reduced energy and concentration, fatigue, mood changes, anxiety and depression. When you begin to notice a change in your energy levels or any of these symptoms, recognise that menstruation may be approaching and the intensity of your workouts should be reduced. This can be a challenging time when trying to conceive, as you are in your two-week wait and agonising over every tiny symptom and deliberating when to take a pregnancy test. If you are not pregnant, it is perfectly understandable to feel disappointed and experience low moods and energy when your next period arrives. Honour this time and prioritise self-care and rest.
Women that exercise often feel better about themselves and their changing bodies during pregnancy, however three out of four pregnant women do not get enough exercise. 20-30 minutes of moderate intensity exercise on most days of the week has enormous benefits in helping the body cope with the increased demands on the muscles, joints, heart and lungs and prepare for labour and birth.
You should consult your care provider before starting a new exercise plan or if you are new to exercise (another reason to build healthy habits before pregnancy!). Make sure you have addressed any problems or discomforts you may have during pregnancy and check if you should be taking any special precautions.
Pregnancy is not the time to be trying a new and strenuous activity for the first time – aim to start gently with low impact exercises such as walking or swimming. Some women wait until the second trimester once morning sickness and fatigue have settled, but there is no risk in starting in the first trimester if you are feeling good. If you are new to exercise, start with 10-15 minutes and gradually work up to 30 minutes each day.
Benefits of exercising during pregnancy:
Benefits for labour:
The first trimester refers to the first ten weeks after conception, or the first twelve weeks after the first day of your last menstrual period. This is a period of significant change, where cells are growing and differentiating quickly to form tissues, organs and entire body systems. The hormonal changes that occur during early pregnancy impact how your body systems will operate throughout your pregnancy. It is usually these hormonal changes that cause the common and unpleasant symptoms that you experience during the first trimester, such as nausea, dizziness and fatigue. Exercise can stimulate early growth of the placenta and helps your body to better adapt to pregnancy, improving your symptoms.
Exercising during the first trimester can be a challenge. Your blood volume increases while blood pressure decreases, making you more prone to low energy, dizziness, rapid heart rate and shortness of breath. Women who exercised regularly pre-pregnancy may notice these changes during their workouts before actually realising they are pregnant. Morning sickness and fatigue can make exercising less than appealing, but many women find that even 10-15 minutes of gentle exercise such as walking can temporarily relieve their symptoms and give them a much-needed energy boost. Your pregnancy is a priority at this time. Always use your common sense and be guided by how you feel. If your fatigue or nausea is so extreme that you cannot make it through a workout, you may need to take it easy for a few weeks until your symptoms start to settle.
Before and during exercise, you must take note of how you are feeling; including any injuries, illness or fever; vaginal bleeding or cramping, and any sudden onset of new pain, especially around the abdomen or pelvis. It is important to prevent overheating your body, so avoid exercising in hot or humid conditions and stay hydrated. Hydration is essential for maintaining a stable cardiovascular system, especially during early pregnancy when the changes to blood volume and blood pressure have not yet resolved. Maintain regular fluid and salt intake throughout the day and especially during exercise. Check the colour of your urine for dehydration, it should be light yellow or straw-coloured, and don’t exercise if you think you may be dehydrated.
Time eating with exercise to maintain stable blood sugar levels and minimise unpleasant symptoms such as nausea and dizziness. Eat a small snack of complex carbohydrates about an hour before exercising and eat another small snack immediately after exercising. Ideally, exercise in the morning and drink a liquid snack during exercise, followed by a small breakfast rich in complex carbohydrates. Eat regularly, at least every 4 hours.
It is important to avoid excessive fatigue in pregnancy, and both exercise and rest are equally important. A good way to ensure you are getting a balance of activity and rest is to plan one hour of quiet rest time or “me time” for every hour of exercise you do. For those women who are already looking after young children, make sure you keep an energy reserve to look after your children after your workout.
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