Fit To Deliver

Does exercise matter?

Mon, 29 Jun 2009 00:00:04 -0800

One in five of women attending prenatal care in the UK is obese. How's that for a sobering statistic? To read the feature article by Dr. Karen Nordahl, click the link below:

Article: Does Exercise Matter? (PDF)

Postpartum depression: can exercise help?

Wed, 06 Feb 2008 14:11:27 -0800

by Karen Nordahl, MD

As printed in the Winter 2005-06 issue of Urbanbaby & Toddler magazine

You may have noticed that the subject of postpartum depression has made its way into the mainstream media.

Brooke Shields has written a book (which brought several of my own patients into the office), Oprah has discussed the issue, and although I do not agree with his comments, Tom Cruise did help publicize the condition.

But what does this all mean? How can you tell if you are depressed when you have little time for anything except for the care of your baby? You are not sleeping as well, not eating properly and at times overwhelmed by the new arrival. When does it get serious?

Parenting, the ergonomic way

Wed, 06 Feb 2008 14:03:57 -0800

by Dr. Karen Nordahl and Carl Petersen, PT

As printed in the Fall 2006 issue of Urbanbaby & Toddler magazine

Besides the anatomical and physiological changes that happen during pregnancy, the actual movements of motherhood can cause aches and pains. Fitness professionals often teach clients the proper ergonomics to with regard to office space and typical everyday movements. However, the movement patterns of mothers are quite unique and can cause serious distress on the body if not done functionally. The spine is subjected to abnormal stresses which over time can lead to injury or degeneration of spinal structures

Exercising when you're pregnant

Wed, 06 Feb 2008 14:01:01 -0800

by Callie Camp

As printed in the Summer 2006 issue of Urbanbaby & Toddler magazine

Does any mom-to-be still believe that the next 40 weeks are a time for putting up her feet and indulging every craving? These days pregnant women are working full-time jobs right up until their due dates and multitasking to get things squared away before baby comes along. Today's expectant mothers are as busy as before they got pregnant, if not more.

And the trend is amplified in the fitness sector. Everywhere, pregnant women are grunting through squats with stability balls and sweating on the treadmill, balancing in yoga poses and strengthening their abs in Pilates classes. Even women who were previously inactive are seeking out prenatal fitness classes now that more expectant moms are recognizing the benefits of exercise during pregnancy. But even with this shift towards physical fitness, there are still lingering myths surrounding pregnancy and exercise.

Managing weight gain in pregnancy

Wed, 06 Feb 2008 13:56:46 -0800

by Dr. Karen Nordahl

As printed in the Spring 2006 issue of Urbanbaby & Toddler magazine.

We don't need research to show us that Canadians are weighing more. All we need to do is walk down any street. But it has presented new challenges for health professionals who see pregnant patients in their offices.

In the 1950s, when pregnant women were eating less, the medical profession developed an 'eating-for-two' policy. Today, with 34 percent of the pregnant population starting out moderately overweight or obese, eating for two can be dangerous to both mom and baby.

Should pregnant women stop exercising?

Wed, 06 Feb 2008 13:49:48 -0800

by Renee Jefferys MSc., Dr. Karen Nordahl MD

For those of us with an interest in antenatal fitness, as well as a physician who practices obstetrics, the recent article in the November 2007 British Journal of Obstetrics and Gynecology has started some lively discussion.

To summarize the article (the reference is below) Madsen et all performed phone interviews with over 92 000 pregnant women, inquiring about their leisure time physical activities in pregnancy.1

The conclusion drawn from the study was that "the study suggested that exercise early in pregnancy is associated with an increase risk of miscarriage".1 The authors also went on to state that the results should be interpreted with caution, as the study was retrospective and there was a possibility of recall bias.

Home Page Message

Wed, 06 Feb 2008 13:18:41 -0800

“We have a vision that someday, for herself and her newborn, every pregnant woman will chose to follow a planned prenatal fitness program.”

Fit to Deliver™ Introduces: The Core Stability Series 1, 2 & 3

Fit to Deliver - Co-Author Carl Petersen BPE, BSc (PT) has teamed up with Fit to Deliver certified trainer Nina Nittinger to develop a series of Core Stability DVD's entitled Fit to Play & Perform.

Improve core stability with functional exercises that work the muscle slings and connect your upper & lower core muscles. This DVD series focuses on functional core stability training with physio/stability balls, balance equipment and elastic resistance bands. Work with a qualified trainer or caregiver to determine which exercises are most appropriate for your individual circumstances and fitness level.

Click to download PDF for order information.

Information on purchasing can also be found at www.citysportsphysio.com or by e-mailing carl@fittodeliver.com or telephone (604) 606-1420.

Host an Accreditation Course

Wed, 06 Feb 2008 12:52:14 -0800

If you are interested in hosting an accreditation course at your fitness facility, physiotherapy clinic or community center please contact karen nordahl via email: karen@fittodeliver.com

Review British Columbia Medical Journal July 2006

Tue, 25 Jul 2006 21:21:48 -0800

Fit to Deliver: An Innovative Prenatal and Postpartum Fitness Program. By Karen Nordahl, MD, Carl Petersen BPE, BSc(PT), and Renee Jeffreys, MSc. Vancouver: Hartley & Marks Publishers Inc., 2005. ISBN 0-88179-208-X. Paperback,163 pages. $24.95.

This book is written by a physician, a physical therapist, and an exercise physiologist. The stated goal of the book is to “give women the ability to modify their existing fitness program (or, for those new to exercise, to start a program) and to go one step further by offering state-of-the-art training techniques to better prepare for delivery and the postpartum period.”

The authors suggest that the first two chapters of the book be read prior to other chapters. In these first two chapters, the benefits of exercise for both the mother and the baby are outlined, as well as the absolute and relative contraindications to aerobic exercise during pregnancy. The authors then go on to outline a detailed program of exercise based on building core strength.

There are chapters on warm-up, cool-down, and stretching routines, cardiovascular training (including a walk-run program much like that proposed for Sun Run training in Vancouver), resistance training, balance training, relaxation techniques, and guidelines for adapting these approaches to the postpartum period.

The authors make claims that would entice any woman into their fit-to-deliver program. For example, they say that with a moderate exercise program, women have a reduced time in the “active stage” of labor and children have greater neuro-developmental scores in oral language and motor areas when tested at age 5. Although there are general references at the end of the book, specific references for facts such as these are not provided.

The book is nicely laid out. Pencil drawings of parts of the body and various muscles are clear and aid in the reader’s understanding of the purpose of each exercise. There are photographs of pregnant women demonstrating the various exercises, and on every second page, there is a “Tips from the Team” box, which emphasizes the interdisciplinary approach this book takes.

There are aspects of the book that reflect the upper middle class experiences of the authors. They recommend that every woman work with a qualified fitness professional during the pregnancy and suggest that women invest in good exercise clothing.

The program requires time and discipline. However, because of the clarity of its presentation and the range of exercise options not often seen in pregnancy exercise books, I do recommend this book.

— Elaine Carty, MSN
Professor and Director
UBC Midwifery Program

"Face your toughest pounds" from Chatelaine.com

Mon, 06 Feb 2006 12:02:13 -0800

At certain life stages, you're more prone to weight gain. Here's what to watch for – and what you can do to take charge of your body. Read article by Rhea Seymour at Chatelaine.com (opens new window).

Fit To Deliver reviewed by: Robyn Churchill, CNM, MSN

Fri, 03 Feb 2006 13:48:58 -0800

Fit to Deliver by Karen Nordahl, Renee Jeffreys, and Carl Petersen is a complete guide to maintaining fitness throughoutpregnancy. Written by a Canadian physician, an exercisephysiologist, and a physical therapist, this book is atimely addition to the layperson’s literature on pregnancy.As our society faces increasing obesity rates and decreasingactivity levels among all ages, addressing questions abouthow to safely exercise is a public health mandate. Fit toDeliver can contribute both to establishing a healthierlifestyle as well as to decreasing obstetric complicationsdue to excessive weight gain and limited exercise inpregnancy.

Fit to Deliver was developed for use as an instructionalmanual in a prenatal exercise program. While it is not ascholarly text, the authors do reference ACOG’s 2002statement on the benefits of appropriate exercise duringpregnancy, and they include more than a page of selectedreferences for those women looking for academic supportfor their exercise program. The book begins by explainingthe role of proper exercise during pregnancy. The authorscite current studies in both obstetric and physiologic literatureon the benefits of exercise in pregnancy. They discussspecific effects of prenatal exercise on physiologic wellbeingin pregnancy, including alleviation of back pain,constipation, and leg cramps, a reduction in risks ofdeveloping PIH and gestational diabetes, and building morestamina to cope better in labor.

The first chapters of Fit to Deliver provide a background forunderstanding the fitness program. The authors explain thedivision of pregnancy into three trimesters and offer generalguidelines for safe exercise during each. For example, theyrecommend that in the third trimester, a woman should dono exercise requiring lying directly on her back for morethan 30 seconds. There is a good section on proper postureand lifting techniques. There is also discussion throughoutthe book about which exercises address which commondiscomforts of pregnancy.

The fitness program itself begins with a core workout,including pelvic floor and abdominal strengthening exercises.These are described and illustrated well, usingpregnant models who demonstrate the exercises bothlying on the ground and sitting on a chair. Other chaptersaddress aerobic training, strength training, and balance.There is a good explanation of how to build a comprehensive workout session using the various types ofexercise. Nearly all the exercises can be done at homewith little equipment. A physical therapy ball and elasticbands are used in some exercises, and a few require freeweights. The workouts are not overly intense and can bemodified for women who have not been working outprior to pregnancy. The authors appropriately recommendthat a pregnant woman discuss safe levels ofexercise with her obstetric provider before beginning anexercise program during pregnancy.

After the exercise chapters, the authors have included achapter on “Relaxation Techniques,” written by a contributingauthor and RN. This chapter presents breathing,aromatherapy, hydrotherapy, and visualization in fourpages. While the philosophy of relaxation in pregnancy andlabor are consistent with the fitness program, not enoughtime is devoted to it to do it justice. At the same time, toomuch space is given to it to suggest a woman should domore reading on the subject on her own. With a bit morework, this chapter could either become a much strongercomponent of the book and a more integrated element of apregnancy fitness program, or, conversely, it could bemoved to the appendix section, along with a reference list,with suggestions for relaxation or childbirth readings and/orclasses.

The final chapter on postpartum exercise is very well done.There are general guidelines about when to start each typeof exercise after a vaginal birth or after a cesarean delivery.Again, the authors emphasize the importance of discussingpersonal recommendations with a provider. They alsorecommend including baby in the postpartum exercises,and many are demonstrated by using a baby, which makesthese exercises both more fun and more realistic for newmothers.

There are two appendices, one on diet, including recommendationson nutrients and calories, foods to avoid, anddietary approaches to common discomforts, such as nausea,heartburn and constipation, and the other on preconceptualhealth, and fitness, nutrition, and smoking cessation. Infertilitydue to extreme behaviors such as strict dieting,excessive exercise, or obesity is touched on, as well as therole of stress on fertility. These appendices are succinct andclearly presented.

Overall, the book is excellent. The illustrative photos showthe exercises very clearly, although they depict only Caucasianwomen. The women vary in shape, and very fewhave highly athletic bodies, so a moderately active womanwould not be intimidated by them. The major weakness,from this reviewer’s perspective, is that midwives are never mentioned. However, there seems to be an assumption ofvaginal birth, and perhaps even an unmedicated birth,although that is not directly stated. The content of Fit toDeliver meshes well with the midwifery model of promotingwellness and normalizing and addressing commondiscomforts of pregnancy from a holistic perspective. It is awelcome addition to the lay literature on healthy pregnancy.

Originally published in "American Journal of Midwifery and Women's Health," February 2005

Links

Sun, 18 Sep 2005 13:19:50 -0800

Welcome to a wealth of beneficial information to help you make informed choices & be actively in charge of your pregnancy and early parenthood.

www.strollerstrides.com
www.activebirthcentre.com
www.eatingforenergy.com
www.pregnancyweekly.com
www.essentialtalk.com
www.mothers-in-motion.com
www.nomorexcuses.co.uk

FTD Advanced Education Courses

Sun, 18 Sep 2005 13:19:45 -0800

See Dr. Karen Nordahl present "Exercise and Pregnancy-how current research assists you with your clients" at the Fit Pro Spring Convention, Loughborough University, Great Britain April 17,2009

All courses are held over two days and are accredited for 1 ACE , 10 BCRPA and 16 CPD (REPS) credits.

Vancouver, BC June 27-28 2009, the one day recertification course will be held on june 28 2009
Cost: two day course $350, recertification course $150
Address: City Sports and Physiotherapy Clinic, 890 West Pender, Vancouver

Contact: kelly@fittodeliver.com or 604.437.9065.

Gloucester, Ontario
April 4-5 2009
Contact Judith-Proulx-Snedden
judephysio@hotmail.com or 613.830.4806

London, England 21-22 November 2009, the One Day Refresher Course (for those candidates that have been previously certified) will be held on 21 November,2009
Address: Club Esporta, Battersea London
Contact: Jane Wake

Course Overview

Theoretical

A review of current exercise and pregnancy research
The physiological changes of pregnancy
Relative and Absolute Contraindications to prenatal fitness
ACOG Guidelines 2002 & CSEP Guidelines
Fetal and Maternal Responses to Exercise
Fetal and Maternal Benefits to Exercise during pregnancy
Post Partum Guidelines
Preconception Guidelines

Practical

Practical ABC's of Pre & Post Natal Training
Practical-Pelvic floor & Core Training
Practical -Dynamic warm-up and flexibility for pregnancy
Practical- Posture, lifting (exercises to correct)
Practical- FTD class demonstration with pregnant clients
Practical ways to modify & expand exercise repertoires for pregnant participants (UB/LB/core)
Practical -mock class small groups & feedback.

***To attend this course and write the continuing exam you must have a degree in Allied Health or Exercise Science or have a current certification as a fitness instructor or personal trainer.

Pre & Post Natal Fitness Continuing Education

The Fit to Deliver Course Manual
The Fit to Deliver Team has developed a comprehensive manual that can be used to guide exercise prescription throughout the childbearing years. The manual was developed by a Team of Health Care Professionals consisting of Dr. Karen Nordahl (MD), Carl Petersen (Physical Therapist/Fitness Coach) and Renee Minges Jeffreys (Exercise Physiologist) with additional input from Physical Therapists, Personal Trainers and a Nurse/Birth Educator.

The education and practical experience of these contributors ensures the manual is full of material that is comprehensive and easy to understand and apply.

The Fit to Deliver Exam

Those who choose to complete the Fit to Deliver continuing education must complete a theoretical and practical exam. These components evaluate the course participants knowledge and understanding of pre & post natal exercise concerns.
They as well ensure the ability to apply the theory to provide safe and effective exercise options for a pre and post natal woman.

By Completing the Fit to Deliver Continuing Education you..

Show you are committed to Professional Development.
Demonstrate your competency in Pre & Post Natal Fitness.
Become a reliable source of information on Pre & Post Natal Fitness.
Improve your marketability within the field of Women's Health Issues.

For information and registration please contact 604.437.9065 or 1.800.511.1225 or email kelly@fittodeliver.com.

Postpartum Exercise

Sun, 18 Sep 2005 13:19:40 -0800

After your birth responsibilities for your baby escalate, and it's very easy to forget your own health needs. Fit To Deliver has partnered with the Stroller Strides group to provide easy access to post-partum fitness programs in your neighbourhood.

Please visit Vancouver's Stroller Strides website.

Prenatal Fitness

Sun, 18 Sep 2005 13:19:35 -0800

First Trimester (weeks 0-12)

Congratulations on your impending arrival, this is a very exciting time for all concerned. If you were active before you became pregnant you can continue to be active as long as you’re not developing any aches and pains. Always remember to listen to your body and respond appropriately. This will usually mean, take a break if you feel overly tired or fatigued.

Pregnancy is not the time to improve your fitness but to maintain the level of fitness you had achieved prior to pregnancy. Note if you were inactive prior to this pregnancy you can begin a walking program and progress to a walk-jog program as fitness and endurance increases. Stationary cycle, pool running or swimming and other non-weight bearing activities can be used as well.

Try to be active at least 4 to 5 days per week.
Since you are still able to be comfortably on your back this is a good time to work on core strength in the supine (lying on back) position.

Throughout your pregnancy be sure you don’t overheat, don’t get exhausted or overtired, don’t get dehydrated, and don’t over train. Both of our books include guidelines and exercises for the first trimester.

Second Trimester (weeks 13-27)

By now you are getting used to the idea of being pregnant and hopefully all the unpleasant side affects have settled down.

If you have been exercising regularly keep it up consistency is the key to reaping the benefits of exercising while pregnant. By now the fetus is large enough to put pressure on your vena cava (vein bringing blood back to your heart) so you should limit time spent on your back to 30secs. This means that you can no longer do the traditional sit-ups you did in the first trimester or other work on your back, instead you need to change to an incline or side-lying position.

Remember, don't overheat, don't get exhausted or overtired, don't dehydrate, and don't over-train.

Third Trimester (weeks 28-delivery)

You are more than half way there now and hopefully all is going well. You should try to be consistent with your workouts and try and keep up both the frequency and intensity. Listen to your body very closely during this trimester to avoid turning minor aches and pains into injuries. Since it is much easier to over heat in the third trimester, ensure proper exercise environment, clothing and hydration.

Again you should not be exercising on your back for more than 30secs. Continuing to exercise throughout your pregnancy will give you the strength and stamina you need for delivery, caring for your newborn and carrying out your normal activities of daily and nightly living.

Remember as always don’t overheat, don’t get exhausted or overtired, don’t dehydrate, and don’t over train.