Exercise Concerns & Strategies

• Postpartum Exercises: When and How to Start

• Getting Rid of Post Pregnancy Belly Weight

• Tennis and Weakened Posture

• Gym Classes: Where to Begin

• Pregnancy and Exercising

• Staying Fit Without Access to a Gym

• Getting Started

• Running and Leg Pain

• Eating Before Exercise

• Exercise Bulimia

• Coffee Before Working Out

• Exercises With the Greatest Return

Leslie McNabb

A. Yes and no. Many new mothers are in a rush to get their pre-baby body back quickly. It's important to be cleared for exercise by your doctor before starting an exercise program of cardiovascular or aerobic work, strength training and stretching. Your doctor may give this OK around six weeks after your baby's arrival, when your uterus and joint ligaments have returned to pre-pregnancy size and strength.

There are a few exercises you can do soon after delivery to help prepare your body for working out once you get clearance. Many doctors suggest starting pelvic-floor exercises (often called Kegels) as soon as the first week after delivery. If you had an episiotomy, a surgical cut to enlarge the vagina and aid birth, you may need to wait longer.

During childbirth, your pelvic floor, or Kegel, muscles stretch to make room for the baby's birth. Returning these muscles to their pre-baby tone will help you do more later and get your body back faster. Your pelvic floor muscles support the organs in your lower abdomen and help core function, spinal health and continence during high-impact activities such as running and jumping.

You can also do isometrics and small-range abdominal contractions to regain muscle strength. These exercises are also useful after cesarean-section deliveries; however, you should wait until your C-section incision heals and you have clearance from your doctor.

1 week after giving birth:

Pelvic Floor Activation
To activate your pelvic floor, imagine you are stopping the flow of urine. Hold muscles for 10 seconds (don't hold your breath) and slowly release. Do 20 holds 5 times a day. This exercise can be done while sitting or standing—even when nursing!

2 weeks after giving birth:

Transverse Abdominal Exercise (sitting)
Sitting with your back supported, place your hand on your upper and lower abdominals. Inhale through the nose and exhale through the mouth with pursed lips a couple of times, breathing slowly and deeply. Breathe out and tighten your abdominal muscles by pulling your navel toward your spine. Sit tall; do not allow your shoulders to round forward. Hold for 30 seconds or less. Repeat 10 times.

3 weeks after giving birth:

Transverse Abdominal Exercise (side-lying)
Same technique as above; perform exercise while lying on one side with legs slightly bent and holding a pillow between the knees. Support head with a pillow or a rolled up towel.

Transverse Abdominal Exercise (on all fours)
Same technique as above, on all fours with shoulders lined up over hands and hips over knees. Keep spine still as you pull your navel to your spine.

Pelvic Tilts

Lie on your back with knees bent, feet resting on the floor and holding a pillow or a rolled up towel between the knees. Inhale through the nose and exhale through the mouth several times without changing the natural curve in the back. Breathe slowly and deeply. Then breathe out, tighten abdominal muscles, pulling the navel to the spine. With the navel pulled toward the spine, pull your lower abs in and flatten back by tilting your pelvis. Use your abs; do not push with your legs. Hold for 30 seconds; repeat 10 times.

4 weeks after giving birth:

Leg Slides

Lie on your back and complete a pelvic tilt (see above). Keep abs tight and back lengthened along the ground; inhale and slide one leg out along the floor until fully extended if possible. Do not loosen abs or let your back leave the ground, even if you can't extend the leg fully. Exhale and slide leg back to start. Repeat 20 times on each leg.

Head Lifts

Lie on your back, knees bent, squeezing a pillow or a rolled up towel between your knees. Pull navel toward spine and complete a pelvic tilt (see above). Wrap hands around upper waist; squeeze hands together as if making a corset around your middle. Slowly lift head off the ground to look at your navel. Keep shoulders on ground. Work up to 2 sets of 10 repetitions.

Continue to do these exercises until your six-week check-up. After your doctor clears you for full activity, use these exercises as a warm-up routine prior to more intense activities.

Back to Ask the Trainer Topics

Leslie McNabb

A. If you are doing cardiovascular exercise regularly, you are on the right track! To rev up your metabolism more, add strength training. You'll burn calories, plus the added muscle will keep your metabolism running faster—making it easier to shed pounds. This is the only way to lose fat regardless of where it sits on your body.

Having a baby has added a few pounds and stretched your abdominal muscles. You will lose body fat through healthy nutrition, cardiovascular workouts and training your abdominals back to their original shape.

I recommend fitting in some kind of cardio activity two to three times a week and 30 to 45 minutes of strength training at least three times a week. Try these Pilates exercises to help your muscles:

Pilates Single Leg Stretch
Lie on back, knees bent to your chest. Hold knees loosely with hands and elbows pointing out. Exhale, engage your abdominals and curl your head and upper torso forward.

On your next exhale, stretch your right leg out, taking hold of your left knee with your right hand. Keep the extended leg in line with your shoulder. Maintain the curve of the upper torso and keep your shoulders down.

As you exhale, change legs, taking hold of your right knee with your left hand and your right ankle with your right hand. Try not to use the arms to pull the leg in. Maintain the curve of the upper torso as you alternate legs; repeat 16 times.

If you feel strain in the lower back, keep the straight leg higher by reaching for the ceiling. For neck strain, support neck and shoulders with a pillow folded in half.

Pilates Obliques

Lie on your back with knees bent into your chest and arms behind your head. Exhale, engage your abdominals and curl your head and upper torso forward. Without letting the back arch, move both knees forward until they are directly over your hips. Exhale, extending one leg out, and twist the upper torso toward the bent leg. Inhale as you bring the torso back to the center and return the straight leg to the beginning position. Keep head and torso forward; alternate legs 16 times.

For low-back tension, keep legs bent or on the floor until you are stronger. If neck tension occurs, use a rolled-up pillow to support the head and neck.

Back to Ask the Trainer Topics

Leslie McNabb

A:It could be. Most sports require lots of repetitive movements that can lead to muscle imbalance. The tennis swing is a pushing motion that emphasizes the muscles on the front of your shoulders, chest and abdomen. Done repeatedly, your chest and shoulder muscles can shorten and start to pull your shoulders forward, giving them a rounded appearance.

What's more, the strong upper abdominal work needed for a powerful tennis serve can start to round the upper back. To counteract this, stretch these overused muscles after a game. Doing resistance exercises for your upper back and rear shoulders also will help keep your posture in check and make you less prone to injury.

Try these posture-strengtheners.

Chest opener:

• Stand with your back against a wall, holding your abdominal muscles tight.
• Bring your arms up until your elbows are the same height as your shoulders.
• Rotate your arms to bring your hands as close to the wall as possible.
• Slowly, lift your arms toward your head by sliding your hands upward. Go only as far as you can without letting your back come off the wall.
• When you reach that point, slowly slide your arms back to the beginning position.
• Repeat 10 times.
• Note: If your head doesn't touch the wall, prop a pillow behind your head.

Shoulder external rotation:

• Hold an exercise band (available at sporting goods stores) in both hands. with your palms up and elbows bent next to your sides.
• Keeping the elbows by your sides, slowly start to rotate the upper arm bone and move your hands away outward to expand the band. Do not let your back come away from the wall.
• Return to starting position slowly.
• Repeat 10 times.

Rear deltoid (back of shoulder):

• Hold an exercise band in front of you at about shoulder height with straight arms and palms facing up.
• Move your arms to the sides. Keep your hands at shoulder height or slightly below.
• Return to starting position slowly.
• Repeat 10 times.

Upper back extensors:

• Lie on your stomach on the floor. Place your hands on top of your head, finger tips together.
• Lift elbows off the floor without moving your hands.
• Then, slowly, lift your head and upper body off the floor while holding your abdominal muscles in. Imagine your upper back and shoulder muscles pulling your upper body off the floor.
• Return to starting position slowly.
• Repeat 10 times.

Back to Ask the Trainer Topics

Leslie McNabb

A: The best class for you is one you get excited about and will do! However, as a beginner, it's important to start slowly and make sure your body is ready to meet the demands of the class.

"Boot camp"-style classes are intense strength-training sessions. They feature high-impact cardio workout drills such as jumping jacks and running. These classes—often featuring the words "extreme," "blast" or "boot camp" in their titles—may have loud, heart-pumping music and an instructor who uses a commanding tone of voice to get you to work your hardest.

Such a fast-paced, high-energy class can cause you to forget about proper form and push yourself beyond what your body can do safely. Since you are new to exercise, I recommend finding a class that will focus on your postural muscles and body awareness.

A Pilates or Pilates-inspired body sculpting class is a good place to start. This type of class typically works your core, challenges your balance and coordination and uses light weights to strengthen your arms and legs. Since the pace is slower, you can focus on perfecting your form and working your joints safely. Practicing slow, controlled movements with proper form is challenging and will give you the foundation you need to safely join a faster-paced class later on, if you want to.

For the new exerciser, I recommend taking this type of class twice a week for four to six weeks before trying a high-impact class. Because Pilates-type classes do not include cardiovascular training, add low impact activities like walking on the treadmill, stationary biking, or swimming for a well-rounded workout routine.

Back to Ask the Trainer Topics

Jaime Longval, M.S., C.S.C.S.

A: Exercise is a wonderful thing you can do for yourself and your baby. It can improve your mood, increase your energy and help with those ever-so-common backaches.

Check with your doctor before starting any exercise program, especially since you are pregnant and going into your second trimester. In general, healthy women with healthy pregnancies who did not exercise before becoming pregnant can exercise safely.

Start your adjustment to exercise slowly. Try to include a 5- to10-minute warm-up and cooldown that includes some light stretching. Begin by walking for 5 minutes a day. Increase that amount by 5 minutes each week until you are conditioned to walk for 30 minutes on most days of the week. Be sure to:

• Walk at a pace that is faster than what you usually walk but doesn't leave you breathless or exhausted.
• Listen to your body. It will let you know if you are overexerting yourself.
• Staying hydrated is important for any exercise program, so remember to drink water.

If walking is too hard on your muscles and joints or causes any discomfort, try swimming. Pool water provides great support for your expanding belly and keeps the weight off your joints.

You also can gently work your abdominal muscles while sitting in a chair or standing. Squeeze your abs, hold the squeeze for 5 seconds, then release.

Pregnant women should not participate in any type of contact sports and should avoid activities that are jerky, bouncy or require balance or where there is an increased risk of falling. At this point in your pregnancy, you should also avoid any activity that requires you to lie flat on your back. If you have any questions about the specific activity you want to pursue, talk with your health care provider.

If you get any of the following symptoms while exercising, The American College of Obstetricians and Gynecologists recommends that you stop the activity and call your doctor right away:

• Vaginal bleeding
• Dizziness or feeling faint
• Increased shortness of breath
• Chest pain
• Headache
• Muscle weakness
• Calf pain or swelling
• Uterine contractions
• Decreased fetal movement
• Fluid leaking from the vagina

Back to Ask the Trainer Topics

Jaime Longval, M.S., C.S.C.S.

A: One easy solution for getting a cardiovascular workout is to go for a walk or jog, depending on your fitness level, exercise preference and physical condition. You can walk or jog just about anywhere, for no cost. Walking indoors, at home, is a great option. Some cable companies offer walk-at-home programs as part of their free, watch-anytime services.

Lots of people enjoy walking outdoors, even in winter. But if walking in the cold is not your cup of tea, you may want to go to the mall—not to shop, but to walk! Some malls even open early specifically to accommodate walkers, so call your local mall to see if they do. Just remember to walk for at least 10 minutes continuously before stopping to shop. And stay away from the food counters selling cookies, cinnamon buns and ice cream!!

You can also keep up with your strength exercises during the time you can't get to the gym. The following exercises can be performed at home without any special equipment:

• Push ups—These great overall upper body exercises work the chest, shoulder and tricep muscles all at once, so they're a good timesaver.
  • If the standard push up is too difficult, try a modified version. Get into a push up position and then drop your knees down so they are resting on the floor. Your body should be aligned from the top of your head to your knees.
  • Bend your elbows and lower your body toward the floor as far as you can without touching, then push back up to the starting position. Keep your abdominal muscles tight and maintain the straight line position.
• Lunges—For overall lower body exercise, these can't be beat. They work the muscles of the quadriceps, hamstrings, and bottom.
  • Stand straight with your arms down by your side. Step forward with the right foot and lunge until you have achieved a 90 degree angle at your knee. Keep your abdominals muscles tight, back straight and left foot in place. Do not allow your right knee to go over your right toe.
  • While keeping your left foot planted, push off with your right foot to return to a standing position. Repeat on the other side.

Do what you can, but don't beat yourself up over not getting in a workout or two. You can get right back on schedule once your gym resumes normal business hours. Just try not to get out of your routine for too long. It's a lot easier to stop exercising and lose motivation than it is to get that motivation back and start exercising again.

Back to Ask the Trainer Topics

Jaime Longval, M.S., C.S.C.S.

A: Right now, you are in what experts call the contemplation stage of exercise. You're thinking about how to put what you want into action. Start simply by adding a little physical activity into your day whenever you can, such as walking around the block for 5 minutes before you go to work.

Consider a variety of options. One day, try working out for 20 to 30 minutes in the morning and, on another day, switch exercising to the evening. Then see if you're more consistent when you do the activity in 10-minute bouts throughout the day. Vary your physical activities to find which are most enjoyable to you.

Your environment also affects exercise success. Try working out alone as well as with a buddy, group or in a class. You may prefer certain settings, so compare exercising at home with going to a gym or park.

It will take some trial-and-error before you figure out what works best for you. Set specific, easily attainable, realistic goals (short- and long-term), so you don't set yourself up for failure. Don't pledge to run 5 days per week when you're only able to walk 2 days each week. Reward yourself when you reach a goal. That gives you something to look forward to and reminds you of your success.

When you've been exercising regularly for at least 6 months, you will have advanced to the maintenance stage—when you continue being physically active because it's become part of your life and thinking. There will be times when you relapse, which is not unusual. Just get back to your regular program as soon as possible.

Back to Ask the Trainer Topics

Jaime Longval, M.S., C.S.C.S.

A: Several factors could be contributing to your leg pain. You might simply be doing too much too soon. As a first-time runner, you need to start off slowly by walking and then build up to running. At the start of each exercise session, walk on the treadmill for about five minutes to warm up your muscles. Then gradually increase to the desired speed. Doing leg stretches also may help minimize pain and/or injury. You'll get the most benefit from stretching when it's done over several weeks.

How you run can also create pain in your ankle or knee. For example, your foot may be rolling inward or outward when it strikes the treadmill's belt. A shoe designed specifically for running might add support. In addition, since running on a treadmill allows only a limited amount of space, you may be altering your gait. That can put added strain on joints and cause pain.

There are pros and cons to running on a treadmill or track. A treadmill gives you a bit more "cushion" than most tracks, while running on a track allows you to move freely, decreasing the chances of affecting how you run. Try both types of running and see which feels more comfortable for you. If the pain is persistent or severe, see your health care provider.

Back to Ask the Trainer Topics

Jaime Longval, M.S., C.S.C.S.

A: You need fuel to get the most out of your workout, and food provides that fuel. When you wake up in the morning, it's been a long time since dinner, and your energy levels are depleted. So eat a little before your workout. What, when and how much you eat really depends on the intensity and duration of your workout.

If you don't like to have breakfast first thing in the morning, eat a small snack that's high in carbohydrates and easily digestible or drink a sports drink, preferably 30 minutes to an hour before your workout. Afterward, you can then eat your normal breakfast. A good "after-workout" meal would contain both protein and carbohydrates, such as a whole-wheat English muffin spread with peanut butter.

Back to Ask the Trainer Topics

Jaime Longval, M.S., C.S.C.S.

A: In the eating disorder known as bulimia, a person consumes excessive amounts of calories and then gets rid of those calories by vomiting and/or taking laxatives. With exercise bulimia, calories are also consumed in large quantities, but they are purged through excessive exercise.

Dangerous consequences may occur from exercising too much: musculoskeletal injuries, dehydration, osteoporosis and a possible halting of the menstrual cycle. Exercise is excessive when it becomes like an obsession—you plan your life around the exercise, continue to exercise with an injury, exercise for hours at a time or skip important prior commitments to get a workout in.

If you think you may have exercise bulimia, or are exercising excessively, talk with your health care professional or seek help from a therapist.

Back to Ask the Trainer Topics

Joseph Ciccolo, PhD

A: Although caffeine is a diuretic, a very recent study has busted the conventional wisdom that drinking coffee (or other caffeine use) can worsen dehydration or hyperthermia during exercise. Even moderate levels of caffeine consumption have not been shown to negatively affect exercise performance through dehydration/fluid or electrolyte balance, temperature regulation or diminished heat tolerance.

In addition, other studies have shown no significant differences in exercise performance when comparing a caffeine drink to a placebo.

Given the lack of evidence for or against pre-exercise caffeine consumption, I would suggest that if you want to drink coffee before you work out, do it on a trial-and-error basis. Caffeine's effect on your digestive system may affect how you feel when working out, which could be important to your exercise enjoyment and success.

Back to Ask the Trainer Topics

Joseph Ciccolo, PhD

A: It's helpful to think in terms of physical activity, not exercise. Many people think they don't have time for exercise but are surprised to realize how much they can increase their daily physical activity outside of an official "exercise routine." That boost, even in small amounts of time, pays off for your body.

To maintain health, the national guidelines for physical activity set forth by the American College of Sports Medicine and the U.S. Centers for Disease Control and Prevention (CDC) recommend adding 30 minutes of moderate-intensity activity (brisk walking), five or more days per week, or 20 minutes of vigorous intensity activity (running), three or more days per week. If you want to lose weight, you will need to burn an additional 500 to 700 calories per day.

Think this would take up a lot of time? Relax! You don't need to find a free half-hour. Research shows that you will gain the same benefit if you complete the daily activity in three 10-minute bouts. Here are great moderate and vigorous activities that take only 10 minutes and can be incorporated into your day:

• Jumping rope
• Gardening or raking
• Dancing
• Brisk walking or jogging
• Vacuuming
• Stair climbing or marching in place
• Push-ups and sit-ups
• Jumping jacks
• Bike riding for errands or short commutes
• Incorporating activity into your workday—use the stairs instead of the elevator, walk to talk with co-workers instead of e-mailing, stand (it burns more calories) when you would usually sit

Push-ups may remind you of the terrors of high school gym class, but they're a terrific strength training activity for women that can be done at home (or almost anywhere else) easily, at your own speed. Try them for a 10-minute session:

• Lie on the floor, facing chest down. Put your hands flat on the ground, at shoulder level. Place your feet together and parallel. Throughout the push-up, always look forward and not down at the floor.

• Straighten your arms as you push your body up off the floor and exhale. Keep your body straight. Do not bend or arch your upper or lower back as you push up.

• For a classic push-up, balance in a straight line from your toes. If you have trouble with that, try a modified version: pivot up from your knees instead of your toes.

• Slowly lower your body until your chest touches the floor. If you are pivoting from your toes, keep your knees off the floor. For either position, keep your body straight and your feet together. Repeat.

Back to Ask the Trainer Topics