Exercise for Pregnancy

HURRAY!! I got an A- for my Master degree's final project. YAY!!!!!!! I am officially done with my master and convocation will be on 26th July. Finally, the ordeal is over...

Anyway the theme of my final project was "Exercise for Pregnancy". I reviewed the literature of exercise guidelines available from various governing bodies in US, UK & Australia, conducted mini surveys with some local obstericians & gynaecologists, and interviews with some pregnant ladies to understand their attitude towards exercise during pregnancy. There have been lots of paradigm change within the medical world over past decades regarding exercise prescription for pregnant women. Let me share what I have found in my project, but for certain sensitivity issues, I shall keep the "attitude" of the local doctors portion of my project discrete here ^_^

I would actually prefer any mom-to-be (or dad-to-be) to read the whole guideline from American College of Obstetricians & Gynaecologists, so to fully understand the physiological changes happening during pregnancy, the benefits of exercise during pregnancy for mom & growing foetus and what can be done and what not. But if you find it contain too much jargons and alien language (aka medical terms), you may find the patient info (pdf) published by the Royal College of Obstetricians & Gynaegologists concise and easy-to -read.

Anyway, below are important pointers below, for easy reference:

• It is safe to exercise if your pregnancy has NO complication (ie. pregnancy with no health issues such as hypertension, gestational diabetes, etc). Get clearance from your doctor.
  
• Most local women cut down exercise or even stop it all together, as they think that being active may harm their growing baby. It is actually a myth that all pregnant women need to cut down the frequency and intensity of exericse during pregnancy. The rule of thumb is, do not exceed the frequency & intensity of what you have been doing before pregnant. Pregnancy is really not the ideal time to take up new physical challenge. Thus forget about training for your 1st marathon if you had only been running regularly at 10km-distance. Exercise within your pre-pregnancy fitness level.
  
• Do not over-exert. Listen to your body, stop when you are tired.
  
• Avoid being over-heated, dehydrated, exercise in supine position (lying flat on the back) from 2nd trimester onwards, over-stretched (or ballistic/ jerky stretches), exercise at high altitude and sports that require sudden change in directions.
• Type of exercise: NO scuba diving, water skiing, martial arts, gymnastics, trampoline, etc.
  
• Eat well during pregnancy, do not exercise continuously for more than 45 min to prevent depleting blood sugar level to dangerous level.
  

As for the Pilates Lovers, good news is that Pilates is fantastic for pregnant woman. Because it is non-impact, and it stregthens all the important muscles (respiratory muscles, core muscles, pelvic floor muscles and so on) which will all come in handy during childbirth and when taking care of the newborn. However, it is very important for you to inform your instructor that you are pregnant, so that he/she can give you extra attention and modify the exercises for your safety.

Exercise is good for you and your baby, it improves your fitness level and uplifts your spirit. So stay active during pregnancy if there is no complication!

Research on Pilates - ACSM

It is a misconception to many that Pilates is just another fitness hype and there is no systemtic scientific study conducted on Pilates. Well, here is one presented at ACSM in March 2005:

"LAS VEGAS - Pilates is a beneficial exercise to enhance flexibility and muscular fitness and endurance, particularly for intermediate and advanced practitioners, but may have limited potential to notably increase cardiovascular fitness and reduce body weight. New researchconducted by Michele Olson, Ph.D., FACSM and presented today at the American College of Sports Medicine (ACSM) Health & Fitness Summit & Exposition supports the practice of Pilates to achieve some health benefits, and adds to the knowledge about the technique

In a recent study of the method, Olson and her team measured the metabolic and caloric cost of basic (beginner), intermediate, and advanced Pilates mat workouts to assess what the popular technique may and may not do for exercisers. Participants performed basic, intermediate and advanced workouts in random order while the research team monitored heart rate, metabolic rate and rate of perceived exertion.

Results indicated basic Pilates activity translated into low-moderate intensity, comparable to active stretching. The intermediate workout was shown to be of a moderate intensity level, similar to the energy requirement of speed walking at a rate of 4 to 4.5 mph. The advanced workout was found to be of high-moderate intensity, equivalent to basic stepping on a six-inch platform.

The team also found the most dramatic increase in caloric cost occurred when participants progressed from basic to intermediate or advanced levels of training. Additionally, the duration of the workout affected energy cost in intermediate sessions. For example, a 30-minute session at an intermediate level burned 180 calories, and continuing the workout burned an additional 90 calories each 15 minutes...

...an another phase of the study, the team measured abdominal muscle activity during key Pilates mat exercises. Participants performed five Pilates ?ab? exercises, then basic crunches for comparison. Results showed that the rectus abdominis muscle, which runs along the mid section of abdomen, was challenged similarly for most of the Pilates exercises. However, the Teaser exercise and Roll-Up challenged this abdominal muscle more than the crunch. The external obliques, the muscles on either side of the abdomen, were challenged to a greater degree by all of the Pilates exercises compared to the basic crunch. In particular, the Criss-Cross was the most effective for the external obliques....

...Olson says the practice of Pilates promises to become even more mainstream, and warns that this can potentially create a problem with a lack of quality instructors. ?A qualified Pilates instructor has studied for five or more years, and may have even traveled and taken intensive courses from masters. There are more than 500 exercises, and it takes more than a workshop or short course to learn and teach it correctly."

Make Your Body Burn More Fat on Its Own!

There are many things in life that doesn't work in the "more-the-merrier" manner, unlike what most people think, dieting and exercise are just two of such examples.

Many overweight people achieved incredible amount of weight loss when they change their lifestyle, that is by eating less and exercise more. But they soon reach a weight-loss planteau, the speed and amount of weight loss start to slow down and even stop. They become so eager to continue losing weight that they stop eating proper meals, and they do cardio exercises like running and biking for few hours, DAILY.

Problem is, what if these people hit another weight-loss plateau? Are they going to increase their exercise duration to 24/7 just to lose extra pounds?! That just doesn't make any logical sense.

What really happen to these people is, as explained by Yahoo Health:

Our bodies are built to survive, so when you exercise for long periods of time (often and consistently) your body thinks it needs to hold on to fat for energy. Doing short (12-15 minute), intense exercise sessions builds strength and burns calories, but not fat, so it “feels safe” using fat stores for energy after exercise.

So if you run everyday for 30 minutes, you are turning your body into a fat-sparing machine. So what is the ideal strategy to keep your body efficient in burning fat and to spare your precious time for social life than to be stuck in endless cardio exercise?

1. Instead of running/biking everyday for 30min, exercise in short, intense bursts (interval training) for effective fat burning after exercise. E.g. Run for 10-15min at 80-85% (depends on your fitness of course ) max heart rate (MHR) instead your normal routine of 30min at 65% MHR

2. Build more lean muscle by increase the amount of resistance/strength/weight training you do. Muscle is ‘metabolically active’ and burns more calories than other body tissue even when you’re not moving. Don't worry, weight training is NOT going to make you look like body builder that easily.

3. Chill on the amount of food you are eating.

Here is a sample five-day/week training schedule for you:

Day 1 Weight training for big muscle groups (Back/Chest/ Legs) and short & very intense cardio training , e.g. 15-minute fast run/walk or fast cycling sprint intervals. Day 2 Moderately long, moderately intense session (30-45 minutes) of strong walking, cycling, or Pilates Day 3 60-90 minutes of a moderately paced walk/hike. Day 4 Short & very intense cardio session, e.g. 15-minute fast run/walk or fast cycling sprint intervals. Day 5 Weight training for big muscle groups (Back/Chest/ Legs) and moderately long, moderately intense cardio (30-45 minutes)

It would be great if you can add on daily Pilates practice to your training scheule too! But remember, more does not equal to better. Make sure you practice Pilates exercises with control and precision. Repetition is never the emphasis in Pilates.

Pilates and Sex - For Men

A reader asked how exactly can Pilates help in sexual sensation (as mentioned in my previous post). She understands that strong pelvic floor muscles can affect the tone of vagina, thus better sexual sensation for the lady. But what about the men? It never even occurs to her that men also have pelvic floor muscles! So, while keeping P-latte NC-16, I will write a little more about Pilates and Sex - for MEN.

Joseph Pilates stated that the five basic principles behind his method of exercise are concentration, control, centering, flow, and breathing. All very good compliments on how to have better sex.

Generally speaking, studies have shown that a key to an improved sex life is a healthy fit body. More specifically, Pilates fitness can show you how to have better sex. Because of the obvious, and not so obvious, body-strengthening benefits of a regular Pilates routine.

First and foremost, strong pelvic floor muscles equal stronger orgasms - for both men and female. Besides, in a study published in the British Journal of General Practice, 40 per cent of the male subjects who were put on Kegel exercise, attained normal erectile function, and another third showed improved performance at the end of study. Grace Dorey, visiting professor at the University of the West of England, Bristol, and lead author of the research, said that the results showed that pelvic floor exercises should be the first treatment for all men with erectile disorders and weak erections. Such exercises could also prevent impotence in men, and even improve the performance of those who do not have problems. “When men are going through a normal sex life, they should be looking to these exercises to extend their sex life. If you are performing reasonably well, this research would suggest that you may be able to improve your performance further,” the professor said. Pilates strengthen pelvic floor, thus enhance sexual performance.

Next, stronger abdominal muscles help to sustain the actions of sex. Stronger core equals stronger movements for a longer period of time. Isn't stronger and longer means better?

Want to try some of those fabulous Kama Sutra poses, but can’t quite get your leg over your head? Pilates improves your flexibility and overall range of movement at the joints.

Looser hips give you greater ease of movement and a freer feeling body. Nice.

In addition, some of the less obvious benefits of Pilates and how to have better sex have to do with oxygen. Pilates requires very deep, sometimes sustained breathing. This oxygenates your blood and sends oxygen to your muscles faster. The increased blood flow that comes from Pilates exercise can also benefit men who are experiencing some erectile difficulties; and increased blood flow in certain areas of man’s body can increase their feeling of strength., according to experts.

Plus, stronger body also allows for better stamina and an overall feeling of well being.

Last but not least, sex is many times more mental than physical. We all know how a little mental concentration can boost your experience. (wink…nod) Pilates exercise utilizes mental imagery to achieve the correct form and feeling to each exercise and the mental strength recruited during a pilates class can also be used in your sexual workout.

So you see, be the master of your mind and body and you will have control in all areas of your life. Pilates will be the way to an improved sex life.

Toes Saver for High-Heel Wearers

High-heels are must-have in a lady's wardrobe. They come in different shapes and styles and they are always in the fashion trend.

Why? Because high-heels can do wonders to enhance a lady's look. They make her look taller, legs appear longer and more slender. And they can also miraculously make buttocks seem firmer and rounder to the eyes.

But wearing high-heels regularly have detrimental effects to the feet, and to other parts of the body too. It may cause foot deformities like bunion and degenerative changes in the knee joints. Since high-heels affect the way a lady stands, it affects her posture and thus might cause problem in the spine too.

But how can any lady give up the sexy heels? Moderation is the key. Choose heels fit properly (though oftern not easy!), wear high-heels on alternate days allows your foot to rest and recover with wearing more comfortable footwear. Of course doing Pilates can help too, it can maintain foot health as many Pilates exercises stress on proper foot/ toes alignment, balancing and strengthening the foot structures.

You can also save your foot (and save yourself from giving up wearing that favourite pair of heels!) by spending just 5 minutes every night doing simple stretches. I had made a video sometimes ago to demostrate these stretches, but I have yet to figure out how to add on subtitles (can some kind soul pls enlighten me!). So instead I have borrowed a good illustration from a Hong Kong lifestyle magazine, Sudden Weekly, which demostrate the stretches. Please bear with these static images and instructions till some kind soul enlighten me with simple and non-time-consuming video editing:
For those who can't read chinese, here is the translation:

1st Pic on the left: Gently pull the 1st tarsal (aka the big toes) downwards. Hold 30 seconds to lengthen and relax the joint.

2nd Pic on the left: Gently pull the big toes and 2nd toes apart. Hold for 30 seconds to "straighten" the big toe

3rd Pic on the left: Grab a small towel firmly with all the toes, repeat 3 sets of 20 repetitions to strengthen the foot muscles.

1st Pic on the Right: Stretch the big toe up towards your shin. Hold for 30 seconds to lengthen and relax the plantar fascia (fibrous supportive tissue) under the foot

Calf Stretch: Stand with back foot flat on floor and transfer weight to front foot. Keep your back straight and hold for about 20 seconds for each leg. This will help relax and lengthen the calves muscles.

Remember just 5 minustes a day can help prevent bunion and give you a prettier and healthier feet. It can also reduce your chance of having to go thru expensive and painful bunion surgery.

~~ 5 minutes a day will give you a prettier and healthier pair of foot!

Choosing The Right Shoe

Getting the right shoe for sporting activities really can make a difference to the likelihood of suffering a sports-related injury (see Sports Injuries - Prevent than Treat).

Sports are generally dynamic activities involving lots of movements at speed, so there are many ways in which injuries can happen. Good shoes can help the feet to function at optimum efficiency, absorbing shock from the force of the body's weight being transmitted through the bones, ligaments and tendons with each movement. People who take part in sport on a regular basis can suffer aches, pains, sprains and even fractures as a result of overload on the tissues caused by lack of shock absorption or mechanical inefficiency of the foot. Modern sports shoes are made of hi tech materials that have been developed on the basis of millions-dollars worth of research to ensure maximum performance with minimum risk of injury. This has resulted in the amazing array of shoes available on the shelves in the shop.

Thus when one step into a sport shoe boutique, it is not difficult for him or her to feel lost at choosing a right pair of shoes. First of all, do not be tempted (though not easy at all) to buy shoes just based on the cool look they gives u. Buy shoes that is meant for your intended activity.

Running shoes are very flexible, which enables the foot to bend and flex through each step. As running mainly involves moving forwards at varying speeds, running shoes are not really suitable for activites involving side to side movements (such as tennis or aerobics). The amount of flexibility in the shoe can mean that the foot "goes over" at the ankle when sharp turning or sideways movements are made at speed. If your suffer from ankle pain or injury, it may be because you have been wearing running shoes for other kinds of sport!

Cross trainers are much stiffer and provide greater support for the foot when side to side movements are made. This means that they can be used across a range of activities. The downside is a loss of flexibility across the ball of the foot & the toes, which means that the muscles and other soft tissue structures in the foot & leg have to work harder to bend the foot in the shoe when running.

Court shoes, specifically designed for Tennis, basketball etc, fall somewhere between the two, giving a combination of flexibility and sideways support.

Fitness shoes, designed for aerobics etc, also combine flexibility with support and they incorporate cushioning to lessen the effect of shock generated during high impact work.

Besides choosing the right shoes for your activity, find a pair of shoes that is designed for your foot type! In a perfect world, we would all have perfect feet that would carry us around and allow us to perform the actvities of our choice with no ill effects at all. Unfortunately, this is the real world & life (and our feet) just isn't like that!

Feet that flatten out excessively when weightbearing (a movement of the joints within the foot known as pronation) tend to get aches & pains as a result of stress on the soft tissues as the foot moves more that it ideally should. People with this type of foot will benefit from a shoe that supports the inner border of the foot.

High arched feet (where the joints are in a postion known as supination) are less flexible & so support on the inner border of the foot is less important. However, this type of foot needs much more cushioning in the shoe to compensate for the lack of natural shock absorbsion caused by the relative rigidity of the joints within the foot.

To find out your foot type, you can do a little Wet Test. Notice how much (or how little) of your instep is clear in your footprint. If you find it too troublesome to check your feet after a shower, your shoe wear pattern will drop you some clues on what kind of feet you have.

Besides matching shoes with your foot type, make sure to choose shoes that are shaped to provide the appropriate amount of support for your foot.

Shoes are made on foot-shaped moulds known as lasts. Lasts can be straight, semi incurved or incurved. In a straight lasted shoe, a line drawn through the length of the shoe from the mid point of the sole at the back of the heel to the toe will pass though the point where the second toe (the toe next to the big toe) would lie. The same line on a shoe built on a semi incurved or incurved last will pass closer to the place where the little toe would lie. Shoes built on straighter lasts give more support to the inner border of the foot & so they are suitable for customers with pronated feet. People with rigid, supinated feet will do best with an incurved or semi incurved shoe.

In short, if you are pronator (foot that tends roll inwards):

• Look for: Firm midsole. Board or combination lasting. Straight/slightly curved last. Firm heel counter.
• Avoid: Extra soft midsole. Slip lasting. Very curved last. Soft heel counter.
• Common injuries: Patellofemoral knee pain. Medial knee pain. Plantar fasciitis. Shin splints. Tibial stress fractures. Lower spine pain.

And if you are supinator (Foot that tends to roll outwards):

• Look for: Soft midsole. Curved last. Slip lasting. High heel lift.
• Avoid: Very firm midsole. Straight last. Board lasting. Thin heel.
• Common injuries: Nerve pain behind the toes. First toe pain. Plantar fasiitis. Achilles tendon pain. Illiotibial band syndrome. Heel pain.
  

Further reading...

Resume Running!

I have stopped running/training after the 2006 marathon (shamefully that was more than 8 months ago), and I had hardly been active since then. I was too overwhelmed with both the demand of my new job and the super hectic wedding preparation. There was not any moment that my mind could completely calm down for more than 3 minutes, so practicing Pilates in my noisy home was quite impossible.

After months of disuse, my muscles are extremely weak. Resuming running is never easy, and frankly I hate to feel my heavy feet dragging on the ground, while my whole upper body struggled to keep itself upright. I decided to take it slow to build back my fitness, so I allowed myself to walk as and when I needed to during the first few slow jog sessions. Afterall exercise and training should be enjoyable, never torturous.

During the first few slow jog sessions, I ignored how far or how fast I had run but focused only on my own body. I made sure while I ran my tummy was engaged, my shoulders were properly organised, my neck stayed long and my chest was opened-wide. I also focused on breathing with my ribs to fully expand my lungs (which were so compressed by inactivity). It was tough to apply all these Pilates fundamentals to my weak moving body, but the hard work paid off. After just three re-conditioning runs (plus few short Pilates sessions at home), my muscle memory came back and I felt at ease running again. It was a wonderful feeling to know that I can actually run again!

Now I am more confident that I can complete the Triladies Triathlon on 23 Sept 07. It will be my "come-back" race since the OSIM tri July 06.

Do I need Pilates if I'm already Weight Training?

Yes! Weight trainers should also do Pilates, as they have particular benefits to draw from Pilates. Many weight-training exercises tend to concentrate on isolated muscle groups, where the muscle "bulk up" over time. Pilates simultaneously strengthens and lengthens your muscles uniformly, creating supple power.

Moreover, Pilates saves precious time by training all the small (but important) and deep stabilizing muscles along side with the large ones, which would otherwise be very time-consuming to train using traditional weight training method (imagine doing 3 sets of 15 reps of weights for each and every small muscle!)

By training the stabilizing muscles and teaching the body to move in good motor control, Pilates will make every movement more efficient and powerful, allowing the weight-trainer to train harder and reap more benefits from each weight training session. It also help to prevent injuries from weight lifting too.

Pilates VS Yoga

When I tell others about Pilates, most people would tell me, “Oh, I know! That thing that looks like yoga right?”, or “is it the same as yoga?”

In this geographical region yoga has been more established while Pilates is the up and coming "new" fitness trend. Pilates and yoga have exploded in popularity and have millions of enthusiastic practitioners throughout the world. They are both considered 'mind-body' fitness workouts; it makes it even harder for people to tell the difference when some Pilates exercises are actually strikingly similar to that in yoga. Many people would wonder: which is better? Well, as is often the case, there is no simple answer to this question. Both Pilates and yoga have many, many benefits associated with practicing them on a regular basis. Both will help you improve your coordination, flexibility, and posture while relieving stress and reducing 'imbalances' in your musculoskeletal system. But the real difference between Pilates and yoga are probably more philosophical in nature.

So, with my limited knowledge, I attempted to do a super simplified list of the differences between Pilates and yoga here:

Pilates	Yoga
Created about 80-years ago by Joseph Pilates, who was inspired by various exercise methods & systems including the ancient yoga asanas.	An ancient practice that was originally practiced in Northern India over 5,000 years ago.
An exercise system of effective but gentle, whole-body conditioning and corrective exercises. It was first practiced by dancers and gained mass attention in recent years because of its largely aesthetic body sculpting effects.	A lifestyle, rather then simply an exercise. It includes everything from physical postures and healthy diet to breathing, relaxation and meditation skills.
Mainly concentrates on cultivating core strength in the body, lengthening the spine. Also, Pilates is a valuable tool for increasing strength, definition and proper posture	Has a 'spiritual' focus and it aims to work the body equally and unite the body with mind and spirit; and it helps people find harmony and release stress
Pilates has a full complement of mat work, but it also incorporates work on Pilates machines, such as the reformer, cadilac and the barrel.	Yoga has many different styles, but all are generally performed in a group setting on a yoga mat with the aid of a yoga instructor.

In conclusion, although both exercise forms aim at connecting mind and body, Pilates is non-spiritual and takes a scientific approach towards bringing the parts of the body into control and balance. The breathing is different - in Pilates, you pull your stomach in to build abdominal strength, while in Yoga you allow it to expand as you breathe. Pilates is about the body in motion, while Yoga entails holding the body in a variety of poses.