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  • Hopkins Looks Into Fitness Guidelines For Pregnant Women

    This article by Meredith Cohn, The Baltimore Sun

    Study to see how much exercise is healthy for mom, baby.

    Her Asics laced up and her water bottle at her side, Meredith Dobrosielski stepped onto the treadmill for a robust half-hour walk.

    For the Towson runner, this wasn't just any trip to the gym. The session took place in a lab at Johns Hopkins Bayview Medical Center in Baltimore. And each step offered information on the impact of exercise on her fetus. Dobrosielski is about 8 months pregnant.

    Doctors expect the information collected to fill in some gaps in the data on how much pounding is OK for a developing baby. Eventually, they hope to be able to develop personalized workout schedules for women in different states of fitness.

    "We do know that not only can exercise be done, it should be done," said Dr. Andrew J. Satin, professor and vice chairman of the department of gynecology and obstetrics for the Hopkins School of Medicine. "But the level of fitness should impact the individual's prescription."

    Not too long ago doctors used to tell all women not to exercise when they became pregnant, but that advice has changed, said Satin and Dr. Linda Szymanski, a fellow in maternal fetal medicine helping conduct the research. But there still is little data about what's too much for the elite athlete verses the couch potato and those in between. Satin said much is based on "opinion and common sense."

    They believe research is limited because doctors fear testing pregnant women. But nine months into the study, there have been no adverse reactions. As a precaution, the hospital's labor and delivery area is close by.

    About 60 women in their third trimester of pregnancy take turns on the treadmill. Some are regular runners and others are sedentary. Everyone takes a moderate walk, and the regular runners also run until they hit their peak capacity but don't linger there. Several measurements are taken over the sessions from fetal heart rate and blood flow to the womb to fetal movement and amniotic fluid levels. The fetuses are examined by ultrasound before and after treadmill work.

    Over time, the doctors plan to measure the impact on fetuses; partner with biomedical engineers to develop new ways to monitor the fetus, perhaps wirelessly during exercise; and collect long-term data on the pregnancy outcomes. The treadmill tests are the first step and some solid data should be available in a couple of months.

    Doctors and groups such as the American College of Obstetricians and Gynecologists and the American Pregnancy Association now give blanket advice to pregnant women to get 30 minutes of exercise a day.

    Potential benefits include improvement in general health and a decreased chance of gestational diabetes and hypertension, among others. Also, these groups say, that labor, delivery and recovery can be easier.

    But the advice is based on recommendations from government and groups such as the American College of Sports Medicine that non-pregnant people get such exercise. And it's filled with notes of caution for those who are just starting and those with certain conditions. The college suggests seeing a doctor first, starting slow and stopping when there's pain or bleeding — advice Satin doesn't dispute.

    He added that doctors do know driving up a heart rate and maintaining it there for too long can cut off blood flow to the fetus. Getting overheated and dehydrated are also problems. Joints also can become lax and balance may be off, so some exercises should be avoided, such as street biking late in pregnancy. Contact sports, horseback riding and downhill skiing also may cause injury from blows or falls.

    But he and others say not everyone has gotten the message that exercise is beneficial.

    It was a big change in 2008 when physical guidelines were published for Americans, including pregnant women, said James Pivarnik, who works with the sports medicine college and is professor kinesiology and epidemiology and director of the Center for Physical Activity and Health at Michigan State University.

    He said the guidelines do indicate "that the elite runner can continue doing what she is doing for a bit, provided her health care provider is in the loop, and that she has no warning signs or other issues." But he said "boutique" recommendations are hard with so many possible circumstances.

    "Pretty much the aerobic recs are the same as for anyone," he said.

    Pivarnik agreed more research is needed, such as Satin's. He's now looking at how much weight lifting is good for pregnant women.

    Szymanski said the incomplete data has only confused the message. "[Pregnant] women express frustration because a number of doctors give different advice. Some still tell them not to exercise, especially if they haven't been exercising."

    Outdated information and myths perpetuated by the Internet still mean many women who had been exercising — up to a quarter by some accounts — stop because they fear they will harm their babies, the doctors said.

    Satin said it's actually a really good time to suggest starting an exercise program. Women are more apt to take care of themselves when they are pregnant. They'll quit smoking, eat better and exercise for the sake of the developing baby and then carry over the good habits, he said.

    As long as jogging is comfortable, runners can keep at it. Stationary bikes and running in a pool also are good exercises, Satin said. And walking is safe for nearly everyone. The fetuses are not "flipping and flopping," he said. In fact, the entire uterus is moving with the exercise motion, buoying the fetus.

    Satin said his interest in pregnant athletes grew out of his work with women in the military who wanted to stay physically fit. He was formerly a professor and chair of the Uniformed Services University F. Edward Hebert School of Medicine in the obstetrics and gynecology department. Szymanski also is an exercise physiologist and collegiate athlete.

    Dobrosielski, who is about to have her second child, said she decided to participate in the study because she wanted to help other women. She's been running "forever" and played field hockey in high school and college. An ankle injury stopped her from running after 4 months, but everyday she runs in a pool, or does yoga, lifts weights or rides a stationary bike.

    She knows she won't lose as much of her fitness and will be able to return to running, even racing, quickly. Others should be able to find out what's good for them, she said.

    "It's a special population and there's so little time for study," she said of pregnant women. "I felt comfortable exercising and I knew when I needed to stop. I think it's important for all women to exercise and maybe this research will convince them to do that."

    Exercising while pregnant

    Several medical organizations recommend 30 minutes of exercising a day for pregnant women.

    •If you're just beginning or have a condition, consult your doctor. Start slow and stop if you have pain or bleeding.

    •Don't get overheated, stay hydrated and take breaks.

    •Your joints may be lax and your balance off, particularly in later months, so avoid unstable ground or consider a stationary bike or running in a pool.

    •No contact sports, but some weight training is OK. Avoid lying on your back after the first trimester.

  • Swim Your Way To A Healthy Pregnancy

    Whether you were an exercise buff, weekend warrior or more of a couch potato before you were pregnant, swimming is one exercise that almost anyone can do without injury when expecting.

    Swimming provides you with a buoyancy and weightlessness that is welcome to most pregnant women. Especially when past the halfway mark of 20 weeks, you begin to feel the lethargy of those extra pounds and awkwardness of a growing belly. It is also a great way to relax and stretch out those ligaments and tendons that have been working overtime during pregnancy.

    Best Exercise for Warm Weather

    One of the best benefits of swimming during the hot summer months is that it really does cool you down. Overheating is a big risk for pregnant women especially when exercising outside as the temperature begins to sour in the summertime. Women who are pregnant already have a naturally higher internal basal temperature which is one of the early indicators of pregnancy. The cool water of a swimming pool helps to prevent overheating while exercising. However, it is important to remain hydrated even when you are in the pool as your body is working out and expending. It is also important to listen to your body and ease into exercise and take frequent breaks. Your pregnant body will tire quicker and your heart rate should not exceed 140 beats per minute.

    Low-impact and Easy to Do:

    Water exercises are very easy to do. You don’t have to sign up for a fancy class or need years of yoga training to be ready to do some simple water aerobics. Best of all water exercise is low-impact, so it is very hard to injure yourself as the water breaks the impact of a slip or fall. Even just walking back and forth across the length of the pool is a good water resistance exercise. If you are more ambitious, grab a kick board and kick a few laps or do a frog kick breaststroke. If you are up for a little more, swim a few laps. Just a half hour of swimming or water exercise a day will help tone up your muscles for supporting your baby, can reduced pregnancy-related swelling, lower blood pressure and give more lubrication to your joints and ligaments.

    Family Friendly Exercise:

    Best of all swimming is a fun exercise the whole family can enjoy. If you have other small children, swimming is a great way to engage with them when you are pregnant and more limited in your physical activity or exercise endeavors. Everybody loves the water and swimming is great way for you to cuddle, hold and actively play with young children who may normally be too heavy for you to lift and carry and while pregnant. It’s also a great time to improve swimming skills and water safety for early swimmers with you in the pool with them rather than watching from the bench. Just helping a little one to swim is water aerobics exercise in itself!

    Low Start-up Costs:

    In terms of equipment for water exercise, all you really only need is access to a pool and a comfortable maternity swimsuit. Prego Maternity has some excellent simple one piece maternity swimsuits such as the Empire Tank for $69 which gives excellent bust support and a great suit for real swimmers. For a lower cost check out Prego Maternity’s Texture Heart Swimsuit for $48 which is a great all around one piece suit for swimming or water aerobics.

    Be sure to get your doctor’s permission before embarking on a prenatal exercise program. There are some high-risk conditions that do rule our exercise during pregnancy. But, for most expecting women it is one of the best exercises you can do for your body and mind.

  • Eight Sleep Tips for Every Child

    This article by Elizabeth Pantley, author of The No-Cry Sleep Solution

    Up to 70% of children under age five have sleep problems. Sleep issues are complicated and have many causes. They’re hard to deal with because when children aren’t sleeping, parents aren’t sleeping, and that lack of sleep affects every minute of every day for every person in the family because lack of sleep isn’t just about being tired. Sleep has a role in everything -- dawdling, temper tantrums, hyperactivity, growth, health, and even learning to tie his shoes and recite the ABCs. Sleep affects everything.

    The following ideas are of value to almost any sleeper, of any age. These tips can bring improvement not only in your child’s sleep, but also in her daytime mood and last, but not least – improvements in your own sleep and outlook as well.

    # 1 Maintain a consistent bedtime and awaking time.

    Your child’s biological clock has a strong influence on her wakefulness and sleepiness. When you establish a set time for bedtime and wake up time you “set” your child’s clock so that it functions smoothly.

    Aim for an early bedtime. Young children respond best with a bedtime between 6:30 and 7:30 P.M. Most children will sleep better and longer when they go to bed early.

    # 2 Encourage regular daily naps.

    Daily naps are important. An energetic child can find it difficult to go through the day without a rest break. A nap-less child will often wake up cheerful and become progressively fussier or hyper-alert as the day goes on. Also, the length and quality of naps affects night sleep – good naps equal better night sleep.

    # 3 Set your child’s biological clock.

    Take advantage of your child’s biology so that he’s actually tired when bedtime arrives. Darkness causes an increase in the release of the body’s sleep hormone -- the biological “stop” button. You can align your child’s sleepiness with bedtime by dimming the lights during the hour before bedtime.

    Exposing your child to morning light is pushing the “go” button in her brain — one that says, “Time to wake up and be active.” So keep your mornings bright!

    # 4 Develop a consistent bedtime routine.

    Routines create security. A consistent, peaceful bedtime routine allows your child to transition from the motion of the day to the tranquil state of sleep.

    An organized routine helps you coordinate the specifics: bath, pajamas, tooth-brushing. It helps you to function on auto-pilot at the time when you are most tired and least creative.

    # 5 Create a cozy sleep environment.

    Where your child sleeps can be a key to quality sleep. Make certain the mattress is comfortable, the blankets are warm, the room temperature is right, pajamas are comfy, and the bedroom is welcoming.

    # 6 Provide the right nutrition.

    Foods can affect energy level and sleepiness. Carbohydrates can have a calming effect on the body, while foods high in protein or sugar generate alertness, particularly when eaten alone. A few ideas for pre-bed snacks are: whole wheat toast and cheese, bagel and peanut butter, oatmeal with bananas, or yogurt and low-sugar granola.

    Vitamin deficiencies due to unhealthy food choices can affect a child’s sleep. Provide your child with a daily assortment of healthy foods.

    # 7 Help your child to be healthy and fit.

    Many children don’t get enough daily physical activity. Too much TV watching and a lack of activity prevents good sleep. Children who get ample daily exercise fall asleep more quickly, sleep better, stay asleep longer, and wake up feeling refreshed.

    Avoid activity in the hour before bedtime though, since exercise is stimulating – they’ll be jumping on the bed instead of sleeping in it!

    # 8 Teach your child how to relax.

    Many children get in bed but aren’t sure what to do when they get there! It can help to follow a soothing pre-bed routine that creates sleepiness. A good pre-bed ritual is story time. A child who is listening to a parent read a book or tell a tale will tend to lie still and listen. This quiet stillness allows him to become sleepy.

    Work with these eight ideas and you’ll see improvements in your child’s sleep, and yours too.

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