I think if you have a healthy woman and a healthy
pregnant woman, you should recommend strength
training because it's really important, as we
know, for pre -parent, post -natal health, not
only for the baby, also for the woman herself.
Hi Katja, it's my pleasure to have you on Evidence
Strong Show. If you could briefly introduce yourself.
Hello, nice to meet you. I'm Katja. I'm from
Austria, Lower Austria, living near Vienna. And
I'm a physiotherapist. In June 2023, I did my
bachelor's degree at IMC Fachhochschule Krems
in Lower Austria. And since August 2023, I'm
working as a physiotherapist at... Universitätsklinikum
Hochegg in Lower Austria with neurological patients.
Since two weeks, I also finished my training
as a sports physiotherapist. And in my bachelor's
degree, I wrote about strength training in pregnancy,
especially in the third trimester. Awesome. That's
the topic of our conversation today. And let's
start with the third trimester. Yes. third trimester.
It's between weeks 29 and 40. There are a lot
of physical changes that occur. The musculoskeletal
changes include increased lumbar lordosis and
the loosening of the ligamentous structures,
particularly in the pelvis, the sacroiliac joints,
the pubic symphysis. And this leads to a change
in posture and thus to a new sense of balance.
The third trimester seems to be very impactful
on the health of a woman. She's growing a baby.
The baby is big by then and it changes how the
body functions. So what do we know so far in
terms of strength training in pregnancy? It's
difficult because I researched a lot and there
is not much you can find in the web. Because
I think people don't talk about strength training
in pregnancy. because it's, yeah, you shouldn't
do that and so on. But strength training during
pregnancy offers many benefits such as improving
core and pelvic floor muscles, relieving back
pain, stabilizing joints, demonstrating positive
effects on blood pressure and blood sugar, facilitating
labor and promoting faster post -natal recovery.
Previous studies show that moderate controlled
strength training for example two to four times
per week for 30 to 45 minutes at 50 to 60 percent
intensity can be safe until shortly before delivery
and of course there are also contraindications
such as bleeding pre -major birth cervical insufficiency
strong intra -abdominal pressure for example
from deadlift or the leg press as well as supine
exercises in the late stages. What was your study
about? So what were you trying to find out? The
aim of my study was to determine whether and
to what extent healthcare experts recommend strength
training in the third trimester and then to identify
the health benefits pre, peri and postpartum
and to identify risks and formulate a conclusion.
recommendations for safe implementation for coaches,
physiotherapists, gynecologists, and so on. How
did you design your study? The chosen method
was qualitative research with structured guided
interviews. I transcribed the interview content
using Mayring's content analysis, paraphrased
it, and divided it into four thematic areas.
The advantages and disadvantages the professional
experiences and the public perspective and personal
recommendations of the interviews. I invited
five experts, including a midwife, a gynecologist,
a sports scientist and two physiotherapists.
And the inclusion criteria were active professional
practice, regular work with 10 or more pregnant
women per year. and the experience in prenatal
and postnatal care. Awesome. So you interviewed
five health professionals who actually work with
pregnant women and women who are in postpartum,
so just after delivery. Then you tried to come
up or qualify the answers into four buckets.
Yeah. So could we go again through the buckets?
Advantages and disadvantages of strength training
during third trimester. The next one was? The
next. Next was the professional experiences of
the experts, then the public perspective and
the personal recommendations of the experts.
I was a little bit shocked because the gynecologist
was the one that was the most... cared of strength
training in the pregnancy and the physiotherapists
where the they do and they train and they run
and they yeah they love doing sports in pregnancy
all right so let's go through all four buckets
so what did you find in each of all the four
categories of fulfilling of your data yeah all
the experts recommended um controlled strength
training even in the third trial provided it
is of high quality and individually tailored.
Pre -nectally, strength training offers improved
body awareness, prevention of diastasis recti,
reduction of back pain and water retention, and
maintenance of stability despite ligament loosening.
During labor, they call benefits like increased
strength and endurance. for labor and the ability
to change positions more quickly. And postnatally,
they think strength training during pregnancy
leads to a faster recovery from labor and improved
pelvic floor and core function. The risks of
strength training were overloading, incorrect
technique and breathing patterns, excessive intra
-abdominal pressure and pre -major labor or bleeding.
So that were... the advantages and disadvantages
of the experts. The experiences were, as I've
told before, that gynecologist was a little bit
scared about strength training in the third trimester.
But... Did they say why? What they were scared
of? Not really. She always called the risks,
but she never said, don't do it. Yeah, but I
think she's... yeah she's a little bit scared
of training in late pregnancy all the other experts
were really thought good about strength training
even in week 40 of pregnancy yeah then the public
perspective is as we all know most people think
not all but most people think when you're pregnant
you have to lie in the bed and don't do training
don't do for it's not much only walk slowly don't
carry your bags i think the public doesn't know
how much your body can do in pregnancy yeah and
you don't have to be scared about lifting weights
because for example you have a five -year -old
child and it comes to you and you are pregnant
and you take it and that's also weight yeah that's
also training yes I think many pregnant women
forget that, forget about that. I think also
if you will lie down for nine months, it will
be very hard to then function normally after
the baby comes. So you mentioned there was one
of the categories was personal experiences. Could
you say a little bit more about that? What did
health professionals said in this category? Yeah,
the physiotherapists especially work with pregnant
women or women that just had the library so they
do go through a lot of women that don't want
to train. They are scared of training, but they
always do strength training with them because
they think the labor can be so much better. You
have so much more endurance and strength for
the delivery. And after that, you have so much
endurance and strength for raising the little
baby, the midwife. makes courses for more than,
it were, about 10 women to prepare for the delivery.
And there they do breathing techniques, training
of the muscles in the abdominal area. Yeah, and
the sports scientists do just the same, like
the midwife. The gynecologist, she doesn't do
training with pregnant women. So she just cares
more medically. checking whether baby's mind
is growing and so on. She told that she has patients
that train in pregnancy, but she doesn't do any,
she doesn't say, okay, you have to do this and
this and only lift five kilograms or so. She
just does the medical examinations. Interesting.
Okay, so it seems from what you said that the
health professionals who do work, so they actually
work with pregnant women and their main work
is to prepare them for delivery physically. These
specialists will recommend strength training
and then they will be involved in the process
and advice on how the client woman should be
or could be training. Whether they're gynecologists,
the doctor will mainly focus on medical checkups
and the medical side of running the pregnancy.
They were not involved in that. training or preparation,
physical preparation of the mother. Yeah, that's
true. The main message was that strength training
is safe, beneficial and should be recommended
to support pre -parent postnatal health when
the strength training is correctly adapted to
the individual and taking into account medical
contraindications. What do you think should be
the main message from your study? I think you
should Try to do sports, do strength training
in late pregnancy if you have done it before.
Don't start with training. In late pregnancy,
do it since the beginning or before pregnancy.
And I think it's important to go to your medical
examinations, check -ups. Would you have any
advice for coaches who either want to work or
are working with pregnant women or they have
clients who are about to get pregnant or just
got pregnant? What would be your advice? My recommendations
are to consider previous athletic experience.
Beginners should be introduced to train slowly.
The focus should be on full body and strength
endurance training. Perform twice a week at moderate
intensity. Of course, when you always trained
harder, when you have always trained harder,
you can do that hard training as well. in pregnancy.
The supporting muscles of the torso, the pelvic
floor, the back and the oblique abdominal muscles
are particularly important. Exercises that place
strong pressure on the abdomen or are performed
while lying on your back should be avoided and
of course the subjective feelings of the pregnant
woman should always be taken into account. Training
must be discontinued or adjusted if any discomfort
occurs and you have to do your medical checkups
of course i just wanted to add one thing i had
christina private on this podcast a few weeks
ago and she researched who do a Valsava maneuver
in late pregnancy. And she found, this is, of
course, association study. This was not randomized
controlled trial, but she found that there is
no negative correlation between outcomes for
mother or for baby when using Valsava maneuver
with 80 % of the weight. So it seems like, you
know, in science, we go slowly, especially during
pregnancy, that the safety of the mother, the
baby is at the forefront. So this was just retrospective
association study, but there are slowly coming
up randomized controlled trials. And it looks
like strength training in healthy pregnancy is
pretty safe. And the athletes who were training
strength training before pregnancy are continuing
with good results through pregnancy, even to
the third trimester, and then picking up strength
training pretty early after. So these things
are changing constantly. So studies like yours
are very important so we can monitor what is
safe and what works and also how it then trickles
into clinical practice. Because your study shows
that gynecologist, this one in your study, was
pretty scared and risk averse and was on the
safe side, which was, I'm not telling you not
to do it, but I have some reservations. Physiotherapists
who work with pregnant... athletes or pregnant
lifters or they are more experienced and therefore
the risks for them are a little bit different
or they i don't want to say less because if there
are some contraindications i'm pretty sure that
that that would be taken into account but they
have bigger knowledge and bigger experience to
advise yeah and i also think the physiotherapists
they know about training they know about weight
training they and the gynecologists don't have
this know -how. So it's pretty, yeah, it's not
easy for them to do any recommendations. But
what do you think? Maybe that would be the way
that gynecologists... focus on finding and assessing
the risks and assessing the medical side and
are very vocal if there are contraindications.
But if it's a healthy pregnancy and there are
no problems, especially when a woman had experienced
strength training before getting pregnant, that
should be under care of other health professionals
like physiotherapists, like midwives, like old
scientists. Yeah, I think. If you have a healthy
woman and a healthy pregnant woman, you should
recommend strength training because it's really
important, as we know, for pre -parent postnatal
health, not only for the baby, also for the woman
herself. Yeah. So let's come and train. I agree.
I agree. Okay. Two short questions to finish.
The first one is, what is your favorite exercise?
You personally? I think deadlifts. Whoa, really?
Yeah. I love them because you have the whole
body, not only the legs, the back, the grip strength.
And it's so cool. You can do it with children.
You can do it with grandmother and grandfathers.
So, so cool. All right. And the last question
is if someone wants to follow your research or
ask a question, where should they go online?
I'm not that active online, but I have a private
Instagram page called Katja. Yeah, you can follow
me there and write your questions. And if you
want, I can send you my study. Thank you so much,
Katja. It was a pleasure. Thank you, too.