WEBVTT 00:00:00.000 --> 00:00:03.600 I think if you have a healthy woman and a healthy 00:00:03.600 --> 00:00:06.980 pregnant woman, you should recommend strength 00:00:06.980 --> 00:00:10.240 training because it's really important, as we 00:00:10.240 --> 00:00:13.900 know, for pre -parent, post -natal health, not 00:00:13.900 --> 00:00:17.260 only for the baby, also for the woman herself. 00:00:19.440 --> 00:00:22.059 Hi Katja, it's my pleasure to have you on Evidence 00:00:22.059 --> 00:00:24.820 Strong Show. If you could briefly introduce yourself. 00:00:25.079 --> 00:00:28.199 Hello, nice to meet you. I'm Katja. I'm from 00:00:28.199 --> 00:00:31.739 Austria, Lower Austria, living near Vienna. And 00:00:31.739 --> 00:00:37.039 I'm a physiotherapist. In June 2023, I did my 00:00:37.039 --> 00:00:41.000 bachelor's degree at IMC Fachhochschule Krems 00:00:41.000 --> 00:00:45.859 in Lower Austria. And since August 2023, I'm 00:00:45.859 --> 00:00:50.280 working as a physiotherapist at... Universitätsklinikum 00:00:50.280 --> 00:00:54.520 Hochegg in Lower Austria with neurological patients. 00:00:54.719 --> 00:00:58.659 Since two weeks, I also finished my training 00:00:58.659 --> 00:01:03.659 as a sports physiotherapist. And in my bachelor's 00:01:03.659 --> 00:01:07.719 degree, I wrote about strength training in pregnancy, 00:01:08.079 --> 00:01:11.739 especially in the third trimester. Awesome. That's 00:01:11.739 --> 00:01:15.159 the topic of our conversation today. And let's 00:01:15.159 --> 00:01:19.329 start with the third trimester. Yes. third trimester. 00:01:19.349 --> 00:01:24.129 It's between weeks 29 and 40. There are a lot 00:01:24.129 --> 00:01:29.650 of physical changes that occur. The musculoskeletal 00:01:29.650 --> 00:01:33.609 changes include increased lumbar lordosis and 00:01:33.609 --> 00:01:35.950 the loosening of the ligamentous structures, 00:01:36.370 --> 00:01:40.069 particularly in the pelvis, the sacroiliac joints, 00:01:40.349 --> 00:01:44.010 the pubic symphysis. And this leads to a change 00:01:44.010 --> 00:01:47.209 in posture and thus to a new sense of balance. 00:01:47.469 --> 00:01:50.370 The third trimester seems to be very impactful 00:01:50.370 --> 00:01:53.010 on the health of a woman. She's growing a baby. 00:01:53.069 --> 00:01:56.829 The baby is big by then and it changes how the 00:01:56.829 --> 00:02:00.730 body functions. So what do we know so far in 00:02:00.730 --> 00:02:03.829 terms of strength training in pregnancy? It's 00:02:03.829 --> 00:02:07.290 difficult because I researched a lot and there 00:02:07.290 --> 00:02:11.629 is not much you can find in the web. Because 00:02:11.629 --> 00:02:15.610 I think people don't talk about strength training 00:02:15.610 --> 00:02:18.539 in pregnancy. because it's, yeah, you shouldn't 00:02:18.539 --> 00:02:22.680 do that and so on. But strength training during 00:02:22.680 --> 00:02:26.520 pregnancy offers many benefits such as improving 00:02:26.520 --> 00:02:30.060 core and pelvic floor muscles, relieving back 00:02:30.060 --> 00:02:33.560 pain, stabilizing joints, demonstrating positive 00:02:33.560 --> 00:02:37.639 effects on blood pressure and blood sugar, facilitating 00:02:37.639 --> 00:02:42.219 labor and promoting faster post -natal recovery. 00:02:42.719 --> 00:02:46.400 Previous studies show that moderate controlled 00:02:46.400 --> 00:02:50.340 strength training for example two to four times 00:02:50.340 --> 00:02:56.419 per week for 30 to 45 minutes at 50 to 60 percent 00:02:56.419 --> 00:03:00.439 intensity can be safe until shortly before delivery 00:03:00.439 --> 00:03:03.800 and of course there are also contraindications 00:03:03.800 --> 00:03:09.240 such as bleeding pre -major birth cervical insufficiency 00:03:09.240 --> 00:03:13.439 strong intra -abdominal pressure for example 00:03:13.439 --> 00:03:18.180 from deadlift or the leg press as well as supine 00:03:18.180 --> 00:03:22.020 exercises in the late stages. What was your study 00:03:22.020 --> 00:03:24.219 about? So what were you trying to find out? The 00:03:24.219 --> 00:03:27.460 aim of my study was to determine whether and 00:03:27.460 --> 00:03:31.319 to what extent healthcare experts recommend strength 00:03:31.319 --> 00:03:36.000 training in the third trimester and then to identify 00:03:36.000 --> 00:03:39.719 the health benefits pre, peri and postpartum 00:03:39.719 --> 00:03:44.300 and to identify risks and formulate a conclusion. 00:03:44.330 --> 00:03:48.189 recommendations for safe implementation for coaches, 00:03:48.629 --> 00:03:53.069 physiotherapists, gynecologists, and so on. How 00:03:53.069 --> 00:03:55.270 did you design your study? The chosen method 00:03:55.270 --> 00:04:00.590 was qualitative research with structured guided 00:04:00.590 --> 00:04:03.930 interviews. I transcribed the interview content 00:04:03.930 --> 00:04:07.689 using Mayring's content analysis, paraphrased 00:04:07.689 --> 00:04:10.810 it, and divided it into four thematic areas. 00:04:10.990 --> 00:04:15.569 The advantages and disadvantages the professional 00:04:15.569 --> 00:04:19.810 experiences and the public perspective and personal 00:04:19.810 --> 00:04:23.589 recommendations of the interviews. I invited 00:04:23.589 --> 00:04:29.189 five experts, including a midwife, a gynecologist, 00:04:29.790 --> 00:04:33.750 a sports scientist and two physiotherapists. 00:04:33.790 --> 00:04:37.610 And the inclusion criteria were active professional 00:04:37.610 --> 00:04:41.709 practice, regular work with 10 or more pregnant 00:04:41.709 --> 00:04:46.379 women per year. and the experience in prenatal 00:04:46.379 --> 00:04:49.639 and postnatal care. Awesome. So you interviewed 00:04:49.639 --> 00:04:53.579 five health professionals who actually work with 00:04:53.579 --> 00:04:57.100 pregnant women and women who are in postpartum, 00:04:57.120 --> 00:05:00.220 so just after delivery. Then you tried to come 00:05:00.220 --> 00:05:03.819 up or qualify the answers into four buckets. 00:05:03.920 --> 00:05:05.879 Yeah. So could we go again through the buckets? 00:05:06.180 --> 00:05:09.060 Advantages and disadvantages of strength training 00:05:09.060 --> 00:05:11.699 during third trimester. The next one was? The 00:05:11.699 --> 00:05:14.899 next. Next was the professional experiences of 00:05:14.899 --> 00:05:18.519 the experts, then the public perspective and 00:05:18.519 --> 00:05:21.800 the personal recommendations of the experts. 00:05:22.079 --> 00:05:25.639 I was a little bit shocked because the gynecologist 00:05:25.639 --> 00:05:31.519 was the one that was the most... cared of strength 00:05:31.519 --> 00:05:35.740 training in the pregnancy and the physiotherapists 00:05:35.740 --> 00:05:40.579 where the they do and they train and they run 00:05:40.579 --> 00:05:44.180 and they yeah they love doing sports in pregnancy 00:05:44.180 --> 00:05:46.779 all right so let's go through all four buckets 00:05:46.779 --> 00:05:50.860 so what did you find in each of all the four 00:05:50.860 --> 00:05:53.860 categories of fulfilling of your data yeah all 00:05:53.860 --> 00:05:56.980 the experts recommended um controlled strength 00:05:56.980 --> 00:06:00.750 training even in the third trial provided it 00:06:00.750 --> 00:06:05.269 is of high quality and individually tailored. 00:06:05.589 --> 00:06:09.610 Pre -nectally, strength training offers improved 00:06:09.610 --> 00:06:13.410 body awareness, prevention of diastasis recti, 00:06:13.529 --> 00:06:16.889 reduction of back pain and water retention, and 00:06:16.889 --> 00:06:21.189 maintenance of stability despite ligament loosening. 00:06:21.410 --> 00:06:25.610 During labor, they call benefits like increased 00:06:25.610 --> 00:06:30.389 strength and endurance. for labor and the ability 00:06:30.389 --> 00:06:34.089 to change positions more quickly. And postnatally, 00:06:34.310 --> 00:06:37.730 they think strength training during pregnancy 00:06:37.730 --> 00:06:40.810 leads to a faster recovery from labor and improved 00:06:40.810 --> 00:06:44.730 pelvic floor and core function. The risks of 00:06:44.730 --> 00:06:47.990 strength training were overloading, incorrect 00:06:47.990 --> 00:06:52.329 technique and breathing patterns, excessive intra 00:06:52.329 --> 00:06:56.470 -abdominal pressure and pre -major labor or bleeding. 00:06:56.649 --> 00:06:59.959 So that were... the advantages and disadvantages 00:06:59.959 --> 00:07:05.639 of the experts. The experiences were, as I've 00:07:05.639 --> 00:07:10.180 told before, that gynecologist was a little bit 00:07:10.180 --> 00:07:14.199 scared about strength training in the third trimester. 00:07:14.360 --> 00:07:17.220 But... Did they say why? What they were scared 00:07:17.220 --> 00:07:21.480 of? Not really. She always called the risks, 00:07:21.839 --> 00:07:25.560 but she never said, don't do it. Yeah, but I 00:07:25.560 --> 00:07:28.720 think she's... yeah she's a little bit scared 00:07:28.720 --> 00:07:32.740 of training in late pregnancy all the other experts 00:07:32.740 --> 00:07:37.339 were really thought good about strength training 00:07:37.339 --> 00:07:41.920 even in week 40 of pregnancy yeah then the public 00:07:41.920 --> 00:07:46.120 perspective is as we all know most people think 00:07:46.120 --> 00:07:50.360 not all but most people think when you're pregnant 00:07:50.360 --> 00:07:55.000 you have to lie in the bed and don't do training 00:07:55.000 --> 00:08:00.420 don't do for it's not much only walk slowly don't 00:08:00.420 --> 00:08:04.060 carry your bags i think the public doesn't know 00:08:04.060 --> 00:08:08.139 how much your body can do in pregnancy yeah and 00:08:08.139 --> 00:08:11.839 you don't have to be scared about lifting weights 00:08:11.839 --> 00:08:15.459 because for example you have a five -year -old 00:08:15.459 --> 00:08:19.660 child and it comes to you and you are pregnant 00:08:19.660 --> 00:08:23.839 and you take it and that's also weight yeah that's 00:08:23.839 --> 00:08:27.850 also training yes I think many pregnant women 00:08:27.850 --> 00:08:31.310 forget that, forget about that. I think also 00:08:31.310 --> 00:08:33.809 if you will lie down for nine months, it will 00:08:33.809 --> 00:08:36.289 be very hard to then function normally after 00:08:36.289 --> 00:08:39.110 the baby comes. So you mentioned there was one 00:08:39.110 --> 00:08:41.929 of the categories was personal experiences. Could 00:08:41.929 --> 00:08:44.850 you say a little bit more about that? What did 00:08:44.850 --> 00:08:47.690 health professionals said in this category? Yeah, 00:08:47.690 --> 00:08:52.090 the physiotherapists especially work with pregnant 00:08:52.090 --> 00:08:57.210 women or women that just had the library so they 00:08:57.210 --> 00:09:01.570 do go through a lot of women that don't want 00:09:01.570 --> 00:09:05.429 to train. They are scared of training, but they 00:09:05.429 --> 00:09:09.070 always do strength training with them because 00:09:09.070 --> 00:09:13.470 they think the labor can be so much better. You 00:09:13.470 --> 00:09:17.190 have so much more endurance and strength for 00:09:17.190 --> 00:09:20.409 the delivery. And after that, you have so much 00:09:20.409 --> 00:09:24.190 endurance and strength for raising the little 00:09:24.190 --> 00:09:30.950 baby, the midwife. makes courses for more than, 00:09:31.009 --> 00:09:35.629 it were, about 10 women to prepare for the delivery. 00:09:35.990 --> 00:09:40.289 And there they do breathing techniques, training 00:09:40.289 --> 00:09:45.309 of the muscles in the abdominal area. Yeah, and 00:09:45.309 --> 00:09:48.909 the sports scientists do just the same, like 00:09:48.909 --> 00:09:52.629 the midwife. The gynecologist, she doesn't do 00:09:52.629 --> 00:09:55.769 training with pregnant women. So she just cares 00:09:55.769 --> 00:09:58.340 more medically. checking whether baby's mind 00:09:58.340 --> 00:10:03.360 is growing and so on. She told that she has patients 00:10:03.360 --> 00:10:08.179 that train in pregnancy, but she doesn't do any, 00:10:08.279 --> 00:10:11.600 she doesn't say, okay, you have to do this and 00:10:11.600 --> 00:10:15.580 this and only lift five kilograms or so. She 00:10:15.580 --> 00:10:19.500 just does the medical examinations. Interesting. 00:10:19.679 --> 00:10:22.200 Okay, so it seems from what you said that the 00:10:22.200 --> 00:10:25.860 health professionals who do work, so they actually 00:10:25.899 --> 00:10:29.200 work with pregnant women and their main work 00:10:29.200 --> 00:10:32.500 is to prepare them for delivery physically. These 00:10:32.500 --> 00:10:35.120 specialists will recommend strength training 00:10:35.120 --> 00:10:37.980 and then they will be involved in the process 00:10:37.980 --> 00:10:41.919 and advice on how the client woman should be 00:10:41.919 --> 00:10:44.419 or could be training. Whether they're gynecologists, 00:10:44.720 --> 00:10:48.720 the doctor will mainly focus on medical checkups 00:10:48.720 --> 00:10:51.740 and the medical side of running the pregnancy. 00:10:51.740 --> 00:10:56.500 They were not involved in that. training or preparation, 00:10:56.940 --> 00:10:59.659 physical preparation of the mother. Yeah, that's 00:10:59.659 --> 00:11:03.240 true. The main message was that strength training 00:11:03.240 --> 00:11:07.240 is safe, beneficial and should be recommended 00:11:07.240 --> 00:11:10.960 to support pre -parent postnatal health when 00:11:10.960 --> 00:11:14.539 the strength training is correctly adapted to 00:11:14.539 --> 00:11:18.480 the individual and taking into account medical 00:11:18.480 --> 00:11:21.360 contraindications. What do you think should be 00:11:21.360 --> 00:11:23.820 the main message from your study? I think you 00:11:23.820 --> 00:11:27.289 should Try to do sports, do strength training 00:11:27.289 --> 00:11:30.909 in late pregnancy if you have done it before. 00:11:31.389 --> 00:11:34.970 Don't start with training. In late pregnancy, 00:11:35.169 --> 00:11:38.690 do it since the beginning or before pregnancy. 00:11:39.110 --> 00:11:44.090 And I think it's important to go to your medical 00:11:44.090 --> 00:11:47.649 examinations, check -ups. Would you have any 00:11:47.649 --> 00:11:51.450 advice for coaches who either want to work or 00:11:51.450 --> 00:11:53.870 are working with pregnant women or they have 00:11:53.870 --> 00:11:56.629 clients who are about to get pregnant or just 00:11:56.629 --> 00:11:59.370 got pregnant? What would be your advice? My recommendations 00:11:59.370 --> 00:12:03.309 are to consider previous athletic experience. 00:12:03.309 --> 00:12:07.629 Beginners should be introduced to train slowly. 00:12:07.889 --> 00:12:11.110 The focus should be on full body and strength 00:12:11.110 --> 00:12:15.110 endurance training. Perform twice a week at moderate 00:12:15.110 --> 00:12:19.230 intensity. Of course, when you always trained 00:12:19.230 --> 00:12:22.029 harder, when you have always trained harder, 00:12:22.129 --> 00:12:26.860 you can do that hard training as well. in pregnancy. 00:12:27.039 --> 00:12:30.879 The supporting muscles of the torso, the pelvic 00:12:30.879 --> 00:12:34.539 floor, the back and the oblique abdominal muscles 00:12:34.539 --> 00:12:39.080 are particularly important. Exercises that place 00:12:39.080 --> 00:12:43.460 strong pressure on the abdomen or are performed 00:12:43.460 --> 00:12:46.320 while lying on your back should be avoided and 00:12:46.320 --> 00:12:49.840 of course the subjective feelings of the pregnant 00:12:49.840 --> 00:12:53.220 woman should always be taken into account. Training 00:12:53.220 --> 00:12:57.720 must be discontinued or adjusted if any discomfort 00:12:57.720 --> 00:13:02.259 occurs and you have to do your medical checkups 00:13:02.259 --> 00:13:05.299 of course i just wanted to add one thing i had 00:13:05.299 --> 00:13:08.539 christina private on this podcast a few weeks 00:13:08.539 --> 00:13:13.539 ago and she researched who do a Valsava maneuver 00:13:13.539 --> 00:13:17.639 in late pregnancy. And she found, this is, of 00:13:17.639 --> 00:13:20.440 course, association study. This was not randomized 00:13:20.440 --> 00:13:22.820 controlled trial, but she found that there is 00:13:22.820 --> 00:13:26.639 no negative correlation between outcomes for 00:13:26.639 --> 00:13:29.899 mother or for baby when using Valsava maneuver 00:13:29.899 --> 00:13:33.700 with 80 % of the weight. So it seems like, you 00:13:33.700 --> 00:13:36.100 know, in science, we go slowly, especially during 00:13:36.100 --> 00:13:38.679 pregnancy, that the safety of the mother, the 00:13:38.679 --> 00:13:43.710 baby is at the forefront. So this was just retrospective 00:13:43.710 --> 00:13:47.370 association study, but there are slowly coming 00:13:47.370 --> 00:13:49.649 up randomized controlled trials. And it looks 00:13:49.649 --> 00:13:53.009 like strength training in healthy pregnancy is 00:13:53.009 --> 00:13:55.529 pretty safe. And the athletes who were training 00:13:55.529 --> 00:13:59.370 strength training before pregnancy are continuing 00:13:59.370 --> 00:14:02.610 with good results through pregnancy, even to 00:14:02.610 --> 00:14:05.149 the third trimester, and then picking up strength 00:14:05.149 --> 00:14:08.289 training pretty early after. So these things 00:14:08.289 --> 00:14:12.669 are changing constantly. So studies like yours 00:14:12.669 --> 00:14:15.730 are very important so we can monitor what is 00:14:15.730 --> 00:14:20.590 safe and what works and also how it then trickles 00:14:20.590 --> 00:14:23.570 into clinical practice. Because your study shows 00:14:23.570 --> 00:14:27.429 that gynecologist, this one in your study, was 00:14:27.429 --> 00:14:30.570 pretty scared and risk averse and was on the 00:14:30.570 --> 00:14:33.289 safe side, which was, I'm not telling you not 00:14:33.289 --> 00:14:37.409 to do it, but I have some reservations. Physiotherapists 00:14:37.409 --> 00:14:39.679 who work with pregnant... athletes or pregnant 00:14:39.679 --> 00:14:43.500 lifters or they are more experienced and therefore 00:14:43.500 --> 00:14:46.840 the risks for them are a little bit different 00:14:46.840 --> 00:14:49.600 or they i don't want to say less because if there 00:14:49.600 --> 00:14:51.860 are some contraindications i'm pretty sure that 00:14:51.860 --> 00:14:54.919 that that would be taken into account but they 00:14:54.919 --> 00:14:57.899 have bigger knowledge and bigger experience to 00:14:57.899 --> 00:15:02.120 advise yeah and i also think the physiotherapists 00:15:02.120 --> 00:15:04.940 they know about training they know about weight 00:15:04.940 --> 00:15:09.080 training they and the gynecologists don't have 00:15:09.080 --> 00:15:12.919 this know -how. So it's pretty, yeah, it's not 00:15:12.919 --> 00:15:16.679 easy for them to do any recommendations. But 00:15:16.679 --> 00:15:18.240 what do you think? Maybe that would be the way 00:15:18.240 --> 00:15:22.179 that gynecologists... focus on finding and assessing 00:15:22.179 --> 00:15:25.259 the risks and assessing the medical side and 00:15:25.259 --> 00:15:28.000 are very vocal if there are contraindications. 00:15:28.159 --> 00:15:32.179 But if it's a healthy pregnancy and there are 00:15:32.179 --> 00:15:36.419 no problems, especially when a woman had experienced 00:15:36.419 --> 00:15:39.600 strength training before getting pregnant, that 00:15:39.600 --> 00:15:43.340 should be under care of other health professionals 00:15:43.340 --> 00:15:46.960 like physiotherapists, like midwives, like old 00:15:46.960 --> 00:15:50.799 scientists. Yeah, I think. If you have a healthy 00:15:50.799 --> 00:15:53.940 woman and a healthy pregnant woman, you should 00:15:53.940 --> 00:15:57.460 recommend strength training because it's really 00:15:57.460 --> 00:16:01.659 important, as we know, for pre -parent postnatal 00:16:01.659 --> 00:16:05.399 health, not only for the baby, also for the woman 00:16:05.399 --> 00:16:09.019 herself. Yeah. So let's come and train. I agree. 00:16:09.220 --> 00:16:11.820 I agree. Okay. Two short questions to finish. 00:16:11.879 --> 00:16:14.000 The first one is, what is your favorite exercise? 00:16:14.399 --> 00:16:18.080 You personally? I think deadlifts. Whoa, really? 00:16:18.340 --> 00:16:21.529 Yeah. I love them because you have the whole 00:16:21.529 --> 00:16:25.549 body, not only the legs, the back, the grip strength. 00:16:25.850 --> 00:16:28.750 And it's so cool. You can do it with children. 00:16:28.789 --> 00:16:32.210 You can do it with grandmother and grandfathers. 00:16:32.509 --> 00:16:34.990 So, so cool. All right. And the last question 00:16:34.990 --> 00:16:38.330 is if someone wants to follow your research or 00:16:38.330 --> 00:16:41.590 ask a question, where should they go online? 00:16:41.789 --> 00:16:45.210 I'm not that active online, but I have a private 00:16:45.210 --> 00:16:49.710 Instagram page called Katja. Yeah, you can follow 00:16:49.710 --> 00:16:54.610 me there and write your questions. And if you 00:16:54.610 --> 00:16:58.669 want, I can send you my study. Thank you so much, 00:16:58.690 --> 00:17:00.429 Katja. It was a pleasure. Thank you, too.