Qn of the Month: Are there Physical Activity Guidelines for Post-Pregnancy?

MH900427748A: Yes! In the United States, postpartum physical activity recommendations come from two main sources: the American Congress of Obstetricians and Gynecologists (ACOG) and the U.S. Department of Health and Human Services 2008 Physical Activity Guidelines for Americans. In the United Kingdom, recommendations come from a 2006 statement issued by the Royal College of Obstetricians and Gynaecologists. Guidelines from the 2008 U.S. Physical Activity Guidelines for Americans are to aim for a minimum of 30 minutes of physical activity most days of the week (so at least 150 minutes a week) of at least moderate intensity. The good news is that this amount can be spread out into 10 minute blocks of moderate intensity activity throughout the day. Much more manageable if you’re handling a young infant!

A recent study reviewed the physical activity guidelines similarities and differences among 5 countries (Australia, Canada, Norway, United Kingdom, and United States).  Although there are quite a few variations between the country-specific guidelines, one thing is clear: physical activity is good post-pregnancy and brings a host of benefits! Advantages for mothers can include an improved mood, improved weight control, increased weight loss, maintenance of cardiorespiratory fitness, reduced depression and anxiety. Recommended types of physical activities from these different country guidelines are aerobic, pelvic floor exercises, strengthening, stretching and walking. Overall, it may be best to build up the intensity of exercise gradually in the postpartum period depending on your body. If you’ve had a cesarean birth, it is likely best to speak with a health care provider first, before resuming previous physical activity levels.

Hopefully in the future, there can be more consistency across countries and more specifics provided within each guideline to help postpartum women.

(Sources: ACOG. Exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 267. Obstet Gynecol. 2002; 99(1):171–3. [PubMed: 11777528]

U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans.Washington, D.C.: 2008. ODPHP Publication No. U0036. http://health.gov/paguidelines/. Accessed September 25, 2015.

Evenson KR, Mottola MF, Owe KM, Rousham EK, Brown WJ. Summary of International Guidelines for Physical Activity Following Pregnancy Obstet Gynecol Surv. Obstet Gynecol Surv. 2014 Jul; 69(7): 407–414. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4134098/pdf/nihms-616584.pdf. Accessed September 19, 2015.)


Qn of the Month: I Had Gestational Diabetes in Pregnancy. Can I Forget About Blood Sugars Now That Baby’s Out?

Not quite – let me explain why.

Like me, you may have had gestational diabetes (GDM) during pregnancy, or you are currently experiencing it. Regardless, no one likes it, but it’s something we endure for the sake of delivering a healthy baby. The worst part I found was not so much that I had to constantly watch what I ate, but because I had to poke my finger to check the blood glucose level at least four times a day. The best part though is post-delivery when blood glucose levels often quickly improve and you can enjoy high carbohydrate foods again. But before you sigh with relief, forget all about blood glucose checking and throw away your testing kit, there are still a few things you should know now that you have a history of GDM.

As you may already know, gestational diabetes carries risks for both the mother and the developing fetus within the womb, as well as to the post-natal infant immediately after delivery. Women who have gestational diabetes are also at a higher risk of developing type 2 diabetes later in life. I was given some differing bits of advice from different countries. When I was in the United Kingdom (UK), a midwife told me that after the baby was born, to check my blood glucose level every year on baby’s birthday. In Singapore, however, my OBGYN doctor told me to randomly check my blood glucose level once in a while after a high carbohydrate meal.

So what should really be done now that baby’s out? In the United States, the American Diabetes Association (ADA) provides some guidelines for post-partum women who have had a history of GDM. Recommendations call for women with a history of gestational diabetes to be tested at the 6-12 weeks post-partum check-up for persistent diabetes. This should be done using the oral glucose tolerance test (OGTT) involving a standard glucose load and comparing the results to non-pregnancy diagnostic criteria. The reason for this is because while most women’s blood glucose levels return to normal post-delivery, some women may continue to have high blood glucose levels.

It is also recommended that women with a history of GDM should have lifelong screening for the development of diabetes or prediabetes at least every 3 years. In those found subsequently to have prediabetes (i.e., results indicating they are on the borderline of being diagnosed with type 2 diabetes), ADA recommends these women to receive lifestyle interventions or the medication named metformin to prevent diabetes.

So if you’ve have a history of GDM, you can relax…but not too much. It is still important to take care of your health and body, and to a certain extent be somewhat mindful of what you are eating. This means being aware of and possibly limiting high carbohydrate nutrient poor foods, avoiding excessively large portion sizes, having regular spaced meals/snacks during the day and staying active. And you’ll still need to periodically have your blood glucose levels checked!

(Source: American Diabetes Association. Standards of Medical Care in Diabetes – 2014. Diabetes Care. Jan 2014; 37 Suppl 1: S14-S80. http://care.diabetesjournals.org/content/37/Supplement_1/S14.long#sec-22. Accessed May 30, 2014. Note that there is a correction published for one of the sections within this article at http://care.diabetesjournals.org/content/37/3/887.1)

Qn of the Month: What are Calisthenics?

Veering slightly away from the usual nutrition slant, this month I decided to answer a question of my own. This came off of the back of a health assessment I did recently (see post ‘Step it Up!’) which piqued my own interest in exercise and how to get more active (while being a working mother of a toddler). After all, real health is not just about nutrition. It’s nutrition plus being physically active. That’s when I discovered Calisthenics.

What is it exactly? It’s a word I’ve heard of sporadically and knew it was connected to exercise but never really took the time to delve more deeply into until now. Here’s a simple definition (courtesy of the Merriam-Webster dictionary):  “Systemic rhythmic bodily exercises done without special equipment.” Sounds good and simple to me! Calisthenics can be counted as part of strength training, which is recommended in a 10-20 min segment 2-3 times a week. Strength training (also called weight or resistance training) is just as important as stretching as it helps to build and maintain muscle as well as bone density (especially important for keeping strong bones ladies!).

I find calisthenics exciting because it seems easy to implement, doesn’t require much space or extra expensive equipment, and could probably also be done during toddler waking hours. The best part is, depending on the intensity and length of the session, doing a few circuits of exercises as part of a calisthenics workout daily should get the heart pumping and would probably also count towards the 20-30 minutes of moderate activity recommended every day! A great way to achieve two goals with one!

See these videos for many examples of different exercises you can do (with modifications if desired). Just pick a few exercises to put together your own Calisthenics workout routine. As always, start gradually and then build up the length and intensity of the routine over time. Enjoy!

Step it Up!

I recently took an online health assessment promoted by my insurance company and received a score of 86 (which was compared to my peers scoring 89). Was I surprised? Yes, more than slightly. My husband, incidentally, got a 94 on his assessment!

Upon deeper reflection, I guess I  really shouldn’t be surprised since I currently don’t do any regular physical activity. Between working and taking care of a toddler, I haven’t had much time lately to invest in activities that I enjoy and that will also make me move more (like dancing, my favorite!). I think subconsciously I also thought that my daily stretches, playtime with my toddler, and moving around doing house chores to keep the house tidy would suffice. Not quite. This assessment was a good wake up call.

The health assessment reminded me that physical activity doesn’t have to be all in one 30-minute or more session a day. It can actually be broken up into 3 10-minute sessions of moderate activity to have the same health benefits. However, the lower the intensity of the physical activity, the longer a session you would need to aim for. See this helpful chart provided at the end of the assessment:


Intensity level Sample activities Minutes/day
Low Slow walking, light gardening, recreational volleyball 45-60
Moderate Brisk walking, raking leaves, swimming, cycling 20-30
Vigorous Running, lap swimming, fast cycling, snow shoveling 15-20

Besides increasing general physical activity, the health assessment also recommended aiming for 2-3 strength training sessions (10-20 minutes each) a week. These can be as simple as a regimen of push-ups, sit-ups, pull-ups and calisthenics. And of course, doing  some simple stretching at least 2-3 times a week can maintain your flexibility, as well as reduce possible back aches and injuries from running after a toddler!

With the warmer spring/summer weather approaching, getting more physical activity should become easier. These can be activities that both you and your toddler/child enjoy (e.g., kicking a ball, going for a walk/hike, swimming). So let’s all get moving and stay active for better health!

What You SHOULDN’T Expect From Breastfeeding

I was debating whether to put this under the ‘Milk Milk Milk’ section or under the ‘You and Your Body’ section, but finally decided on the latter. This has much more to do with protecting your body from the possible long term effects of breastfeeding than on milk production. Read on ladies!

Prolapsed Nipples.
Yep, that’s right. Prolapsed nipples. Over time, the nipples naturally change in shape slightly to adapt to continued breastfeeding. However, you don’t want your nipples to change in shape more than they have to. So ladies, always make a conscious effort to keep baby’s mouth on par with the nipple level when feeding and ensure a good latch. It’s so easy to forget this (especially when you’re tired, and it’s another night feeding), but doing so will prevent baby from pulling on the nipple and cause the nipple to gradually sag or droop a little over time due to the pressure from baby’s mouth and weight of baby’s body. Baby will get increasingly heavier too, so make baby adjust to you, not the other way around!

Lower Back Pain.
It’s very easy to get lower back pain from sitting prolonged periods in certain breastfeeding positions trying to breastfeed baby, and doing this multiple times a day. So it’s very important to get a good breastfeeding pillow and a comfy breastfeeding chair with pillows to support your back. And of course, elevate, elevate! Bring baby to your breast level and don’t try to bend over to meet baby’s mouth instead. If you need to, you can use another pillow on top of a breastfeeding pillow to support baby’s body and head. This will help bring baby up more to ‘breast-level’ while feeding. This will help your posture too. Also, keep stretching! A daily simple stretch routine (5-10 minutes) can really keep backaches from getting worse and soothe those strained lower back muscles at the end of the day!

Becoming a Hunchback of Notre-Dame (or Godzilla…).
When my baby turned 9 months old, I happened to look in the mirror and was horrified that I had turned into a kind of ‘Hunchback of Notre-Dame’ with my shoulders hunched over and my shoulder blades sticking out. Either that or I had become like Godzilla with the stooping small rounded shoulders. I had unknowingly let my posture go to the wayside over all these months because of my focus on taking care of baby. Of course breastfeeding made matters worse, because often in my efforts to maintain a good latch while baby breastfed, I wasn’t sitting straight with a good posture. Even my husband noticed (and he doesn’t even usually notice when I have a haircut)! So when breastfeeding, get yourself into a comfortable position first before latching baby on, and try to keep sitting tall and straight. If you find yourself hunching over or in an uncomfortable position, then detach baby and re-latch baby on, or try a different breastfeeding position. And as you go throughout your day, remember what your mother told you all along, “Stand up tall and straight, and keep your shoulders back!” Or like in the film Miss Congeniality, Sandra Bullocks was told by the beauty pageant consultant to, “Keep your chin parallel to the floor!”

Take a moment to…sTrEtchhhHH!

I remember a physiotherapist from a UK antenatal class once saying, “It is going to be after delivery that you will experience the most potential for injury to your body, not before.” Somehow that comment stuck with me, and when I went to Singapore, another physical therapist said a similar thing! What they say makes absolute sense. Why? Because during pregnancy, you are more or less taking care of your body, and making sure you’re not overstraining yourself or carrying heavy objects. However, after delivery, you will be so busy running around trying to take care of baby, picking baby up to feed (possibly breastfeeding as well), changing clothes, diapers, bathing baby and picking things off the floor, that it is easy to forget about your body and having the right postures when performing these actions.

I found this to be the case after my baby was born, and actually strained my lower back at least once and had other minor injuries. And believe me, when you strain your back, it is hard to pick baby up or breastfeed! So what I found really helped was to take 5-10 minutes a day (or twice a day) and just take a breather to relax and do a simple stretching exercise routine. This can be at the end of the day after baby has been put to bed, giving you a chance to wind down too. Not only will the stretching help loosen and relax those tense muscles, it will also help relieve the minor backaches and strains, preventing these from turning into bigger problems. A little bit of daily stretching really goes a long way!