Tuesday, June 8, 2010

Pregnancy Running - I'm Done Thinking, Now for Some Conclusions

I appreciate everyone who has put up with my analyzing and overanalyzing (to some) of my current and future physical condition, the safety of the baby, and my mental/emotional health in relation to staying active and exercising during pregnancy.  I know I am a weird mix sometimes of extremely emotional and yet critically analytical - and it creates a giant cluster of thoughts and feelings.  I was surprised how many read all my musings on pregnancy running and this whole situation - I had about 150 unique visitors to this blog over the last week!

So here is an update on my more recent workout and heart rate testing (test #3), research and anecdotes everyone has provided or I've found on my own in the last few days, and conclusions on my workout and total body-and-baby health plan moving forward!  I know it's long but necessary to be to get all this out and done and move on with staying as healthy as possible through the rest of this pregnancy!

Update on Latest Workout
I can tell that I feel amazing.  After a 30 minute elliptical workout of 3.5 miles yesterday morning, I also accompanied my friend Sarah to our first 1 hour Zumba class last night.  It's kinda like step aerobics without the step, then shake your hips, booty, and chest the whole time - oh, and throw in some basic salsa moves.  Kinda fun, definitely not as hard as running for an hour.  I wore the heart rate monitor and most of the class my heart rate hovered around 130, had some jump-ins for short times to 140-155, but it would bounce back down super quick.  There's a 10-20 second break every couple minutes between songs so that bit of recovery was quite noticeable on the heart rate monitor.

Research and Anecdotes from Others
A load of googling and reading articles I've found and that others have been so kind to send me has been very helpful.  I understand that my doctor appears to be using very conservative rules for exercise during pregnancy - I can't really blame her, she's just the type to want to guarantee the safest pregnancy possible for her patient.  And, while some suggested I consider changing doctors over this, that's not the best choice overall for me.  This doctor is an amazing Type A woman who is a great fit with my personality and who has already gone through a pregnancy and delivery with me - overall, I really enjoy having her as my doctor.

After reading articles, including going directly to sources like the American College of Obstetrics and Gynecology, I feel much more comfortable now knowing that there are less strict, more fluid guidelines available with ranges of safe percentages of max heart rate and a more subjective test of using perceived exertion, which can actually help a pregnant woman, by staying body aware, carefully limit her activity more over time as she feels the exertion required for the same exercises is higher.

And here's a sampling of the personal anecdotes:
  • Lisa W.: "My Dr said the 140 was out of date and to run at conversation pace. As long as I could keep up a conversation without huffing and puffing I thought that was an ok pace. That did mean about 1-2 min slower per mile than my non pregnant pace though."
  • Elizabeth M.: "I could not keep my heart rate below 140 when running while pregnant, which is why my doctor came to the compromise (after he did research as I was going to keep running) that as long as my heart rate went back down within 2 minutes of stopping, I was okay. There is a big difference between pregnant fit women and unfit women when it comes to heart rates."
  • Abigail H.: "I read your blog and feel your pain! I ran through the first 20 weeks of this pregnancy and used the elliptical after that, up until the day I delivered last week. I used 'perceived exertion' as my guide, and my heart rate usually was between 150 and 160. Lillian was born healthy and happy with no damage. I don't want to disagree with your doctor, but that was my experience."
  • Lena H. (a newly certified personal trainer): "The general consensus tends to be that it is safe to run during pregnancy if you ran before you are pregnant, are generally healthy, take some precautions, and check with your doctor (which you did). The 140 heart rate rule is considered "old school" by many, and obviously didn't work very well in your case. Rating of perceived exertion (RPE) may be a better estimate of effort. You need to work out at a moderate level, where you can talk (which means you are working aerobically). Also, your joints get looser during pregnancy, which means you are more prone to injury and have to be VERY gentle if you are stretching. Finally, a disclaimer: I'm not a doctor, just a personal trainer, and cannot tell you for sure when it is safe to run. Maybe a second doctors opinion is in order."
  • Jonathan P. (medical student): "For what its worth, what I've heard both in class and in my reading is that in addition to the heart rate rule there are two other rules. 1. You should be able to hold a conversation while you are running, and 2. If you were running a lot before pregnancy (which obviously you were) then maintaining that level of activity, perhaps slightly decreased, should be fine. So if while your heart rate is around 160 you can still carry on a conversation, seems like you could be good to go. Hope you are able to come to a conclusion that both you and your doctor are happy with!"
  • Jennifer K. (head training coordinator for a large Dallas running training program): "Ok- a few thoughts. I certainly don't want to disagree with your doctor- he/she knows best....but it is my understanding that the 140 HR is kind of "old school". Here's a quote from an article:


    “One of the keys is whether a woman exercised before her pregnancy,” says Burke. “If she exercised at 70 percent of her maximum heart rate (age subtracted from 220 times .70) before she became pregnant, she might be able to continue at that rate even if that number is above the 140 beats per minute (bpm) benchmark that has been established for pregnancy. Otherwise, she should keep her heart rate below 140 bpm at all times during her pregnancy. The Polar monitor will help her follow her doctors recommendation.” http://www.howtobefit.com/heart-rate-during-pregnancy.htm

    That being said- I think the effects of the heat are what you need to be concerned about...your core body temperature is already elevated because of the baby, you may tend to be a bit dehydrated....so consider doing the test inside on a treadmill or at a cooler time of day. Stay hydrated and cool because those things cause everyones HR to be elevated. Runner's World has a pretty good book about Running in Pregnancy- you might want to check it out.  If it continues to stay higher- you might even consider water running (although in my opinion it is about as fun as watching grass grow). Try it inside and see what happens."
  • Lisa: "The 140 heart rate is very old school. New recommendations use 'perceived exertion'. 140 is very arbitrary and feels different to each person. You might want to get a second opinion. I have been through training with experts on prenatal fitness and there is no reason why you shouldn't be able to run with a healthy pregnancy. I have some articles that I can send you when I get home...  Don't get discouraged."
Additionally, some comments were more along the lines of encouraging cross-training of swimming or biking (neither sport I've ever done, including the fact I can't swim, so now's not really the best time to start out of the blue), treadmill running, taking it completely easy, that it would have been good to have a baseline heart rate before pregnancy (yeah, I know that NOW. Hindsight is 20/20), etc.

Current Conclusions on Workouts
There are currently three things I feel I need to watch out for...

1) Stressing my heart and therefore, the baby's heart:

Zumba and elliptical have proved to be clearly safe.  For running, more detailed testing on run/walk intervals and paces and different times of day still need to be performed.  But more and more, I'm willing to just TRUST HOW I FEEL.  So far, while my heartbeat may seem high to my conservative doctor, I'm at conversational pace, I'm feeling good, I'm not feeling overheated, etc.  I'm going to stick with not too many miles, work in these other types of cross-training workouts that are more heart-rate friendly, and "run happy, not hard".

2) Thermoregulation (overheating my core body temperature which stresses the baby):

Again, Zumba and elliptical will help as indoor workouts.  I'll also be especially cognizant of the weather forecast, both temperature and humidity, and adjust when and how often I run around that!  This will probably include a lot of evening runs.

Major hydration will continue to help throughout this!

3) Caloric Intake

This is an issue not previously discussed in my blogs but one I've been thinking about.  I'm not great about consistent calories throughout the day and day by day.  I wouldn't say I've increased my calories more than pre-pregnancy, and I had read that a 30% increase to daily caloric intake is good during pregnancy to provide the baby the needed "fuel".  So if I additionally burning calories by the hundreds multiple days a week, I will really need to commit to eating more often.  I've already been making changes the last couple weeks of consistently getting in a breakfast now (used to be really bad about that!).

So with a plan in hand, I'm ready to move on to the next thing to stress about - ha ha! Kinda kidding, kinda not. Those that know me well will completely understand.

7 comments:

  1. I'm a little late to the party, and I have never been pregnant before, but I can say that there is a pregnant lady who swims at my pool 2-3 times a week and she is in fantastic shape (she still wears a 2 piece workout swim suit). Swimming could be another workout option for you as you advance more in your pregnancy. Congratulations, btw!

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  2. Thanks, Naomi, but don't know how to swim and am a bit waterphobic. :-(

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  3. You're going to hate my comment. My suggestion is to be very careful. It sounds like you've really taken 6 weeks mostly off since mid-April with the excpetion of a couple short runs, and people tend to lose fitness very quickly. Non-preg runners lose a lot after just 2 weeks off with an injury or vacation and need to rebuild carefully. So you might not have been quite as fit to start as you thought initially, just because of taking normal recovery time after your last half. I don't think you can compare yourself to someone who was running five days a week for 45 minutes at a time for the couple months before pregnancy and the first couple months of pregnancy. You'd run maybe every other week or so for a short time? You'd know best, but be honest with yourself. You might be ready to come back to it now, but the pregnancy might mean this isn't the best time to come back.

    And also remember to ask yourself if it's worth the risk. You can try to convince your doc not to follow her initial rec, but how would you feel if the extra outdoor exertion cooked your baby's brain just a little? You're a great mom and you wouldn't really want to jeopardize your baby's health, even though running might be something you really, really want to do. But it seems like you're hearing and choosing comments that support the result you understandably want, that you can go above 140 and the baby will be fine. While your doc might be too "conservative" for your tastes, as you put it, just remember to weigh pros and cons. Heck, you can drink when you're pregnant too -- it's just not worth the risk to the baby. You said, "She's concerned and sticking to her guns about 140." You said you weren't ready to give up, and that you were going to try to convince her, but maybe you should just listen. Think about the risks carefully. It's really not worth I don't think, espesially when you hadn't been running much over the last 7 weeks or so anyway.

    So my thoughts, for what they're worth (probably nothing), are to stop fighting your doctor. Stick with zumba and walking and the elliptical. Don't keep testing yourself to see how you can make your numbers seem more palatable to your doctor. Don't keep pushing to see if there's some way you can run under ideal conditions that will keep it lower than 140. Take a break from running for the summer and use the time to do less intense non-running exercise and maybe read some running books that will help you when you get back to it. Form technique, chi running, etc. Then when you pop out a healthy and well-developed baby, you'll know you did your best to give him/her every chance in the world in the future, and then the running world will be yours for the taking again. But like I said, I know you don't want to hear these thoughts, just thought it might be something to consider. You (or in this case, your doctor) knows best.

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  4. "Anonymous", I do appreciate the feedback. It includes things for me to think about. The hardest part of all of this has been that it's not just about baby's health - my physical/mental/emotional health strongly affects the baby's health and development as well, so if those suffer, so will baby. Weighing all those factors with my medical condition and painful first pregnancy have made for a tough decision. Additionally, I have a hard time with one doctor's one-size-fits-all rule since she has basically no knowledge of my running history. I felt a lot better today when, and I should have added this in the post, I visited my sports chiropractor (also a runner and previous history as a running coach) for a tune-up. He has seen me at least once a month and often once or more a week for several years and we routinely discuss and tweak my training together. Having treated my fibromyalgia and my first pregnancy, he agrees at this time that the benefits of an easier but still running-included routine will be beneficial to me and the baby.

    And at the end of the day, I'll keep listening to my body and the nice thing about making about your mind is that you can change it! :-) Thanks again for sharing your feedback.

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  5. Sorry, I just came back to say I wish I could change the tone of my comment. I didn't mean for it to sound bad, and thank you for not taking it that way! I think I'm more pro-life than most people and feel strongly you should do everything you can to protect and grow your baby! And I know your mental health is important too, but remember to consider other ways for you to maintain your health without jeopardizing your baby more than necessary. The "what's good for mom is good for baby" reasoning only goes so far! Maybe consult your husband too on this? I know you'll listen to your body, just don't let your type A goals get in the way of protecting this new life!!

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  6. I can't comment on the pregnancy thing at all - but every time I take a break from running but continue to work out, I come back stronger. Zumba, elliptical, biking... all very good workouts. I hope you can figure out the running thing though! I know my heart rate resting is abormally low (in the high 40s - low 50s) at rest and my last half? I ran the 2 hours right about 160-175. So I think that our bodies are very different and one number isn't the end all be all.

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  7. I am glad that you feel more at peace with all of this. I HATE the implication that you might risk the health of your baby for your own benefit. You are trying to do the right thing, to the point of obsession (which is exactly what I would do, btw) It is obvious to me that you would never risk the health of your baby.

    I know that you are going to have a much better pregnancy this go around and end up with a wonderful, healthy baby!!

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