The Food Medic - S8 E5: Staying active during and after pregnancy

Episode Date: July 28, 2022

This week we are talking about staying active in pregnancy and getting back to activity in the post-partum period with two experts in this space - Emma Brockwell and Dr Marlize De Vivo. Emma is a Specialist Pelvic Health Physiotherapist . She has co-authored the first ‘Returning to Running Postnatal Guidelines’ and published her book ‘Why did no one tell me? How to protect, heal and nurture your body through motherhood In 2021.Dr Marlize De Vivo is a qualified Biokineticist, Sports Rehabilitator and Trainer, and senior research fellow at Canterbury Christ Church University. She is also Co-CEO and and founding member of the Active Pregnancy Foundation This episode covers*Staying active safely in pregnancy *Benefits for mum and baby*situations where a woman may be advised not to exercise*Lifting weights during pregnancy*Pelvic girdle pain*getting active in the post-partum period*Running during and after pregnancy*how to train your pelvic floorIf you loved this episode make sure to give it a review, rating (hopefully 5 stars) and share it with your friends and family. Thank you to our season sponsor WHOOP. Right now, you can get your first month free when you checkout through join.whoop.com/thefoodmedic@thefoodmedic / www.thefoodmedic.co.uk Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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Along with your favorite restaurant food, alcohol, and other everyday essentials. Order Uber Eats now. For alcohol, you must be legal drinking age. Please enjoy responsibly. Product availability varies by region. See app for details. Hello and welcome back to a brand new episode of the Food Medic Podcast. I'm your host as always, Dr. Hazel Wallace, a medical doctor, nutritionist, author and founder of The Food Medic. Now this week we're talking about staying active in pregnancy and getting back to activity in the postpartum period. We covered this on the podcast before but I wanted to revisit it with two experts who are very heavily involved in research and clinical practice in this space. Emma Brockwell and Dr Marlies de Vivo. Emma is a specialist pelvic health physiotherapist. She has co-authored

the first Returning to Running Postnatal Guidelines and has published her book, Why Did No One Tell Me How to Protect, Heal and Nurture Your Body Through Motherhood in 2021. Marlies de Vivo is a qualified biokineticist and sports rehabilitator and trainer. She's also senior research Fellow at the Canterbury Christchurch University and co-CEO and founding member of the Active Pregnancy Foundation. Just a quick reminder before we jump into the episode, if you do want to submit a question to our Ask Dr. Hazel mini episodes every week, make sure to send your voice recorder question to lindsayatthefoodmedic.co.uk for your chance to be featured. Today's podcast is brought to you by our season sponsor Whoop. Whoop 4.0 is a 24-7 digital fitness and health coach

that provides actionable insights to help you recover faster, train smarter and sleep better. And unlike most other wearables in the sense that it doesn't just tell you what you've done, but it tells you what you really need to know. I've been a fan of Whoop for a long time because it allows me to perform and recover at my best. Each morning when you wake up, you get a recovery score from Whoop, and this is based on your sleep and other health metrics. That score helps to guide your day and informs you how much strain you're ready to take on. Another reason why I love Whoop is how they're supporting their female members, which you know is super important to me, with features like their menstrual cycle coach.

Recently, I've joined Whoop's women's performance collective along with other researchers and athletes to better cater for the unique physical and physiological needs of females using their technology. And right now you can get the first month free when you check out through join.whoop.com slash thefoodmedic. Emma and Marlies, thank you so much for joining me on the Food Medic podcast today. Thanks for having us. Thank you so much. It's so nice. I wanted to have this conversation with both of you for some time now.

Actually, both of you contributed to my book. So thank you so much for that and sharing your expertise in terms of staying active in pregnancy, which is what we're going to talk about today. Now, when I knew that we were going to have this conversation, I put up a question box on social media and there was a lot of questions about staying active in pregnancy, what you can and can't do, and a lot of fear around actually doing certain things. So I have so many questions for you today. And I hope that we have time to cover everything, which I'm sure we will. First things first, Marlies, I'm going to start with you. Why is

it important for mum and baby to stay active in pregnancy? Well, I think over the last few years, the research and evidence base has grown so much that we can now with confidence say that, you know, over and above the general benefits of being active, there are unique benefits to be obtained during pregnancy in the postnatal period. So we know specifically that the bulk of the high quality evidence is telling us that it reduces the likelihood of developing gestational diabetes, the bulk of the high quality evidence is telling us that it reduces the likelihood of developing gestational diabetes, the risk of developing preeclampsia or high blood pressure problems associated with pregnancy. It reduces the chance of excessive weight gain in pregnancy, but over and above that, we still can improve mood, quality of sleep and cardiorespiratory

fitness. And what we also now know is that these benefits extend into the postnatal period. So a very important and topical issue at the moment is perinatal mental health. So we know that moms who are active in their pregnancies reduces their chances of developing postnatal depression by up to 25%. And that's quite significant and very important. Yeah. And when it comes to staying active um what are the general guidance and what you can and can't do and how much should we be aiming for

okay well the first thing i would say is that you know physical activity is quite a broad and inclusive term so i think we have to recognize that physical activity can mean different things to different people and that quite often we have to meet them where they are at. So, for example, we may be dealing with mother athletes, so sports people. We may be dealing with people who are already engaging in structured activities and they have, you know, their Pilates class that they love. But we might also be dealing with people who are not particularly active and because of pregnancy, they now want to make this lifestyle change. So it's important to recognize that, you know, movement counts, it's movement that is really important. In terms of guidelines, what we know is that most of the health benefits are obtained at around 150 minutes of what we call moderate

intensity physical activity. And typically, this means being active at a level where you can still hold a conversation. So we're not really expecting anyone to be looking at heart rate. But what we really want them to do is still to be comfortable in the conversations they are having. And then we know it's probably the right level. So we know that throughout the week, if you accumulate around 150 minutes of moderate intensity physical activity, but also and very importantly, now engage in at least two days of strength training. And this has become a really sort of a bit of a hot topic, but also, and very importantly now, engage in at least two days of strength training. And this has become a really sort of a bit of a hot topic, I think, at the moment in terms of being functionally fit for motherhood, because we know we're going to have a baby that is going to increase in size and weight, and we're going to have to lift baby, we're going to have to move

car seats and prams and buggies. So being functionally fit and strong is also really important. So in terms of guidelines, that's what we are looking at. And from what can't I do? What's unsafe? What are the kind of important things for a woman to remember? So the first thing to recognize is that the guidelines applies to women who are typically healthy with uncomplicated pregnancies. And for them, in most cases, it's safe to engage in physical activity throughout their pregnancy, bearing in mind that there may be some adaptation required as pregnancy progresses. But two important questions that we need to ask at the start is, you know, are you already active? And if you are not active, the point is really to start

gradually and not to do too much too soon and to gradually build up physical activity levels. Now, in terms of medical conditions or those complications that we are talking about, we can put them in sort of in two groups. And the one we refer to as absolute contraindications. In other words, if you have a severe cardiorespiratory disease, for example, or uncontrolled diabetes, it is not advisable for you to do moderate or vigorous intensity activities, but you may continue with activities of daily living. So we've kind of moved away from bed rest as well. And then in the other group is the more sort of relative and mild condition. So if you may have diabetes, but it is controlled, you may have mild symptoms of cardiorespiratory disease. So in those cases,

what we are suggesting is supervised or monitored and controlled training. So perhaps with an exercise physiologist or physiotherapist, whoever is appropriately qualified. And in those cases, you know, you need to have a discussion with your healthcare team because, you know, going out by yourself may not be the most, the best thing for you to do and and it's really important to have a discussion with your team at that point yeah i think something that's really important that you just said is um you know the kind of guidance is 150 minutes across the week and two strength sessions per week which is the same for the general population and i think we often still think that women should be doing less during their pregnancy

as opposed to trying to keep them active. Are there certain sports or activities that you would advise against for women? Yes. So there's a bit of a sort of catchphrase, I would say, and it's don't bump the bump. So any activity that, you know, increases the likelihood of your bump being bumped, it puts you at a risk of falling or direct trauma, try and avoid those. But then also activities where there's an increased physiological risk. So for example, skydiving or scuba diving, try and avoid those. And then generally speaking, any activity that puts you in a situation where

you are active in a hot or humid condition for longer than an hour. So, you know, hot yoga is out. Try and avoid those and then obviously stay hydrated throughout any activity. So those are probably the three top tips in terms of choosing an activity. But what I would also say is really important with pregnancy is this idea of adapting as you progress. So it may be the case that you come into pregnancy as a runner or a cyclist, you know, things may not become a little bit uncomfortable. And being open to changing your activity, I think that's really important. And perhaps trying something different. And there is a myth that says, you know,

don't do anything new in your pregnancy. And that's absolutely not true. You can try different and new things, but gradually build them up. Don't go out there and do any running if you perhaps weren't someone who did running before. So be sensible around your activity choices. Yeah. And Emma, I know that you have kind of written a lot in terms of getting back to running postnatally. But in the kind of during the pregnancy, what advice do you give to women who are runners and want to continue running? Is that safe to do? Yeah, I mean, if you don't have any contraindications to exercise during pregnancy, then embrace running. I think there's been too much misinformation around particularly high impact training and running during pregnancy and as a result of that we've scared women off of doing those sorts of

activities and the fact is that running brings so many physical and mental health benefits that we should be encouraging women to continue to do to run but also if they want to, to start running, but as Marlee says, to gradually introduce that into their new regime. We carried out a study last year that was led by Izzy Moore and we surveyed about 881 women and asked about their running habits during and after pregnancy. And we found that women who continued to run during their pregnancy were more likely to return to running postnatally so it's a really really good sport to continue doing so long as you're listening to your body if you're experiencing any forms of pelvic floor dysfunction be it urinary incontinence or vaginal heaviness or even pelvic pain then pull back from that and as Marley says modify work with a pelvic health

physiotherapist or experienced fitness professional to seek some guidance on how perhaps you can keep that running in your program but with modification and a thought to cross train or find other forms of exercise that you might enjoy so that you can remain as active as as possible throughout the pregnancy yeah and as you both mentioned it's adjusting what you're doing, perhaps as the bump is growing and you're progressing and listening to your energy levels and things like that. One of the topics that we talk about a lot in the food medic is weightlifting and a lot of women are afraid to weightlift as well during pregnancy.

Is this safe to do and how can we adjust across kind of the trimesters to ensure that we're doing it correctly and safely I think we should be encouraging women to lift during their pregnancy and maintain their strength or gain some more strength during pregnancy simply because being a mum requires you to be strong you know you give birth and immediately you have a heavy weight to lift alongside all the equipment as well and obviously baby grows as well so your body needs to adapt to that that change that it will be exposed to if you can gain strength or maintain strength during your pregnancy that's really important I guess for me with my patients I tend to adapt as we go so always listening to

the symptoms that they might be presenting with but ultimately maybe changing the equipment that they use so as as bump gets bigger perhaps dropping the barbell and changing to free weights or kettlebells considering that balance and posture is going to change as well so it's a constant adaptation but with the the concept that we continue for them to strength and load their system so that they're best prepared for their their postpartum journey yeah and most classes if you go to a class they should be able to adapt for you and just kind of mentioning in the beginning that you are pregnant. Marlies, you covered off some situations where women maybe advise that they're in a high risk category or a complicated pregnancy and that they shouldn't exercise without any supervision. If they're in that kind of category, how would you advise someone who maybe was previously active?

Like how can you deal with that? Because I'm sure there's a huge psychological component there as well. So those people would typically fall in what we call the relative contraindications group. And I suppose it's really hard when you've really enjoyed and engaged in some sort of routine or physical activity and suddenly, you know, the level of your engagement is all of a sudden taken away from you. So I think it's really important to have a discussion with your healthcare team around what it is that you can do and perhaps of your engagement is all of a sudden taken away from you. So I think it's really important to have a discussion with your healthcare team around what it is that you can do and perhaps setting specific parameters and then engaging with the right professional. So we've recently published in the Basie's Disportant Exercise Sciences guidelines in terms of how do we take care of

pregnant women when they come for exercise physiology testing. So it might be a case of getting, you know, an exercise physiologist involved who can measure the different parameters. But also, you know, physiotherapists, that is their job. They are highly skilled exercise professionals. And you can engage the services of perhaps a pelvic health physiotherapist, depending on obviously what your situation is at that time. And what we've seen recently is quite a few midwives training as personal trainers as well. So, you know, that's perhaps a good person to have on board, someone who understands your condition, someone who's

aware of all the limitations. And that would be a really good person to approach. It is really hard. I know it is hard. Adaptation is hard when you are a really active person to suddenly have that taken away from you. So it's being open to doing things a little bit differently, I suppose. For example, you might, you know, an aquatic environment might be suitable for you depending on the condition rather than, you know, high impact running outside. So it's about being open about things, but not stopping completely. And I think that's a really important message is that there are different ways to engage in physical activity. Yeah, I love that message. You know, obviously we are dealing with our body changing and things like that.

But also there can be things that come with pregnancy, like pelvic girdle pain, which I know that's super common and you talk about it all the time. I actually didn't realize how common it was until I read one of your posts. I think you said like a third of women? Yeah, it's really common. Incredibly common and can for many women be rather debilitating as well. Pelvic girdle pain tends to occur around the front of the pelvis, the low back, into the groin, into the hips. And for some women, it can mean that they can't even walk without experiencing huge amounts of discomfort. The biggest issue for me around pelvic girdle pain is often women are told, well, if you're experiencing it, then the best news is that

you'll recover from it once you've had your baby. But if you experience that pain at three months of pregnancy, that's a long, long time to be in so much pain and discomfort so if anyone is experiencing pelvic girdle pain I would say you don't have to put up with the pain and fundamentally there is some really good treatment options out there for you and you can actually be pain-free during your pregnancy if you are experiencing pelvic girdle pain. There's a lot of myth around pelvic girdle pain so when I trained as a physiotherapist many years ago, we were led to believe that pelvic girdle pain occurred due to biomechanics and instability often driven by hormones. So I guess we demonized relaxing a little bit. And for some women, that relaxing surge would occur too soon, instability would

occur and that would cause the pain well we know now know thanks to lots of research um led specifically by a great physio in canada called chenet de four that pelvic girdle pain actually is caused by tissue sensitivity and so what we're now encouraging women to do is seek treatment and find a treatment that works on desensitizing the tissues for example prenatal yoga mindfulness things that will calm the system down reduce the sensitization of the tissues and therefore reduce their pain so it's now no longer considered an issue of instability it's an issue of sensitivity and there's an awful lot that we can do to help I love that so you can stay active and absolutely I'd encourage you to do so yeah because I

definitely have heard that um that you should kind of slow down and stop and things like that and allow yourself to recover so that's a really great message so we're kind of moving through pregnancy now we're coming to kind of postpartum period and obviously there will be a period of women kind of resting and then wanting to get back to activity and this will differ depending on the type of delivery that a woman's had what's the guidance around how soon can you move postpartum whether it's vaginal delivery or c-section guidance really is move as soon as you feel well enough to move um for a long, long time, I think there was this belief that you had to wait to move too much before you had your six-week GP check. And we

need to really reframe the postnatal period as a condition where we should be thinking of it more as like a sports injury. You know, we wouldn't consider that anyone with a sports injury like sprained ankle should rest for six weeks and not move until they've perhaps seen their physio for the first time so as soon as you've had your baby and you feel well you're not in too much pain we encourage movement we encourage gentle strengthening exercises simple pelvic floor exercises going out for short walks getting moving sooner rather than later is really, really important. And we actually encourage that you try and think about strengthening before that

six week mark. So carrying out squats, carrying out lunges, so long as your body feels good and it feels okay to do so, then you're doing those sorts of movements when you're picking up baby, when you're picking up the car seat. So it makes sense to use those functional movements as a means to strengthen a lot of the muscles that have become lengthened and weakened during your pregnancy. And then with time, we want to think about gradually loading the body sensibly so that it becomes ready for any form of exercise that you might want to introduce at a later time. And what are some of the, I mean, obviously, there's some very obvious barriers that come up,

that women come up against in the postnatal period, like they have a new baby to look after. What are some of the other physical barriers that a woman might come up against yeah i mean postnatally women can experience quite a few issues and concerns so if we're thinking pelvic floor dysfunction so urinary incontinence or urinary urgency vaginal heaviness which might might mean that a woman is experiencing pelvic organ prolapse painful sex is another symptom that women might experience. And then diastasis recti, which is where the tissue that sits between

the six pack, the linear alba, just becomes thinned. And for some women, it gives this look of like a mummy tummy, doming or a bulging, which aesthetically can be really troubling for lots of women and really affect their confidence and their self-esteem. That ordinarily, that whole abdominal wall takes a good 10 weeks to really strengthen and tension to regain. So for some women, at least two thirds of women by 10 weeks, that won't be an issue anymore. But for a third of women, that will remain an issue. And that's where we want to think about rehabilitation for those symptoms of pelvic floor dysfunction for those symptoms of pain and for those symptoms of abdominal separation and where could where could they get support if someone was experiencing that

unsurprisingly i'm gonna say pelvic health physiotherapists. And if you're looking for pelvic health physiotherapists, you can self-refer, you can see us privately, or you can, of course, ask your GP for a referral as well. Yeah, amazing. I think there's a lot of pressure on new mums to get back to activity, not from a kind of total body health point of view, but like lose the baby weight. Would you agree

you guys are both mums right did you feel the pressure no I am headstrong so no I didn't experience it in the same sense as other people did but I have noticed for a long time on social media you know they were the celebrity mums who would jump back into shape very quickly and make a big fuss and hoodah about it. And then also in terms of the fitness world, we'll have before and afters of, you know, mommy makeovers, or even as far as, you know, plastic surgery would go as, you know, a mommy makeover and a mommy tummy being fixed surgically. But I have to say recently, I have almost felt like there's a bit of a, been a woman empowerment drive in that we are accepting changes and we are proud of what our

bodies can do. And I have seen that a lot more in that we are taking ownership of how amazing our bodies are. And I know it will take time to sort of filter down, but I have seen this sort of real change in social media in that aspect. And I mean, I do think there's a long way for us to go and there's still a lot more that the media can do to portray you know real real mums in in that no filters um you know saying it as it is and not being shy to talk about the issues that affect us in the postpartum period so I have personally noticed the real change I don't know about you Emma yeah I think clinically um I definitely see that women feel less pressure to return to the sport that they want to return to. There's much more of an idea that women want to, I guess, future-proof their pelvic health and their general health.

And so they're prepared to wait that little bit longer before getting back to what they want to do. There is always the pressure, I I think of that bounce back you know you see I had a lady in clinic last week and she showed me a picture of one of her NCT friends who on the picture looked like she had bounced back within six weeks and of course there are always those women whose bodies do just spring back and that's incredible but for the majority of women that doesn't happen it takes time and women need to you know accept that but also appreciate what an incredible job their body's just done and and really feel empowered by that it's such an incredible thing to watch a woman through pregnancy and also through labor it's just

amazing i will never like every time i see it I just find it completely amazing um but you're right Marlies I think there is a change in conversation around it I think definitely on social media a lot of the mainstream media you do see them really focusing on celebrities postnatally and like how amazing they're looking or if they've not bounced back and I think that's just like such a shame that we're still seeing that in 2022 because women are far more than how they look. But kind of coming back to what you mentioned on pelvic floor, Emma, I think this is a really important conversation, not just for women who are going through a pregnancy and postnatally,

but something that we should all be doing. And I know that you really preach this. And for a lot of people people they're not entirely sure where the pelvic floor is they know in general where it is but how to find it how to actually train it and I wonder could you run us through that yeah so the pelvic floor is of course one of my favorite muscles and it is just such an incredibly important muscle it sits at the base of your pelvis and it attaches to the front of your pubic symphysis all the way to your coccyx, your tailbone, and then attaches to your

sit bone. So it's quite a big muscle. And it also connects into lots of fascia, connects tissue and nerves. So it's quite a complex area. And it's invaginated by three holes. So we have your urethra, your vagina and your anus. Now, ultimately, that pelvic floor has quite a lot of functions, but I guess it's three key functions. Our continence, it stops us leaking poo and wee and wind. It supports our pelvic organs, so our bladder, our bowel and our uterus. And it also has a key role during sex. So maintaining the strength of the pelvic floor is really key for those functions. So if we stop or if we experience any dysfunction around the muscle, we might then experience some of the symptoms I mentioned earlier,

urinary incontinence, pelvic organ prolapse, painful sex, pelvic pain. So particularly when you've had a baby but I would personally recommend that women from puberty all the way through their lifehood life transitional periods do pelvic floor exercises and the best place to do your pelvic floor exercises is in standing ultimately but you might might find if you haven't done pelvic floor exercises before that you want to start them lying progress to sitting and then up to standing and the best verbal cue I can give you to engage your pelvic floor is to squeeze your back passage as if you're trying to stop yourself passing wind and then squeeze your front passage as if you're trying to stop yourself peeing when you do that you'll feel hopefully a squeeze and a lift of your perineum. So that's that bridge between the vagina and the anus.

And we encourage you to try and do 10 second holds, 10 times. So we're working on the slow twitch fiber of that muscle complex, as well as 10 quick squeezes with a slow release, because there's also fast twitch fibers within that muscle component. But like any muscle it takes time to build up to that so it's perfectly fine if you don't feel you can hold for 10 seconds it might be that you start with a three second hold and you build up to 10 seconds and always try and emphasize that the pelvic floor is just like any other muscle in your body it takes time

to strengthen so I wouldn't expect to get a six--pack muscle or look of a six-pack in a week. So you wouldn't expect to strengthen your pelvic floor in a week. It takes quite some time. And there's other ways of knowing if you're doing your pelvic floor exercises incorrectly. So you should always be breathing when you do your pelvic floor exercises. Don't hold your breath.

Don't squeeze your bum cheeks. That's quite often something that I'll see. Or don't grip your legs or clench your quite often something that I'll see, or don't grip your legs or clench your jaw. Those are signs that you might be doing your pelvic floor exercises incorrectly. And if you find that you just cannot find that muscle, that's where someone like a pelvic health physiotherapist can really come into its own to show you how to do your pelvic floor exercises. Yeah, that's a really good, really good way of explaining it. And what are some signs that we may be having some problems with our pelvic floor? I know you mentioned a few earlier, but I

think it's good to just kind of summarise. Yeah, so signs of pelvic floor dysfunction are urinary incontinence, urinary urgency, faecal incontinence or faecal urgency. If you just cannot control wind as well, that's also a sign the pelvic floor might need a little work. If you're experiencing painful sex or pelvic pain, or if you're experiencing any bulging or heaviness in the vaginal area, that might be a sign of pelvic organ prolapse. And all of those symptoms are really, really common, but they're not normal and they're symptoms that pelvic health physiotherapists treat really well. Yeah, that's a really important message. I think like a lot of women assume it's just part and

parcel of being a woman, especially when it comes to exercise. And I was in the CrossFit space for a long time. And there's so many ongoing jokes around how common it is to be leaking urine when you're kind of skipping or doing double unders or weightlifting. Can you bust that mitt? Is that normal? No, that is not normal and it's not a badge of honor. I think within CrossFit it was almost considered a badge of honor, wasn't it? Yeah. You're working hard if you're leaking urine. Well, no, that isn't normal and if that is happening to you, you can address those symptoms. It doesn't mean we stop you doing those exercises, it just might mean that we need to modify and help you rehabilitate to get you back to doing that exercise

leak-free, without any heaviness, without any any pain but you should be able to do those exercises without any symptom whatsoever it's not normal is there any times where it's absolutely inevitable if someone's doing you know like power lifters who are doing one rep max at crazy crazy weights and they leak some urine is Is that ever normal? No. Was it? No. Okay. No.

But we don't really understand the mechanism behind what's happening. So what I would say is, it's not something that we, you know, I think these things are so important that women continue to do them. So I don't want to spread the message that you shouldn't be doing them, but I do think you need to get a little bit of help and guidance if you are experiencing that, so that you're doing that leak free because that's that's a horrible feeling if you're leaking when you're you're performing that sort of exercise and you shouldn't have to experience that yeah i completely agree i did see one tiktok with a girl who was leaking

urine when she was lifting very very heavy weight and then she did a transition into after 12 weeks of pelvic floor training lifting the same weight and didn't leak a transition into after 12 weeks of pelvic floor training lifting the same weight and didn't leak urine and I was like I love that that's a really great message that's the type of before and afters we like to see yeah we love that um and we've talked a lot about pregnancy in the postnatal period but what how can we use exercise to get us ready for pregnancy I think that there's three to six months before conception, so what we would call the preconception period, is a really important time. Now, I know not all pregnancies are planned, but if you are planning and thinking about it, getting the right lifestyle habits in

place, so thinking about your diet and your physical activity habits, getting your BMI or your weight to an ideal state, you are more likely to conceive. But those habits are quite often carried into pregnancy. And we know that women who are active in their pregnancy are more likely to be active after pregnancy. So if we think of this as a sort of, you know, a life course approach, those three to six months before pregnancy is actually a really important time to make sure that you lay down

those habits, but also making sure that you lay down those habits, but also making sure that you have the support mechanisms in place to support you in pregnancy. So, for example, we know that child care is a huge issue for mums in our surveys that has certainly come up as one of the top barriers in terms of physical activity in pregnancy. So if you have a support system in place where you can take time off or away for yourself, whether that's, you know, for going for a walk or to the gym or whatever your chosen activity is, if you have support in terms of childcare already, then you are more likely to sustain that habit in pregnancy. And then when you have another child sort of after pregnancy, if those systems and support mechanisms are placed, you are in a really good place to be able to lead an active lifestyle.

Yeah, that's a really good message. I don't know if kind of you guys have come up against this, but I think a lot of women who are struggling to conceive are often told to not exercise at all. How do you feel about that? That's a very interesting sort of space at the moment. So we don't actually have guidance, any sort of formalized guidance in terms of physical activity levels when trying to conceive. But what we do know is that too much activity and too high intensity activity sustained over a longer period can impact on fertility. So it's a really hard one actually to answer at this point in time. But I would in all cases say that, you know, not doing any activity is not healthy. And it's finding that balance between not doing too much and doing

enough so that you still benefit mentally and physically from it. Because fertility treatment can really take its toll on your mental health as well. So, you know, going for a walk as a form of physical activity, at the very least, is something that you can continue doing. Yeah, yeah, that's a really good, great message. I have three questions for you each before we finish. The first one's easy. What's your number one takeaway from the podcast? I'll start with you, Emma. That physical activity and exercise during pregnancy and postnatally are just incredibly beneficial, not just for your mental health and your physical health, but for your kids as well. Actually, we see that active mums tend to have a more active family. So I think that's really exciting when you consider how much of a public health priority

physical activity and exercise is. Yeah, that's great. And how about you, Miley? I'm going to say I'm going to have sort of three key messages, and I hope people remember at least one of them. So the first one is, you know, the golden rule is if it feels good, keep going. At any point, if it is uncomfortable or you notice anything unusual, stop and seek advice. And I think that's a really important safety message. The second one is don't fall in the trap of comparing yourself to other mums, other pregnant women.

Every pregnancy and postnatal journey is different, and every woman has a story to tell. fall in the trap of comparing yourself to other other moms other pregnant women every pregnancy and postnatal journey is different and every woman has a story to tell so please don't compare yourself to others journeys and then sort of finally is be kind to yourself there are days when you are going to feel awful and you're not going to want to do any activity and you know on those days it's okay to you know have a nice long bath or a snooze or read a book or whatever it is that you need to do to feel good. So that element of self-care is really important and it's not selfish. So be kind to yourself. Amazing.

The next question is more about you and your career. So, Emma, I'd love to know what's kind of like the number one lesson that you've learned from your career? I think as clinicians, we're really lucky to be privy to so much information and if it's evidence-based then we need to be educating people that we work with so that they can future-proof their their health so education really I think I think is just so key and it's it's it's it's a huge part of the job that I do to help women that I work with. Yeah, absolutely. And how about you, Myles? I think I have sort of in my early career found myself as a bit of an outsider.

You know, a female sport and exercise scientist by itself is quite something. You know, you are seen as that person over there and you need to look a certain way and dress a certain way. And I like to challenge those conceptions of norms, really. And I think working in this perinatal physical activity field, there's so few of us. So I think collaboration is the key to success. We can't all be an expert in everything and sharing our learnings and, you know, working collaboratively, I think. But also on a personal level, I think there's so much to do. And it's so overwhelming that, you know, learning to say no can be very empowering as well. So it's, you're taking a step back and taking a moment for yourself is, is really useful. Really important, really important to learn how to say no and when to say no.

Final one. What is your motto in life? It's a bit cheesy, but it's work hard play hard and be nice that's what I tell my kids anyway and that's that's how I hope I I live as well I think you do look like that I bet you might leave yeah I think my my motto has changed throughout the sort of various life changes I've been through. And if I sort of stand back and think really hard about where I am right now, it's probably saying, you know, don't let life happen to you. Be an active participant in your own life, because

I feel I do a lot and I give up a lot of my time to drive my, you know, the things that I'm really interested in, in my passions and all of that. But sometimes it's about really standing still and, you know, smelling the roses and just taking those moments to take care of yourself as well. Amazing. I love asking those questions because I feel like I come away with something every time. So thank you for sharing. And thank you both for coming on the podcast. Before we go, where can people find you on social media or websites and things like that so you can find me on instagram i'm at physio mum uk and via my website www.physiomum.co.uk i think the best way to probably find me is on the active pregnancy foundation which is a charity we've recently established and and we host and share all sorts of evidence-based information and resources so probably best to find me via those channels.

Amazing. Thank you both so much for coming on. It was such a great podcast. Thank you so much. Thanks for having us. Thank you so much for tuning in today. If you loved it, you know what to do. Leave us a review, a rating, hopefully five stars and share with someone you know will love it too.

That's all from me. See you again next time.