Exercising during pregnancy and returning to training postpartum can be challenging for female athletes and their coaches, but our guest on this Fast Talk Femmes episode, Catherine Cram, is one of the experts in the field. Cram has published extensive work on prenatal and postpartum exercise, helping to improve the knowledge and information available to those looking to stay active during pregnancy and return to activity and training after giving birth.
In the show, Cram helps to dispel many of the outdated myths surrounding training during pregnancy, such as “don’t let your heart rate rise above 135 bpm.”
Co-host Julie Young said: “As a coach, I was always a bit tentative to work with pregnant athletes as there was no definitive or individualized guidance. The information I found to guide training with pregnant athletes evoked a bit of fear, implying that pregnant athletes were very fragile and training could jeopardize the health of the baby.”
Armed with the latest knowledge and having authored a number of books on the topic, Cram underscores the importance of being educated and sensible when training while pregnant, yet she also highlights the fact that pregnant women are much more durable than antiquated information would lead us to believe.
Cram has a master’s degree in exercise physiology from San Diego State University. Some of her publications include Exercising Through Your Pregnancy, which she co-authored with Dr. James Clapp, and Fit Pregnancy for Dummies. She is also a contributing author of Women’s Health Care in Physical Therapy. She has developed and teaches MedBridge courses on postpartum and prenatal fitness programs, all of which provide the most recent, evidence-based maternal fitness guidelines.
Cram is also the owner of Prenatal and Postpartum Fitness Consulting, a company that provides pre- and post-natal fitness certifications and information to hospitals, health/wellness organizations, and the military. They offer innovative information to pregnant and postpartum women and their health/fitness providers.
Also included in this show is an interview with Melissa Bishop-Nriagu, an elite track runner who finished 4th in the 800m at the Rio Olympics in 2016 and is the current Canadian record holder at this distance. After giving birth to her first child in 2018, she competed in the Tokyo Games in 2021. In July of last year, she gave birth to her second child and is now ramping up her training with a view to the 2024 Olympics. In this episode she shares her personal experience as a mom and athlete, how she approached exercise during her two pregnancies, and how she’s returning to full-time training now.
Dede Barry 00:05
Hi, welcome to Fast Talk Femme with DeDe Barry and Julie Young. Our guests on today’s episode are Catherine Cram and Melissa Bishop-Nriagu. With the proven health benefits for both the mother and the baby and staying active and fit during pregnancy, countless examples of women becoming fitter and stronger post-partum, as well as the increase in women athletes competing and winning at the elite level in sport postpartum. We’re looking forward to speaking with Katherine and Melissa about how to optimize exercise and training prenatally and postpartum. Catherine Cram is an expert on prenatal and postpartum exercise. She has a master’s degree in exercise physiology from San Diego State University, and her research and published studies have focused on prenatal and postpartum athletes. She has developed and teaches medbridge courses on this topic. Her courses provide the most recent evidence based maternal fitness guidelines. Later in the episode we speak with Melissa Bishop-Nriagu,, a runner who’s the current Canadian record holder in the 800 meter. Melissa is a silver medalist at the track and field World Championships, a Pan-Am Games gold medalists, and she finished fourth at the 800 meter at the Rio Olympics in 2016. After giving birth to her first child in 2018, she came back and competed in the 2020 Olympics in Tokyo. Melissa will share her personal journey as a mom and athlete, how she approached exercise during her two pregnancies, and ramping up her training post-partum to return to international competition. Welcome Catherine and Melissa.
Brittney Coffey 01:36
Hi, listeners, we’re so excited that you’re here to check out Fast Talk Femme, a new podcast series that’s all about the female endurance athlete. Here at Fast Talk Labs we pride ourselves on being the pioneers of information and education in the endurance sports world for both athletes and coaches. If you like what you hear today, check out more at fasttalklabs.com.
Dede Barry 02:00
Welcome, Catherine, thank you for joining us today.
Catherine Cram 02:03
Great to be here.
Dede Barry 02:04
Can you share with our listeners a little bit about your background and your experience and working with female endurance athletes during pregnancy and postpartum.
Catherine Cram 02:12
I got into this field, I’m kind of interestingly, I got my exercise degree in exercise physiology. And there was really no information taught back then about prenatal fitness. And when I moved to Madison, Wisconsin, there was an opening for prenatal fitness director. And I thought, “Well, that sounds interesting.” And I took it. And in doing so kind of started this whole amazing journey of working with prenatal and postpartum women. And then, as I got further along, women that were higher level of exercise and athletes, and I worked at University Wisconsin Sports Medicine, and a lot of the work that I did with was with a myriad of levels, but we would have women who had never exercised and those that were at higher, much higher level of fitness. And the difficulty back then is there really wasn’t any data. So we really didn’t know what was going on. We did ultrasounds of fetal heart rate to try to measure that to see if there was any changes in what was a normal fetal heart rate. And as time went on, we had more and more data. And we’re able to kind of push that envelope a little bit more, more ways to monitor exercise. So that has been really exciting because the whole thing is shifted from don’t ever exercise, don’t lift more than 20 pounds, keep your heart rate at 142, we’re really kind of pushing that envelope and finding that first of all that fetus is well able to take care of itself and accept the most extreme situations. And that fit mothers tend to have a much healthier pregnancy. And we even see some longitudinal studies where they may even have a healthier baby. So these are really interesting things that have come about, and I’m really happy to see this shift.
Julie Young 03:52
Catherine, I am excited and looking forward to our conversation for many reasons. But one in particular, as a coach, having worked with pregnant athletes, I just felt like I was floundering. I just could not find good, solid definitive guidance on how to train these athletes. And it was concerning because first and foremost, you want to make sure the training is safe. And it seemed like most of the information I would come up across was like very absolute, like oh train under 135 beats per minute and your heart rate. And of course we know that heart rates vary relative to each individual. And then I thought it was interesting. I ran a physiology and biomechanics lab in a sports med center and one of our physicians is an avid runner, and she trained through her pregnancy. So I spoke with her and she admitted she didn’t even have, you know, good guidance or good resources. So I realized gosh, there is a huge void here and I finally did find this IOC consensus paper as a 2016 paper, but it’s so good to know you’re out there now and your books there, it’s such a good resource. But just to start our conversation off, can you provide us with an understanding of what’s happening physiologically and anatomically during pregnancy. And again, you know, so that female endurance athlete and their coaches can understand how to modify training to keep it safe, first and foremost and effective.
What is Happening Physiologically and Anatomically During Pregnancy
Catherine Cram 05:29
Sure and, you know, I think it’s really great to start with this to really understand for women that are going through this to understand that this, in essence, is a training of in it of itself to be pregnant. And one of the things I always tell them in my classes is that we want to look at first these cardiovascular fitness changes. And actually the changes that initially happened just with pregnancy, so we see tremendous changes in cardiac output– about a 40% increase through the duration of pregnancy. So we have increased stroke volume, blood volume, the heart rate is increased to make up for some of these differences that are occurring. And we also have a decrease in blood pressure. So a lot of times what we’ll see that first trimester is women probably feel more side effects from pregnancy than then until very late in pregnancy, because we have all these hormonal shifts, cardiovascular, respiratory shifts that are making it, the body’s kind of trying to reach homeostasis again. And until that happens until blood volume increases, she’s going to feel lightheaded, many times and knowledge is an issue. But one of the other things to keep in mind is that women that are fit and continue to exercise, they really have some benefits. So you’re getting these benefits with pregnancy as it is, the changes in cardiac volume output all of that, but then you have an additive effect of fitness and training on top of that. So what the bottom line is, is what we’re looking at cardiovascularly when women stay fit, and have that little kind of I call it a safety valve for the fetus. There’s some interesting things that have occurred, we see with fetal growth and with placental perfusion that occur with that additive of exercise. So I think that’s tremendously important to keep in mind, a lot of women think, oh, boy, there’s going to be oxygen shunting. There’s going to be blood flow going away from the placental unit. But actually, what we found in women who train throughout their pregnancy, there’s actually about 1/3 greater blood flow to the placenta. So what does that mean? Against the all of the worries that actually exercise is going to cause a problem, what we’re finding is it builds probably a stronger, better baby and in essence, the baby is going through a training effect. And I can talk a little bit more about that later. But I think that’s a really fascinating point to keep in mind, because it’s kind of a safety valve for women who are training that allows that fetus to deal with this intermittent stress, and intermittent reduction in uterine blood flow. So that’s fascinating. And the other thing is that there’s a lot of respiratory changes. But really, it doesn’t make a lot of difference in how much air she’s actually able to bring in. But what we’re finding is that that first trimester, that change in progesterone, and that hormone, causes something called over-breathing, so she’ll feel really out of breath. But essentially, over pregnancy, it stays about the same as far as her respiratory intake. But we do see that a lot of women feel that they’re much more out of breath. And then when biomechanical changes, and then we see the change in her body shape, the diaphragm isn’t able to work as effectively. So sometimes it’s more difficult for her to get a deep breath. So that’s sometimes can be a problem for women, when they’re training hard. But we don’t see that correlated with any reduction in oxygen to the fetus. So that’s a really, I think, an interesting point to look at. And the other one is musculoskeletal. And I always say to women, that there there’s no other time, in human lifespan, that there’s that many changes that are going on physiologically, you know, psychologically, and it’s a real testament to the female body, that they’re able to maintain throughout all of those changes in and really stressors. And so when we look at this change in body shape, where we have this increased lordosis, and she’s getting more of a sway back and shoulders are coming forward, pelvis, anterior tilts, that can play a role in gait. And actually, her gait is shortened, there’s more time that both feet are on the ground versus one foot on the ground and in running. So she may find that that’s going to cause some problems with her running, or certain things that if she has it, even with biking, it can change, positionally. So these are all factors to keep in mind. It doesn’t mean you don’t keep doing that. And that’s the thing that I want to talk a lot about is it’s not that we stopped doing something we start thinking about how can we modify this to keep it safe? To keep it comfortable has to be both. If it’s not comfortable, she’s not gonna be able to do it. And for the most part, it’s pretty difficult to do something with With exercise that is going to be detrimental to the fetus, you really have to work at levels that are over 90%. And that, that is something that I think is really easy to modify. And for a lot of women, they’re going to kind of self correct, because as you get further along in your pregnancy, it’s just too hard. And one caveat to keep in mind, a lot of women would say to me, I feel like my workloads are going way down, I can’t maintain this level anymore. And so I don’t want you to keep in mind that pregnancy is like putting on a backpack every week, we’re gonna put a rock in there. Now think about how much harder it is to walk up a hill with a 30 pound load. So essentially, they have to modify their workloads to maintain. So that’s and then that the light bulb goes on, and they go, “Okay, now I see. That’s why I feel so tired.” So these are all things that come into play that I think what makes it so exciting. And I love this field so much, because it is so exciting to look at how do we empower and reassure and hand it back to the women to say, here’s your tools, here’s what you need to look for, and you know, your body better than anybody else. So those are just some of the basic factors. I mean, we can go into a ton of things. But I think, predominantly to keep in mind that we really don’t see any data that shows that even higher level activity is going to cause problems with the fetus. Now, I want to talk really quickly though, about that first trimester. And we do have one worry that I always have women keep in mind in that first six weeks of pregnancy, usually when a lot of people don’t even know they’re pregnant, that’s when that neural tube is being formed. So we want to avoid any kind of really high heat environment, or exercising at a level that raises core temperature. So what we’re looking at is we don’t want to get maternal core temperature, over 39 degrees Celsius, which is about 102.2 Fahrenheit. Now, how do we know? Monitoring is difficult. But if you have access, of course, rectal thermometers are the best way to know a core temperature. Other thermometers aren’t giving you as good idea of how hot your core temperature is. But I still think even monitoring with a good digital thermometer in that first six weeks is important. What else can we do? Avoid high heat environments. So just go to an air conditioned gym, stop, drink water, let yourself cool down. There’s all kinds of ways to prevent that ever getting to that point. And it’s fairly easy once you look at okay, what are my options? That first six weeks, I’m not going to go outside when it’s 80 degrees and high humidity and run intervals, I’m going to go into the gym, I’m going to stop and rest a little more to get that core temperature back down cool liquids. So a lot of things like that I tell women and it makes a really big difference. A couple other things is just want to talk about like with that core temperature, there’s really been no studies that I could find that showed even in higher end athletes that they get up to that high 39 Celsius. So it takes a lot. Now, again, studies aren’t perfect. We have a lot of metal analysis that people are looking at. We don’t have a lot of big good studies. But I think what’s important is they’re not seeing anything detrimental at this point. And so we can pretty much extrapolate from that, that if we keep a cooler environment. If she’s at all worried do some temperature measurements for that first six weeks. And after that neural tube development occurs and it closes. It’s really not as much of a worry, I always say that. Totally avoid hot tubs, saunas, high heat, humidity environments, that’s just across the board makes sense. So that’s for the first trimester. And so monitoring that temperature, modify your environment. And just try to keep in mind that really high intensity workouts where you feel like you’re getting overheated or something to avoid.
Dede Barry 13:54
You mentioned earlier in the first trimester there being a risk of overheating. I was just wondering during the other trimesters, wouldn’t that also be somewhat of a risk? Especially doing a sport like cycling or running, for example, where you’re in the heat? Like, would that also be a risk? And then are there certain tools that you recommend athletes use to monitor their exercise in the heat and mitigate the risks associated with that?
Monitoring Exercise in the Heat
Catherine Cram 14:22
Well, first of all, I the reason we talk a lot about first trimester is because the most severe issue that has to do with high heat exposure, is that neuro tube. So that’s like I said, the first six weeks of pregnancy, that’s when that’s being formed and encloses. And when we have high heat exposure to the fetus, then we see sometimes in some instances when it’s sustained, or chronic, then there’s issues with that neural tube. So that’s why that’s the biggest issue then, but for the rest of pregnancy, it would probably for me, I feel like it’s the same sort of risk you have of heat exhaustion or heat stroke. And also again, if you’re really overheated as far as uterine blood flow shunting, but one of the things that you can just mitigate that risk totally is don’t exercise in high heat environments. So I really talked when about, you check the temperature, you check that heat index out there, you want to see what’s the humidity, what’s the heat at, and then you don’t go out there when it’s in danger levels. The other thing is, is switch around to going earlier in the morning or later in the evening, or just completely get that risk out of the way is excercise indoors in an air conditioned environment. Which I think anytime it gets hot, you’re looking at even in the 80s and if you’re working out at a really high level, then that is an issue. And you’re going to have a much greater risk of having a high core temperature. But one thing to keep in mind is that with pregnancy, the female body is better at dissipating heat. First of all, that sweat point lowers, so she starts to sweat it up earlier rate of what her core temperatures at so we tend to be able to get that environmental heat loss through evaporative heat loss. But if she’s out in a hot, humid environment, that’s not going to occur. So we want to make sure that we can use those mechanisms so far out there, and it’s too humid to dissipate that into the environment, then she’s going to just keep sweating and sweating, sweating, get dehydrated and overheat. So that’s a really important factor. And also, because of her larger body mass, she doesn’t heat up as quickly. So we see that there’s a lot of factors that are involved. Also her because the cardiovascular changes, and she’s got vascular changes that cause her to dilate blood vessels closer to the skin; so more of that poor blood is coming to the surface to be cooled down by evaporative heat loss. So these are some mechanisms that the pregnant female is able to incorporate. And we find that it’s additive with exercise. So women who are fit tend to sweat more profusely and quicker, they tend to have much better vascular blood flow to the surface and increase basal dilation. So we see a lot of ways that she’s able to kind of get away from having her core temperature build up too quickly. But just to completely avoid it is avoid those high heat environments, make sure you exercise in a cooler environment, make sure you’re stopping to rest, get that core temperature down, a lot of cool liquids. And I used to tell some of the women that they would have a route and one of them was a runner, and I say, now let’s just find out where she can go into there was a McDonald’s, there was a Denny’s and she would stop in the cool for like five minutes, get a drink, get her temperature down, stop again. And so this is a way she could keep running. She lived in San Diego, and it got hotter then it used to I think that when I lived there, but she found that that worked really, really well and she didn’t overheat. And when you’re carrying more body weight is just much more of a workload.
Julie Young 17:48
So a couple things that when I was working with pregnant athletes, a couple things that concerned me the idea of laxity of ligaments and supine positions. So you know, is it okay for women to do strength work? Or is the laxity of the ligaments a concern? Is it okay for them to do trunk stability in that supine position?
Strength Training and Exercise During Pregnancy
Catherine Cram 18:09
Well, not only is it okay, but it’s really essential to do strength training. And one of the things we talk about the laxity issue, it’s never been born out in studies to show that that means they will have a higher risk of injury in those joints. So we have not seen that. So you know, the whole reason that relax and hormone is produced that allows that symphysis pubis to pull apart enough that the baby can pass through the canal, they see all connective tissue; diastasis recti, which is a separation of the muscles in the abdominal area, that’s all occurs because of that. But we haven’t seen any correlation with that at all. So I just tell women, just like I would anyone else, stability, your posture, mirror imaging, so she’s making sure because as she gets further along in her pregnancy, because of her change of body shape, I see a lot of drift that occurs with her positioning. So repositioning talking about “Okay, it looks like now you were not getting those knees bent enough, maybe we need to modify in this position or sitting position.” Those I think strength training exercises are absolutely crucial and we don’t do enough of them. So and we have a lot of women that come in that are doing very high level of strength training, we have them continue, we talk about things like you know, you don’t want to do the valslva maneuver, no bearing down. If you have to bear down as you do your press or or any exercise, then that’s something we have to modify because then we talk about pelvic floor issues and possibly causing problems with that supine. What one of the things they always say is what position do they have women in when they’re at the doctor in checking? She’s on her back theoretically, and it makes sense the vena cava, when that uterus and the baby gets big enough, it’s going to compress that vena cava. But when you think about that physiologically, that’s blood flow back to maternal heart, lungs, brain, and usually she’s going to feel it. So before it would ever impact the fetus, when we’re talking about exercise, there’s even been some studies that have said that they don’t even see as much of that occurring when women are exercising versus at rest. But just to be safe, I just modify position so we don’t have supine positioning after that first trimester. We’re going to incline up, use pillows, lots of lots of things we can do. And mostly because I don’t want her to get lightheaded. And if she starts to feel lightheaded in a position, then we know that we need to modify that. But it’s not going to cause catastrophic, you know, outcomes with the fetus. She would get very lightheaded and dizzy well before that point. And so again, I think that’s really reassuring. But, you know, in all my classes, I always just modify those exercises at the first trimester.
Julie Young 20:56
So, and I think that’s great. I think rather than kind of fixating on that one thing you can’t do, there’s always so many other things you can do. So Catherine, I realized this next question basically takes your book to answer. But can you give us just a brief overview of what exercising during pregnancy looks like? And again, I understand there’s huge individual variability in this answer.
Catherine Cram 21:18
But what I think should look like is first and foremost, it should be something that makes that woman feel good, empowered. I’m always trying to tell people take the no away. So what we want to do is have her either continue with what she was doing. And I strongly encourage women that aren’t exercising to start. So what we look at is we want to try to find a way to of course, set up an intensity and duration of frequency and a type of exercise that works for her lifestyle. If she’s training, if she’s in a sport, of course we want to do the type of exercise that’s going to enhance whatever she’s doing. I really think it’s important to though, especially even in higher end athletes, to change it up a little bit, because there is a lot of benefit to doing that, especially when she may find that as she gets further along. If she’s a runner, she can’t continue to do that without discomfort, or she has wrong ligament pain, or she gets Braxton Hicks contractions. Well, we try a belt, we try a lot of different things, and it doesn’t work. If we got a couple other things in the back pocket that she’s been doing too, that’s really important. The key and the data supported this all along, the key is to find a way to keep her exercising to the end of her pregnancy, because all of the benefits that reduce fat gain over the point where she should, the less retention of fat, the changes in placental blood flow, muscle pain or musculoskeletal issues, all of that is critically dependent upon that she continues to the end of her pregnancy. What we find is when women stop halfway through many times, and we’re not sure exactly why this is, but probably because they’re still eating calories at the level that they were with exercise. And they tend to gain more weight, they tend to lose their fitness level. And they tend to have a harder time postpartum, coming back to their fitness program. So we really try to always say, “Okay, what can we do to change this? How can we make this comfortable? What can we do to deal with that to keep you exercising, and keep that workload at a level that feels challenging.” So these are all those fun little things I like to play with, with each woman and see, okay next, I always tell people, when you’re working with a regular person, you set up a work like set up a training regime, and that you kind of build but it doesn’t have week to week changes in ability, pregnancy does. And you can have a great week, and then a week that’s backward because she hasn’t been able to sleep. And these are all things that play into it.
Dede Barry 23:49
Catherine, I can really relate to what you’re saying about never say no, and also individually planning for each woman. And I think even each pregnancy, from my experience, I have two kids who are now 15 and 17. But I got pregnant with my first right at the end of my professional cycling career. So I was a month and a half out from the Olympic Games and the World Championships and really fine tune probably fitter than I’ve ever been. And I can remember I was splitting my time between Spain and Boulder and I had two OBGYNs, and the one in Boulder really encouraged me to be active. And the one in Spain thought I was crazy for even mentioning the idea of riding my bike during pregnancy. And it was really interesting because I obviously you know, did a lot of research and got advice from a wide range of people, but I stayed incredibly active during both of my pregnancies. But both pregnancies were very different and I was at a different phase physiologically at the start of of each pregnancy. But, you know, from my standpoint, I never imagine myself going back to competing again at the level I had been at before. But cycling and running and cross country skiing were very much a part of my life and my lifestyle. And I wanted to continue doing them. And I felt like, especially the mental health benefits were huge for me during that time, but also physically, it made me feel great. And I think it’s so good that now it seems to me that the messaging is more positive around women staying active during pregnancy. I can remember, when I was in Spain, another funny story was that a lot of the elderly women in the street, they would see me riding my bike when I was nine months pregnant and about to give birth, and they’d say, “Oh my God, you need to put more clothes on and keep the fetus warm, and get off the bike,” and make comments like that. And I think there’s lots of that. Now, I think that the general population is starting to understand that, you know, there are benefits. But can you share with our listeners, you’ve you’ve spoken a little bit about the benefits of exercise during pregnancy, but but can you go a little bit deeper into that? Because I, you know, I do think there’s a wide range of them. And sometimes they’re overlooked.
Benefits of Training During Pregnancy
Catherine Cram 26:12
You know, one of the things, in fact, I’m going to talk a little bit about is, I think one of the biggest issues is, people are really worried about what’s that’s going to hurt the fetus. And really, what we’re finding is they talked about the fetus is actually well able to take care of itself and get what it needs. Sometimes at the sake of the mother’s health. You know, we see that a lot of times where it just the moms are just not gaining weight, the fetus is doing fine. But I think what’s really important is to keep in mind that you’re building a healthier, better baby. So we know that we have, as I said, all of the changes as far as central blood flow, there’s been some interesting longitudinal studies that have looked at these children of exercising moms actually do better five years out with psychological testing, physiological testing, whether or not that’s something to do with the mother reads more or whatever. But we do know in that population, we’re seeing that, but we also the bigger benefits, and especially in this culture have to do with I think the mental health, and that that doesn’t get talked about as much as a physiological but it’s every bit as important. Our society, once a woman becomes pregnant, it’s like, everyone’s able to make comments to her, and be able to tell her how to do things. And what we stop doing is looking at her as the expert of herself. And so when you exercise during pregnancy, you are in tune with your body more, you are feeling a little more empowered about that. And I think that psychologically, that’s just huge because we see a lot of mental health issues with pregnancy and postpartum now. And I think a lot of that is due to the fact of just a disconnect. But also, I think what’s interesting too, is we see a lot of women after pregnancy that get back into sport and do better. And there’s been a lot of theories. Why is that? Why is women competing at a higher level after she’s had a baby? And some of it might be to do with that change in in cardiovascular, cardiac output, all of those things that have changed. I think also there’s a mindset change. So those two things can make a big difference as well in helping a woman in her postpartum period, through her recovery. And like I said, we see a lot of women who have done better and competed at a higher level after she’s had one or two children. And whether or not it’s residual effect, like I said, of the cardiac output changes, the musculoskeletal changes, we’re not sure. But these are really positive things. So and then the other one I talked about is the weight issue. I’m really really cagey about this one, sometimes talking too much about it because in higher end athletes, higher level athletes, we see a lot of problem with eating disorder. We talk about RED-S, relative energy in sports, you know, she probably talked about that before. It’s something that I tie into dealing with prenatal and postpartum athletes, because that is probably the biggest issue. I see some disordered eating, and not on purpose, but it would be considered disorder for pregnancy. So they’re eating like they would have when they’re training before. But when they become pregnant, they really have to monitor much more closely how much nutrition they’re getting. How many calories they’re getting. And that’s why there’s kind of, I have like a mantra that I go through with everyone. It’s like an athlete’s checklist for pregnancy. So number one, form a team. You really need your team for the general woman who’s because pregnant wants to exercise. This isn’t something she has to have. But for someone when they’re at that level, this professional, high end athlete, eye level athlete, then you do. And what I really tell everyone is when you get a physical therapist, who’s a woman’s health specialist, you of course, have your health care provider OBGYN, you want to have a mental health professional that can help through some of the issues of the athlete mindset and being able to help her kind of rejigger how she thinks about all of those things and how her body and being able to say, “Okay, I can pull back.” Also, you want to have a trainer that has background in prenatal and postpartum exercise. And that’s one of the things I don’t see a lot of. So that’s what I like to see as well. And a registered dietician that has experience with dealing with women in sports. And then of course, in postpartum, a lactation specialist. So this is your team; when you have that team you have everyone that’s in their scope of practice, that team is going to make sure that she can keep her exercise at training level safely, she’s going to stay healthy, and that she’s going to have healthy pregnancy. So that makes sense about just looking at it as prenatal and postpartum. Really important to get that team together. And then I talk about monitoring tools. So the monitoring tools that we have our of course, RPE. And rating of perceived exertion is good, but it doesn’t give you a lot to go on. And what we’re starting to revisit is looking at training heart rate with athletes. So maybe pulling that in as well, there are really not a lot of guidelines as to where should she be training at, but I just have her use what she’s usually using at her carbona and formula, whatever she wants to use, keep it below 90%. So that’s you do not want to be up any higher than that. She can do up close to that and like interval work, but keeping it around 60 to eight. So using those two tools, because if she gets further along in her pregnancy, first of all, that heart rate isn’t a very good way of telling how her VO2 max, it’s not a linear response that we see in a regular nonpregnant person. She has an increasing that resting heart rate, that’s going to play kind of a role in that heart rate monitoring not being as accurate. But by using both of them the day she didn’t get enough sleep, or if she’s overtraining if her RPE is pretty high, even if her heart rate isn’t, that’s a signal, and vice versa. So she can use those together. Also, really well versed in overtraining. What does it mean? What should I be looking for? So things like heart rate variability, and I probably talk a lot about that as a really great tool to see how her body is responding to stress. So I’m not going to go off on a lot, but these are just some of the things. And then there’s one and I call this the mantra that every woman should know, and it’s the key eight. So there’s eight questions that she needs to ask herself weekly. And one of them, does your health care provider feel you’re gaining weight normally? I don’t like to send out “Okay, you should gain this much, you should gain this much.” No, that’s between her health care provider and herself to see what’s right for her. If she’s underweight, it’ll be more, if it’s overweight, a little less. So it’s hard to set those standards and I think you’re better off to work with a healthcare provider. Two, do you feel well physically and mentally? Three, can you exercise without pain or exhaustion? Four, is energy level normal? Or are you feeling extreme exhaustion after your workouts. Five, is there a change in fetal movement? Now, most women won’t notice fetal movement to between 20 and 22 weeks, but after that point, there becomes like a pattern she’s used to. And what we say is we should feel about two movements within 20 to 30 minutes after exercise. So that’s kind of a key. And if a woman says to me, “Fine, my baby isn’t moving normally, or what I’m used to,” I listen to that. And that’s usually a point where we stop the exercise, we consult with health care provider. And then the other thing is measures of fetal growth. So either fundal heart height measurement, or if she’s using having an ultrasound, if those measurements are up to gestational age, that is giving us some insight that something’s awry as far as either training level, what she’s eating, or some other complication of pregnancy. So those questions, again, empower her to say, “Okay, all these are check, check, check. Good, then I’m doing great.”
Dede Barry 33:53
That’s really interesting. During my pregnancy, the general consensus of the advice I got was that as an endurance athlete, I shouldn’t push myself up to threshold, I should always stay below my lactate threshold. Is that still the consensus? I’m getting the sense from you that it’s not?
Catherine Cram 34:12
Well, it’s kind of hard to know for sure what that is, is your pregnancy progresses too. Were you being tested? Were you doing sub max? How are they testing to determine what that was, say when you were at 20 weeks?
Dede Barry 34:22
Yeah, so I wasn’t doing any testing, I would say I had a pretty high level like I had race professionally and cycling for 16 years at that point. So I had a really good sense of my RPE in relation to my threshold. And so that was what I went by. I went very much by feel. I didn’t use a heart rate monitor. But I felt like I had a really good sense of where my heart rate was when I was exercising. So I went very much by field but I could see how using a heart rate monitor for some women might be beneficial, although perhaps there’s a lot of variation during pregnancy with heart rate.
Catherine Cram 35:00
You are exactly the dream client because, and this is what we see mostly in athletes is that they do have a sense that RPE, they understand that I mean, I almost never check heart rate because I know what it feels like. It just everybody’s a little different. Some people just aren’t as tuned in. I almost never use heart rate, some women just really insist on doing it. But I always say, you really get to see how you feel. And I think you just hit the nail on the head. If you know your body that well, then you know what that feels like when you reach that. And, you know, I think we can test and do all these different things to gather data. But what it really comes down to with pregnancy, it’s not just cardiovascular, what we’re looking at, we’re looking at, you know, you’re tired, your muscles are sore, your joints are sore, your biomechanically things are different. So these are all these kind of global things that you’re looking at, that play into and your RPE is going to reflect that far better than just a heart rate. So to me, that’s ideal. And if a woman really feels that she has a good handle on that, that is exactly the gold standard
Julie Young 36:02
Way to go. So I just realized this when I’m in the lab doing tests, like a lactate threshold test, for example, and you’re monitoring lactate and heart rate, but also perceived exertion. And I find it so interesting, like the really good athletes, the lifelong athletes, or elite athletes are so spot on, it’s crazy. But then people that are new to sport are really off the charts. So I think again, it’s kind of one of those things is case by case.
Catherine Cram 36:32
It is and I think that benefit of working with athletes is that most of them are spot on, you know, when I’m working with women who have never exercised, and then it’s just trying to get them to understand RPE, everything feels hard, everything feels weird. So I think that’s a benefit to working with athletes is that it really makes it a lot easier not to have to worry about that end, because they really, unless they aren’t able to listen to the fact that that’s too high. And sometimes it’s difficult when you’ve been an athlete all your life, it’s so hard to say, this is just really hard, I maybe shouldn’t push through this. And that’s where, you know, psychologically talking about that. And I always talk about the athlete mindset, and postpartum because we see a lot of women just want to get right back into it. And it’s psychologically and I totally get it, they’re feeling depressed, they want to get back to what makes them feel in charge of their body and themselves. And then they push it. So it’s, it’s really a, it’s a fine tune game. And I think the more women have a team to help her say, that’s normal. But here’s some action points you can do. That gives her something to do to build, but it’s going to enable her to build that foundation before we get right back into it. And then she gets injured in or a pelvic floor wasn’t healed, or some issue that’s going to keep her from being able to get back into her training. So it’s a real dance that postpartum period. And we don’t have enough, I think things set up to really put these things into place and help women, and it’s going that way. But as I talked about that physical therapist, Grant Donnelly, she’s done a beautiful piece on returning to running, and just talking about what are some of the things we can do, first of all, to get all of these things in place to get back to training in a way that isn’t going to cause her to break down.
Julie Young 38:23
Catherine, you had mentioned training below 90% during pregnancy 90% of what Oh, trainee heart rate, okay, but is that like 90% of your max 90% of lactate 90% of co2?
Catherine Cram 38:40
Well, you know, if your athletes have a chance to be able to actually go in and look at what their max co2 is, and then we’d be able to use a direct measure of that. If you don’t, then again, we’re looking at carbohydrate formula, just calculating the training heart rate and looking at what your max is from there. And then what 60% of that, and staying below that 90 If we push it. So it really depends a lot on what access she has to testing. And, you know, I think that for the most part, most athletes do have access to to much more fine tuned testing to establish that before her pregnancy. And they’re even dabbling into doing that during pregnancy. Now, have you done that at all in your lab with any pregnant athletes, we have not hard to, you know, get something like that set up? And I’d be really curious to because I would love to see, you know, how does that correspond with when they’re not pregnant? And you know, it’s just an interesting, I think thing to look at, but for across the board, we’re just looking at, you know, for most women that I work with, we just have a training heart rate that’s established, you know, formula.
Julie Young 39:41
Catherine, we’ve touched on this a little bit, but can we take a closer look at what it looks like once the baby’s born in terms of the training?
The “Fourth Trimester”
Catherine Cram 39:50
It’s what I call the fourth trimester. And I think it’s incredibly important to get on board right away, and so we can look at if she’s had a vaginal delivery or Severian. The first So we want to do is get her back to doing her k or pelvic floor exercises, and get the team going. So we want to first and foremost get her a referral to a physical therapist that specializes in women’s health. And I say this across the board, there is no reason not to. And it’s a great value, because the things that are going to keep her from getting back into her training are usually pelvic floor related, or musculoskeletal. So we get her with her team person, that’s physical therapy, and get started with assessing pelvic health, whether she has any conditions that maybe she has incontinence, she can have either, you know, urinary or fecal incontinence problems, there can be pelvic floor problems, pelvic girdle issues, all of those, we start right away, so we can start working towards getting that foundation built. Then the other thing is talking about body mechanics, because a lot of women even though you know, they think they understand how to move and do it safely. Once you get a baby on board, she’s lifting improperly. And we have a lot of back injuries that occur because of that improper lifting techniques. She doesn’t have her workstation for diapering setup, so that it’s really ergonomically right for her body. So getting that going so that we don’t end up with injury from the day to day, minute by minute lifting that she’s doing every day. And then with a cesarean section, I also talk a lot about that healing time, it’s a major abdominal surgery. And with any other major abdominal surgery, boy, there’s rehab time there’s take some time to heal, with pregnancy and postpartum then we hand the woman the baby, and there’s really not very much aftercare. And there’s things to deal with, as far as first of all, she’s going to be deconditioned, from the couple of weeks, she’ll probably have to be resting more to heal, there’s scar issues. So scar mobilization gets started with physical therapy so that scar tissue doesn’t form and cause adhesions so that she’s not able to move through her range of motion. So that can get on board. And again, getting that team going pelvic floor work with that and lifting techniques, then we move to working with the physical therapist on assessing whether she’s ready for impact exercise. And that’s the hardest thing to deal with. Because a lot of times it can take three months before or even longer if she’s had some injury. So there’s some assessments and that’s when I talked about Grean Donnelly, that physical therapist has a really good overview of exactly what you want to look at before we get started with exercise. So pelvic floor, are there any conditions that are keeping her from being able to exercise or do weight, kind of weight bearing exercise, all of that needs to be assessed, we also talk about red, so we really want to make sure that her diet is optimal, if there’s any other physiological conditions that she has to deal with, and psychological as well. So that’s kind of building that foundation starting from day one, bringing that team on board and each person in that team working to bring her back to the point where she can start training effectively.
Rob Pickels 43:08
In module 10, our latest in the Craft of Coaching series, we’re turning our attention to the coaches who are bringing up the next generation of junior athletes. Coaching juniors is wildly different from coaching adults, and applying the same principles often causes young athletes to burn out and quit the sport. Learn how to tailor your knowledge to junior athletes by checking out the Craft of Coaching at fasttalklabs.com.
Dede Barry 43:34
Ahead of this episode, we had the chance to speak to 800 meter runner Melissa Bishop-Nriagu, about her personal experience as a mom and athlete how she approached exercise during her two pregnancies, and how she ramped up her training postpartum to return to international competition. Welcome, Melissa. Melissa, thank you for joining us today.
Melissa Bishop-Nriagu 43:57
Thank you for having me.
Dede Barry 43:59
Can you tell our listeners about your background as a runner, what you’re working towards at the moment and where you’re headed?
Melissa Bishop-Nriagu 44:06
Sure. So I am originally from Eganville, Ontario, which is up by Ottawa. I now live in Windsor. I came down here for university. I met my coach down here and he really helped put me on to the international scene with renting I met my husband then and we ended up staying here. So I am based in Windsor, Ontario. I have competed in three Olympic Games 2012 and London 2016. In Rio, and the 2020 games in Tokyo. It was fourth at the 2016 Games in Rio de Janeiro. And in 2020 I didn’t make it out of the first round. I ended up tearing my hamstring about seven days prior to the 800 meter going off. I had my first child and 2018 after the 2016 games, came back to make the 2020 Olympic team and then I just gave birth to our second child earlier this So we’re in July, actually. And right now I’m working on coming back for the 2024 games.
Dede Barry 45:06
That’s amazing. Really unfortunate, though, that you had that injury just before the Tokyo Games had to be really frustrating.
Melissa Bishop-Nriagu 45:14
It was extremely frustrating. The timing wasn’t ideal. Injuries are never an ideal timing. But you know, these things happen. There is no guarantee in life really. And there’s no guarantee that, you know, everything will work out the way we want it to, we just tried really hard to not have those little things stand in the way and to be able to get to the line healthy because I was really, really fit going into 2020 games. But again, we can’t control everything. And these things happen.
Dede Barry 45:43
Yeah. So in 2018, when you were pregnant with your first child, can you tell us a little bit about your experience? Did you actually train through that pregnancy? And did you intend to come back as an elite runner after that pregnancy?
Melissa Bishop-Nriagu’s Experience
Melissa Bishop-Nriagu 45:56
Yes to both of those questions. So I trained probably like running training up until about before 20 weeks, I was able to run maybe even like the 16, 18 week mark pregnant is when I had to stop running because I was having a lot of pain in my pelvic region. I was having these these bulging varicose veins, like it sounds disgusting, but they’re essentially my varicose veins were just all the blood was rushing down every time I would stand or walk or just be in an upright position. So I had to switch to cross training, which was elliptical bike swimming. And I did that for the remainder of my pregnancy. Up until probably the last two months of pregnancy, my coach just said, You know what, enjoy being pregnant. This is the time you only get to do once or twice, or maybe three times in your life, who knows, but just enjoy this right now. And just rest your body because what’s to come is very demanding on you. So I did train through majority of it with the intention of coming back for the 2019 World Championships in Doha, which were just over a year, actually, after my scheduled delivery date. They were actually in October, they weren’t held in the summer, because they were in Doha, Qatar with the weather, they moved it back into the fall. So I had more than a year on paper to get myself back into shape for that. So after I delivered, you know, all my goals, and my intentions, were working towards those World Championships in 2019, which in the end, I didn’t end up making because my body was not ready for the demand I wanted to put on it.
Dede Barry 47:26
When you were pregnant. Were you training at a wide range of intensity levels? Or did you try and stay within certain ranges?
Melissa Bishop-Nriagu 47:36
Yeah we tried to stay within a certain range. So my coach trans dealing with his wife went through the exact same process, she had a baby went back to training and made her Olympic team in 2016. So he’d already been down this road with her. He’s a research based doctor by trade, I’ll call it so there isn’t a lot of research on elite athletes and pregnancy and training through that. So it was really trial and error for us. But he had a very good like groundwork laid of what I could do. And so we were very cognizant of my heart rate zones. When we’re getting into the intense running, we never let them go above a certain level. Totally based on feel, you know, because your body’s changing so much in these times. It depended on my energy levels, that first trimester just it zapped me. So we tried to stick within one intensity level, it was pretty low key first trimester, you know, we could push the barriers a little bit. But you know, once things started to grow, and things started to progress with my pregnancy, we really tried to keep a cap on things, just I mean, the main priority was at the baby be safe. And then it was my health after that.
Dede Barry 48:43
And did you find you’re more prone to injury and just general discomfort, like during your pregnancy and postpartum?
Melissa Bishop-Nriagu 48:52
Yeah and I think that that’s the hard part is that I’m after 12 years of being a professional runner, I’m so in tune with my body and I know every ache and pain and so I’m reporting every ache and pain, even though maybe it’s not that big of a deal. And I remember in 2019 when I was on my comeback for the dollar championships within that year, at first I wasn’t reporting aches and pains because I knew my body so well that it was like oh, this is just a little niggle. I just need to give it a few days and it will go away. I would never report that to my coach. And I learned out of it that postpartum I needed to report those aches and pains because those aches and pains grew into something much bigger, a much bigger injury. And the fact of the matter is, is that I was dealing with a very different body than I had before I was pregnant and I had to relearn how to read it.
Dede Barry 49:44
And did you do more cross training postpartum than you had done prior to having your child?
Melissa Bishop-Nriagu 49:50
Yes, like like it started off well running and then I hit the Christmas time Mark December and I was having this like really intense pain in my lower back I got in for an MRI and it showed a stress fracture in my sacrum. So then everything switched to cross training at that point, because, you know, my goal was still the World Championships, I still needed to gain my fitness. And so we did a ton of cross training. And I don’t know if all athletes feel this way. I don’t like to cross train. I’m not good at it. That’s probably why I don’t like it. There is a benefit to it, certainly. But yeah, we did a lot of cross training, a lot of cross training just to be able to maintain the fitness to build the fitness. And then when I was able to run, just trying to reload my body, it was very difficult. They were it was a lot harder than I thought it would be. But now that I’ve done this two times, I know I know what I’m doing. And I know that the extent of this work.
Dede Barry 50:44
Yeah, that’s really interesting. And what about nutritional strategies? Did you employ any different nutritional strategies prenatally and postpartum?
Melissa Bishop-Nriagu 50:54
So oddly enough, with my first pregnancy, I didn’t employ anything specific, I just ate how I always ate as an athlete, I’d never worked with a nutritionist, I had a general idea of what I needed, my body knew where to go. And then we got into training after my first baby. And I couldn’t keep the weight on, like, I couldn’t keep ahead of it, I was working so hard as an athlete, and then I’m burning all these extra calories, with nursing and with caring for my little one, and just the general day to day stuff. And I was finding it hard to time manage, when to sit down and get a meal, like my meals ended up being like the leftovers on the cutting board that I was giving my daughter, which is not enough for an athlete training at that level. And so then in came my nutritionist, Jen Zygo. And she helped put me back on the track of how much I need to eat and the priority that I had to place on it because I was my body was in such a demand for calories. And I couldn’t get enough of them on me. And so that too, was part of the struggle in that that first year was not only the injury bit and trying to come back to be peak performance, but also fueling appropriately for that. So during my second pregnancy, after I just had Olivia in July, I emailed Jen and I was like, Look, these are the demands I have right now. I think I know where I need to be, but I need the reminders, I need the gentle reminders. And I wasn’t training at near the level, I was simply I was walking for maybe 30 minutes a day, like I was very fresh out of delivery. And she just said, Melissa, you need to eat as if you are training right now. Because there are so many, there’s so many caloric needs. Like even just a simple 30 minute walk, the breastfeeding alone is taking so much out of you. You need to eat like you’re training. And that has always been something I’ve struggled with, especially in the postpartum phase.
Dede Barry 52:43
That’s interesting. I wasn’t trying to return as an elite athlete, I had actually retired before the birth of our first child. But with both kids postpartum, I was actually the lightest I’ve ever been. And I think even within three weeks postpartum.
Melissa Bishop-Nriagu 52:58
Yeah, it’s wild what your body does, like I couldn’t, I wasn’t the strongest, I had the most muscle mass I’ve ever had. We do body comps all the time, as you know, like benchmarks of where we are and where we need to be. I’ve been doing them for 12 years. And when I was at the Tokyo Olympics, I was carrying the most muscle mass, I was the leanest I’ve ever been, I still had my period, like I was this Lean machine. And it’s, it’s wild what carrying a baby can do and your hormones and my coach’s wife was the same way she maxed out in the weight room postpartum, like she was so strong.
Dede Barry 53:32
That’s interesting. I was too and I can remember it really not taking me very long at all to bounce back like I was similar to you and that you know how you explain your second pregnancy those first few weeks, I was really only going for long walks. But I remember at about a month, I started running a lot and cycling a lot. And I couldn’t believe how strong I was. But in terms of like coming back to the elite level, like when was your first elite international competition? Was it the World Championships in Doha post the birth of your first child?
Melissa Bishop-Nriagu 54:04
That would have been but I didn’t make the team I ended up having, like I still had to run the time in order to get there. And I wasn’t able to do that my body was in, oh, I don’t know how to describe it, but it was just like sending off all the alarm bells like every other week, it was something new, some new injury that couldn’t stay ahead of and it was I just said like, I need a break. Like I’m exhausted, my body’s exhausted. And the break actually was the best thing for me because I was able to bounce back that following year. And we were ready in an COVID hit, obviously, but I was stronger because of that rest. I’ll put it that way.
Dede Barry 54:37
So you had been running though and national level events to try and make the times. Yes, I know you said the Canadian record while before the birth of your child. But how long did it take you to get kind of within a close margin of that?
Melissa Bishop-Nriagu 54:50
To qualify for the Olympics, I think the time was about 1:59. My Canadian records 1:57 The year after I gave birth to my first in 2019 I I think I was around the two minute mark. So I was chasing that 1:59 barrier. And then by 2020 Olympics and mind you, we had a, we had more time, we basically were given time with COVID. I was back down to that 1:50 range by the time Tokyo came around, so I was really close to my Canadian record, if like we were expecting something very fast in Tokyo, like, that’s how fit we were. I don’t know how else to describe it. But yeah, in the simplest terms, like we were ready for a really big one, but my body had other plants.
Dede Barry 55:30
Yeah. And was your first birth natural or by C section?
Melissa Bishop-Nriagu 55:35
Both were natural.
Dede Barry 55:37
In terms of nutritional strategies, were there any supplements, for instance, that Jen Sigo recommended prenatally or postpartum?
Melissa Bishop-Nriagu 55:46
Prenatally, no. I was just on the regular prenatal vitamin. I was taking iron. I’ve always been the iron deficient right on that cusp. But we had tackled that well, before we even discussed getting pregnant. So I had my iron was at a good level, but I just stayed with it. postnatally it took me to get my stress fracture and me to connect with Jen, which I didn’t do until after I had a stress fracture to realize I needed a calcium supplement. Like it just seems like so obvious. Like why would you think that if your baby’s taking all this milk from you? Why wouldn’t you need to replace that same mineral or vitamin and so it took me a while to figure that out until I talked to Jen. So we got on a calcium supplement after that with the iron and then a regular multivitamin. But otherwise, there was no nothing specific that I was using.
Dede Barry 56:32
And who else was part of your team? Like you’ve talked about your nutritionist Jan. I’m sure you worked with an OBGYN and your coach. Was there anyone else?
Melissa Bishop-Nriagu 56:41
Yeah my physio, my PT Mary Brandigon here in Windsor. And my massage therapist Jen Brown. They both were pinnacle and me returning to sport at such a high level. My family Doctor Andrea Steen was an Olympic foreign meter hurdler. Back in the 80s. So she was really homed in on like what I needed. And she knew that I couldn’t be treated as a regular birth. She knew my goals coming back. And so she was really able to help put things in place that could fast forward and she knew where I wanted to go and what the body needs because she has three kids of her own so and she’s been at that level. So I had a really great team. I had an experienced team. My OBGYN. He was great. He worked really closely with my family doc Dr. Steen. I had a really great team.
Dede Barry 57:28
Yeah, that seems really important.
Melissa Bishop-Nriagu 57:30
Yeah, no. So my OB, at first I asked him about exercise through pregnancy. And he was like, “No, your heart rate can’t go above this level, and you need to be cautious.” It was very much that old way of thinking. And then he found out you know what I do for a living, who my doctor is Andrea Steen. And they had worked very closely together for many years. And he was like, “Okay, let’s take a different approach to this.” And I knew of Andrea, Dr. Steen was giving me the okay, then that would be okay. But funny enough of the riding the bike thing that they delivered, I was induced with Olivia and my husband and I were just getting ready to go for a bike ride. Before they called to say, are you ready to have a baby? And we were like, “Okay, I guess we’re not biking today.” And the nurses thought it was hilarious that I was nine months pregnant getting ready to go and exercise and it was the running joke in the room. The other thing in the delivery room, the heart rate monitor kept going off and that you probably experiences with both of your pregnancies, but our heart rates are at rest very low. And so it kept setting off the heart rate monitor in the room and it kept beeping and they were coming in and saying like, “Are you alive? Like, is this normal?” And I was like, “Yes, this is normal.” And so after, they just ended up turning the monitor off because it just kept triggering it. But they had to like tell every nurse on the shift change like heart rates, low heart rate monitors off, she’s alive. Everything is fine. It’s just a low heart rate.
Dede Barry 58:50
Yeah, I’ve had that a lot over the years, actually. Yes, yeah, I get crazy. A little heart rate. But yeah, how long did you breastfeed with each kid?
Melissa Bishop-Nriagu 58:59
Oh my gosh, with Corinne, I made it up until about six months. And then my supply of I was getting into heavy training, nutrition with gin. That work hadn’t set in yet. So I was like my, my supply was like, plummeted. With Olivia. I also had supply issues. So we were topping her up with a bottle. And then at the two and a half month mark. She woke up one day and was like, Nope, I’m done. I don’t want a nurse. I want the bottle. And I was not ready for that. That was so hard for me to deal with. We tried. I tried very hard to keep her nursing because I wanted to nurse but ultimately she has to eat and she was refusing me. So I’m about two months with Olivia sadly.
Dede Barry 59:43
Yeah. So tell me a little bit about your plans in the coming year. Have you race since you gave birth in the summer?
Melissa Bishop-Nriagu 59:51
No, no. I’m taking my time with this one because I know with my first my goal within that like let’s call it 14 months, was quite aggressive. And so I this time, like if 2024 is my focus I have until then I’m not putting the pressure on myself to do that again, because I don’t want to come out of this injured and having to go through that all again, the to like between my first and my second how I feel in my body has been completely different with my first I felt like I could bounce back, no trouble, I got fit really fast. With this one, I’m having a lot more aches and pains. I was up to running probably by the time she was 15 weeks or so I was running very short amount of times like 10 minute run one minute walk, 10 minute run, I was getting close to going to a study run. And I’ve just run into a lot of like knee trouble. A lot of rib diaphragm issues, too. It could be my age, I’m 34. But it’s also I think, just the wear and tear on my body of a second pregnancy. And so this one has been very different. So the goal is 2024. And I have time to get there. And I think that’s what I have on my side is time so I’m not rushing things because I want to avoid those really big catastrophic injuries like stress fractures.
Dede Barry 1:01:06
How long do you have to make the qualifying times?
Melissa Bishop-Nriagu 1:01:09
Oh, I have up until like, a couple of months before the games go off. Okay, so hats off I my national championships, but it also will have to run the time again. So I have time.
Dede Barry 1:01:20
Yeah, that’s good. Melissa. Thank you. You’re welcome. And good luck as you work towards 2024. Thank you.
Trevor Connor 1:01:29
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Dede Barry 1:02:04
Catherine, I delivered both of my children naturally and bounce back amazingly quickly. I mean, I was active within a week and felt super good. And I remember with my first I was just so shocked because I expected it to be a much longer period of recovery postpartum. But I know many of my friends who delivered via C section struggled a lot more. And it took them much longer to come back. What is the average time? Or is it just so individually variable that you can’t really give a timeline?
Catherine Cram 1:02:36
It depends a lot. Sometimes if the baby is not doing well, if there’s some other issues with the baby anymore, that can slow things down. What’s her quality of sleep? Is she not getting sleep? Is there a fussy colicky baby? These are a lot of issues that play into that even with a vaginal delivery. And the thing is, is that athletes, you know how you compare yourself to everybody else, it’s really difficult because a lot of women expect they’re going to come right back. Because they’ve exercise they’re fit, they’re healthy. And then oh, you know, they had a tear. And they’ve got a lot of problems with pain and discomfort or they have incontinence issues, or they’ve got some prolapse issues. You never know what’s going to happen. And as much as you want to try to control for that. I try to get women in the mindset that there’s no absolutes. So if your friend was back running in a week that’s meaningless to your recovery, because I think there’s a lot of shame involved when someone has has issues. And they think well, what’s wrong with me? Why aren’t I able to get back into this like everybody else that I talked to? So, you know, with us as Aryan, I’ve had women that were back exercising in three weeks, and some it took three months, just quite variable.
Julie Young 1:03:50
Some of the athletes that I’ve worked with that have had C section seem to have a challenge, recovering abdominal muscle function and strength. Do you have any suggestions for that?
Catherine Cram 1:04:01
A lot of that depends on the incision, it really can depend on to the size of the baby, and afterwards to how much they’re lifting. But there’s a lot of talk about something called a diathesis ref chi. And I think you’ve probably heard about it the separation of the midline that occurs during pregnancy. It gets medicalized, but it’s normal. I would say 100% of women during pregnancy have some separation. You have to to make room for that baby. The muscles not in itself separating people think it’s tearing, it’s that connective that tissue that linea alba that should thin and widen. We really don’t know why some women have a really great widening of it more than two and a half three fingers worth or some have very little. I think it’s mostly genetics, number of pregnancies, size of baby, all of those play a role, because the strength of the abdominal muscles have very little input to that during pregnancy, but postpartum if you’ve had a cesarean section, nerve innervation all of that can be affected. adhesions can be affected. So there are some really great things that physical therapy can do to slowly bring that back. And it used to be, we’re really nervous about doing any exercise like, oh, it’s going to put so much pressure on that linea. Alba it’s going to tear apart. And what we’re finding is actually no, pretty much any exercise is fine. It’s about loading. So we want to look and see, with postpartum, you’ll see that coning. And sometimes it’ll think was someone moved, most women are caught up, we watch for that, because we want to bring it just below that kind of like, Angela, you find that threshold and stay a little bit below it, it takes really small steps, and then building in a lot of transverse work, some rectus abdominus, you know, we want to really breathe a whole core in there. But it’s about these micro changes over time to allow the muscles to regain strength, that nerve innervation to come back, if it was a C section, and there were some issues with that, and to not freak out about it. Because, you know, even the measurements, you know, it’s meaningless. I mean, someone can have four finger rectus abdominus, some people too, and the person with two has more low back pain, what do we know that from that, we really don’t have a lot of good data on it. And I think quite frankly, it’s one of these things about function. And let’s start working back at function and not worry too much about that distance, because in time, it’ll come back somewhat. But it’s really the luck of the draw how much it does, and whether that really affects strength. We’re not seeing that if we build back over time.
Julie Young 1:06:28
Do you have a good exercise progression to build back from this,
Catherine Cram 1:06:33
One of my favorite things for abdominal wall for a new mom, is that starman exercises, if you’ve seen, they’re very gentle, but they’re mostly transverse. The thing I love about them, they’re a series of five exercises. And they start first with stabilization, learning how to breathe, and then hold the belly tight as you do the exercise. So that stabilization is crucial. Gotta get that first because if she can’t hold that contraction and still breathe, normally, she doesn’t have enough control, then we move to level one, where it’s just extending the leg out. So there’s a series of five of them. They’re just amazingly effective. And I use them for everybody. Because they’re a great way of strengthening that abdominal wall without putting a lot of pressure on the low back, when you look at like doing a regular sit up, what happens postpartum her muscles are, first of all, the rectus abdominus is so far apart, there’s a lot of loss of strength and stabilization. And we’re recruiting. So we’re really ended up getting neck aches, we’re not doing a lot of actual strengthening. And so I find even just that she brings her head up slightly and gets just that small contraction, almost like a little isometric contraction, that gets things working again, but it’s a real patients thing. But I have seen amazing, amazing changes, if she doesn’t go too quickly. And I would also don’t get too worried about it, I don’t think there’s a lot of data that’s shown that, if they’re exercising wrong, they’re going to make it worse, we just really haven’t seen a lot of that. And it’s a very different thing than a herniation. So a lot of people think they’re herniated. That’s different. So but their risk of herniation is a little higher if they have a very weak linear elbow, but I don’t see that, you know, a lot.
Julie Young 1:08:14
Do you have the progression in your book?
Catherine Cram 1:08:16
I do. I have it in the course book. And I do believe it’s in the doctor clap book, too. And there’s a lot of exercises, but there’s no bad one. It just needs to be modified.
Julie Young 1:08:28
Catherine, you had mentioned this, this idea that and we see these female endurance athletes, and I think of, you know, some of the elite athletes, they return so quickly to sport and seemingly stronger than before. But yet, I’ve read and you mentioned this, that perhaps it could be mainly attributed to increase in blood volume, which will then up the VO2, but I’ve read varying opinions on this. So the IOC paper says there’s a possible five to 10% increase post pregnancy of VO2. Another paper suggests that this only applies to recreational athletes, and it’s short term. So can you help us understand this boost in performance? Is it fact or fiction?
Catherine Cram 1:09:15
You know, I can’t tell you for certain, but if we just want to think about it, I mean, these changes, the physiological changes fall away pretty quickly postpartum. So you know, when you get to the point where you’re competing, I think those changes are pretty much long gone. And again, I can’t quote the answer, because I don’t have the day we don’t have data on it. I suspect that there’s some psychological component to that as well. I really, really believe that because I think that it challenges women in a way pregnancy and being a mom challenges woman in a way that makes her stronger. And, you know, there may be something and I think they’d be great to do research on this that changes physiologically that’s a more permanent change, but I can’t really see how when the hormones far away, and that caused those changes, then what would be the impetus for that to continue? What would keep doing? You know, that’s what’s the difficult part. So to me, it just comes back to that sense of empowerment. And I would I don’t know, what do you think, DeDe. What do you think?
Dede Barry 1:10:16
I would agree with that. I would I agree that there’s a higher level of empowerment when you become a mother. And meaning, I think,
Catherine Cram 1:10:24
When you think of training, when you think of competing, I mean, how much of it is physiological part and how much of it is a mental? I mean, they’re both very, very important.
Dede Barry 1:10:34
They’re very much intertwined with each other.
Julie Young 1:10:36
Yeah and I agree. And, Catherine, when you’re talking about just the value, I mean, at one point, you’re talking about kind of changing the mindset. And then further in the conversation, you mentioned the importance of mental health, and all of those things apply to every athlete. And I agree with you, because that mental side is less tangible, or less measurable, we seem to overlook it. And I agree 100% with you.
Catherine Cram 1:10:59
It’s everything that I’ve seen in the past 25 years, that in some ways, it’s great. We’re changing how we look at women during pregnancy, and less kind of punitive on you can’t do this or that. But we still don’t honor it as well. And they’re getting there. But I just think it’s it’s the woman’s finest moment. There’s many other fine moments, but to me, when she’s working with her body in that way, and as an athlete I am, it’s just fascinating, you look at pregnancy, in and of itself, being so different, and everything changing. But then to be an athlete and see your body doing that. It’s, it’s fascinating. And I think that it’s really amazing. And I that’s why I love this field, because I just love seeing how women adapt, they’re so adaptive to every change that’s thrown their way. And with athletes, I find those times easier to work with, because they’re more intuitive. They know themselves so well. But you start to take away that training and that ability to trust in her body. And that’s where we make a mistake in trying to throw a lot of numbers and throw a lot of parameters, instead of saying you hold the key to this because you know yourself. And in all the years I’ve done this, I have never had exercise directly cause an issue with a pregnancy. And that’s saying a lot, I’ve had thousands of women come through the programs. We never had a direct, you know, she’s exercising, and this is cost. So I think that’s really amazing. And that’s not to say something can’t, but it just shows a to tell women of all the things that we do in our life, pregnancy, even if you don’t do everything right 99% of the time when you’re pregnant, it’s going to be a healthy baby. And so just relax and enjoy this would take that fear away?
Julie Young 1:12:45
Well, I would imagine to just reducing that mental stress is going to provide such a much more healthy pregnancy.
Catherine Cram 1:12:52
Absolutely. And I envy you being in the lab. I mean, that would be just fascinating. And I’m sure you just would love to bring in some of these women and look at that. And I hope you do, because that’s something that’s lacking. I mean, I get to go out there and apply all this. But it’s the researchers that are giving us all that great information. And I’m just so glad that started to open up more. And we look at more of that because we really need it. And it’s just going to be more empowering for women.
Three Pieces of Advice for Endurance Athletes During Pregnancy
Dede Barry 1:13:18
Katherine, can you provide our listeners with your top three actionable pieces of advice for endurance athletes who plan to exercise during pregnancy?
Catherine Cram 1:13:27
Well the first one is, establish your team. If you don’t already have it, established your team have a physical therapist, health care provider trainer, mental health provider, lactation specialists and registered dietitians. So get them on board right away. And if you have trouble finding them, ask your healthcare provider for referrals or friends. But that’s your first thing. Then think about your monitoring tools. So understand what radio perceived exertion is all about. If you want it to use heart rate, how you’re going to use that with RPE. Talk a little bit about or learn a little bit more about heart rate variability and using that as a tool to find out whether or not you’re overtraining. So that’s something that your trainers should be able to help you with Know the signs of overloading. So understand what it feels like when you’re doing too much exercise. And most athletes already know this, but have that list available that you can look at and check off. And then the last thing is know the key eight questions, the ones that went over earlier about, you know, looking at what your baby’s growing the rate is it gestational age, how are you feeling? are you gaining weight, normally all of those, if you are covering all those things, you really aren’t going to go wrong. You’re doing an excellent, excellent job then, of making sure that your exercise program is healthy and safe for you and your baby.
Dede Barry 1:14:42
Catherine, thank you. It was excellent speaking with you today. And we really appreciate all your insight and advice.
Julie Young 1:14:49
Yeah, Catherine, thank you so much. Appreciate your time really enjoyed our conversation.
Catherine Cram 1:14:53
Well, it’s great talking to you too. Thank you so much.
Dede Barry 1:14:57
That was another episode of Fast Talk Femme. Subscribe to Fast Talk Femme wherever you prefer to find your favorite podcasts. Be sure to leave us a rating and a review. The thoughts and opinions expressed on fast talk them are those of the individual. As always, we’d love your feedback, and any thoughts you have on topics or guests that may be of interest for you get in touch via social. You can find Fast Talk Labs on Twitter and Instagram at Fast Talk Labs where you’ll also find all our episodes. You can also check them out on the web at fasttalklabs.com. For Catherine Cram, Melissa Bishop-Nraigu and Julie Young. I’m DeDe Barry. Thanks for listening.