[This appeared in the March/April 1994 issue of Mom's Network News and was reprinted in East Bay Kids] STRENGTH TRAINING FOR MOMS by Colleen Kay Porter Many moms can relate to the ancient athlete Milo of Crotona, who lived in the 6th Century B.C. This early Olympian practiced progressive weight training by lifting a calf several times a week. When it grew into a full-sized bull, he could still lift it, because his own strength had gradually increased. Most moms can lift their babies as they grow, but injury may result when we have to pick up two children at a time, or the kids are kicking and screaming, or we snatch them up to get out of the rain. Genne McDonald, senior therapist in women's physical therapy at North Florida Regional Medical Center has treated many mothers who have back trouble, "especially moms who have been on extended bed rest during pregnancy; they lose upper body strength, and then get back to lifting things after the baby is born." Lifting children isn't our only need for upper-body strength; as moms we also do a lot of toting laundry, hauling groceries, carrying library books and hefting garbage cans. A systematic program of strength training can help mothers do their jobs more efficiently and safely, and can complement aerobic exercise like walking or bicycling. Back problems are among the most common ailments, costing the U.S. 60 billion dollars each year. Many back injuries result from misuse of the back when other muscle groups should be doing the work, so we need to develop the areas that should be used, and strengthen muscles which support the back. GETTING STARTED Find a medical book that has a diagram of the human body, showing the different muscle groups. Spend some time studying where the muscles are attached and visualize how they move the bones. This will help you appreciate how your body works, and learning the muscle names will help you understand the terminology of an instructor or video. For moms, there are two areas that need special attention: abdominals and the upper body. ABDOMINALS Women who have given birth are anxious to get their tummy back into shape. But a well-toned abdomen does more than satisfy one's vanity; it is important in strengthening the lower back and preventing prolapse of internal organs. There are several exercises that can isolate various parts of the abdominal muscles. The sit-ups learned in high school have fallen out of favor due to the stress on the back and the possibility of the workload transferring to other muscles. If you do not have access to an exercise machine, abdominal crunches are the exercises that many fitness experts recommend. Lying on your back, flex your knees. (Resting your feet up on a stool or aerobic bench step will help keep your back down.) Put your hands behind your head, and exhale as you slowly raise your head and shoulders off the ground. Make the movement slow and controlled; don't worry about how far you move, just concentrate on using the abdominal muscles to do the work. After childbirth it is also important to work the oblique muscles, which run diagonally, by doing cross-wise crunches: instead of lifting both shoulders at once, lift only one shoulder, aiming for the opposite hipbone. Make sure that the cross-wise movement starts right from the floor. McDonald cautions that postpartum moms should check their abdominal muscles for separation before starting any abdominal exercise program. Test this by pressing your fingers into the area by your belly button as you attempt to do one of the crunches described above. If you can put more than one or two fingers in between the muscles, you will need to modify your exercise. Place your feet the same way, but cross your arms across the abdomen and squeeze together as you exhale, lifting only your head. UPPER BODY WORKOUT Strengthening all the muscles in the body is important, but women often neglect the upper body. Women are born with less upper-body muscle than men, and society has not encouraged us in axe-toting, hammer-wielding and other activities that help build men's muscles. There are several ways of exercising these muscles, but all make the muscles work harder to accomplish a motion by forcing them to work against some form of resistance. Several methods can provide resistance: using a machine, lifting hand-held weights, or pulling on elastic bands. The advantage of weight machines is that they put less stress on the joints and force one into the proper positioning, minimizing chances for injury. They isolate certain muscle groups and offer a quick workout. If you purchase your own machine, it will be available when you want it and already adjusted for your height and current weight goals, but good multi-station machines are expensive, take up a lot of room and lock the owner into technology that may become obsolete in a few years. If you work out at a health club, you have access to state-of-the-art machines and expert advice, but there is a cost for membership, and you must plan your workout around their business hours. The advantage of free weights is that they can be done anywhere, any time The disadvantage is that there is greater potential for injury, and proper positioning is a constant concern. Beginners might start by doing the exercises without weights, just concentrating on positioning and form. Don't be shocked if you start to feel the exercises, even without weights; your body provides some resistance itself, and the muscles are being used in a way that they may not be used to. It should never be painful, but soreness the next day is common. Before you invest in a set of weights, you might want to consult your friends and test-drive theirs. Some people prefer the foam-covered weights because they absorb the sweat and also allow a relatively loose grip. If you clutch the weights too tightly, the major workload shifts to your hand and wrists, rather than the muscle groups you are trying to strengthen. Exercise bands are compact and lightweight, ideal for packing on a business trip. Commercial exercise bands are available, or you can use a length of blue medical tubing. Loop one end under your foot and the biceps and triceps can be worked by lifting up, just as you would with dumbbells. Bands can also provide something that free weights do not: horizontal resistance. By closing a knotted end of the band inside a door, you can pull across your body to work the shoulders and upper back. One nice thing about strength training is that you don't get all sweaty as with running, so you can do it while watching television or talking on a telephone with a speaker. DEVELOPING A ROUTINE Start out slowly. Do a simple warm-up to get the circulation going. At first, concentrate on the correct exercise form, not how much weight you are using. If you are doing an exercise with some kind of resistance device and cannot do at least 10 repetitions, try dropping the weights or bands, shake out your muscles, and finish out the 10 repetitions unaided. Work in slow motion. Take at least two seconds to lift up, and at least that long to lower down. Don't go so fast that you get momentum going. The effort of lowering the weights should also be slow and controlled; this is called "negative resistance" since you are not working against gravity. Exhale on the effort. Don't hold your breath, but control it and establish a rhythm so that, for example, you exhale as you lift your shoulders up on an abdominal crunch. Always work opposing muscle groups in the same session, to maintain balance. So if you work biceps, work triceps as well. If you are tired, wait for another day to work on the chest--but then work both the chest and upper back muscles. You will need time between workouts for the muscles to recover, as overuse of muscles can cause injury. About 24 hours is sufficient for young people, but for pregnant women and those over 35, you might need to allow more time between workouts of each muscle group. DURING PREGNANCY If you are pregnant, consult your doctor or midwife before beginning a strength training program. While most women benefit from such exercise, there are a few conditions which may preclude it (i.e. history of threatened miscarriage, high blood pressure, incompetent cervix). In 1992 the American College of Obstetricians and Gynecologists (ACOG) issued guidelines for exercise during pregnancy, which include the following: "Resistance training: lifting weights against resistance promotes muscle toning, and one set of such exercises may be conducted at least twice a week, with a period of at least 24 hours between each session. Light weights (2 to 5 pounds) should be used to prevent injuries to joints and ligaments." While journal articles offer some warnings about potential dangers from exercise during pregnancy, one should keep these cautions in perspective: "People have been so worried about the risks during pregnancy that women haven't been getting the benefits of exercise," said Karen Coley-Cannon, manager of Gainesville Health and Fitness Center for Women. Benefits may include a more comfortable pregnancy, easier delivery and quicker recovery. Cheryl Maddox is an aerobics instructor who is five month pregnant with her fourth child. "I was exercising 10 days to 2 weeks after delivery and teaching within a month," she said. Her oldest child is 7 years old, and her health care team was supportive of exercising throughout her pregnancies. A thorough warmup and stretchout are essential for the pregnant exerciser; moms often report that it takes longer to warm up during pregnancy, perhaps due to changes in circulation. Avoid straining, and don't hold your breath. As your pregnancy progresses, it will become harder to maintain your balance, so learn to work sitting down whenever possible. Abdominal exercises can help preserve muscle tone during pregnancy and take strain off the lower back. However, you might need to learn new routines, since most experts have counseled against lying on your back after the fourth month due to pressure on the vena cava, the blood vessel that returns blood from the lower body to the heart. The book Pregnancy and Exercise by Raul Artal offers many suggestions for safely strengthening the abdominals. Recent studies on exercise in breastfeeding moms have raised questions about exercise increasing production of lactic acid, which sours breastmilk. None of the moms we talked with reported such problems, and as a practical matter found they were more comfortable when the breasts were emptied immediately before exercise. Water intake is also a concern for breastfeeding moms; they find they need to drink water before, during and after exercise. LIFTING YOUR CHILD While exercise can strengthen your back, another protection against back problems is using safe lifting techniques. Don't bend over from the waist. When your toddler needs you, squat down to their eye level by bending with your legs, keeping your back straight. Perhaps you can comfort the child, and then stand back up. Even if the sobbing or tantrum doesn't stop and you need to pick up the child, you are in better position to do it, using the muscles in your legs rather than putting the pressure on your lower back. Be sure to hold the child close to your body as you lift. Once a baby is in your arms, be extra careful about how you bend down to retrieve a pacifier or toy. Their extra weight can make even simple moves more dangerous. Again, follow the safe pattern of squatting with your back straight, rather than bending over. "BUT I"M A MOM NOT A WEIGHT LIFTER!" Strength training does not mean looking like a body builder. Much of the bulky look comes from male hormones; besides, those guys use heavy weights, with 1-3 repetitions of each exercise. To tone and strengthen muscles without adding bulk, one can do 10+ repetitions of each exercise, but with lighter weights (the average woman would probably start with 1-1/2 lb. dumbbells). Women who do strength training on a regular basis tend to look trim and fit, not bulky. But expect some teasing comments from friends and family when you begin. It has only been in the last decade that strength training has become popular for women; if you are pregnant, you can expect twice as many stares. Male friends may scoff at your wimpy dumbbells, but they'll stop laughing the first time you open a pickle jar that no one else has been able to open. OTHER BENEFITS Strength training will help you in daily life and your job as a mom, but there are many other advantages as well. Muscles burn fat, so increasing muscle mass enhances the potential to get rid of those unwanted "baby" pounds. It will also help you become more effective at sports that contribute to overall fitness: tennis players, swimmers, and golfers all benefit from strength training. Osteoporosis is a degenerative bone disease that afflicts many post-menopausal women, making them susceptible to fractures and hindering their lifestyle. Strength training has been shown to increase bone density and maintain bone mass, particularly important to women nearing the end of their child-bearing years. There are psychological benefits as well. It can boost self- esteem when your increased strength enables you to do things yourself. Exercise can also reduce stress and provide an excuse to be with other adults. As moms, we spend much of our day doing things for other people. "This is something I do for MYSELF," said Suzanne Page, mother of a teenager and toddler.