Trends : Pregnancy, Exercise: An Emphasis on Safety : Obstetricians, Gynecologists to Release Their Version of Videocassette Program
While the concept is far removed from the nation’s hottest-selling videocassette, “Star Trek III,” one of the nation’s most prominent medical organizations is entering the video market to correct misimpressions that it fears have become widespread among pregnant women who wonder how much--and what types of--exercise they can safely tolerate.
Actually, two cassettes will be introduced--one for pregnant women and one for women who have just had their babies. And neither represents the pioneer foray into the childbirth fitness videocassette market--that distinction is enjoyed by tapes already marketed by Jane Fonda.
In fact, the new releases may mark the beginning of something of a sales rivalry between the physician group and Fonda’s prominent Beverly Hills exercise and fitness boutique, Workout. If it is to be competition, though, it will remain genteel.
Neither producer will criticize the other publicly and each has wished the other’s project well. There are few, if any, major differences of approach between the two programs, though the look of the productions is quite different, as is the order of exercises. Basically, though, each one offers essentially the same advice.
First Major Group to Join
But, as 25,000 of the nation’s doctors in the next three weeks begin to receive detailed descriptions of the new production, the American College of Obstetricians and Gynecologists will become one of the first major organizations in mainstream medicine to join directly in commercial patient education geared expressly to the mass consumer market.
And a mass market it is, according to Dr. Harry Visscher of Washington, a vice president of the college, which represents the majority of the nation’s mainstream obstetricians and gynecologists. Visscher said that about 3.5 million U.S. women are becoming pregnant every year and that a growing number of them are women actively involved in America’s exercise and fitness boom.
There is no sign that the trend will abate. In fact, most experts agree, more and more women who are actively engaged in exercise are becoming pregnant, and many of them have no intention of discontinuing their conditioning programs.
Unfortunately, agreed Visscher and Dr. Art Ulene, the television reporter and medical commentator, many women who are pregnant and choose to continue fitness and aerobics programs have gotten bad advice on how to do so--advice that may place them and their babies in danger of injury.
An active woman can continue to work out--something that probably has become a vital component of her life--in an intelligently and cautiously planned exercise program, while not at the same level of aerobic condition. Exercise also aids a woman’s mental outlook, and well-conditioned muscles can help a woman cope with some of the routine physical stresses of being pregnant and continuing professional and everyday activities.
Benefits Indicated
Some studies, noted Ulene, have indicated that well-conditioned women may use less anesthesia and fewer other drugs during labor and delivery. Other evidence, said the two doctors, specifically indicates that conditioned pregnant women have less back and hip pain than those who are not in good shape.
Ulene, who was a practicing obstetrician-gynecologist for nearly 20 years, first suggested the pregnancy and postpartum videocassettes to the American College a year ago.
The project is a commercial joint venture of Feeling Fine Productions, a Hollywood-based company partly owned and headed by Ulene, and the college, headquartered in Washington, which will earn royalties from sales of both video and audio versions of the two programs.
(The two major competitors have similar prices: about $40 for each of the two American College of Obstetricians and Gynecologists videotapes and about $45 for the Fonda version. Audio cassette versions of each retail in the $15 range. Bookstores and maternity shops will likely carry both in most of the country, and brochures for the American College tapes will be widely available in the offices of doctors who belong to the organization.)
Some Bad Advice
Among the bad advice--much of it promulgated, Ulene and Visscher say, by misinformed exercise and aerobics teachers, studios and some fitness books--are these specific points:
-- If you are in good condition and exercise throughout your pregnancy, you will enjoy a briefer, easier labor and a faster recovery from childbirth than if you are not in good shape. As appealing as this may sound, agreed Visscher, Ulene and Dr. Raul Artal, a prominent researcher on the effects of exercise on pregnancy at the USC School of Medicine, there is no scientific evidence that muscle tone and fitness affect the duration and difficulty of labor. Nor is there any evidence that delivery will be “easier,” or the number of fetal complications fewer, for a woman in good shape than for a sedentary woman.
While some scientists consider the question of the link between conditioning and pregnancy ease unresolved, virtually all of them believe that no one has proved there is any such relationship and that woman are being hoodwinked by exercise and fitness buffs who tout individual pregnancy exercise programs as able to decrease the arduousness of carrying a fetus to term. Some researchers say they suspect that such a link may ultimately be found, but the nature of the connection--if it exists--remains a mystery.
Intensity Level
-- If your conditioning program has been actively developed before you become pregnant, you can safely keep up the same intensity level throughout pregnancy. This impression, all experts questioned said, is not only wrong, but risks injury to mother, fetus or both. The fact is, agreed Visscher that hormonal and other chemical changes that occur in a woman’s body make continuation of a full exercise program not just dangerous but, in many ways, impossible.
The problem is that the chemical alterations of pregnancy bring about unpreventable loosening of ligaments and tendons that support virtually every joint in the body. No amount of stretching exercises can overcome the natural tendency of the pregnancy-loosened joints to buckle under severe stress. In addition, Ulene, Visscher and Artal say, there is the obvious: Pregnancy profoundly alters a woman’s center of gravity, inevitably making her clumsy and prone to falling down. No matter how well coordinated or athletically developed a woman is, she cannot overcome the fact that she is going to be uncontrollably top-heavy during much of her term.
-- If you are careful, you can continue exercising simply by performing your normal aerobic routines, slightly less vigorously than normal. Wrong, say Ulene, Visscher and Artal, as well as Femmy DeLyser, author of the widely sold “Jane Fonda’s Workout Book for Pregnancy, Birth and Recovery” and producer of the Fonda pregnancy exercise videocassette.
Several specific types of exercise are out for pregnant women, no matter what, these experts say. Any kind of sudden movement and almost every sort of maneuver in which the woman’s body actually leaves the ground introduce stresses on pregnancy-loosened joints that may cause them to fail--or, especially in the case of a woman with a history of premature labor, to induce birth too early, bringing with it the prospect of prolonged hospitalization or damage to the newborn. Even deep knee bends are unacceptably risky.
Any form of calisthenic movement performed flat on the back is also out, say these experts, because animal experiments--many of them conducted on sheep by Dr. Lawrence D. Longo at the Loma Linda University School of Medicine--strongly suggest such exercise can endanger circulation of the blood to the fetus.
This apparently occurs, Visscher and Ulene say, because lying flat on the back during vigorous activity allows the amniotic sac, in which the fetus is contained, to press downward on the vena cava, one of the body’s largest arteries and a major vessel that plays a key role in fetal circulation. Though confirming tests in human subjects have not been done--and may never be done because of ethical restrictions--every expert questioned agreed that animal studies raise so many serious questions that pregnant women in fitness routines must avoid any exercise movement while lying flat on their backs.
To a woman who has regularly attended exercise or aerobics classes--or engaged in vigorous sports like running, tennis, skiing or racquetball--before her pregnancy, the new videocassette program will seem a trifle dull. “Our decision was that the goal is to avoid risk to the fetus,” Ulene said. “The woman is clearly going to give up something. To a woman who has been marathoning or (involved) in an all-out aerobic program, this is going to seem tame.
“We say, that’s fine . . . that’s as it should be at this time in life.”
Aerobic Fitness Unattainable
Such sports as skiing, roller skating, bicycling, scuba diving, mountain climbing or anything with a major risk of falling, making body contact or a reliance on abrupt directional change are on the prohibited list. “Well, you (can) say tennis should be out,” Ulene observed. “We should say that if you’re going to play a game of tennis to win, you should not be playing in pregnancy. If you’re just going out on the court to get a workout and you’re willing to let the far ones go by, OK.” The consensus answer to what is the safest sport for pregnant women: swimming.
Overall, the American College program represents, Ulene said, a reduction in intensity of about 25% from levels to which a fit woman may be accustomed. And safe exercise regimes in pregnancy, Ulene emphasized, cannot maintain true aerobic fitness. A pregnant woman, he, Artal and Visscher agreed, simply has to accept these limitations.
True aerobic fitness represents an unattainable goal, the experts agreed, because the body chemistry changes of pregnancy are so pronounced that they affect a woman’s cardiac reserve that enables her body to compensate for increases stresses of heavy exercise.
The intensity level was difficult to calculate, Visscher said, and several versions of the tape and program were developed and test marketed on pregnant women. An eight-doctor committee established by the American College supervised the production. Visscher and Ulene exercised right along with some of the testers, and Ulene said he gained new respect for pregnant women and the physical ardors with which they cope in the process.
“What amazed me,” Ulene said, “was how strong legs of pregnant women must be. I could not do the leg exercises, and I found the arm exercises very difficult. Women seem to handle that better . . . better, at least, than me.”
A new publication being circulated by the American College to obstetricians and gynecologists across the country also lists several technical medical conditions under which a woman should refrain from exercise during pregnancy. No woman, these experts agreed, should begin such a program before she consults with her physician.
Under no circumstances, however, said the doctor brochure, should vigorous exercise be attempted by a woman who has: a history of three or more spontaneous abortions; any evidence of ruptured membranes in the amniotic sac; any indication of premature labor; medical diagnosis of an imminent multiple birth; an abnormal cervix; a history of bleeding or diagnosis of irregular placement of the placenta, or diagnosis of heart disease.
Any woman who exercises should carefully monitor her heart rate, taking her pulse about every 15 minutes. The heart rate, for instance, should not be allowed to exceed 142 beats per minute for the average 30-year-old or 146 for the average 25-year-old. Temperature should not rise to more than 100.6 degrees Fahrenheit. A woman should make sure she replaces fluids she loses during a workout and should drink water or some other quenching liquid before and after exercise--and during a workout, too, if necessary.
While much of the advice in both the new American College of Obstetricians and Gynecologists tapes and the existing Fonda cassettes is based on extended research, both Ulene and Visscher agreed that the general subject of pregnancy and exercise has been of surprisingly little interest to scientists--especially in light of the simultaneous advent of the so-called Baby Boomlet and the rise of interest in exercise and fitness.
One of the few places such work has been done is in Artal’s laboratory, where, six years ago, Artal said, “I found there were no standards for exercise in pregnancy. They are available for every subgroup (in the population) but not for the pregnant woman.”
Pregnant women have gotten so much bad advice from incompetent exercise instructors, Artal contends, that he believes the state Board of Medical Quality Assurance should step in and regulate the industry. Many exercise instructors, Artal contends, “conduct their programs by motivational arguments, and they push (pregnant women) to perform exercises for which they are mentally prepared but not physically.”
Artal, who holds a dual appointment as professor of obstetrics-gynecology and physical education, said his studies have made him believe that although definitive research remains to be done, there is no effect of fitness on the ease of labor and delivery. Artal acted not just as principal consultant to the two new productions, but was a key medical counselor to the Fonda tape project, too, a Fonda spokesman said.
“We cannot train the muscles (involved) in the passages of labor and delivery,” he said. “The structure cannot be controlled by physical training.
“I think there is also a fallacy that is strongly believed by exercise instructors that by doing flexibility and stretching exercises, one can improve one’s ability to perform labor and delivery,” Artal said. “But because of the hormonal and physiological changes of pregnancy, women are already stretched to the limit. If they stretch themselves anymore, they can have very serious injuries.”
Loma Linda’s Longo agrees, but he also believes that it may ultimately turn out that there is a beneficial effect on the ease of delivery attributable to exercise. Longo has done most of his work on research animals and agrees that, even though he personally suspects there may turn out to be some effect, it would be foolhardy for women to believe such an assertion now because no one has found evidence that it is true and the risks are so great.
A unique perspective on the question is that of Kimberley Dashiell, 25, a former ballet dancer and exercise instructor who is featured in the new American College of Obstetrics and Gynecology tapes. She is the lead instructor in both, since she was in the final weeks before her due date when the pregnancy tape was produced and returned two months later to prepare the postdelivery cassette.
Dashiell, who first started serious dance when she was 8, has been an exercise instructor for six years. She is in very good condition, yet, she said, “I was so amazed throughout my pregnancy how different I felt compared to how I thought I would feel.
“Just little things. Like, how do you get down on the floor? Bring on the crane.
“I’m a strong girl, but there is such a difference in the strength that is required just to get you through the day. But, if I was a woman who went through this program, it would be something that would make me feel really, really good, but it would not be so strenuous that I needed to take a nap afterwards.”
As things turned out, Dashiell timed things just right. Ulene’s production company taped the pregnancy cassette last Dec. 11. Dashiell’s little girl, Cody Noel, hardly had enough patience for it. Her birth date: Dec. 12.
