Episode 1592 - Exercise risk tolerance in the perinatal space

Dr. Christina Prevett // #ICEPelvic // www.ptonice.com

In today's episode of the PT on ICE Daily Show, #ICEPelvic division leader Christina Prevett delves into the need for a shift in the perinatal space, moving away from a fear-focused message and towards one of empowerment. Christina emphasizes the significance of understanding and respecting individual risk tolerance when it comes to making decisions about exercise and healthcare during pregnancy and postpartum. Christina argues that healthcare providers should not impose their own risk tolerance onto their patients, but rather support and empower them in making informed choices that align with their own comfort levels. She also highlights the presence of unwarranted shame in the perinatal space and encourages listeners to critically evaluate their own risk tolerance zones, challenging any beliefs or practices that contribute to this shame. Christina underscores the importance of evidence-informed practice and the facilitation of movement and exercise, rather than creating barriers based on fear.

Take a listen to learn how to better serve this population of patients & athletes.

If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.

Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter!

EPISODE TRANSCRIPTION CHRISTINA PREVETT Hello, everybody, and welcome to the PT on Ice Daily Show. My name is Christina Prevett. I am one of our team within our pelvic health division. And if you have been catching all of the news coming out of the ice world, you know that we just announced our pelvic certification, CertPelvic. And we are so excited to bring this to you all. One of the missions that we have been kind of on this journey for over, you know, the last four or five years has been to try and flip the script in pelvic health and really create a fitness-forward approach to pelvic health, just like we are trying to do in the orthopedic spaces. And so our cert pelvic is our next Step in that trajectory. And so we are going to have three courses in our cert pelvic curriculum We have our two-day live course and then we're gonna have two eight-week online courses level one and level two if you have taken Our live course that is going to count as your cert pelvic The only additional piece is that there is going to be an added skills check to the end of our second day. If you are interested in becoming CertPelvic, you will have to find a time when we are near your area to be able to take that skills check for the end of day two. You don't need to take the course again. You do not need to pay a fee for the skills check. We just have to get that from you for individuals who have already taken our live course. And if you're interested in catching our live course one more time, or getting in before the end of 2023, we have two opportunities left. Alexis is gonna be in Bayer, Delaware on the 18th and 19th of November, so in two weeks. And then at the beginning of December, December 2nd, and 3rd, I am gonna be in Halifax. And that course you'll see is slightly less because we are making it equivalent to the Canadian dollar. So if you're wondering why that course is at a different price, it's because we're creating an equivalency to the Canadian dollar. And so if you're interested in catching us before the end of 2023, those are your last two opportunities. EXERCISE IN THE PREGNANT & POSTPARTUM SPACE Okay, let's talk about exercise in the perinatal space. You know that we have been on a huge journey to reframe the idea around Pregnant and postpartum exercise it is no surprise to any of you who are listening and have listened to our division that we are very pro pushing the boundaries and that we believe from a fitness perspective that the answer should be yes For health promoting behaviors instead of flipping to the no and proving it I did a podcast episode a little while ago where I said is it ethical, you know to remove resistance training in a pregnant individual and because we don't have an abundance of literature. And I made the argument that it isn't. Until we have safety data to take away a health-promoting behavior, we should start with the yes. And so this kind of goes into this reframe. I was talking to Sinead DeFore, who is a Ph.D. who's looking at diastasis recti and pelvic girdle pain literature, and she created this idea around risk tolerance within my brain and it has really helped me to solidify our thoughts and feelings about exercise our sparks notes a very first thing is that We are going to have individuals who are going to have their own Risk tolerance and I'm gonna give you a couple of different examples. So everyone is gonna have their own risk tolerance when it comes to exercise. Personally, when I got pregnant with my daughter five years ago, I was a national-level weightlifter. A barbell was an extension of my hand. I knew where it was going to go. I knew what it was going to do. I could make finite, tiny little details and I would be able to manipulate my technique. I felt extremely confident moving around a barbell during my pregnancy. Was not a runner. I had done CrossFit but I wasn't doing CrossFit at that time so my body was not used to the impact of running and So I didn't feel that good running after about 18 or 20 weeks of pregnancy And so I removed running from my exercise routine I was not running that much to be good with but I removed it and I kept Olympic weightlifting all the way up until delivery and That is my risk tolerance. I decided what felt good for my body and I made decisions within that. That does not mean that I do not have individuals that I have seen that were running right up until delivery and then a heavy squat or squatting below parallel just did not feel good for them. It didn't feel good on their pelvis. So many people have their own risk tolerance. we are starting to see people push the boundaries in almost every stretch from a pregnant and postpartum fitness perspective. We are seeing individuals, part of my postdoctoral work is some of our team members are talking about contact sports, for example, and contact sports are contraindicated during pregnancy. People are told to not do equestrian, for example, during their pregnancies. And then you have some equestrian riders who feel extremely confident with the horse that they are working with and may continue to ride. Even though right now our data says that maybe we shouldn't do that on the chance that somebody falls off a horse. I treated an individual who was snowboarding, 17 weeks pregnant, fell so hard she broke her collarbone, baby ended up being okay. Another one of these decisions would probably not have been within my risk tolerance, but individuals are starting to push the boundaries. We are starting to see changes in the military with respect to flying restrictions. We were being told that when you found out that you were pregnant you were grounded with respect to flying hours. Yeah, right. Someone says, I grew up showing horses and you couldn't get any of those ladies I knew at the barn to get off that horse. Absolutely, right? And that is, again, literature that we are basing off of a lack of understanding. I'm sure that there are so many examples exactly like that, where individuals feel so confident with their horse that they are not worried. We don't have any evidence to say that Riding a horse is bad, but we just don't want to minimize the risk of falling But here's the thing if we kind of take this back and talk about risk tolerance as grown-ups We can decide it for grown-ups or not But as grown-ups we are taking risk every single day every time we walk out of our house We are deciding if it is snowing and we decide to jump into a car. We are making a decision and we are calculating We are creating risk thresholds. When we are even talking about health-promoting behaviors, we are talking about stacking the deck in our favor or away from it, right? We are health-promoting or we are taking things that are going to increase the risk of an adverse event. But none of these things are guaranteed, and everybody is going to have their own risk tolerance zones. BECOME A PRO AT PUSHING THE BOUNDARIES As physical therapists who are working in the perinatal space, it is time for us to embrace that risk tolerance, embrace the fact that individuals' risk tolerance may be different than ours. And I'm talking about kind of pushing the extremes of exercise, but I'm also talking about allowing individuals who do not feel safe continuing to do certain exercises to be allowed to step that back if that pulls them within their risk tolerance zone. We do not have a movement problem in our society. We have a lack of movement problem. All of our divisions are screaming this from the rooftops. You're going to hear me say this in geriatrics. What that means though and what we see is that during pregnancy and postpartum exercise goes down and we see that fewer individuals are hitting the exercise guidelines despite the fact that our guidelines during pregnancy from an intensity and a Duration perspective mirror that of the general population what I mean by that is we are still trying to accumulate 150 minutes of moderate-intensity exercise during pregnancy and moderate intensity resistance training are Recommended but what we see is that during pregnancy for a whole slew of reasons Not just the fact that individuals are pregnant and getting scared away from exercise though. That is a component We are seeing that individuals are less active so Then we go into the postpartum period, and it's the same thing. THE RISKS OF NOT EXERCISING DURING PREGNANCY Our division is adamantly against the six-week blanket statement that we shouldn't be doing any exercise, and we are 100% against the five in the bed, five around the bed, five in the home type of rhetoric. The reason is that it's going to increase our risk for blood clots, and it is unrealistic for so many individuals who do not have a village that allows them to be able to do that. If you are trying to bond with the baby and that is something that you want to do, excellent, but I also think that it's important for us to be able to make informed decisions, which includes the fact that early movement, and I'm not talking exercise, I'm talking about getting out of bed, is really important for the management of postpartum complications. risk tolerance is going to be different. We see a lot of individuals who want to go to the gym two weeks postpartum. Are they jumping into a CrossFit workout? No, but are they becoming around their village because they feel really lonely and sad and their hormones are all over the place and somebody is going to take their baby and tell them and have an adult conversation and that's something that they want to do completely. their risk tolerance is going to be different. Do we have some individuals who adamantly want to wait until six, eight, 10, or 12 weeks, who do not have the mind to go in, who are struggling with sleep, who are having trouble with hormones? Absolutely. And so we are going to meet them where they're at. REFRAMING RISK TOLERANCE And so why is this reframe around risk tolerance so powerful? we don't have a movement problem, which means that we need to push our recommendations within a person's risk tolerance. And the message needs to be around facilitating movement, not creating barriers to exercise, right? As physical therapists, our job is to help facilitate movement. And when we create fear in the perinatal space, by moving or shifting a person's risk tolerance down beyond the level that they want to accept. We are not providing evidence-informed practice, right? One, we don't have the evidence to show that there are things that are adverse, and many of these things are mechanistic based on theory and are starting to be disproven. But the second thing is that we need to be taking our clients' wishes and hopes into perspective and that is an equal part of the triangle of evidence-informed practice and then obviously our clinical experience. Our clinical skilled care is where we can move those buoys, and give individuals ways for them to navigate exercise so that they know what they are listening to their bodies for, in order for us to be driving change in this space. When we accept this model of risk tolerance, we get to move from the no or I don't know to the yes within these kinds of buoys or navigational obstacles that we're going to be able to keep individuals within. We need to think that we want to move individuals away from being more sedentary out of fear in the perinatal space and move them to more empowered movement of their bodies in order for them to feel strong and empowered. We are starting to see over and over and over again that Individuals who maintain strength during their pregnancy have a much easier time postpartum from a muscular physical reserve perspective. We see this across everything in rehab. Our body needs to be strong enough to handle what we're asking it to do. It doesn't it breaks down. There are overuse injuries if the tensile strength of our bone does not match the force at which we hit the floor We have a fracture we see this in orthopedics the same is true in the perinatal space like our body needs to be able to respond to the stress is on their body in the pregnant and postpartum period and if we are deconditioning our pregnant individuals we are not setting them up for success and so we need to be able to have a shifting and moving risk tolerance to meet the risk tolerance of the person that is in front of us and then if there's obviously some big risks or red flags, we are going to educate on that. But most of the time, it's our own discomfort because their risk tolerance doesn't match our risk tolerance. And then we are making recommendations that are not serving them, but making us feel more comfortable. And so my call to action for you all today is to push your comfort zones. Really reflect, is there a discrepancy or difference between your risk tolerance and mine? And if there is, is that because of my own experience in this space? Is it because of my own lack of experience with somebody with this type of risk tolerance? And then how do I marry those two things to respect where the evidence is, but also where my client's perceived risk is? And then how can I bring my own clinical practice to help marry those two things together to serve the person that is in front of me? All right, I went off on a soapbox. I can't believe I'm already 14 minutes in. I hope that you found that helpful. This idea of risk tolerance and being able to see this as a moving target, I think is going to shift us away from a fear-focused message in the perinatal space towards more one of empowerment. And if your risk tolerance is less than your client's, that is not bad, but it is not our job to project our risk tolerance onto a patient, especially when we don't have any justification for that kind of shifting or that moving away from a person's own tolerance zone. And I really challenge individuals to not make individuals feel bad. There's a lot of shame in the perinatal space that is unfounded. And I think it's really important for us to really think critically about these risk tolerance zones and where ours exist. All right. If you have any other questions, if this is something that is a reflection point for you, I want to hear about it. If you want to see more of the research and get more of the news coming out of our pelvic division, cause geez, things have been moving really fast in our divisions. I encourage you to sign up for our ice pelvic newsletter. It's a research-focused newsletter that comes out every two weeks on Thursday. Our last one went out last week. If you have any other questions about our ice pelvic cert, please reach out to us. We've been fielding questions. We just love the interest that we've seen in our certification and we are so excited to show it all to you. Otherwise, I hope that Alexis sees some of you in Bayer or I will see some of you in Halifax. Have a wonderful rest of your Monday, everyone, and we will talk soon.

OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.