A mama asked this question and I figured, rather than respond to her privately, I’d reply for the benefit of everyone.
Q: My daughter is 20 months old and I was on strict bed rest from 20 weeks until 36 weeks. My question is, “How long does it take before your muscles get back to “normal”? My leg muscles are still horribly weak. I work out, hike, ride horses and walk a lot. Will my muscles ever return to normal? Has anyone else experienced this?”
Bed rest has been long been known to cause bone loss, muscle weakness and loss and weight loss. The first studies done by NASA to determine the effects of weightlessness on metabolism established that in as little as 60 days, women on severely restricted activity can lose up to half their strength. What’s more, not even dietary changes can help. The NASA study showed that women placed on high protein diet lost even more muscle mass than women who made no dietary changes.
Exercise was the only intervention that NASA found to reverse the negative physical effects of activity restriction. In their study,
The exercise regimen included a 40 to 50 minute aerobic workout two or three times a week and 20-minute strength tprraining sessions two or three days a week. While lying on their backs, the women did multiple sets of thigh and calf exercises using a flywheel device similar to a typical leg press machine at a gym. They also worked out on a vertical treadmill.
While many may balk at the thought of the vigorous exercise prescription recommended by NASA being used for women on bed rest, there really isn’t any reason that women on bed rest can’t participate in modified exercise programs.
So let’s get back to our mama’s question. She is 20 months post partum and still feeling significant muscle weakness. When I reviewed the literature, there is consensus that bed rest does in fact significantly reduce muscle mass and strength, and according to Judith Maloni, PhD, in her publication Antepartum Bed Rest For Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth “the physical changes that occur during bed rest are not resolved by 6 weeks post partum.” Unfortunately, I was unable to find any publications that looked at the effects of bed rest on maternal physical health specifically, and no publications that were able to give a time frame within which a mama can expect to regain her pre-bedrest strength and endurance.
One thing that I have seen coincidentally is that many women come off of bed rest, either just before or at delivery, and want to resume their pre-pregnancy activity levels immediately post partum and feel that something is wrong with them when they are unable to “jump right back” into their pre-pregnancy activities. I always recommend that “former” Mamas on Bedrest ease back into activity. Mamas who were on strict bed rest during their pregnancies for two weeks or more are significantly de-conditioned (the longer the bed rest stint, the more de-conditioned mamas body becomes), and the approach needed to regaining strength and endurance is not unlike that needed to retrain individuals to walk again after a significant injury (i.e. a car accident). People who suffered significant injuries resulting in weeks to months in a coma or in bed take months to years to regain their functionality. While the bed rest prescription does not create the same type of insult to the body physically as a traumatic injury, the effects on the physical function of the muscles and bones is very similar. So much like an injured person must go through weeks to months of physical therapy, Mamas on Bedrest should take a similarly slow, gradual, step by step incremental approach to regaining their pre-pregnancy physical strength and endurance. They may choose to work out with a personal trainer, a physical therapist or in a class specifically designed for post partum mamas, with emphasis on mamas who have been on prescribed bed rest.
So how can Mamas on Bedrest avoid or at least reduce the deconditioning they may experience as a result of bed rest? They must exercise while on bed rest! While the NASA study had the astronauts using flywheel cycles and weight, mamas on bed rest can perform modified stretches and strength training right from their bed. We put together a full set of exercises and stretches in our Bedrest Success Kit, yours free when you subscribe to our monthly e-newsletter (The upper right hand corner of this page!!), as well as several samples of exercises on the Mamas on Bedrest Youtube Channel.
So good luck Mamas! Let me know how this post helped you in the comments section below. I am eager to hear your success stories and other questions! You can also send e-mail to firstname.lastname@example.org if you prefer a private correspondence.
I love it when research confirms what I already know and am doing.
Shelley Wilkinson and H. D. McIntyre started a program in Australia called “Healthy Start To Pregnancy” in Australia. Their premise was that women given information and tangible guidance at the beginning of and during pregnancy will have better outcomes.
The researchers compared 182 “Usual Care” women, i.e. women who received routine prenatal care from the Maternity Hospital to 178 women who enrolled in the Healthy Start to Pregnancy Program, a low intensity, behavior modification program. The program consisted of (2) one hour prenatal workshops (one at the start of the program and one midway through) presenting information on healthy nutrition, exercise , information on smoking cessation, information on appropriate weight gain and Breastfeeding education . The women who participated in the program were also given written information to which they could refer. The researchers found that approximately half of the study women completed the study. The researchers found that significantly more women in the study met the prenatal guidelines for consumption of fruits and vegetables and for exercise than women not in the study. The study women were also more likely to be in range for appropriate weight gain. There was not a significant difference between women who quit smoking or intended to breast feed between the study and non-intervention groups.
I believe that studies of this nature are important and highlight some really important habits that we here in the United States need to notice. While most (but not all!) women in the United States have access to good quality prenatal care, just as it was shown here, medical prenatal care alone is not enough to ensure healthy prenatal outcomes. Women need tangible information and as this study shows, having access to support and guidance further enhances outcomes. Many obstetrical offices offer birthing classes and breastfeeding basics. But classes targeted specifically to prenatal nutrition and exercise have significant impact on compliance and on outcomes.
One thing that the researchers noted and I have seen in my practice as well, programs have to be easily accessible so women can participate. Hospital based programs, while often good aren’t always the best venues. Many women get their prenatal care at offices that may be close to work but would prefer to exercise closer to home for example. Other women may only have access to public transportation so they will make the trek to see their health care providers but not necessarily for a fitness or nutrition class. And when I was teaching prenatal fitness, having childcare was a must-especially at morning classes. Now add the twist of women on bed rest and we now need to integrate technology so that ALL mamas can reap the benefits of these proven behavior strategies.
We’re getting there. As awareness of the necessity of behavior modification during pregnancy (and during many other phases of a woman’s life) rises, my hope is that the US medical community will recognize the great benefit of such programs on health and promote more of these programs. As you all know, I am “Pro Action”, working to maintain rather than fix once broken. I believe that if in the US we can adopt a more “Pro-Action” stance, especially as it pertains to pregnancy and prenatal care, we can improve outcomes as well as improve women’s overall pregnancy experiences.
In my quest to be ever balanced, I have filmed a short stretch/strength series for an upper body workout. Enjoy!