Book Reviews

Review British Columbia Medical Journal July 2006

Fit to Deliver: An Innovative Prenatal and Postpartum Fitness Program. By Karen Nordahl, MD, Carl Petersen BPE, BSc(PT), and Renee Jeffreys, MSc. Vancouver: Hartley & Marks Publishers Inc., 2005. ISBN 0-88179-208-X. Paperback,163 pages. $24.95.

This book is written by a physician, a physical therapist, and an exercise physiologist. The stated goal of the book is to “give women the ability to modify their existing fitness program (or, for those new to exercise, to start a program) and to go one step further by offering state-of-the-art training techniques to better prepare for delivery and the postpartum period.”

The authors suggest that the first two chapters of the book be read prior to other chapters. In these first two chapters, the benefits of exercise for both the mother and the baby are outlined, as well as the absolute and relative contraindications to aerobic exercise during pregnancy. The authors then go on to outline a detailed program of exercise based on building core strength.

There are chapters on warm-up, cool-down, and stretching routines, cardiovascular training (including a walk-run program much like that proposed for Sun Run training in Vancouver), resistance training, balance training, relaxation techniques, and guidelines for adapting these approaches to the postpartum period.

The authors make claims that would entice any woman into their fit-to-deliver program. For example, they say that with a moderate exercise program, women have a reduced time in the “active stage” of labor and children have greater neuro-developmental scores in oral language and motor areas when tested at age 5. Although there are general references at the end of the book, specific references for facts such as these are not provided.

The book is nicely laid out. Pencil drawings of parts of the body and various muscles are clear and aid in the reader’s understanding of the purpose of each exercise. There are photographs of pregnant women demonstrating the various exercises, and on every second page, there is a “Tips from the Team” box, which emphasizes the interdisciplinary approach this book takes.

There are aspects of the book that reflect the upper middle class experiences of the authors. They recommend that every woman work with a qualified fitness professional during the pregnancy and suggest that women invest in good exercise clothing.

The program requires time and discipline. However, because of the clarity of its presentation and the range of exercise options not often seen in pregnancy exercise books, I do recommend this book.

— Elaine Carty, MSN
Professor and Director
UBC Midwifery Program

Fit To Deliver reviewed by: Robyn Churchill, CNM, MSN

Fit to Deliver by Karen Nordahl, Renee Jeffreys, and Carl Petersen is a complete guide to maintaining fitness throughoutpregnancy. Written by a Canadian physician, an exercisephysiologist, and a physical therapist, this book is atimely addition to the layperson’s literature on pregnancy.As our society faces increasing obesity rates and decreasingactivity levels among all ages, addressing questions abouthow to safely exercise is a public health mandate. Fit toDeliver can contribute both to establishing a healthierlifestyle as well as to decreasing obstetric complicationsdue to excessive weight gain and limited exercise inpregnancy.

Fit to Deliver was developed for use as an instructionalmanual in a prenatal exercise program. While it is not ascholarly text, the authors do reference ACOG’s 2002statement on the benefits of appropriate exercise duringpregnancy, and they include more than a page of selectedreferences for those women looking for academic supportfor their exercise program. The book begins by explainingthe role of proper exercise during pregnancy. The authorscite current studies in both obstetric and physiologic literatureon the benefits of exercise in pregnancy. They discussspecific effects of prenatal exercise on physiologic wellbeingin pregnancy, including alleviation of back pain,constipation, and leg cramps, a reduction in risks ofdeveloping PIH and gestational diabetes, and building morestamina to cope better in labor.

The first chapters of Fit to Deliver provide a background forunderstanding the fitness program. The authors explain thedivision of pregnancy into three trimesters and offer generalguidelines for safe exercise during each. For example, theyrecommend that in the third trimester, a woman should dono exercise requiring lying directly on her back for morethan 30 seconds. There is a good section on proper postureand lifting techniques. There is also discussion throughoutthe book about which exercises address which commondiscomforts of pregnancy.

The fitness program itself begins with a core workout,including pelvic floor and abdominal strengthening exercises.These are described and illustrated well, usingpregnant models who demonstrate the exercises bothlying on the ground and sitting on a chair. Other chaptersaddress aerobic training, strength training, and balance.There is a good explanation of how to build a comprehensive workout session using the various types ofexercise. Nearly all the exercises can be done at homewith little equipment. A physical therapy ball and elasticbands are used in some exercises, and a few require freeweights. The workouts are not overly intense and can bemodified for women who have not been working outprior to pregnancy. The authors appropriately recommendthat a pregnant woman discuss safe levels ofexercise with her obstetric provider before beginning anexercise program during pregnancy.

After the exercise chapters, the authors have included achapter on “Relaxation Techniques,” written by a contributingauthor and RN. This chapter presents breathing,aromatherapy, hydrotherapy, and visualization in fourpages. While the philosophy of relaxation in pregnancy andlabor are consistent with the fitness program, not enoughtime is devoted to it to do it justice. At the same time, toomuch space is given to it to suggest a woman should domore reading on the subject on her own. With a bit morework, this chapter could either become a much strongercomponent of the book and a more integrated element of apregnancy fitness program, or, conversely, it could bemoved to the appendix section, along with a reference list,with suggestions for relaxation or childbirth readings and/orclasses.

The final chapter on postpartum exercise is very well done.There are general guidelines about when to start each typeof exercise after a vaginal birth or after a cesarean delivery.Again, the authors emphasize the importance of discussingpersonal recommendations with a provider. They alsorecommend including baby in the postpartum exercises,and many are demonstrated by using a baby, which makesthese exercises both more fun and more realistic for newmothers.

There are two appendices, one on diet, including recommendationson nutrients and calories, foods to avoid, anddietary approaches to common discomforts, such as nausea,heartburn and constipation, and the other on preconceptualhealth, and fitness, nutrition, and smoking cessation. Infertilitydue to extreme behaviors such as strict dieting,excessive exercise, or obesity is touched on, as well as therole of stress on fertility. These appendices are succinct andclearly presented.

Overall, the book is excellent. The illustrative photos showthe exercises very clearly, although they depict only Caucasianwomen. The women vary in shape, and very fewhave highly athletic bodies, so a moderately active womanwould not be intimidated by them. The major weakness,from this reviewer’s perspective, is that midwives are never mentioned. However, there seems to be an assumption ofvaginal birth, and perhaps even an unmedicated birth,although that is not directly stated. The content of Fit toDeliver meshes well with the midwifery model of promotingwellness and normalizing and addressing commondiscomforts of pregnancy from a holistic perspective. It is awelcome addition to the lay literature on healthy pregnancy.

Originally published in "American Journal of Midwifery and Women's Health," February 2005

Dr. Karin Kausky MD

This book covers it all; prenatal and postpartum, beginner to advanced, cardio, strength training, core stability, as well as explaining all of the normal physiologic changes in a woman's body throughout pregnancy. Very concise and easy to read with lots of accompanying photograghs.

I am a family physician that does a lot of prenatal and postpartum care in a very fit community---this book is indispensible in my practice.

Contact Magazine

Carl Petersen (Vancouver, BC) teamed up with Karen Nordahl (MD) and Susi Kerr (personal trainer) to co-author and self publish the book, "Fit to Deliver," outlining an exercise program for expecting and new mothers and their babies.

(Official News magazine of the Canadian Physiotherapy Association) January/February 2001

Sidelines

Great new text for your clinic or home library! Fit to Deliver: an exercise program for you and your baby. By Karen Nordahl MD; Susi Kerr, BA; Carl Petersen PT.

(Sport physiotherapy BC Newsletter) Vol 6, Number 6 Summer 2000 writes in their Bulletin Board section.

Kinnected

Andreja Kovacevic writes:

Fit to Deliver.: A prenatal fitness guide. A few weeks ago a client of mine approached me with a question, "Is it safe for my wife to begin an exercise routine if she's 3 months pregnant? Most of us have been introduced to the theories of exercising, pregnancy and the issue of safety, but I must admit I've never had to put it to use. When posed with this question I went digging into the library at the BACK and borrowed Fit to Deliver. The first thing that appealed to me about the book was the fact that it was written by three multidisciplinary health care professionals. I found this allowed for a collaboration of ideas and methods into one research material. It's great when you can find all that you're looking for in one place!

I also found the book easy to read and understand which caters to the average person or the avid health professional. For the health professional it allows a thorough breakdown of the exercise progressions from first to third trimester. The vast number of ideas it provides for exercises also helps customize the routine to the individual categorizing them as either beginner, intermediate or advanced in fitness level. Helpful topics such as posture during pregnancy and nutrition during pregnancy are also discussed. If you are currently working with a pregnant population or just want to learn more about the safeties of exercising while pregnant consider taking time out to peruse this books knowledge and wise!

(British Columbia Association of Kinesiologists) Vol 9, issue 4, Nov 2000

Canoe.ca

Fitwise by Karen Tankard

"Exercise and Pregnancy"

You're more likely than ever before to run into a pregnant woman engaged in exercise, especially if you're a gym member. That's because many fitness facilities are developing specialized exercise programs with expectant moms in mind.

One of the people leading the way is Dr. Karen Nordahl, a physician who practices in Burnaby, British Columbia. She's one of the creators of, 'Fit to Deliver', a fitness program designed especially for pregnant women. A book based on the program has just been released.

Nordahl began researching exercise and pregnancy in 1996 because her female patients kept asking for exercise guidelines. "I didn't have a lot of information and the fitness industry didn't know very much about it either," Nordahl says.

Nordahl says there are numerous emotional and physiological benefits to exercising pregnant. "You tend to feel more energized when you exercise, you tend to sleep better and day to day activities don't seem to be as difficult if you're fitter," she says.

Expect to hear a lot more about Fit to Deliver in the coming months.

Moms in Motion

Fit to Deliver is an outstanding guide to all aspects of keeping fit during pregnancy. Fit to Deliver is a practical workbook tailored for different fitness levels and stages of pregnancy that focuses strictly on fitness during pregnancy to help women prevent common complaints during pregnancy, prepare for delivery and restore their figures more quickly during postpartum. It is the only program of its kind created with the input of a physician, personal trainer and physical therapist. This complete book includes suggestions for exercises, aerobics, strength training, stretches and nutritional recommendations for all three trimesters.

Directions in Physiotherapy

Going for Gold

Elite athlete trainer and co-author of the prenatal program Fit to Deliver, Carl Petersen's career show's the sky's the limit for physiotherapists with skill and drive. He admits to working 10-12 hour days five days a week, and says he wears many hats: physiotherapist, coach, lecturer, author, consultant and film producer. Speaking four languages, he puts them to the test with extensive travels between sojourns at Cit Sports & Physiotherapy Clinic's. Petersen is recognized as an expert in designing training programs and recovery protocols for both elite and recreational athletes. He has written over 100 journal articles for a variety of scientific, professional journals and lay magazines on all aspects of health, fitness, physiotherapy and sports medicine.

The Vancouver Sun

Pregnant and fit

Dr. Karen Nordahl, a Vancouver-based family physician and co-author of a just released book about exercise and pregnancy called Fit to Deliver says the common fears about exercise during pregnancy are unfounded. " There is no relationship between exercise and miscarriage or premature labour," she says. And as long as women don't try to climb Mount Everest where oxygen is a problem for everyone, there is no danger of depriving the baby of oxygen with a tough cardiac workout. Nordahl quotes a five-year study by Dr. James Clapp, a physiologist in the maternal physiology lab at Case Western University in Cincinnati that found children born to exercising mothers began life with a much easier labour-fewer C section and forceps deliveries and shorter labours. They also had less excess fat as they grew and grasped spatial and motor skills sooner than the children of non-exercising mothers.

Fitness Business Canada

Reviewed by Tiffany Moffatt

How refreshing to have a comprehensive Canadian resource on exercise and pregnancy, one that brings together the expertise and various strengths of a physician, personal trainer and physical therapist! Based upon the three principles of "prevention," "preparation," and "restoration," this easy to read guide on exercise during pregnancy explores how to reduce pregnancy symptoms through exercise, how to strengthen the muscles needed in labor and how exercise will ease recovery postpartum. "Tips from the Team" throughout the book offer little treasures of information for exercising moms, including advice on how to prevent back pain and how to stretch effectively. Plenty of photographs throughout Fit to Deliver aptly illustrate the authors' well-chosen stretches, warm up, and muscular conditioning exercises. The Fit to Deliver team devotes a chapter to pregnancy posture and in turn do a nice job outlining stretches and core conditioning exercises that target muscles compromised by poor pregnancy posture.

Just like any good personal trainer, the book offers variety in the cardiovascular exercise programs, with specific guidelines for walking and water fitness routines, as well as stationary cycling, stairclimber, crosstrainer and rowing workouts. Variety is also the main focus of the strength training routine, in which alternatives for different trimesters and numerous exercises are illustrated to avoid boredom. The last chapter puts it all together by outlining programs for each trimester and for beginner, intermediate and advanced moms-to-be. Overall, the combined voices of the three authors are authoritative and knowledgeable. Fit to Deliver expels any old myths and misconceptions the reader may have had on exercise and pregnancy and offers up-to-date guidelines for a safe and effective workout.

What some people are saying about Fit to Deliver

Fit to Deliver is brilliant and I've never seen anything else like it on the bookshelves. I thought that the advice in the book (both the very general and the specific) was helpful. It's something that every pregnant woman with an interest in fitness should have in her library.

- Reviewer: Dr. Cheryl Mutch MD, Pediatrician, Burnaby, BC

Fit to Deliver is very informative and easy to follow. The book provided valuable information that enabled me to comfortably exercise throughout my pregnancy. It's about time.

- J. Ewuk from Vancouver, BC

Finally there is a practical book that focuses strictly on exercise and pregnancy. Too bad it didn't come about sooner! As a mother of a two year old and a four month old, I understand the desire and importance of staying fit, not only before pregnancy, but during and after pregnancy as well. I also know the difficulties of finding time and energy to keep in shape. This book gives you practical and safe exercises to do in your own home throughout each stage of your pregnancy. When done right along with a proper diet this program should help you feel good and stay healthy. We're planning on having another baby down the road and I am looking forward to using this book as a guideline to be fit to deliver again.

- Debbie from Abbotsford, BC

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