138: Exercise, Fertility, and Pregnancy: How Much Is Helpful—and When It Hurts with Dr. Hannah Ryles

It isn't just about trying to get pregnant. Yes, this is one phase of your life, but ultimately, if we can get you to be a more healthy version of yourself, that's going to be a win. And ideally, that results in a pregnancy. Ideally, that results in a healthy baby. But really, what's in most of the part is a healthy patient for their lifetime. By listening to the Conscious for Tilly podcast, you agree to not use this podcast as medical advice to treat any medical condition and either yourself or others. Console your own physician or healthcare provider for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Welcome to Conscious Fertility, the show that listens to all of your fertility questions so that you can move from fear and suffering to peace of mind and joy. My name is Warren Brown. I'm a doctor of traditional Chinese medicine and a clinical hypnotherapist. I'm on a mission to explore all the paths to peak fertility and joyful living. It's time to learn how to be and receive so that you can create life on purpose. Today, we're joined by Dr. Hana Riles. She's a board-certified OBGYN trained at the University of Pennsylvania and the University of Chicago. And she's one of the medical advisors for expect. That's a first prenatal and postnatal fitness app where every workout is reviewed and approved by an OBGYN. Now, Dr. Riles brings a rare combination of clinical expertise and real world experience. In her practice, she sees firsthand how exercise influences menstrual health, ovulation, metabolic regulation, pregnancy outcomes, and postpartum recovery. Something that our listeners are very interested in learning more about today. She's passionate about helping women understand that movement isn't just about fitness. It's one of the most powerful, accessible tools we have to support fertility, pregnancy, and long-term hormonal health. Today, we are diving into the latest research on how the right kind of exercise can optimize fertility, what's safe, and also what's not. And when you're trying to can see and how postpartum training affects reproductive health far beyond the aesthetics. Dr. Riles, thank you for being here and I'm really looking forward to our conversation today. Awesome. Well, thank you so much for having me. I'm excited to talk a little bit more about this. This is kind of the first time we're really getting to meet and know each other. So for everybody's sake, including my own, I want to know a little bit about you and curious, like, kind of what drew you into obstetrics and when did fitness become part of your medical lens? Just a little bit about me is that I, um, my dad was in the military, so I kind of moved around a lot, got to fortunately see quite a few different cultures. Group primary, I spent a big talk of my time in Japan before coming back to the States for college and then stayed around in Philadelphia for undergrad and then med school and then actually came to Chicago to pursue fellowship training in gynecologic surgery. And so I actually focus specifically now more so on gynecology and conditions like endometriosis, pelvic pain and fibroids, but definitely also see patients and have previously worked with pregnant patients and post, and I still see post-partum patients as well. But what initially drew me to getting involved and expect and is just really the power of exercise. So just from like a personal story is I had my first kid in residency and whenever I was delivering patients, the patients that had the best labors and the easiest recoveries, I would always ask them. I was like, what did you do in your pregnancy that your labors were so quick? And a lot of them had a common theme which was exercise or healthy lifestyle. And so that really inspired me so by the time that I got pregnant and was going through my own pregnancy with my first kid, I was really motivated to stay fit and honestly, I increased my exercise a little bit as well because I saw that there was a lot of evidence to support exercise for improving pregnancy outcomes, improving your recovery, improving fetal outcomes. So there's just a lot of evidence for that and that's what really motivated me and I really feel fortunate that I had a smooth recovery as well, which I credit a lot to the exercise programs that I did. And then I think that it's just so important to kind of prescribe exercise. It's not something that, you know, doctors always prescribe, but it's something that's so important to the overall health of a patient that that's what really drew me to it. You know, you said you, the areas we're going to talk about, I want to talk about the pregnancy part because you talked about your increased your exercise and pregnancy. And I want to make sure we have time to talk about the preconception. A lot of our listeners are wanting to grow their family. Some of them are going to arrive the F and I think it's an ordinary to discuss. You said you increased your exercise. So it makes me think of, is there misconceptions that public has about exercise during pregnancy because you actually said you increased your exercise during pregnancy? Absolutely. So that is a nuanced point because there is definitely a lot of misconceptions about pregnancy and exercise. So the one misconception is just to address it right off the bat is that you shouldn't increase your exercise and pregnancy. I think that it depends. You want to be safe about the exercise that you're performing in pregnancy. Any amount of exercise is going to be healthy in pregnancy. So incorporating any exercise program into your daily habits is going to be beneficial with the caveat that there it's not a situation where more is better. So there are nuances to that where you don't want to just go from being complete sedentary to starting a vigorous high intensity interval training program, which is kind of why to bring expect into it is why that is so helpful to have programs like expect, which all of their programs, all their fitness programs are OBGYN approved so that you know you're not going to overdo it. So for example, if you're someone who's never exercised before, you don't want to go straight into spin at the highest level if you're pregnant because that actually can be detrimental. That has been shown in the literature to be detrimental in pregnancy, but also possibly in the preconception phase two, you don't want to be exercising too vigorously. So the reason the expect is really helpful is that it actually has everything broken down by phases. So it actually has preconception each trimester of pregnancy, first trimester, second trimester, third trimester, and then postpartum postnatal programs to make sure that you're exercising at a level that's safe for you in that particular phase. So it's kind of personalized in that way. So we're going to dive into kind of preconception in all the trimesters and posts, but we just mentioned it kind of as passing the expect app. So can you actually, you know, we don't always pick up what we see in the intro. Expect is an app and you said it's an OBGWON approved. Can you kind of share a little bit more about this app and they just go to the app store and look under expect exp, etc. That's what they're looking for. Yes, exactly. Remise we'll talk about a little bit about expect and then we'll pull some of those questions from all the areas of reproduction to postpartum. Awesome. Yeah. So expect is just an app that you can download in the app store. It's pink with a little x logo and to talk more about it, the founder, they really saw the power of exercise for helping pregnant women have again, easier pregnancies and easier recoveries. And they just saw the benefit and there wasn't that much out there to help pregnant women who might not have been necessarily exercising beforehand. How do they start a pregnancy or an exercise program in pregnancy? Because there are some new ones as they're as I mentioned that you don't want to just go off the back and go into like a high intensity exercise program. And so the app, each, every single fitness, a lot of them are videos, some of them are audio, but every single program is OBGYN approved so that multiple OBGYNs have looked through those videos and approved them for specific stages of pregnancy. So again, preconception all the way to postpartum. And the reason that's important is because there are certain things in pregnancy that you want to avoid. So if you're in the second transistor and beyond, for example, you don't want to be lying on your back for too long. So little things that someone who is not an OBGYN might not have thought about in terms of making sure that the exercise that you're doing is actually safe for you in that phase of pregnancy. And then the other part about the app that's really nice is that there's internal cues in each video. So the instructors are making these videos for specific phases of pregnancy or preconception or postpartum. And so there's cues in there to kind of make sure that you're breathing. And it kind of goes against regular fitness culture where regular fitness culture, if you've gone to spin class, they're like push harder and keep going. And you know, that's the culture of high intensity workouts that a lot of people are doing nowadays, which are great. But if you're pregnant, you might benefit from a program that's specifically designed for you that relies on these internal cues within the videos that say, hey, make sure you're breathing, make sure you're drinking enough water. It just kind of helps be more specific about the program. Thank you for that. So again, everybody, that app is called Expect and you can get that off of the app store. Now we're going to focus on movement. And in our practice at acu-balance, we're often sharing how, you know, there's these pillars of health that we do before we bring in our interventions. In our practice, you know, we're using acupuncture supplements, herbs, diet lifestyle so that the pillars are diet, stress management, sleep, avoid toxins, movement. So today we're going to focus on movement. So this is one of the key pillars. And it's interesting, it's one of the pillars that doesn't get a lot of attention as in we mentioned it but we don't go into details so people know exercise is important now but what kind or what I shouldn't do so that's what we'll dive into and I thought maybe we'll go kind of through the journey of preconception and the tri-mestress imposed natal. Now I'm curious about exercise and movement how it matters for fertility because there is research that exercising excessive exercise and I'd like you to define that can interrupt with ovulation and your fertility and so can you share about movement exercise when it comes to benefiting ovulation metabolic health and hormone regulation by kind of this theory behind it and then when does it become counterproductive and when does it become helpful. Absolutely and this is kind of why you know we do recommend working with a provider because or kind of having programs that are specifically tailored towards your fees because it isn't one of those things where you can just say go exercise and that's going to fit everyone and benefit everyone the same way so two big categories generally exercise is thought to be helpful obviously but you're absolutely right the big caveat that I want to focus on first for the preconception and fertility aspect is you can overdo it and that's really important to emphasize so most of the literature out there suggests that for healthy weight women moderate physical activity is likely beneficial for improving fertility outcomes then and I'll go into what like what counts as moderate and things like that but vigorous activity actually as you just mentioned has been shown to possibly reduce fertility outcomes in healthy weight women and so you don't want to go from being sedentary to a starting a vigorous exercise program if you're trying to conceive and you're having difficulty conceiving that possibly could harm your chances if you're in the healthy weight category the other thing before I go back into what counts as modern vigorous is that that is different though so the literature does seem to suggest that for women with metabolic conditions like PCOS or who have elevated BMI the literature is a little mixed but it does seem to suggest that vigorous activity actually still is helpful for improving your fertility outcomes if you have those conditions because those conditions might then self-lead to an opulation and if exercise can improve your chances of opulation through various different pathways but improving insulin sensitivity reducing your androgen levels and kind of improving inflammatory markers in those patients there actually is some evidence that vigorous activity has been helpful so it all it is a little nuanced there can I highlight something you said there just because it because it's what it does so if you exercise and it doesn't impact your the insulin resistance your cells or subdivision insulin if it doesn't impact inflammation you may not see the benefit so it's just like sleep good sleep will lower cortisol help with the metabolic health right stress lower stress so just when you look at those pillars of health we talked about diet a dike can lead to insulin resistance higher blood insulin your blood and inflammation in there for auditory disorders or poorer pregnancy outcomes lack of sleep same thing too much stress same thing lack of movement right so again that's why the lifestyles a big bracket in movement is important part of it so the idea of the exercises we can see these biomarkers change and that's what you guys probably with your expect that have learned as well if I'm understanding correctly yes absolutely absolutely I think you know an overall exercise and health it's supportive of a healthy lifestyle so it helps improve all those markers that you just mentioned would you call an emerged dog once we were talking and he said walking is not exercise if it doesn't elevate your heart rate it's not exercise he calls it walking now I would just read his his line I'm gonna hear because you guys are behind the expect app you are seeing this population he is not he's some people that are getting their arm stitched back on or it's an hardest to do the yard you're somebody that works with women's health fertility pregnancy postpartum can you talk a bit about the exercise what's considered in what's an intense exercise or not what about walking what about heart rate things that you may measure like HRV or heart rate or just enjoy yourself in the in the forest I would disagree I definitely think that walking can be exercise any type of movement I think is helpful and there's so there's many different pillars of exercise so to get into kind of just I wanted into this first part of what counts constitutes that's moderate exercise so moderate exercise based on international guidelines is about 150 minutes per week so that's think about like three to five sessions of exercise of moderate activity so what moderate activity will be is something that elevates your heart rate you're gonna get a little sweaty you're gonna be able to still speak in short sentences but you shouldn't be able to sing your favorite song so that's things like light spinning or light jogging even walking you know around certain like hills or doing a little bit of steps and things like that vigorous exercise is where you are really pushing yourself to exhaustion and that's where the evidence suggests that that could be harmful specifically for healthy weight women is that vigorous exercise which they a lot of different studies define it differently but some of the studies I saw more recently define it as pushing yourself to exhaustion that's where it could possibly harmful especially for fertility and then there's different heart rate markers so moderate intensity is more defined as 50 to 75% of your maximum heart rate which is 220 minus your age high intensity or vigorous is defined as 75 to 95% of your maximum heart rate so that's where you're really really pushing yourself but one other thing I just wanted to mention is that any type of exercise so I think a common misconception is a lot of people will get yoga and don't think of it as an exercise because you know their heart rate might especially some more milder forms of yoga they might not think of as exercise but exercise is not just about raising your heart rate it's also about stress management and so walking if that improves your mental health that to me that's a huge benefit and we can't necessarily measure that but there has been studies that showed that even just walking a few times a week adding a walking program into your into your daily or weekly habit can reduce your stress which we know stress can impact fertility. Yeah perfect thanks for sharing that and there it ties into the whole lifestyle so it's kind of like you don't choose one I'm just going to do diet it's like sleep rest diet movement I'm stress reduction so and they all kind of support each other you know healthy diets going to support your level of stress and your motivation to exercise vice versa. Absolutely. So going back to kind of the fertility journey and even in pregnancy if it fits here how does somebody know if they're pushing themselves too hard do you actually have certain red flags I mean an obvious one to me when I see the high end athletes they lose their cycles sometimes right so any other things that blood markers are other things that you could use as a red flag to let somebody know they're exercising too intense or too hard. Yeah absolutely so you mentioned the most critical one is the mencise in the fertility journey is the most important marker so we want to make sure that that's regular. Some other red flags that you're pushing yourself too hard is if you're pushing yourself to exhaustion so if you are someone that's trying to conceive and you're of healthy weight and you routinely are exercising some of the studies show that you don't want to be having vigorous exercise where you're pushing yourself to exhaustion more than five hours a week so that's the total amount of time spent exercising in a vigorous exercise program that they saw a decrease fertility in these studies so some other things is that if you are experiencing pain if you're losing weight in your in the healthy weight category that's also a red flag in the fertility journey unless and so again that's with the caveat that there are some studies that for patients who have an elevated BMI or have PCOS or other metabolic conditions the evidence is less clear about vigorous exercise where it does seem that it's possibly still beneficial in those patient populations vigorous exercise can still be beneficial in those patient populations but for women in the healthy weight category you don't want to be losing weight. I like this says there's no general person right like general it's an individual thing and you remind me of a saying in Chinese medicine this is two little's two little and too much is too much so you talked about the weight we know there's research that if you have a high BMI and so there's excessive overweight that if you and you're not regulating regularly and you lose anywhere between 5 to 10% of your body weight it starts to help with ovulation fertility right. Totally. And then you're saying if you're already of normal weight or less and you lose 5 to 10% of your body weight this actually can be detrimental so there's the two little two little too much too much. Exactly. The exercise that I'm hearing is it depends like where are you are you like in that normal BMI weight or less than the too much exercise probably is going to be detrimental could be and if you are overweight somebody I'm in my weight loss stage now I was 30 pounds overweight and now I'm so I could benefit from the if I was trying to conceive I could benefit from the more vigorous exercise you on the other hand may not benefit from the absolute. Yeah, no. - Absolutely, it's exactly your exact rates about personalizing it. That's why there's no one size fits all. But I would say the one size is that if you're going to add some movement into your life, that's gonna be beneficial. - Still on the fertility side, just some of the conditions that impact fertility, can you share a little bit of, again, and maybe it's just a repeat, but you talked, you mentioned PCOS, so that metabolic disorder, probably the, I think it's the most common cause of auditory disorders in women with leading to infertility, insulin resistance, any deeper insight for, or anything in the expect app for those people to support them on this journey. - Or, and also, cause of pregnancy, I'm gonna ask, I'd love for you to actually add the story. I didn't drop you there, but, - Oh, no, it's. - Because it's not just getting pregnant, we want healthy pregnancy, and at the end of the birth, our goal's always healthy mom and healthy baby. - Exactly. - And so, let's say they don't do the exercise, they have PCOS insulin resistance, and they take like, clomander, lettrosol, or even IVF, and they get pregnant through, support that way, but they didn't deal with the metabolic disorder. We know that there are health repercussions to the baby, to the mom, and then for the mom later in life as well. - Of course, thank you. - So, our goal is not just to get pregnant, we want healthy pregnancy, healthy baby. So, again, with the PCOS insulin resistance, and even endometriosis, maybe there's stuff that you guys have discovered that helps with that as well. - Yeah, so I think the biggest thing is that, with those metabolic conditions, like PCOS, being just the most common, ovulatory dysfunction disorder, is that more intense exercise is recommended, and beneficial, and I think going back to your point, it isn't just about trying to get pregnant. Yes, this is one phase of your life, but ultimately, if we can get you to be a more healthy version of yourself, that's gonna be a win. And ideally, that results in a pregnancy, ideally, that results in a healthy baby, but really what's in most of the process, a healthy patient for their lifetime. And so, I think the expect act app, I think there's things in the pipeline moving forward, where you can kind of personalize your conditions, like let's say PCOS, I don't think that's at there right now, we can check with the people from expect, but I do know that there's things in the pipeline for people who are trying to conceive in the future, and so they may personalize it a little bit more in that sense, but I think the biggest thing is that incorporating a physical activity program is likely going to be beneficial for your fertility journey. And I think the biggest thing I just wanna mention is that it's really helpful to use your fertility desires as an anchor. And so, we talk about this a lot in OB/GYN, where we have a patient coming to us, they're newly pregnant, and they wanna change their whole lifestyle because they are now newly motivated to have a healthier lifestyle, not just for themselves, but now for the baby that they're carrying. And for Tilly's similar, you wanna change your, you have a goal in mind, and really it's about improving your lifestyle so that you can be the healthiest version of yourself. And so, just to bring it back to expect real quick, is the reason that it's so beneficial, is that it follows you through that whole fertility journey. You can start in preconception phase through the different trimesters of pregnancy and then postpartum. And so, we talk about in medicine, the best, let's say, contraception or birth control. The best version is the one that they're going to use and can use consistently. So, the best form of exercise is going to be the one that you're going to stick with. So, what's nice about it is that it can kind of fall use that whole program. You don't have to have like a separate exercise program preconception, and then switch to a different one for pregnancy and switch to a different one for postpartum. You can kind of use it throughout that whole journey. Perfect, and we'll make sure we put the expect link that link to the app in our show notes as well. And with the PCOS, we talk about PCOS and the exercise will usually benefit them. And there's different phenotypes. So, again, I'm assuming coming back to him, the visualize the thin PCOS type. Again, just because you have the diagnosis of PCOS, movement is important, but then again, the type of movement and how intensive it is would change if you're the thin PCOS type versus the high BMI PCOS type. Absolutely, and I don't, I mean, within the medical field part of that, absolutely you're right. There's different phenotypes of PCOS. So, you know, a patient with more Androgen excess, still might benefit, even if they're thin. They still might benefit from exercise because we know that exercise has been shown to reduce Androgen levels. It has been shown to improve insulin sensitivity, things like that. So, it's new on since it's a little complicated, but you're right. There's all these different phenotypes. I gotta give a shout out to our endocrinologist, Dr. Jarelin Pryard, her in British Columbia, because she's done some research on extras. She's done a lot of research on PCOS, and exercise as well. She's on one of her episodes, people, so check that out. Do you guys have, do you have experience or anything to share regarding IVF, like some women, and I'm talking about, they're going towards a retrieval, so where their ovaries are gonna be purposely hyper stimulated, right to get as many follicles as possible. Is that in the expect app, or do you have anything to share on that? 'Cause I do know the clinics do talk about dos and don'ts for exercise, worried about, you know, certain exercises that could cause a contortion of the ovary, you know, ligaments and stuff, which can be dangerous and painful. That's very true. I think that might be, again, we might have to check with the expect team on that, but that might be built into this preconception, fertility program that they're building out, which is not currently available, but it's likely gonna be available in the future. But with that said, there is recent, or newer research suggesting that, even in patients who are undergoing IVF, starting up exercise program actually showed improvement in the IVF success rate. And so I'm trying to find this article that I had written down here, but it was a men analysis, I believe, that looked at patients who were undergoing IVF. Yes, it was a men analysis from 2018, that they looked at physical activity before their IVF cycles, and they actually found a significantly higher clinical pregnancy rate with the odds ratio of almost two, and also improvement in live birth rate with an odds ratio of 1.95, so compared to inactive women. So this is very important because I think it kind of goes into what you had been saying before about the traditional teaching within IVF was to recommend stopping exercise, or just being very careful about exercise. But there's more newer research that suggests that, exercise does seem to benefit even in patients who are undergoing IVF. We have a little bit more research to suggest that it does seem to help improve natural fertility, but even those patients who have gone and gone to that stage of IVF, it can be helpful. I do want to address one thing that you had mentioned is there are times where a doctor might recommend being careful about your exercise, let's say, if you're stimulated and your ovaries are larger, you're absolutely right. There is a risk of torsion of your ovaries, your ovaries are in large, so during that specific stem phase, they might recommend being careful or just choosing your activities carefully. But aside from that, it does seem that physical activity does seem to benefit even patients who are undergoing IVF. - Yeah, so you may be able to go on a stationary bike and a nice walk, but you may not want to jump on trampoline. - Exactly, exactly. - So the exercise may change. - Exactly. - It's not an excuse not to exercise. - Yeah. - You still do the movement. Can we shift into kind of the pregnancy? Do you, how do you shift during the trimesters? And I had this memory from years ago, she must have been, I don't know where she's running. She's jogging where I was walking and she's wearing a top so her belly's exposed. She looks like she could deliver any moment now. And she is a running. And I was just wondering how those look-up-ins were working. So you've been pregnant, you've exercised in pregnancy, you work with women. When I saw that, I actually thought, is this good for her or not, right? And so now I have you, it was beautiful. It was crazy, beautiful watching this. I mean, literally, you know, like some people really show, like you're in like, many moments now. Maybe that's what she was doing, going on around to get the baby out. - To try to cover baby. (laughing) - You may have shared, but like is, through all the trimesters, for a second, 30 even postpartum, does the exercise change? Like any types of exercise you recommend. And then the woman I saw jogging in your mind is that like, no, that's excellent? Or is, no, there's some risk to that because of the size she was at and to her frame and her ligaments. - Yeah, absolutely. So for the first part of your question, does it change or should it change? It should. So there's a couple of different things with the different trimesters. So in the first trimester, generally most exercises safe, but you want to avoid exercises that are going to cause excessive heat. So it's the same reason that like, sonas and hot tubs are not recommended in the first trimester. You don't want to do hot yoga in the first trimester because we want to avoid anything that's going to raise your internal core temperature. And that's just because that's where the neural tube is developing and all the organs are developing the first trimester. So there's a couple of other things in the first trimester that you might want to avoid, but that's the biggest one. And then in the second and third trimester, your belly is getting bigger. The pregnancy is growing. You want to avoid things that are going to block off the blood flow to the pregnancy. So that's like excessively lying on your back in supine position. You don't want to be doing kind of like lifts with being on your back for too long. You want to make sure that you're kind of doing a side lie modification. And you also don't necessarily want to be pushing yourself to max limit. I'll give one caveat with that. And then resistant training is really important in pregnancy too. So that's-- if you're someone that does cardio all the time, that's great, but adding resistance training is very helpful in pregnancy as well because it helps with your building your muscle mat and helps you get ready for labor and delivery. The one couple of things that I want to say though is that for this is all for kind of the general population. That woman that was running that you mentioned, I think that's a really good example of she probably that probably wasn't her first run, right? She probably had been exercise. She looked like a runner. Like she was having a great time. I was reading a little heavy walking. She was like, you can tell she could do this all day long just like that. Right. That's a really important point in that if you're someone who's already fit, you can continue your fitness journey and you can continue to do the level of exercise that is generally your level of exercise. It's not that all vigorous activity is not recommended. It depends on your fitness level. If you're someone who's sedentary, you don't want to go to vigorous immediately. You want to gradually build up to that. But if you're someone who's like a marathon runner, within reason, there are times where you can kind of continue that level of exercise and that is okay. The big thing in pregnancy is really listening to your body. I kind of bring it back to how I remember before being pregnant and I would go to these spin classes and they're just like pushing you or I would go to these fitness classes and they're like harder, harder. They just push you to kind of your limit. If pregnancy, you want to really take a step back and listen to your body. If you're feeling kind of exhausted, you need to give yourself a break. You don't want to push past pain. You don't want to push past any sense of pelvic heaviness. If you're feeling cramping, you don't want to push past that, which is why on OB/GYN approved programs like expect, they really remind you of that because it's easy to get kind of lost in a workout and just think, okay, I need to push harder. I need to keep going. You want to really have your exercise be mindful. You want to be mindful during your pregnancy and listen to your body and not push past any of those warning signs. Now I want to kind of compare this in Chinese medicine. I want to go into the postpartum aspect. So in Chinese medicine, I think it's around 30 days postpartum. They call it mattress time. They want you to rest. In the West, we're like movement and even for fertility and pregnancy, the shui, the blood that is nourished in the baby, the shui that becomes breast milk in Chinese medicine. If you have a lot of excessive sweating or overexercising, you're consuming that. And they're like, well, you know, movement but safe for the baby. So I'm curious in the postpartum, what you think from a medical doctor trained about the postpartum exercise. I do know, you know, movement and all that stuff is important in Chinese medicine. There is a time period where that first 30 days, they kind of want you to be warm and nurtured and fed those good stews and soups. And then after those 30 days, you get more active, curious what you guys are saying in the expect app. And you're so persistent. I love that because that aligns with so many different things that I believe as well. So first, within a lot of E-Station cultures, it's kind of this confinement where you just, you're supposed to just let your body recover. And it's really important because you need to recover before you can just jump back into an exercise program. The way that I expect treats it, their postpartum exercises are mostly focused on the pelvic floor. And I think the important part of that is that you don't want to just jump into that either. You need to give your body time to relax and heal. And the reason medically is just very important. Your uterus is the size of a baby by the time you deliver. It needs to go back to its normal size, which is about the size of a pair or so. And during that time, it's really important to not push yourself too hard because your ligaments are readjusting. Your ligaments are still softened from pregnancy because of all the different hormonal shifts and different changes. And if you exercise too vigorously, you could kind of impact those ligaments for the long term. I'm not familiar with exact data behind that or the exact signs behind that. And sometimes it's just common sense. So the Chinese medicine, and I'm glad you're highlighting this as well about that rest period because people are like, oh, I got it. I got to exercise. I got to get back in the shape. I got to look like I was before I was pregnant now. And there's some wisdom of like, hey, you just gave birth. You're sharing that the uterus is large. And it's got to shrink back down to that size of a pair that relax and all those hormones have affected the ligaments. So a little bit of what they call in Chinese medicine translates into English mattress time, meaning rest. Right? Absolutely. There is a time period of what type of exercise you're doing in the first 30 days versus post 30 days. Yes, exactly. And it's really, I think, a lot of what I like about Expect 2 is that a lot of the instructors they know they've gone through pregnancy themselves or they've worked with patients who've gone through pregnancy. And they know kind of how to talk to women in this pretty fragile time period actually and just postpartum for my second child as well. And you know, they have a lot of encouragement and any type of movement that you're doing in that postpartum period, you should be congratulated on. You should be, it's about restoring your mental health as well and feeling a human again. And so a lot of it is a little bit more again, the postpartum program is a lot more tailored to the pelvic floor to help reduce stress urinary incontinence, which is a common problem in patients who've had deliveries, whether vaginal or C section. And a lot of the program is kind of tailored towards restranking those muscles, but with the caveat that you don't want to go too hard too quickly. Thank you for that. You know, again, again, two little, two little, two much, two months, and there's some timing as well. So be kind to yourself, especially in that postpartum period. So what we've learned and discussed is movement and exercise can support fertility, but knowing your body weight and where you are physically, you don't want to go from zero to a hundred. You know, there's a strategy for that. And the app talks about this and this could help with your fertility and getting pregnant. We talked about auditory disorders helping with that. Then we shared exercise and throw pregnancy. As you said, you've seen positive births like nice laborers and good pregnancy outcomes. I thought it's part of our kind of a wrap up. I'm always curious like, you know, if you could go back in time, either talk to yourself before pregnancy or because of what you do, what would you tell women then before they're trying to conceive or while they're trying to conceive an impregnancy of movement and exercise? Yeah. I think the biggest thing is kind of something you had mentioned earlier, just being kind to yourself, being kind to yourself and giving yourself grace. So the fertility journey, I've treated many patients with this and not from a reproductive endocrinology standpoint, but just kind of patients who are coming to me who are going through this in the early stages before I refer them out. But it's a really tough journey and pregnancy is really tough and postpartum is really tough. And it's all hard and I like the phrase of choose your hard, everything's hard, right? Exercise can be hard, but it's going to be three steps forwards and possibly two steps backwards, but you're still making forward progress. So I think the biggest message I can give is that be kind to yourself. And to me, exercise is part of that whole holistic picture of being kind to yourself. It's taking time out of your day for yourself. And so if you are a parent or you're wanting to come a parent, there's so many different polls on your time and you want to be able to just give that time to yourself and exercise has so many more benefits just other than the physical. I think a huge, huge, huge benefit. I used to joke that I exercise for my mental health rather than my physical health. The mental health aspects of exercise are huge and that's really important, I think, especially for the fertility patient because that's a really tough journey to go on. And so I think the, I always remind patients of like make sure that you are taking care of yourself and exercise can be one tool in that toolkit of just making that, making sure that you're living a healthy lifestyle, not just with fertility as a goal, but as, you know, that could be your goal. But if your journey towards there makes you a healthier person, that's great. Yeah. And that mental health, I'm, I'm along with that. I do want sometimes twice a day, almost an hour, wrist walk. I live in the water. And that is my, how I like to start my day. It gives me that reset for the day and just being out there, not working yet and just moving my body, fresh air, some early morning sun light. I find a difference. I can tell when I get busy and I skip it. And then I often like, that's my end of day, like, okay, after dinner, let's just move to body. So, and that's not me jogging or doing lots of exercise. That's my mental health, which up, exactly as we talked about it, a pack, your inflammation, food, and resistance, or either health issues. I'm really glad we got together to chat and, and learn about your, the app that, you know, you, you talk about, expect, I really think this is a great resource and in our clinic, we're always looking for good resources because when they come, we have naturopathic doctors, Chinese medicine doctors. So we're really trained and good at talking about diet and lifestyle, right? And we use other things to support what we talked about inflammation, mitochondria, metabolic health. And we talk about exercise and now we have a resource that's OB-GYN approved, um, to help them as well. So I really, I'm glad we got to connect. Anything you want to share and summarize, my take is that exercise. It's not about just fitness. It's about supporting your health on a mind body level, but anything you want any last words that you want to share with the listeners that are trying to conceive or. in their pregnancy or postpartum? Yeah, I think it's kind of almost just parodying what you just said, but exercise is just one tool in this powerful toolbox of broader health. And so it is not a magic bullet, you know, you can't just exercise your weight into a pregnancy, you're into healthy pregnancy or labor and delivery or postpartum, but it's part of a holistic picture of making sure that you're living your healthiest lifestyle. And it's going to be beneficial from kind of to pair your words too. My body approach is that it's not just exercising for physical health. So I think that that's an added incentive is that if you can incorporate an exercise program that you're going to be consistent with, it's not just going to help you physically, but it's also going to help your mental health. It's also going to improve your stress levels. It's also going to improve your metabolic conditions. And so it's just really important to think of it as one part that you can, that you have full control over, that you can incorporate into your lifestyle to just be a healthier version of yourself. Thank you. That's excellent. And Dr. Riles, where do we find you? Are you on LinkedIn, Instagram? Do you have a little social happening? I have an ex account. It's age Riles. I actually am not that much on social media. I should. That's another help. That's another thing we should add to our list of diet, sleep, rest, movement, social. And a boy in social media. That's actually true. I actually don't know for much time. I did get sucked into a little bit, you know, with Instagram 7. I've actually just a random caveat. I deleted Instagram a couple years ago and I felt so much happier. I read, have since reinstalled it, but definitely an impacture of mental health. So you're on X and are you on LinkedIn as well? I am on LinkedIn as well. Yeah, for Hannah Riles. And then we'll put the link for the app in the show notes as well. And you guys can search as well under expect. And thank you very much for making time to talk with us today. I really appreciate it. Thank you so much, Dr. Ron. So before I jump off, Hannah just jumped off. I also want to remind you, we talked about the pillars of help diet being one of them. We offer for free on our website at acubalance.ca, the longevity and fertility diet, which is basically a low glycemic index diet and anti-inflammatory diet. So there's that metabolic health that we talked about about inflammation and insulin issues. So that's free on acubalance.ca. That's with one C acubalance.ca. And you can download that. It has about I think three weeks recipes as well. So tasty food as well that will support you in your fertility journey as well as your pregnancy journey as well in post-partum. So do check that out for a download. And then that holistic approach. And so again, at our clinic, we're usually always talking about diet and lifestyle. And then we bring in our acupuncture, nutritional IVs, herbs, low-level laser therapy to support metabolic health, blood flow, mitochondria health, inflammation. And so exercise is a big part of it. Movement. And so now hopefully this will help you on your journeys. And check out that app called expect. Thank you for tuning in. If you're looking for support to grow your family, contact acubalance wellness center. At acubalance, they help you reach your peak fertility potential through their integrative approach using low-level laser therapy, fertility acupuncture, and naturopathic medicine. Download the acubalance fertility diet and Dr. Brown's video for mastering manifestation and clearing subconscious blocks. Go to acubalance.ca. That's acubalance.ca. Thank you so much for tuning into another episode of Conscious Fertility. The show that helps you receive life on purpose. Please take a moment to subscribe to the show and join the community of women and men on their path to peak fertility and choosing to live consciously on purpose. I would love to continue this conversation with you, so please direct message me on Instagram at Lorne Brown official. That's Instagram Lorne Brown official. Or you can visit my websites LorneBrown.com and acubalance.ca. Until the next episode, stay curious and for a few moments, ring your awareness to your heart center and breathe. [BLANK_AUDIO]