I suppose we've been talking a lot about pelvic floor issues,
challenges that we face with pelvic floor
and also the ways that we can manage treatment.
But what about if you like exercising?
And one of the concerns that I have,
and certainly something that's really important,
is that we know that if you are obese
or you have all sorts of health issues,
that can be related to the fact
that you don't do very much physical activity.
And it's like the chicken-and-the-egg situation -
chicken and the egg -
where you start exercising
and now you're finding yourself wetting yourself.
You find that if you start doing more exercise, it becomes worse.
So, what's the first thing you're going to do?
Stop exercising. Exactly.
So, let's talk about how we can find the right exercises
for your fitness regime.
And I have one theory.
I just say to my clients,
"You need to be as strong on the inside
"as you are on the outside."
Because, unfortunately, a lot of people tend to exercise
because it's about the appearance, rather than the health benefits.
And when we're exercising,
sometimes it can be too much about the appearance
and we tend to push ourselves
in ways perhaps we're not capable of performing as well on the inside.
And those pelvic floor muscles which are part of the core unit,
which Julienne mentioned earlier, are just as important,
and they need to be able to help and also assist
but also be able to stabilise the spine during activities.
So, what are pelvic floor safe exercises?
So, this is a good one.
We tell people not to sit so much.
But if you've got pelvic floor issues, sitting's good,
because when you're sitting when you're exercising,
the chair or the ball that you're sitting on
actually helps with protecting your pelvic floor.
It provides a base of support that you don't have when you're standing.
So sitting on a Swiss ball is really effective
because the ball curves into your body
and you have a better awareness of pelvic floor.
So as you lift the dumbbell and lift the weights,
you are lifting your pelvic floor at the same time.
So, it's great to do pelvic floor exercises in isolation.
In fact, it's required.
You know, what Julienne was saying
about doing your pelvic floor exercises
so that...you know, regularly during the day is necessary,
but eventually, you need to be able
to activate those pelvic floor muscles during movement.
And when you're having a structured exercise session,
it's a great opportunity to add in pelvic floor exercises.
Not the whole way through it.
You just can't be lifting your pelvic floor
for the entire exercise session,
because you'll end up with a tight pelvic floor.
So then you're going too far the other way.
But eventually what will happen
when you're doing something structured with your pelvic floor,
you'll have the opportunity to go out for a walk
or go out for a run, or play with the grandkids, or do other things,
and your pelvic floor automatically switches on,
because it does what it's supposed to do.
So, cycling, as Julienne mentioned earlier before,
is a great form of cardio training.
Ideally, if you have some challenges with pelvic floor,
we recommend that you stay seated, so you're in a seated position,
rather than getting up out of the saddle.
Whenever you're doing, like, weighted-type exercises,
make sure that your entire body is well supported -
you know, when you're lying on your back,
rather than lying on a bench with your feet on the floor, for example.
When you're doing things like push-ups, you modify -
you don't go up onto your toes.
By the way, I'm a fitness instructor. I've been doing this a long time.
I think about 2% of the entire population
actually do a proper push-up.
Everyone else is trying. (CHUCKLES)
I look at people and go, "What are you doing on your toes?"
"It's better."
I'm like, "You're not even moving."
So you need to pop yourself down on your knees and do it correctly.
So, you want to look at low-impact-type activities.
So let's have a little bit of a brainstorm.
What is some low-impact activities that you could consider?
-WOMAN: Walking. -Walking's great.
And do you know what's really interesting too,
is walking uphill or running uphill
has much less stress than going downhill.
So you're trying to think, "Well, what do I do when I go downhill?"
You walk downhill. You don't run downhill.
So if you enjoy running, you know, you run up the hill,
but you walk down the hill, because the load's a lot less.
Also, walking on not a hard, flat surface.
So when we walk on hard, flat surfaces,
we have the same joint stress impact all the time.
So walking on grass, walking along the beach,
so that each step is a little bit different,
and it doesn't stress the pelvic floor constantly in the same way.
What's another great low-impact activity that you can do?
-WOMAN: Swimming. -Swimming!
Swimming's brilliant, because you're horizontal,
so there's no load being pushed down that pelvic floor.
So you're swimming away... Where's my pelvic floor chicken?
OK. We have lots of names for this.
So you're swimming along, the water is supporting you,
so there's buoyancy in there.
Actually, the chicken's upside down.
-Sorry. (CHUCKLES) -(LAUGHTER)
A swimming chicken was something I always wanted to see.
But you're being supported,
so it's a great way to get your heart rate up,
great way to...full-body workout without the load.
What's another way that we can train, low-impact?
-WOMAN: Dancing. -Dancing!
Well, do you know, that's interesting,
'cause I think it depends on the type of dancing you do.
I know that Zumba is a minefield for people with pelvic floor issues.
-Everyone, like... -(CHUCKLING)
I've had many conversations with women
who just go, "I just need to pop the pad in."
I'm like, "What for?" "I'm about to do Zumba."
So I think it depends on the type of dancing that you're doing.
And if you find that the dancing's too vigorous,
then it's not appropriate for you just yet.
'Cause it's all about managing your pelvic floor
so that you can do those sorts of activities.
But good suggestion.
-What's another one? -WOMAN: Yoga.
Yoga!
Now, that's a really good question,
because it depends on the type of yoga.
Now, with yoga, there is an emphasis on...
If you've got a good yoga teacher... And I had one.
She was always talking about the pelvic floor.
And she was giving modifications
for people who had pelvic floor weakness.
Now, that's a good instructor.
So you want to make sure that when you're choosing yoga classes
that they are making sure that they're modifying.
And if you have a conversation with them
and say, "I have a pelvic floor issue.
"Can you please provide me some options?"
If they don't, "Thank you very much.
"That was a great class. See you later."
Or you choose appropriate modifications.
So, yes, you want to be careful about that downward...
..and, you know, all this wide-legged stuff.
So, you remember where...it was... where the pelvic floor was attached?
It was attached where? Give me...?
You know, you've learnt so much tonight
from such amazing professionals.
Where's some bony landmarks we can talk about
as far as the pelvic floor's concerned?
-WOMAN: Pubis. -Pubic bone, yes.
-What's the other one? -WOMAN: Tailbone.
Tailbone. Coccyx.
Alright. So let's do this.
Put your fingers like that.
OK, so pubic bone is where the... apex of the fingers at the front.
Coccyx's down the back, OK?
But it also stretches out towards what we call the sit bone.
So if you all just lean forwards in your chair.
Reach back. You have to let go of the fingers.
-Reach back... -(LAUGHTER)
Just rock from side to side a little bit.
Find the bony bits in your backside. Yeah? Did you find 'em?
Not asking you to touch somebody else's, so relax.
(LAUGHTER)
OK, so that's the bony attachment points on the side.
So if you do this for me.
OK, that's sort of a bit like what your pelvic floor looks like.
OK, so it spreads out. It's a bowl of muscle.
So, do you know what you should do now?
Check if your pelvic floor's bigger than the person's next to yours.
-Have a look. What's theirs like? -(LAUGHTER)
So...so, if you're thinking about that's where it is
and I now stretch those bony landmarks further apart,
can you see how I'm now really stretching it out?
And if it's weak, it's going to...
And those openings are more likely to stay open.
This is not a good position to be in.
So you've got to be careful about all that Warrior Pose stuff
with your legs so wide apart.
Come in narrower, explain to your yoga instructor
that you are modifying exercises to protect your pelvic floor.
They won't argue with you.
They won't argue with you. Very good.
Alright, so, things like being on a cross-trainer
is a great form of low-intensity exercise.
But you want to make sure that you're moving at a pace
that helps elevate heart rate
but doesn't make you like, "Oh, my God, I'm really straining."
Sometimes people exercise too hard to get benefits.
That's an interesting concept.
Michelle Bridges would disagree with that.
OK... (CHUCKLES)
So, you know, you've got to...
..you just need to make movement part of your everyday life.
It doesn't matter how you move,
you're going to get benefits out of it.
So other pelvic floor safe exercises.
And we're always talking about the 'core', aren't we?
What is the core?
Well, I asked my mother
and she said, "It's the centre of the apple."
I said, "You're absolutely right, Mum. You're right, Mum."
Where's the core of the Earth?
It's not Melbourne, is it? It's not Melbourne.
So a lot of people think, "OK, we've got to work the core,"
and they do this tummy-rubbing action,
which I love, because the core's not here.
If the core's the centre of the Earth
and the core's the centre of an apple,
where do you think the core of... where the core muscles are?
In the centre of your body.
You can't see them on the outside.
So all the sit-ups in the world aren't going to train those muscles.
Now, we've talked about three of those muscles.
We talked about pelvic floor. It's like a can.
You've got pelvic floor, then you've got the top, which is your diaphragm,
then we have this really large muscle around the midsection
which we call transverse abdominis.
And that's a very deep muscle. It's not your sixpack.
And then we have some muscles in our back called the multifidus.
They're on the inside of your body.
And so, when you're doing a core exercise,
what do you think is the most important part of that core exercise?
Pelvic floor lift.
If you're doing 'core' training,
knowing that the pelvic floor's part of your core
and pelvic floor's not part of that exercise,
it isn't core anymore.
It's another way to spend time staring at a spot on the carpet.
Because right now, it's not core,
but we're...doing something.
OK, something.
Got to watch the clock, because the longer you do it,
apparently it's better.
But it's not.
So, when we're talking about safe core exercises,
this is a really good one.
It's a modification from doing...
You've seen 'planking', haven't you?
-AUDIENCE MEMBERS: Yes. -MARIETTA: Oh, God.
It's a sport, actually.
There is a 'Guinness Book of Records' -
5 hours and 5...50 sec...?
I remember it was a 5-5.
5 hours and 50 seconds...50 minutes and 50 seconds or something.
And I said, "Wow!
"His core switched off 10 seconds into that
"and he spent the rest of the time sweating it out on the floor.
"Give him a round of applause."
So, you want to be in a position
where you can actively lift your pelvic floor.
That's quite hard. Yeah.
I find when I do my core exercises with my clients,
they just do it like this.
That's enough.
Then, if they can, they lift up one hand
while lifting their pelvic floor during the entire exercise.
It's a core exercise.
It works. It functions.
It's training those muscles to do what they're supposed to be doing.
And it's not that lock-on effect.
Because when you lock on your muscles,
we get this, like, locking-on effect,
you're doing this, OK?
So this is not your pelvic floor activating.
This is your pelvic floor going,
"I don't know what to do with the rest of my internal organs -
"let's push them out."
OK, so you want to make sure you're not locking anything in.
The other thing you want to avoid doing is getting out of the pool.
You know when people get out of the pool,
you can always tell.
They do this... (INHALES)
(LAUGHTER)
..till you get to the safety
either of the changing rooms or the towel.
OK, then we let it all hang out.
I often see this with other fitness trainers,
and fitness trainers have issues, major issues, with pelvic floor,
and there's a lot of this going on, till they get to the car,
and then finally, they release the fart
they've been hanging onto all day.
-(LAUGHTER) -(INHALES) So...
I know too much.
So, this is also another great core exercise.
We're working the back, we're working the glutes,
we're working the hamstrings.
But it protects your pelvic floor.
Don't think that because you're lying on your back
and lifting your hips up
that the pelvic floor now descends towards your head, OK?
(LAUGHS) "It's going to fall back
"and by...by gravity, I'm training it."
No, it's not true. You've got to do it consciously.
Doing push-ups on the wall, they work.
There's nothing wrong with that.
You don't have to get down on the floor.
OK, so what sort of things to think about
if you're going to group fitness.
So, you want to keep your group exercise...
Who enjoys going to group exercise classes?
Oh, I love that you just went like this!
Yes. You're proud of it. I love it.
WOMAN: If I'm lying on the back, it's the hip-raise...
-The bridge, yeah. -..everything goes downwards!
Yes, including your breasts
if you're not wearing a supportive enough bra.
You're like, "Hello! And now I can't breathe."
You don't have to lift that high.
But with group fitness, you want to choose low-impact options.
So even if the instructor's
encouraging you to go high because high is better,
high is not better if you've got pelvic floor challenges.
You also want to reduce range of motion.
So when you take your arms up,
it increases load through the whole body.
So bring your arms down lower. It makes it a little bit easier.
And also reduce 'travelling' distance.
So, you know... Just let me give you an example.
If we're doing something like this, make it small.
'Cause, remember, we're talking about attachment points.
You just need to move.
That's the problem with our society.
Structured exercise never...never existed in my parents' time. Why?
Who needs to go to the gym
when you had to walk 5 kilometres to school and back every day?
-MAN: Yes. -Yeah!
You know, my parents had labour-orientated jobs.
They're not going to go to a gym. They didn't even know what it was.
When I said I'm going to become a gym instructor 27 years ago,
they thought I'd lost my mind.
"What gym? Where? What is that?
"Be a doctor. Do some good for the community."
-(LAUGHTER) -They were very disappointed.
But I think I'm doing
So, I just...I had vision.
So, muscle conditioning,
so weighted-type classes.
And this is a classic, you know,
weight-type exercise.
Now, my friends, this is the sort of
thing you want to be careful of.
So you want to be careful about adding load, OK?
You want to squat - the whole purpose of a squat
is so that you can sit and stand up unaided.
That's why.
I moved into a new house and there was all these rails around the house.
I was like, "What the hell's with all these rails?"
And then I went, "Oh! Someone old used to live here."
So get rid of the rails.
Last thing I want to be doing
is leaning onto something to help me get up,
because that's the job of my legs.
So that's what we do - we train people to do movement
that they're going to do in everyday life.
Rarely do I ever go to the toilet with a barbell on my shoulders.
-(LAUGHTER) -It's...
I never forget to leave it at the gym and take it home with me.
OK, so... You've got to think practical.
Exercise is just about movement. So...
You know, reduce the weight
for comfort levels, reduce the depth.
You don't need to go
all the way down,
regardless of what your trainer says.
There's this theory about, you know, "It's only worth it
"if you can get your backside to touch the ground."
Stupid. No-one does that.
Maybe in Asian countries and they don't have issues.
Modify anything overhead.
Once again, reduce the weight.
Encourage breathing.
So you want to think about breathing out on the contraction.
You know what Julienne was saying,
when you come up and you think about lifting your pelvic floor,
breathe out, rather than holding the breath as you lift up.
And that's actually a common error I often see on the gym floor.
There's a lot of... (INHALES)
(GASPS) And I'm just thinking, "Well..."
I'm waiting for it to come out somewhere. OK.
You want to avoid
holding your core exercises
for more than 10 seconds.
All the research around core training is 10 seconds or less.
What happened in the fitness industry,
we said, "If 10 seconds is good, 20's got to be better.
"And if we can do 20, we can do it for a minute."
It's absolutely unfounded.
There's no research that says it's better. It's worse.
Your body stays really still for a really long period of time.
I don't know when you ever need to do that.
Remember, your body wants to move.
And then also think about
lifting your pelvic floor
during simple exercises.
Does anyone step up and down anything,
whether it be a step class or a box?
The latest craze is a box jump.
You know what that is?
Yeah? So let me give you an example.
That's actually pretty easy.
Where you jump up like that.
I went to a class the other day, a functional training class,
and the box was this high, and I'm like...
Looked at the trainer. She goes, "You can do it."
I'm like... (SCOFFS) .."Could lose my two front teeth
"as I fall over the top of that thing."
"I'm not going to try."
She goes, "You can do it." And I just said, "No."
And she didn't argue with me.
Just be firm. It's your body.
Don't be pushed to doing something you don't want to do.
There's a lot of trainers who think
that the harder they push their clients,
the better the job that they're doing.
Now, when they're 20...
..and you're, like, 45 or 50 or 60, they don't understand.
They don't get it.
And they certainly don't get it with the pelvic floor,
and that's what we've been doing with Pelvic Floor First,
is creating that awareness with our trainers.
And it's growing and it's growing fast, which is really good.
You simply say, "No."
You know, "I'm not doing that."
So, you want to reduce,
you're going to keep it low-impact, you want to reduce the height of it.
Stepping up's great.
There's nothing wrong with that.
Just the jumping is an issue, 'cause it...
(GRUNTS) ..you have to create that force.
Also, we love aqua
and we love swimming
because of that support.
Your body weighs less when you're in water.
No-one said aqua. Does anyone go to aqua aerobics here?
I love aqua. Man, I'm a really big fan of it.
And Jan's here, so she's also an aqua instructor.
So you can speak to both of us about the benefits of it.
But it's a great cardiovascular workout.
It's a great strengthening workout.
And your body is well supported in that environment,
so you can get a really good workout.
So, that's it for me.
-WOMAN: Can I ask a question? -You certainly may.
Running. We walk a kay in the morning along the beach.
And there's a couple of these stairs, you know?
Is it risky? We run up the stairs, about 25-30 stairs.
Is that something that...
That's a really good question.
So the question was running up the stairs.
WOMAN: I'll be more mindful
of the pelvic floor from now on, doing that.
It's just going to...it just helps the legs, doesn't it?
Just to clarify something -
when you're doing something like that activity,
where you're running up stairs, there is...
I would be very impressed if you can actually be mindfully
lifting your pelvic floor as you do that.
I'd be incredibly impressed, because it's too...
Like, it's hard enough just doing the whole all-fours thing
and lifting one arm up and down, you know, and a conscious effort.
But what you want to do is train your pelvic floor
well enough and often enough
so that you maintain good, you know, density in that muscle
and it functions, just like a bicep, so...
I train my bicep so that I can go and lift heavy things
without thinking, "Oh, was that too heavy?
"What was the weight that I used in the gym?"
I will just do it automatically.
It's the same thing with your pelvic floor.
You want to train it so that when you go to do something like that,
it responds to the activity and the intensity that's required.
So is running upstairs good?
Well, only if your pelvic floor can tolerate that.
Yeah, so some people might be, "That's it.
"Nope, I'm walking. I'm going..."
Stairs are great, because it's a functional everyday movement pattern.
And it's great for raising heart rate.
But you can get just as good an effect walking up them.
You don't necessarily have to run.
Running up them is fine - there's nothing wrong with it -
only if you're as strong on the inside as you are on the outside.
Yeah. Yeah. Good question.
Thank you very much.
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