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Oh Baby! Exercise During Pregnancy and the Postpartum Period
Abstract
LEARNING OBJECTIVE: • To understand the latest information and recommendations about exercising during pregnancy and the postpartum period.
... In 1985, certified aerobics instructors were trained not to allow pregnant women to exceed a heart rate (HR) of 140 beats per minute during exercise [2]. Today the professional community of certified instructors understands that HR is not a valid tool to use during pregnancy to monitor intensity. ...
... There is sufficient evidence to support 30 min of moderate aerobic conditioning on most if not all days of the week during uncomplicated pregnancies1236]. Given the variability in target heart rates during pregnancy, it is advisable to use another means to monitor intensity such as: (1) the talk test; (2) the compendium of physical activity chart with metabolic equivalents [(METS)]; or (3) the Borg Rating of Perceived Exertion Scale (RPE) [1,8]. ...
... Enhanced muscular fitness may help compensate for the postural adjustments that typically occur during pregnancy [9,10]. Nonetheless, the recommendation from the ACOG [2] is that exercise in the supine position should be avoided whenever possible because of the relative obstruction of venous return and, therefore deceased cardiac output and orthostatic hypertension, especially after the first trimester. Furthermore, heavy lifting during pregnancy is never appropriate since it may expose the joints, connective tissue, and skeletal structures of a gravid woman to excessive forces [11]. ...
There has been a progressive evolution in the concept of exercise for prepartum women. Per contra, screening guidelines have not changed. All women should have a thorough clinical evaluation by the health care team before an exercise program is recommended. This is true for previously sedentary women or women who have been active before their pregnancy. The consensus today is that given no medical contraindications to exercise during pregnancy women with uncomplicated pregnancies should participate in moderate exercise, such as brisk walking, 30 min a day or more. The use of heart rate to guide intensity is not valid for prepartum women because of the large variability of heart rate during pregnancy. Rather, metabolic equivalents (METS), the Rating of Perceived Exertion Scale (RPE) or methods such as the talk test should be used to monitor exercise intensity. The recommendation is 3-5 METS, an RPE of 12-14 (somewhat hard) on the 6-20 scale, or women should be able to maintain a conversation while exercising. Strength-conditioning activates are also advocated in uncomplicated pregnancies. However, there is less evidence on strength conditioning and weight training in pregnancy. The research on yoga and Plates on gravid women is too limited to make a position stand on these activities. Regardless of the type of activity, all goals should be reasonable. Furthermore, pregnancy it is not a time to reach peak fitness levels or train for an athletic competition. Elite athletes who train during pregnancy require supervision by an obstetric care provider with knowledge of the impact of strenuous exercise on fetal outcomes.
... [5] In 2002, the American College of Obstetricians and Gynecologists (ACOG) published exercise guidelines for pregnancy. [6] These suggested that in the absence of medical or obstetric complications , 30 minutes or more of moderate exercise a day on most, if not all, days of the week is recommended for pregnant women. These guidelines were based on the 1995 joint recommendations ...
... Individualizing an exercise programme for pregnant women involves medical screening with the use of a physical activity readiness questionnaire for pregnancy, [114] an estimation of previous physical activity level and developing a programme specific to the woman's situation. Informing the patient about limitations, contraindications and warning signs should also be performed (table V). [6] On the basis of numerous studies, exercise testing to maximum exercise capacity in pregnant women is safe for both the mother and the fetus. [43,87,92,98,99,103,115,116] Therefore, before an exercise programme is given to a woman, a graded exercise test using a cycle ergometer or treadmill would be an ideal scenario to obtain [25] To estimate the total weekly physical activity energy expenditure from vigorous exercise, a questionnaire such as the 7-day physical activity recall can be used. ...
... Table V . Absolute and relative contraindications to aerobic exercise during pregnancy as well as warning signs to terminate exercise while pregnant (reproduced from the ACOG Committee opinion, [6] with permission from the American College of Obstetricians and Gynecologists) ...
In 2002, the American College of Obstetricians and Gynecologists published exercise guidelines for pregnancy, which suggested that in the absence of medical or obstetric complications, 30 minutes or more of moderate exercise a day on most, if not all, days of the week is recommended for pregnant women. However, these guidelines did not define 'moderate intensity' or the specific amount of weekly caloric expenditure from physical activity required. Recent research has determined that increasing physical activity energy expenditure to a minimum of 16 metabolic equivalent task (MET) hours per week, or preferably 28 MET hours per week, and increasing exercise intensity to >= 60% of heart rate reserve during pregnancy, reduces the risk of gestational diabetes mellitus and perhaps hypertensive disorders of pregnancy (i.e. gestational hypertension and pre-eclampsia) compared with less vigorous exercise. To achieve the target expenditure of 28 MET hours per week, one could walk at 3.2 km per hour for 11.2 hours per week (2.5 METs, light intensity), or preferably exercise on a stationary bicycle for 4.7 hours per week (similar to 6-7 METs, vigorous intensity). The more vigorous the exercise, the less total time of exercise is required per week, resulting in >= 60% reduction in total exercise time compared with light intensity exercise. Light muscle strengthening performed over the second and third trimester of pregnancy has minimal effects on a newborn infant's body size and overall health. On the basis of this and other information, updated recommendations for exercise in pregnancy are suggested.
... El American College of Obstetricians and Gynecologists (ACOG) comenzó a recomendar la práctica del ejercicio físico aeróbico durante el embarazo, aunque advertía del daño que podrían causar actividades de alto impacto como la carrera, y por lo tanto, la aconsejaban con cierta precaución. Las recomendaciones expuestas por este primer posicionamiento resultaron excesivamente conservadoras 4 . En 1994, y dada la alta inclusión de la mujer en todas las esferas sociales y en el deporte, el ACOG revisó su posicionamiento y adoptó enfoques menos conservadores, siempre que la embarazada estuviera sana y no surgieran complicaciones en el transcurso del embarazo. ...
... Las diversas comunicaciones científicas publicadas hasta el momento no han reportado ninguna complicación asociada a la práctica de ejercicio físico adecuada, ni para la madre, ni para el feto 4,11,18,23,24 . ...
... Pese a ello, la mayoría de los estudios sugieren que, a mayor intensidad y duración del ejercicio materno, mayor riesgo potencial de que ocurran efectos dañinos sobre el feto existirá. Aunque, principalmente por motivos éticos, no han podido concretarse las dosis máximas de actividad física a partir de las cuales aparecerán complicaciones para el embarazo 4,24 . ...
Physical exercise and pregnancy relationship has evolved adapting by the time. Nowadays there are data allow to lay the foundations and establish logical action guidelines for prescription of physical activity in pregnant women, assuring minimum risk and maximum advantages. Therefore, the aim of this review has been compiling the scientific information related to this issue. For this, a detailed search has been done of outstanding studies about this aspect. After the works had been reviewed, we can conclude that a personalized physical exercise combining neuromuscular and cardiovascular training is highly recommended in pregnant women, no matter active or sedentary pregnant state, if pregnancy period is free of medical contraindications and problems.
... In the absence of medical or obstetrical complications, pregnant women are encouraged to continue and maintain active lifestyles during their pregnancies [1, 2, 3, 4, 5, 6,7]. In addition, exercise has many benefits including reducing the risk for coronary heart disease, cardiovascular disease, metabolic syndrome and systemic inflammation. ...
... In addition, exercise has many benefits including reducing the risk for coronary heart disease, cardiovascular disease, metabolic syndrome and systemic inflammation. In pregnancy, appropriate exercise decreases the risk of developing gestational diabetes mellitus, pre-eclampsia, caesarean section rate, reduced symptoms from low back pain and improved mental state [2, 3, 5, 6, 7]. Furthermore, babies born from exercising women seem calmer, more intelligent with improved neurological and mental development and adapt faster to the outside. ...
... Motolla and McLaughlin [1] suggest that over time, the attitude towards pregnancy has changed. Going from beliefs that women should not stress their bodies unduly to accepting that exercise could positively affect the health of the mother and child is part of that change [2, 3, 4]. Nonetheless, studies have reported that many expectant mothers still remain inactive and do not meet sufficient exercise recommendations [5, 6, 7, 8, 9, 10]. ...
Abstract: Introduction: In the absence of medical or obstetrical complications, pregnant women are encouraged to continue
and maintain active lifestyles during their pregnancies. Benefits of exercise during pregnancy include; prevention of excessive
gestational weight gain, gestational diabetes, pre-eclampsia, undergoing a caesarean section and reduced low back pain. The
aim of the study was to obtain information on exercise practice among women attending antenatal care at the University
Teaching Hospital (UTH) in Lusaka, Zambia and establish whether, educational level, number of pregnancies and cultural
background had an influence on exercise practice during pregnancy. Methods: We collected data using a self- administered
questionnaire in a cross sectional, exploratory study and summarized data using descriptive statistics. The chi-square test was
used to test association between variables and the significance level was set at 5%. Results: Three hundred women participated
in the survey. The majority of the respondents 74% (n=222) exhibited inadequate levels of knowledge on exercise and the type
of ideal exercises. Exercise practice in relation to the educational levels was insignificant. However, cultural background had a
significant association to the women’s exercise practice (p-value 0.025). In addition, the number of pregnancies was positively
associated to the women’s exercise practice (p-value 0.01) during pregnancy. Conclusions: Pregnant women practice general
physical activities of daily living such as walking and household chores during pregnancy. They do not know the specific
antenatal exercises. Consequently, they are not able to practice the ideal exercise during pregnancy. This highlights the need for
Physiotherapy personnel to be actively involved during antenatal to educate pregnant women on the ideal exercise activities.
... In epidemiological studies a lack of exercise has been found to be a risk factor for RLS/WED [61,62,64,66] and two randomizedcontrolled trials have shown benefit of exercise in non-pregnancy RLS/WED [69,70] . In the absence of contraindications, moderateintensity physical activity is encouraged for all pregnant and postpartum women for multiple reasons, including a decreased incidence of postpartum depression [71,72] . Examples of moderateintensity exercise are brisk walking, water aerobics, ballroom dancing, and general gardening [73]. ...
... Examples of moderateintensity exercise are brisk walking, water aerobics, ballroom dancing, and general gardening [73]. Activities with a high risk of falling or abdominal trauma, such as horseback riding, soccer, or basketball, should be avoided during pregnancy [71,73], as should exercise too close to bedtime, which can interfere with sleep onset. Vigorous/strenuous exercise can induce pain, which may aggravate RLS/WED and interfere with sleep. ...
... Vigorous/strenuous exercise can induce pain, which may aggravate RLS/WED and interfere with sleep. The American College of Obstetrics and Gynecology advises that " previously inactive women and those with medical or obstetric complications should be evaluated before recommendations for physical activity during pregnancy are made " [71]. Similar to moderate exercise, yoga may be beneficial for RLS/WED [74,75]. ...
Restless legs syndrome (RLS)/Willis-Ekbom disease (WED) is common during pregnancy, affecting approximately one in five pregnant women in Western countries. Many report moderate or severe symptoms and negative impact on sleep. There is very little information in the medical literature for practitioners on the management of this condition during pregnancy. Accordingly, a task force was chosen by the International RLS Study Group (IRLSSG) to develop guidelines for the diagnosis and treatment of RLS/WED during pregnancy and lactation. A committee of nine experts in RLS/WED and/or obstetrics developed a set of 12 consensus questions, conducted a literature search, and extensively discussed potential guidelines. Recommendations were approved by the IRLSSG executive committee, reviewed by IRLSSG membership, and approved by the WED Foundation Medical Advisory Board. These guidelines address diagnosis, differential diagnosis, clinical course, and severity assessment of RLS/WED during pregnancy and lactation. Nonpharmacologic approaches, including reassurance, exercise and avoidance of exacerbating factors, are outlined. A rationale for iron supplementation is presented. Medications for RLS/WED are risk/benefit rated for use during pregnancy and lactation. A few are rated "may be considered" when RLS/WED is refractory to more conservative approaches. An algorithm summarizes the recommendations. These guidelines are intended to improve clinical practice and promote further research.
Copyright © 2014. Published by Elsevier Ltd.
... Weight-bearing and non-weightbearing exercises are likely to be safe during pregnancy . However, physically active women with a history of or risk for preterm labor or fetal growth restriction should be advised to reduce her activity in the second and third trimesters [6]. Physical Activity Readiness Medical Examination (PARmed-X) for pregnancy can assist in evaluations of medical problems that may require special considerations in pregnant patients. ...
... Physical Activity Readiness Medical Examination (PARmed-X) for pregnancy can assist in evaluations of medical problems that may require special considerations in pregnant patients. For a full list of absolute and relative contraindications, see the ACOG statement or the ACSM Exercise Prescription and Testing guidelines [6]. ...
The evidence shows that health and well-being are affected and created by a combination of physical activity, nutrition, and rest. Family physicians can directly impact all of these components by educating and guiding patients regarding healthy lifestyle choices. With appropriate nutrition, physical activity, and rest, bodily function is optimized, and health and well-being of patients and communities are improved. In addition, tobacco cessation has been shown repeatedly to directly improve morbidity and mortality. While we know that health outcomes are also heavily affected by socio-demographic factors, this chapter is focused on patient lifestyle choices.
... According to current American [39,40] and Canadian guidelines [41] the general physical activity recommendation for health [42] applies to pregnant women without medical or obstetric complications. This has been restated in the most recent physical activity recommendation updated by the Physical Activity Guidelines Advisory Committee [43]. ...
... Adverse events related to recent physical activity were asked by the nurses at four visits with a structured form. The adverse events included were classified as warning signs for exercise termination by ACOG [39], e.g. vaginal bleeding, major contractions, dizziness, headache, chest pain and muscle weakness. ...
Protocol (previously published in [17]).
(PDF)
... Both sedentary mode of life and excessively intensive and long-lasting activity during pregnancy period, exert a negative effect on pregnant women, development of the fetus, and delivery as well as the state of the baby after birth [10,11]. Based on the Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and postpartum period, in the absence of either medical or obstetric complications, 30 min or more of moderate exercise a day on most, if not all, days of the week is recommended for pregnant women [12,13]. That level of leisure-time physical activity (LTPA) during pregnancy can be associated with many positive outcomes including: a decreased blood pressure and a reduced risk of gestational diabetes, but its long-term consequences for the children, such as improved psychomotor development, have been less frequently investigated [14]. ...
... In the analysis the following MET categories were considered: light intensity activities (MET b 3), moderate intensity activities (MET 3–6) and vigorous intensity activities (MET N 6) [29]. As the American College of Obstetrics and Gynecology' recommendation for physical activity during pregnancy is 2.5 h of moderate exercise per week we have dichotomized the LTPA into 1) ≥3 and ≥2.5 h/week and 2) b 3 or ≥3 and b 2.5 h/week [12,13]. During each perinatal visit scheduled within the study, the women were interviewed by a gynecologist or midwife about the use of vitamins , minerals, other dietary supplements and medications. ...
... The tests consisted of performing two resistance exercises preceded by a rest period, followed by 25 minutes of recovery. Such exercise protocols were selected respecting the guidelines and recommendations published in relation to resistance training in pregnancy 1,13,17,18 . The exercises chosen were pec-deck fly for the upper body and bilateral leg extension for the lower body, since it represents major muscle mass. ...
... However, no alterations were observed in FHR in any of the fetuses examined. The protocol design was selected in agreement with the literature, which recommends resistance training for non-pregnant individuals and beginners, with emphasis on improving muscular endurance, with the performance of 1 to 3 sets with 10-15 repetitions and a relative load ranging from 50 to 70% of 1-RM 21 , which are similar recommendations for women during pregnancy 17,18 . ...
To determine fetal heart rate (FHR) responses to maternal resistance exercise for the upper and lower body at two different volumes, and after 25 minutes post-exercise.
Ten pregnant women (22-24 weeks gestation, 25.2±4.4 years of age, 69.8±9.5 kg, 161.6±5.2 cm tall) performed, at 22-24, 28-32 and 34-36 weeks, the following experimental sessions: Session 1 was a familiarization with the equipment and the determination of one estimated maximum repetition. For sessions 2, 3, 4 and 5,FHR was determined during the execution of resistance exercise on bilateral leg extension and pec-deck fly machines, with 1 and 3 sets of 15 repetitions; 50% of the weight load and an estimated repetition maximum. FHR was assessed with a portable digital cardiotocograph. Results were analyzed using Student's t test, ANOVA with repeated measures and Bonferroni (α=0.05; SPSS 17.0).
FHR showed no significant differences between the exercises at 22-24 weeks (bilateral leg extension=143.8±9.4 bpm, pec-deck fly=140.2±10.2 bpm, p=0.34), 28-30 weeks (bilateral leg extension=138.4±12.2 bpm, pec-deck fly=137.6±14.0 bpm, p=0.75) and 34-36 weeks (bilateral leg extension=135.7±5.8 bpm, pec-deck fly=139.7±13.3 bpm, p=0.38), between the volumes(bilateral leg extension at 22-24 weeks: p=0.36, at 28-30 weeks: p=0.19 and at 34-36 weeks: p=0.87; pec-deck fly at 22-24 weeks: p=0.43, at 28-30 weeks: p=0.61 and at 34-36 weeks: p=0.49) and after 25 minutes post-exercise.
Results of this pilot study would suggest that maternal resistance exercise is safe for the fetus.
... A woman who delivered through C-section is also expected to have more rest time for recovery. She is expected also to start training with low impact activities such as walking and engaging in less strength training than the woman that delivered through vaginal delivery Furthermore, she must engage in light stretches (Avarank & Mudd, 2009). While active women who undergo vaginal delivery will benefit from strong muscles when it comes to "push time", those who end up with C-section who are also active will recover faster with strong and active recovery (Bolaji-Olojo, 2028). ...
Exercise is a component of physical activity done with the intention of getting physically fit to carry out daily activities without undue stress. Habitual participation in exercise is beneficial to all categories of people, including pregnant women. The pregnancy period is regarded as a period of inactivity, but exercise during pregnancy has significant positive health benefits for the mother and the fetus. Despite the positive gains of regular engagement in exercise, many pregnant women do not participate in exercise. To increase participation of pregnant women in exercise, there is a need for women to understand the positive effects of exercise on women during pregnancy and to know exercise protocols for all the stages of pregnancy and the postpartum period. It is believed that if women are aware of the gains of participation in correct exercise regimen during pregnancy, they will be encouraged to engage in it regularly. Through this study, exercise professionals will be kept abreast of the latest research discussions in this area.
... Safety concerns are cited by pregnant women as a barrier to physical activity (Coll et al., 2017). This may have originated from cultural beliefs that women should 'rest' in pregnancy (Coll et al., 2017) alongside former recommendations that physical activity should be limited because of concerns for mother and offspring welfare, including risk of impaired oxygen supply to the fetus during supine exercise (American College of Obstetricians and Gynecologists (ACOG), 1985; Pivarnik and Mudd, 2009). ...
Objective: Evidence suggests that physical activity whilst pregnant is beneficially associated with maternal cardiometabolic health and perinatal outcomes. It is unknown if benefits extend to objective markers of the neonate condition at birth. This study investigated associations of maternal pregnancy physical activity with cord blood pH. Methods: Cord blood pH was measured when clinically indicated in a subgroup of Born in Bradford birth cohort participants (n = 1,467). Pregnant women were grouped into one of four activity categories (inactive/somewhat active/moderately active/active) based on their self-reported physical activity at 26-28 weeks gestation. Linear regression was used to calculate adjusted mean differences in cord blood pH, and Poisson regression was used to quantify relative risks for moderate cord blood acidaemia (pH < 7.10), across physical activity groups. Results: More than half of pregnant women (52.0%) were inactive, one-fifth were somewhat active (21.7%), fewer were moderately active (14.6%) and active (11.7%), respectively. Pregnancy physical activity was favourably associated with higher cord blood pH. Compared to neonates of inactive women, there was some evidence that neonates of women who were at least somewhat active in pregnancy had lower relative risk of moderate cord blood acidaemia (for arterial blood: relative risk = 0.70 (95% confidence interval 0.48-1.03)). Conclusions: Modest volumes of mid-pregnancy maternal physical activity do not appear to adversely influence cord blood pH and may enhance the neonate condition at birth.
... However, the evidence to support advice on exercise for pregnant women with hypertensive disorders in pregnancy is limited. According to the American College of Obstetrics and Gynaecology (ACOG), pre-eclampsia is an absolute contraindication to aerobic exercise in pregnancy [44] as opposed to RCOG which advises caution while exercising with medical disorders in pregnancy [45] . Studies which have investigated whether exercise in pregnancy reduces the risk of preeclampsia , analysis suggests a reduced risk of preeclampsia with increasing levels of physical activity before pregnancy and during early pregnancy [46]. ...
... The current literature indicates that gestational exercise is not associated with any complications, neither for the mother nor the fetus [27]. While uterine blood flow is reduced during exercise, studies indicate that this does not affect the blood flow to the fetus. ...
... Women should avoid activities with potential risk of trauma, like horseback riding and contact sports. [22] Scuba diving is another activity to be avoided since there is a chance of adverse outcome because the fetus is not protected from decompression problems and is at risk of malformation and gas embolism after decompression disease. [23] When exercising lying on the ground, women must be advised to avoid the supine position, especially during the second and third trimesters. ...
Preterm birth is a major reason for infant mortality and morbidity, representing a public health concern worldwide. Regular and voluntary physical activity is healthy behaviour that should be incorporated by everyone, including pregnant women. On the other hand, some women are exposed to highly demanding occupational physical activities during pregnancy that might represent a threat to the fetus and to their own health. This paper is a literature review of studies (1987-2007) on physical activity during pregnancy and its relationship to preterm birth. Although the effects measured by the studies are not strong and the evidence is impaired by many methodological flaws, it seems that recreational or leisure-time physical activities performed regularly provide protection against prematurity. Studies on occupational physical activities, especially standing for long periods, present contrasting results - some presenting standing as a risk factor, but most showing no association. Housework and other daily activities do not seem to be associated with preterm birth. Regardless of the methodological aspects of the studies reviewed, there is a chance that the real effect of occupational physical activity is being blurred by some underlying factors not easily measured in epidemiological investigations. Our conclusions do not reject the idea that working conditions might represent danger for the pregnancy outcome, but only raise the question that maybe the mechanisms through which employment-related physical activities have been considered up till now could be better and more thoroughly studied. Future studies should pay additional attention to psychological and socioeconomic characteristics, without neglecting biological plausibility.
... The non-performance of any exercise before, during or after pregnancy has been associated with a poor general healthy status of the women [1]. Some of the benefits of performing moderate exercise during pregnancy are protective gestational weight gain2345 high pressure control [6], helps to quit smoking during pregnancy [7], increase fitness8910 or increase self-esteem and well mental health [5,11]. Pre-pregnancy Body Mass Index increased the women risks of gestational diabetes [12], hypertensive disease [13], macrosomia [14] or shoulder dystocia [15]. ...
Introduction: Pregnant women are recommended to participate in ‘moderate to vigorous’ physical activity (MVPA), each day, to promote and maintain health. The aim of this study was to assess the changes in Total Energy Expenditure (TEE), MVPA, physical activity levels in four different domains (leisure time, transportation, household/ caregiver, occupational), time spent watching TV, and numbers of women meeting the recommendations, before compared with during pregnancy, by body mass index category.
Method: A systematic sample of otherwise healthy pregnant women attending their scheduled 20-22nd week assessment at a hospital in Spain during a 4 year period, 2004-2007, were asked for information on socio-demographic and medical information. They completed the Paffenbarger questionnaire and provided an estimate of their height and weight, both during the first half of their pregnancy and during the 12 months prior to their pregnancy.
Results: 1.175 women agreed to take part. TEE decreased from pre-pregnancy in all BMI categories (21.77 to 18.89 in ideal; 24.20 to 21.56 in overweight; and 23.82 to 21.21 in obese women) (p<0.001). Physical activity levels in the transportation and leisure time domains, both before and during pregnancy were negligible across all BMI categories (mean around 1-1.5 MET hours/day), although LTPA did decline during pregnancy. Physical activity levels in the household/caregiver domain did not change as a result of pregnancy in any of the BMI categories (mean approx. 11 MET hours/day in ideal compared with approx 15 in overweight and obese categories). Physical activity levels declined in the occupational domain across all BMI categories.
Discussion: Patterns of physical activity appear to be maintained during pregnancy, with the exception of occupational activity which decreases equally across all BMI categories. Motivating women, regardless their pregestational BMI index, to be physical active and less sedentary from the beginning and during pregnancy could potentially increase physical activity levels.
... In a recent study of 1,056 pregnant women in the third largest city in China, Tianjin, women expressed concern about the safety of exercise, with the most common reason given for not exercising during pregnancy being a fear of miscarriage [10] . Accordingly, only 11 % of pregnant Chinese women met the international recommended guidelines for physical activity during pregnancy [11] . Furthermore, 74 % of Chinese women reported reducing their physical activity as their pregnancy pro- gressed [10]. ...
Background
Despite the well-established benefits of exercise during pregnancy, many women remain inactive. This may be related, in part, to women’s beliefs about exercise in pregnancy, which are likely influenced by cultural background. Accordingly, the aim of this study was to compare attitudes, subjective norms, and perceived behavioural control toward exercise, together with current levels of exercise participation between Chinese and Australian women during pregnancy. A second aim was to determine the extent to which these factors predict intention to exercise within a Theory of Planned Behaviour framework.
Methods
Pregnant women (22 ± 2 weeks of gestation) living in China (n = 240) and Australia (n = 215) completed a questionnaire designed to assess a) maternal beliefs regarding the importance of exercise in relation to other health behaviours, b) attitudes, subjective norms, perceived behavioural control and intentions toward exercise, and c) current levels of physical activity. One-way analyses of variance were used to compare the demographics, maternal beliefs, attitudes, subjective norms, perceived behavioural control, intentions to exercise, and current physical activity levels between the Chinese and Australian samples. Structural equation modelling was used to determine which factors predicted intention to exercise in the two samples.
Results
Australian women reported higher levels of current exercise and intentions to exercise in the next four weeks of pregnancy compared with Chinese women. These observations were associated with higher instrumental attitudes, ratings of subjective norm, and perceived behavioural control toward exercise in the Australian women. Instrumental attitudes and perceived behavioural control predicted intention to exercise in the Australian women, while perceived behavioural control was the only predictor of intentions to exercise in the Chinese sample.
Conclusions
Beliefs, attitudes, barriers and intentions towards exercise during pregnancy differ between cultures. Understanding these differences may assist in the design of exercise interventions to maximise exercise adherence and lifelong physical activity patterns.
... Clinical guidelines encourage moderate exercise in pregnancy due to its multiple beneficial effects for both the mother and her offspring123. In long-term, women who continue to exercise during pregnancy appear to exercise at a higher intensity, deposit less body fat, improve fitness and have a lower cardiovascular risk profile than those who cease to exercise during pregnancy [4]. ...
Objective:
To investigate the effects of high intensity interval training (HIIT) on the maternal heart, fetuses and placentas of pregnant rats.
Methods:
Female Sprague-Dawley rats were randomly assigned to HIIT or sedentary control groups. The HIIT group was trained for 6 weeks with 10 bouts of high intensity uphill running on a treadmill for four minutes (at 85-90% of maximal oxygen consumption) for five days/week. After three weeks of HIIT, rats were mated. After six weeks (gestational day 20 in pregnant rats), echocardiography was performed to evaluate maternal cardiac function. Real-time PCR was performed for the quantification of gene expression, and oxidative stress and total antioxidant capacity was assessed in the tissue samples.
Results:
Maternal heart weight and systolic function were not affected by HIIT or pregnancy. In the maternal heart, expression of 11 of 22 genes related to cardiac remodeling was influenced by pregnancy but none by HIIT. Litter size, fetal weight and placental weight were not affected by HIIT. Total antioxidant capacity, malondialdehyde content, peroxidase and superoxide dismutase activity measured in the placenta, fetal heart and liver were not influenced by HIIT. HIIT reduced the expression of eNOS (p = 0.03), hypoxia-inducible factor 1α (p = 0.04) and glutathione peroxidase 4.2 (p = 0.02) in the fetal liver and increased the expression of vascular endothelial growth factor-β (p = 0.014), superoxide dismutase 1 (p = 0.001) and tissue inhibitor of metallopeptidase 3 (p = 0.049) in the fetal heart.
Conclusions:
Maternal cardiac function and gene expression was not affected by HIIT. Although HIIT did not affect fetal growth, level of oxidative stress and total antioxidant capacity in the fetal tissues, some genes related to oxidative stress were altered in the fetal heart and liver indicating that protective mechanisms may be activated.
... Our analysis shows that the current guidelines in different countries should be updated, as suggested also by other authors [12,67,69,70]. Much more practical guidance on exercise during pregnancy is contained in other publications, both in the form of scientific articles [40,52,62] and popular publications [26,27,75]. However, owing to the fact that they do not represent the official position of national or international obstetrics, gynecology, or sports medicine institutions, the scope and prevalence of their use may be limited. ...
Background: Regular physical activity during pregnancy has a positive effect on the psychophysical condition of the pregnant woman, pregnancy and fetal development, parturition and the postpartum period. However, its level in pregnant women is insufficient in most countries. For an exercise program to be effective it must take into account four training components: intensity, frequency, duration and its content - through a proper selection of the type of exercises and their technique. In this work we aimed to answer the question what information on the contents of prenatal exercises is provided in the current guidelines for exercise during pregnancy in different countries. Methods and Results: We have analyzed 11 documents, that were the official position of national obstetrics, gynecology, or sports medicine institutions from 7 countries. The guidelines provide little information on the contents of prenatal exercise and on the adaptation of sports activities to pregnancy. Conclusions: The guidelines for exercise in pregnancy should be updated based on high-quality research and in collaboration with practitioners in the field of prenatal physical activity, which could increase the chances of their implementation. Trustworthy and comprehensive guidelines created on the basis of international and interdisciplinary initiatives should be disseminated among all interested in prenatal physical activity: pregnant women and their families, obstetrics care providers and exercise professionals to enable them an effective cooperation and to globally promote exercise in pregnancy.
http://www.eurekaselect.com/134898
... Recommendations for exercise during pregnancy suggest that, in absence of medical and obstetric complications, pregnant women should aim to perform at least 30 minutes or more of moderate intensity physical activity daily, and/or exercise 3 -5 times weekly for a minimum of 15 - 30 minutes [1,2]. However, being pregnant is followed by increased body mass, as well as several changes in the musculoskeletal system, with possible subsequent pregnancy complaints [3] . ...
Background: To date, there is scant knowledge and inconsistent results about physical activity, exercise and job strain in relation to pelvic girdle pain (PGP). Hence, the aims of the present study were: 1) deter-mine prevalence of PGP and severe PGP during preg-nancy and 2) compare background and lifestyle fac-tors in addition to total physical activity level (at work, commuting, housework and recreational exer-cise) in those who experienced PGP and those who did not in pregnancy. Methods: Healthy pregnant wo-men (n = 467) were allocated to the study from Oslo University Hospital, Norway. The participants filled in a validated self-administered questionnaire, Physi-cal-Activity-Pregnancy-Questionnaire (PAPQ) in ges-tation-week 32 -36. The questionnaire contained 53 questions with nine specific questions addressing PGP. The key question on PGP was asked cross-section-ally and also posed retrospectively for pre-pregnancy, 1 st and 2 nd trimester (During this pregnancy, did you experience any PGP?) ("Yes versus No"). Results: More than half of the women (57.5%) reported to suf-fer from PGP, with 18.4% reporting severe PGP. Compared the no-PGP group, women with PGP were significantly more likely to be sick-listed, multipar-ous, they perceived their job to be physically demand-ing, as well as had physically demanding household chores, including childcare. In addition, they were more prone to have experienced PGP in previous pregnancies and suffered from urinary incontinence (UI) in the current pregnancy. Most women with se-vere PGP reported to be sedentary in the 3 rd trimes-ter; however they performed more strengthening ex-ercises at home than the women without PGP. Severe PGP also showed an association with standing/walk-ing ≥50% at work. Conclusion: Women who exer-cised regularly in the 3 rd trimester were less likely to report PGP, while job strain was associated with higher prevalence of PGP. There is a need for a pro-spective study with larger sample size to further eval-uate if exercise has any causal association with PGP.
Objective
Women are often advised to return to activity (RTA) as early as 6 weeks postpartum, despite undergoing significant physical, physiological and psychological changes. Our objective was to examine existing evidence and clinical practice guidelines to navigate a safe and successful RTA or return to sport (RTS) postpartum.
Methods
We searched CINAHL, Embase, Medline, PsycINFO and SPORTDiscus and included any secondary studies with recommendations or guidelines for RTA or RTS postpartum. Grey literature and primary sources were excluded. Four reviewers independently screened titles and abstracts, followed by full-text review for eligibility, with conflicts resolved by a third-party reviewer. One reviewer extracted data, which was cross-referenced by another reviewer.
Results
5851 studies were screened, and 33 were included in this scoping review. Most studies stated that RTS postpartum can begin once ‘medically safe’, around 6 weeks postpartum, but this term was generally left undefined. In addition, most studies recommended engaging in 150 min of moderate-vigorous physical activity per week after 6 weeks postpartum, but the type of exercise recommended was often non-specific.
Conclusion
A lack of consistent, evidence-based guidelines exist for RTA or RTS postpartum. Multiple evidence gaps require additional research to inform patient and activity specific guidelines for a safe and successful RTA or RTS postpartum.
Esta obra reúne información relevante y novedosa para el estudio de la actividad física durante la gestación y brinda los lineamientos necesarios para que los profesionales de las ciencias de la salud y los profesionales de las ciencias de la educación física y del deporte puedan promover la actividad física y prescribir y monitorear el ejercicio durante esta etapa del ciclo vital de la mujer. Los autores logran dar respuesta a un vacío conceptual y metodológico sobre la forma de promover la actividad física y el ejercicio, ya que durante muchos años se pensó que eran contraindicados durante la gestación.
Physical activity is associated with health benefits during pregnancy, delivery, and the postpartum period. The last three decades produced an increasing amount of scientific evidence on the positive effects of the prenatal physical activity on the maternal and fetal health, as well as in pregnancy outcomes. However, authors from different countries observe insufficient level of physical activity in pregnant women. The lack of information among women on the exercises during pregnancy, and lack of social support are two of the reasons hindering engagement in a prenatal exercise program. According to other studies, the knowledge of health benefits can lead to more favorable attitudes toward exercise during pregnancy, among women, exercise professionals, and healthcare providers. The purpose of this chapter is to review the information provided in the current guidelines for exercise during pregnancy in different countries, regarding the contents related to prenatal exercise programs. We analyzed the changes in recommendations over the past 4 years. Nowadays, experts emphasize the need to limit sedentary behaviors in pregnant women and to individualize exercise, departing from the total limitation of physical activity and bed rest even in complicated pregnancies. There is a more open approach to the continuation of vigorous sports activities during pregnancy by previously physically active women or female athletes.KeywordsGuidelinesExercisePhysical activityPregnancyPostpartum
Physical exercise should be part of an active lifestyle during pregnancy and the puerperium, as shown by growing evidence on its benefits for the health of pregnant women and newborns. Appropriate exercise testing and exercise prescription are needed to tailor effective and safe exercise programs. Exercise testing and prescription in pregnancy is the plan of exercise and fitness-related activities designed to meet the health and fitness goals and motivations of the pregnant woman. It should address the health-related fitness components and the pregnancy-specific conditions, based on previous health and exercise assessments, and take into account the body adaptations and the pregnancy-related symptoms of each stage of pregnancy, in order to provide safe and effective exercise. This chapter reviews the guidelines for exercise testing and prescription of pregnant women to be developed by exercise professionals, following the health screening and medical clearance for exercise by healthcare providers.KeywordsPregnancyPhysical activityExerciseHealth screeningPre-exercise evaluationExercise testingExercise prescriptionSafety
There are several guidelines supporting the benefits of exercising during pregnancy. Those documents contain very general recommendations on physical activity and exercise during pregnancy, such as general guidelines for health screening and prescription of aerobic exercise and strength training. They also include examples of safe physical activities during pregnancy, such as walking, running, swimming, stationary cycling, aerobics, modified yoga, and Pilates. However, those guidelines contain little information that exercise professionals could use when programming the contents of targeted exercise classes for pregnant women. This chapter addresses the steps for planning, conducting, and monitoring prenatal exercise classes, and explains how to select and adapt the exercises making them safe physical activities during pregnancy.KeywordsPregnancyExercisePhysical activityAerobicsResistanceFlexibilityFunctionalNeuromotorBalancePosturePelvic floor muscle trainingBreathingFitnessExercise planning
There are several guidelines supporting the benefits of exercising during pregnancy and postpartum. Scientific research conducted in the last decades has markedly changed the perception of prenatal physical activity, overlapping the conservative approach presented in the first publications. However, those guidelines contain very general recommendations on physical activity during the postpartum period and little information that exercise professionals could use when programming the contents of targeted exercise classes for early postpartum women. Regarding the physical adaptations that persist for several weeks after birth, the early postpartum period can be assumed as the “fourth trimester.” This chapter addresses the steps for planning, conducting, and monitoring early postpartum exercise classes, aiming to help women to resume exercise and sports practice in a transition stage to “normal” life.KeywordsPostpartumExercisePhysical activityFitnessExercise planning
Purpose : We aimed to determine the step-count validity of commonly used physical activity monitors for pregnancy overground walking and during free-living conditions. Methods : Participants ( n = 39, 12–38 weeks gestational age) completed six 100-step overground walking trials (three self-selected “normal pace”, three “brisk pace”) while wearing five physical activity monitors: Omron HJ-720 (OM), New Lifestyles 2000 (NL), Fitbit Flex (FF), ActiGraph Link (AG), and Modus StepWatch (SW). For each walking trial, monitor-recorded steps and criterion-measured steps were assessed. Participants also wore all activity monitors for an extended free-living period (72 hours), with the SW used as the criterion device. Mean absolute percent error (MAPE) was calculated for overground walking and free-living protocols and compared across monitors. Results : For overground walking, the OM, NL, and SW performed well (<5% MAPE) for normal and brisk pace walking trials, and also when trials were analyzed by actual speeds. The AG and FF had significantly greater MAPE for overground walking trials (11.9–14.7%). Trimester did affect device accuracy to some degree for the AG, FF, and SW, with error being lower in the third trimester compared to the second. For the free-living period, the OM, NL, AG, and FF significantly underestimated (>32% MAPE) actual steps taken per day as measured by the criterion SW ( M [ SD ] = 9,350 [3,910]). MAPE for the OM was particularly high (45.3%). Conclusion : The OM, NL, and SW monitors are valid measures for overground step-counting during pregnancy walking. However, the OM and NL significantly underestimate steps by second and third trimester pregnant women in free-living conditions.
There are several guidelines supporting the benefits of exercising during pregnancy. Those documents contain very general recommendations on physical activity and exercise during pregnancy, such as general guidelines for health screening and exercise prescription of aerobic exercise and strength training. They also include examples of safe physical activities during pregnancy, such as walking, running, swimming, stationary cycling, low-impact aerobics, modified yoga, and Pilates. However, those guidelines contain little information that exercise professionals could use when programming the contents of targeted exercise classes for pregnant women. This chapter addresses the steps for planning, conducting, and monitoring prenatal exercise classes and explains how to select and adapt the exercises regarding the suggested safe physical activities during pregnancy.
Physical exercise should be part of an active lifestyle during pregnancy and the puerperium, as shown by growing evidence on its benefits for the health of pregnant women and newborns. Appropriate exercise testing and exercise prescription are needed to tailor effective and safe exercise programs. Exercise testing and prescription in pregnancy is the plan of exercise and fitness-related activities designed to meet the health and fitness goals and motivations of the pregnant woman. It should address the health-related fitness components and the pregnancy-specific conditions, based on previous health and exercise assessments, and take into account the body adaptations and the pregnancy-related symptoms of each stage of pregnancy and postpartum, in order to provide safe and effective exercise. This chapter reviews the guidelines for exercise testing and prescription of pregnant and postpartum women to be developed by exercise professionals, following the health screening and medical clearance for exercise by healthcare providers.
Physical activity is associated with many health benefits during pregnancy, delivery, and the postpartum period. The last two decades produced an increasing amount of scientific evidence on the positive effects of the prenatal physical activity on the maternal and fetal health, as well as in pregnancy outcomes. However, authors from different countries observe insufficient level of physical activity in pregnant women. The lack of information among women on the exercises during pregnancy and lack of social support are two of the reasons hindering engagement in a prenatal exercise program. According to other studies, the knowledge of health benefits can lead to more favorable attitudes toward exercise during pregnancy, among women, exercise professionals, and healthcare providers. The purpose of this chapter is to review the information provided in the current guidelines for exercise during pregnancy in different countries, regarding the contents related to prenatal exercise programs.
Objective:
To evaluate the effect of regular exercise on maternal arterial blood pressure (BP) at rest and during uphill walking, in healthy former inactive pregnant women.
Methods:
A single-blind, single-center, randomized controlled trial including 61 out of 105 healthy, inactive nulliparous pregnant women, initially enrolled in a controlled trial studying the effect of 12 weeks of aerobic exercise (60 min 2/week) on maternal weight gain. Primary outcome was the mean adjusted difference in change in resting systolic and diastolic BP from baseline to after intervention. Secondary outcome was the mean adjusted difference in change in systolic BP during uphill treadmill walking at critical power. Measurements were performed prior to the intervention (gestation week 17.6 ± 4.2) and after the intervention (gestation week 36.5 ± 0.9).
Results:
At baseline, resting systolic and diastolic BP was 115/66 ± 12/7 and 115/67 ± 10/9 mmHg in the exercise (n = 35) and control group (n = 26), respectively. After the intervention, resting systolic BP was 112 ± 8 mmHg in the exercise group and 119 ± 14 mmHg in the control group, giving a between-group difference of 7.5 mmHg (95% CI 1.5 to 12.6, p = 0.013). Diastolic BP was 71 ± 9 and 76 ± 8 mmHg, with a between-group difference of 3.9 mmHg (95% CI -0.07 to 7.8, p = 0.054). During uphill treadmill walking at critical power, the between-group difference in systolic and diastolic BP was 5.9 mmHg (95% CI -4.4 to 16.1, p = 0.254) and 5.5 mmHg (95% CI -0.2 to 11.1, p = 0.059), respectively.
Conclusions:
Aerobic exercise reduced resting systolic BP in healthy former inactive pregnant women.
ABSTRACT:
Introduction: Changes develop in woman’s body after pregnancy and delivery, despite this is not pathological, woman should be back to normal balance as soon as possible. Postpartum exercise is quite important, since will keep woman healthy. Some of its main contributions are: physical and body balance recovery, personal image improvement, self awareness developing and stress reduction. We followed a bibliographycal review in order to develop a postpartum exercise program with newborn, which allowed to work with main muscular groups. This program has been included in Maternal Education Programs of Isabel II Health Center in Parla (Madrid) and Juan de la Cierva Health Center in Getafe (Madrid). Good success among women
Future lines: To quantify advantage of postnatal exercise programs with baby. To compare physical and psychical outcomes in postpartum programs with and without baby. To achieve home exercise program with baby.
Key words: Exercise; postpartum; newborn; postnatal
Objective:
To examine the effect of a prenatal lifestyle intervention on postpartum weight retention (PPWR).
Design:
Randomised controlled trial.
Setting:
Healthcare clinics in southern Norway.
Population:
Healthy, nulliparous women with body mass index ≥19 kg/m(2) , age ≥18 years, and singleton pregnancy of ≤20 gestational weeks.
Methods:
Women were randomised to intervention (dietary counselling twice by phone and access to twice-weekly exercise groups during pregnancy) or control group (standard prenatal care). Intervention compliance was defined post-factum as attending dietary counselling and ≥14 exercise classes.
Main outcome measures:
PPWR (weight measured postpartum minus self-reported pre-pregnancy weight) and the proportion of women returning to pre-pregnancy weight.
Results:
Of 606 women randomised, 591 were included in an intention-to-treat analysis of pregnancy outcomes and 391 (64.5%) were analysed 12 months postpartum. Mean PPWR was not significantly different between groups (0.66 kg for intervention versus 1.42 kg for control group, mean difference -0.77 kg, 95% CI -1.81, 0.28; P = 0.149). An increased proportion of intervention participants achieved pre-pregnancy weight (53% versus 43%, OR 1.50, 95% CI 1.003, 1.471; P = 0.045). However, the difference was not statistically significant when we adjusted for missing data (adjusted odds ratio (OR) 2.23, P = 0.067) using logistic mixed-effects models analysis. Women compliant with intervention had significantly lower PPWR than control participants, also after adjusting for potential confounders (adjusted mean diff -1.54 kg, 95% CI -3.02, -0.05; P = 0.039).
Conclusions:
The Norwegian Fit for Delivery intervention had little effect on PPWR, although women who were compliant with the intervention demonstrated significantly lower PPWR at 12 months.
Tweetable abstract:
Norwegian Fit for Delivery RCT: little effect of lifestyle intervention on weight retention 1 year postpartum.
OverviewPhysiological responses to exercise during pregnancyRisksBenefitsPotential preventive value of exerciseRecommendationsReferences
This article investigates the relationship between four major life events and stopping sport participation in young adulthood. We employ a neo-Weberian theoretical framework related to changes in temporal and social resources to explain how beginning to work, starting to live on one’s own, starting to cohabit or getting married, and the birth of one’s first child affect the risk to stop practising a sport and to end a sport club membership. We used detailed retrospective life-course data from the Dutch SportersMonitor 2010 on 3540 individuals to examine the sport careers and major life events of young adults (aged 18–35). Our event history analyses indicate that the risk to stop practising a sport increases when young adults begin to work, move out to live on their own, and start cohabiting or get married. The risk of ending a sport club membership rises when young adults start to live on their own and when they cohabit or get married. The birth of the first child increases the risks of both stopping a sport and ending club membership for young women, but not for young men.
Background
Exercise prescription for the obese pregnant womanExercise in the postpartum periodConclusions
References
Objective: Our purpose was to investigate the effects of our pregnancy rehabilitation program on pregnancy outcome, experience of labor and delivery of the mothers, low back pain and leg cramps experienced during pregnancy. Material and Method: We designed a clinical controlled trial. We prepared a pregnancy rehabilitation program that consists of counseling on pregnancy physiology and ergonomics, nutrition and preparation for labor and delivery in addition to the exercises. The exercise program was consisted of range of motion (ROM), stretching, posture, strengthening, breathing, Kegel's, relaxation and aerobic exercises. According to American College of Obstetricians and Gynecologists (ACOG) recommendations a total of 36 pregnant women were selected for this study. The pregnant women who could attend exercises three days a week constituted the exercise group (n=15), whereas those pregnants who could not participate in the exercises comprised the control group (n=21). Results: Frequency and severity of low back pain and weight gain were found to be less in the exercise group compared to the control group. The exercises affected the experience of the labor and delivery of the mothers in a better way. The other pregnancy outcome parameters were found similar in both groups. No adverse effects in the exercise group were noted both for the babies and for the mothers. Conclusion: Our pregnancy rehabilitation program seems to be safe for both pregnant women and their babies and to be effective for preventing low back pain and excessive weight gain during pregnancy. This program also seems to have positive effects on the experience of labor and delivery.
Background:
The prevalence of all pregnancies with some form of hypertension can be up to 10%, with the rates of diagnosis varying according to the country and population studied and the criteria used to establish the diagnosis. Pre-pregnancy obesity and excessive gestational weight gain (GWG) of all body mass index (BMI) categories have been associated with maternal hypertensive disorders and linked to macrosomia (>4,000g) and low birth weight (<2,500g). No large randomized control trial with high adherence to an exercise program has examined pregnancy-induced hypertension and these associated issues. We investigated whether women adherent (≥80% attendance) to an exercise program initiated early showed a reduction in pregnancy-induced hypertension and excessive GWG in all pre-pregnancy BMI categories, and determined if maternal exercise protected against macrosomia and low birth weight.
Objective:
To examine the impact of a program of supervised exercise throughout pregnancy on the incidence of pregnancy-induced hypertension.
Methods:
A randomized control trial was used. Women were randomized into an exercise group (EG; N=382) or a control group (CG; N=383) receiving standard care. The EG trained 3 days/week (50-55 minutes/session) from gestational weeks 9-11 until weeks 38-39. The 85 training sessions involved aerobic exercise, muscular strength, and flexibility.
Results:
High attendance to the exercise program regardless of BMI showed that pregnant women who did not exercise are 3 times more likely to develop hypertension [OR (95% CI) is 2.96 (1.29-6.81), p=0.01] and are 1.5 times more likely to gain excessive weight if they do not exercise [OR (95% CI) is 1.47 (1.06-2.03), p=0.02]. Pregnant women who do not exercise are also 2.5 times more likely to give birth to a macrosomic infant [OR (95% CI) is 2.53 (1.03-6.20); p=0.04].
Conclusions:
Maternal exercise may be a preventative tool for hypertension, excessive GWG and may control offspring size at birth while reducing co-morbidities related to chronic disease risk.
Historically, pregnancy was regarded as a state of confinement. More recently, however, research has demonstrated many potential health benefits of aerobic and strength-conditioning exercise in pregnancy and the postpartum period. It is now considered safe, and even advisable, for otherwise healthy pregnant women to initiate or continue an active lifestyle during pregnancy. Many anatomical and physiological changes take place during pregnancy and while there is no evidence to suggest that exercise in pregnancy is associated with any maternal or fetal adverse outcomes, it is prudent to adjust exercise regimes where necessary to avoid potential harm. Contact sports as well as sports associated with a risk of falling should be avoided. Brisk walking, stationary cycling, and swimming are examples of aerobic exercises that are recommended in pregnancy. It is advisable for all pregnant women wishing to pursue exercise in pregnancy to be screened for contra-indications and risk factors, and for subsequent recommendations to be made on an individual basis. It is useful to classify pregnant women into the sedentary, recreational, and competitive athlete, as this will help guide the intensity of exercise. All women should be aware of warning symptoms that may develop during physical activity, and advised to stop the exercise and seek medical advice should they occur. Exercise forms only one component of a healthy lifestyle. A nutritious diet, adequate hydration, and abstinence from smoking, alcohol and illicit drugs are crucial in maintaining optimal health during pregnancy.
Exercise during pregnancy has been a subject of debate and whether gestational physical activity profile affects birth weight is an important issue as birth weight is an indicator of fetal, neo-natal and post-natal mortality. This study was carried at three hospitals in Enugu, Eastern Nigeria to determine the difference between the birth weight of babies born to women who were physically active during pregnancy and those who were sedentary. In this retrospective cohort, gestational physical activity profile of women who gave birth to normal singleton babies through vaginal delivery and did not have any complication were collected with a modified general practice physical activity questionnaire (GPPAQ) enabling participants grouping into active and sedentary groups. Mean birth weight of both the physically active and sedentary groups was significantly higher than the WHO minimum standard birth weight of new born babies. However, no significant difference was found in the mean weight of babies of physically active women and their sedentary counterparts. The mean birth weight of babies in Enugu is significantly higher than the WHO minimum standard and more than halve of the pregnant women in Enugu metropolis are physically active during pregnancy irrespective of their educational qualification with primiparous more likely to be involved in physical activity than multiparous. There was no relationship between maternal physical/occupational activity and the birth weight of babies. An all-inclusive experimental study is needed to establish an effect response trend.
Introdução: Há poucas evidências entre a relação de parâmetros hemodinâmicos maternos e a escala de Borg, durante a prática de exercício físico. Objetivo: Avaliar a relação entre a escala de Borg e os padrões de frequência cardíaca materna e pressão arterial média em gestantes submetidas a exercício físico aeróbico. Métodos: Realizou-se um estudo transversal com gestantes hígidas, selecionadas por amostra de conveniência, submetidas a teste aeróbico progressivo em esteira; sendo avaliados a FC materna, a PAM e o nível de percepção de esforço durante o exercício físico proposto, até a fadiga voluntária. Resultados: A pressão arterial média teve aumento progressivo significativo até o nível de esforço cansativo (p=0,04); já a frequência cardíaca apresentou aumento gradativo, não significativo (p>0,05), em todos os níveis da referida escala. Conclusões: A escala de Borg em atividades com gestantes deve ser aplicada tendo, como limite superior, o nível relativamente fácil durante o programa de exercício.
Although the physiology of the heart and vascular system has not changed, there are many things we have learned and are still learning today. Research related to heart adaptations during pregnancy has been performed since the 1930s. Since the mid-1950s, researchers began to look at changes in the maternal cardiovascular system during exercise while pregnant. Research related to exercise during pregnancy and offspring heart development began and has continued since the 1970s. We will review the normal female cardiovascular system adaptations to pregnancy in general. Additionally, topics related to maternal cardiac adaptations to pregnancy during acute exercise, as well as the chronic conditioning response from exercise training will be explored. Since physical activity during pregnancy influences fetal development, the fetal cardiac development will be discussed in regards to acute and chronic maternal exercise. Similarly, the influence of various types of maternal exercise on acute and chronic fetal heart responses will be described. Briefly, the topics related to how and if there is maternal-fetal synchrony will be explained. Lastly, the developmental changes of the fetal cardiovascular system that persist after birth will be explored. Overall, the article will discuss maternal cardiac physiology related to changes with normal pregnancy, and exercise during pregnancy, as well as fetal cardiac physiology related to changes with normal development, and exercise during pregnancy as well as developmental changes in offspring after birth. © 2015 American Physiological Society. Compr Physiol 5:1325-1344, 2015.
Resumo: Objetivo: Apresentar evidências disponíveis na literatura científica sobre o efeito do exercício físico durante a gravidez sobre a gestante, o peso e a composição corporal do recém-nascido. Métodos: Foram utilizados artigos científicos das bases de dados LILACS, SciELO, MEDLINE e Cochrane. A busca considerou os descritores: exercício físico, gravidez, peso ao nascer e composição corporal. O critério adotado para inclusão foi a especificidade relativa ao tema, utilizando-se, preferencialmente, as publicações a partir de 2000. Publicações anteriores, consideradas relevantes, foram mantidas. Resultados: Embora haja relatos dos benefícios do exercício físico durante a gestação para a grávida, os efeitos sobre o feto permanecem inconclusivos, assim como também não é clara a frequência, intensidade e período de início mais adequado para sua prática. Conclusão: Apesar de algumas inconsistências, acredita-se que o exercício físico, sistematizado e moderado, além de trazer benefícios para a gestante, não causa danos comprovados para o feto. Abstract: Objective: Present available evidence in the scientific literature on the effect of physical exercise during pregnancy on the pregnant woman, and the newborn's weight and body composition. Methods: Were used scientific articles of LILACS, SciELO, MEDLINE and Cochrane basis. The search include the following descriptors: physical exercise, pregnancy, birth weight and body composition. The inclusion criterion used was the specificity relating to the theme, adopting, preferably, the publications from 2000. Publications prior to this period, considered relevant, were maintained. Results: Although there are reports of the benefits of physical exercise during pregnancy for the pregnant woman, the effects on the fetus remain inconclusive, as also is not clear the frequency, intensity and period of initiation most appropriate for their practice. Conclusion: Despite some inconsistencies, it is believed that the physical exercise, systematized and moderate, to bring benefits to the pregnant woman, beyond does not cause damage proven to the fetus.
To critically analyse the benefits of Pilates on health outcomes in women SEARCH TERMS: 'Pilates' and 'Pilates Method' DATA SOURCES: CINAHL, MEDLINE, PubMed, Science Direct, SPORTDiscus, PEDro, Cochrane Central Register of Controlled Trials, and Web of Science were searched up to July 2014 STUDY SELECTION: Published RCTs were included if they comprised female participants with a health condition and a health outcome was measured, Pilates needed to be administered and the manuscript was published in English in a peer-reviewed journal from 1980 to July 2014 DATA EXTRACTION: Two authors independently applied the inclusion criteria to potential studies. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. A best evidence grading system was employed to determine the strength of the evidence DATA SYNTHESIS: Thirteen studies met the inclusion criteria. PEDro scale values ranged from three to seven (mean, 4.5; median, 4.0), indicating a relatively low quality overall. In this sample, Pilates for breast cancer was most often trialled (n=2). The most frequent health outcomes investigated were pain, (n=4) quality of life, (n=4) and lower extremity endurance (n=2) with mixed results. Emerging evidence was found for reducing pain, and improving quality of life and lower extremity endurance CONCLUSIONS: There is a paucity of evidence on Pilates for improving women's health during pregnancy or for conditions including breast cancer, obesity or low back pain. Further high quality RCTs are warranted to determine the effectiveness of Pilates for improving women's health outcomes.
Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Evidence suggests physical activity often declines during pregnancy, however explanations for the decline are not well understood. The aim of this study was to identify modifiable barriers to leisure-time physical activity among women who did not meet physical activity guidelines during pregnancy.
Analyses were based on data from 133 mothers (~3-months postpartum) who were recruited from the Melbourne InFANT Extend study (2012/2013). Women completed a self-report survey at baseline in which they reported their leisure-time physical activity levels during pregnancy as well provided an open-ended written response regarding the key barriers that they perceived prevented them from meeting the physical activity guidelines during their pregnancy. Thematic analyses were conducted to identify key themes.
The qualitative data revealed six themes relating to the barriers of leisure-time physical activity during pregnancy. These included work-related factors (most commonly reported), tiredness, pregnancy-related symptoms, being active but not meeting the guidelines, lack of motivation, and a lack of knowledge of recommendations.
Considering work-related barriers were suggested to be key factors to preventing women from meeting the physical activity guidelines during pregnancy, workplace interventions aimed at providing time management skills along with supporting physical activity programs for pregnant workers should be considered. Such interventions should also incorporate knowledge and education components, providing advice for undertaking leisure-time physical activity during pregnancy.
Gestational diabetes mellitus (GDM) is on the rise globally. In view of the increasing prevalence of GDM and fetal and neonatal complications associated with it, there is a splurge of research in this field and management of GDM is undergoing a sea change. Trends are changing in prevention, screening, diagnosis, treatment and future follow up. There is emerging evidence regarding use of moderate exercise, probiotics and vitamin D in the prevention of GDM. Regarding treatment, newer insulin analogs like aspart, lispro and detemir are associated with better glycemic control than older insulins. Continuous glucose monitoring systems and continuous subcutaneous insulin systems may play a role in those who require higher doses of insulin for sugar control. Evidence exists that favors metformin as a safer alternative to insulin in view of good glycemic control and better perinatal outcomes. As the risk of developing GDM in subsequent pregnancies and also the risk of overt diabetes in later life is high, regular assessment of these women is required in future. Lifestyle interventions or metformin should be offered to women with a history of GDM who develop pre-diabetes. Further studies are required in the field of prevention of GDM for optimizing obstetric outcome.
Despite a rich literature in law and society embracing contracts as exchange relations, empirical work has yet to consider their emotional dimensions. I explore the previously unmapped case of surrogacy to address the interface of law and emotions in contracting. Using 115 semistructured interviews and content analyses of 30 surrogacy contracts, I explain why and how lawyers, with the help of matching agencies and counselors, tactically manage a variety of emotions in surrogates and intended parents before, during, and after the baby is born. I establish that a web of “feeling rules” concerning lifestyle, intimate contact, and future relationships are formalized in the contract, coupled with informal strategies like “triage,” to minimize attachment, conflicts, and risk amidst a highly unsettled and contested legal terrain. Feeling rules are shared and embraced by practitioners in an increasingly multijurisdictional field, thereby forging and legitimating new emotion cultures. Surrogacy offers a strategic site in which to investigate the legalization of emotion—a process that may be occurring throughout contemporary society in a variety of exchange relations.
Current US guidelines suggest that pregnant women should exercise regularly during pregnancy and we examined the neurodevelopment of the children whose mothers had taken that advice.
This Norwegian study included 188 children whose mothers had followed a structured exercise protocol and 148 control children whose mothers had not. Their cognitive, language, and motor skills were assessed at 18-months-of-age by the Bayley Scales of Infant Development-III and daily life functioning with the Ages and Stages Questionnaire.
No significant differences were found between the two groups. Subgroup analyses revealed that the children whose mothers had exercised had a slightly lower motor composite score (mean: 97.6, 95%CI: 96.0-99.2) than the control group (mean: 100.0, 95%CI: 98.6-101.5) (p = 0.03). Boys in the intervention group had lower fine motor scores (mean: 10.6, 95%CI: 10.3-11.0) than boys in the control group (mean: 11.5, 95%CI: 11.0-11.9) (p = 0.01).
Our main finding was that regular moderate exercise during pregnancy does not adversely affect neurodevelopment in children. The lower motor scores in the subgroup analyses are probably clinically insignificant, but the lower fine motor scores for boys in the intervention group warrant further research. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
In a study of 2387 employed women who had worked for more than three months of their pregnancy the data were extracted from a survey carried out on a national sample of births in France in 1981. Manual, service and shop workers had a higher preterm delivery rate than professional, administrative, or clerical workers. Assembly line work was associated with a higher preterm delivery rate even when production workers only were considered. Cumulated physically tiring working conditions--standing work, carrying of heavy loads, assembly line work, and considerable physical effort--were related to higher preterm delivery and low birthweight rate. During pregnancy, sickness absences were commoner when the working conditions were arduous. Changes in the working conditions were less clearly related to arduous work than sick leaves; they were not significantly more frequent for standing work or for assembly line work. Refusals from employers to grant favourable arrangements were more frequent when the working conditions were tiring and sick leaves were more common among women whose requests had been refused.
The retention of weight gained during pregnancy may contribute to obesity. Lactation should promote weight loss, but weight loss is highly variable among lactating women. The risks associated with the restriction of energy intake during lactation have not been adequately evaluated. The purpose of this study was to determine whether weight loss by women during lactation affects the growth of their infants.
We randomly assigned 40 breast-feeding women who were overweight (defined as a body-mass index [the weight in kilograms divided by the square of the height in meters] of 25 to 30) at 4 weeks post partum either to restrict their energy intake by 500 kcal per day and to exercise for 45 minutes per day for 4 days per week (the diet-and-exercise group) or to maintain their usual dietary intake and not exercise more than once per week for 10 weeks (the control group). We measured the weight and fat mass of the women and the weight and length of the infants before, during, and at the end of the study period.
The mean (+/-SD) energy intake decreased by 544+/-471 kcal per day in the diet-and-exercise group. As compared with the control group, the women in the diet-and-exercise group lost more weight (4.8+/-1.7 kg vs. 0.8+/-2.3 kg, P<0.001) and fat mass (4.0+/-2.0 kg vs. 0.3+/-1.8 kg, P<0.001). The gains in weight and length of the infants whose mothers were in the diet-and-exercise group (1925+/-500 g and 7.8+/-2.0 cm, respectively) were not significantly different from those of the infants whose mothers were in the control group (1861+/-576 g and 7.3+/-1.7 cm).
Weight loss of approximately 0.5 kg per week between 4 and 14 weeks post partum in overweight women who are exclusively breast-feeding does not affect the growth of their infants.
The purpose of the present investigation was to examine exercise patterns and psychological variables mediating a return to training and competition after pregnancy. Competitive female athletes who had given birth within the last 10 years completed surveys concerning (a) training patterns before, during, and after childbirth, (b) childbirth complications and training advice, (c) perceptions of success in their postpartum comebacks to training, and (d) self-efficacy, social support, and perceived barriers to training during pregnancy and after childbirth. Results indicated that women decreased both cardiovascular and resistance training during pregnancy. Additionally, training efforts during pregnancy were independent of those during the pre- and postpartum periods. This finding suggests that athletes may be able to alter their training patterns during pregnancy without a significant impact on their postpartum training program.
The physiologic and morphologic changes of pregnancy may interfere with the ability to engage safely in some forms of physical activity. A woman's overall health, including obstetric and medical risks, should be evaluated before prescribing an exercise program. Generally, participation in a wide range of recreational activities appears to be safe during pregnancy; however, each sport should be reviewed individually for its potential risk, and activities with a high risk of abdominal trauma should be avoided during pregnancy. Scuba diving also should be avoided throughout pregnancy because the fetus is at an increased risk for decompression sickness during this activity. In the absence of either medical or obstetric complications, 30 minutes or more of moderate exercise a day on most, if not all, days of the week is recommended for pregnant women.
Few population-based data exist that describe leisure-time physical activity among pregnant women. The purpose of this study was to characterise the prevalence of leisure activity and to examine characteristics associated with participation in leisure activity during pregnancy. Using data collected from the year 2000 Behavioral Risk Factor Surveillance System, information on leisure activity was collected during telephone interviews from 1979 pregnant women and 44,657 non-pregnant women 18-44 years of age, representative of the US population. The prevalence of any leisure activity in the past month was 65.6%, 95% confidence interval [95% CI] 62.0, 69.1, among pregnant women and 73.1% [95% CI 72.4, 73.9] among non-pregnant women. The prevalence of recommended activity was also lower among pregnant women than non-pregnant women (15.8% vs. 26.1%). The most common leisure activity for pregnant women was walking, followed by activities such as swimming laps, weight lifting, gardening, and aerobics. Among pregnant women, any leisure activity was significantly higher for those with higher education, younger age, and excellent or very good health than for those with fair or poor health. Pregnant women reported less leisure activity than non-pregnant women of the same age. Studies to understand the enablers and barriers to participating in leisure activity during pregnancy are needed.
Ahlborg Jr, G (Ōrebro Medical Center Hospital, Department of Occupational Medicine, Ōrebro, Sweden), Bodin L and Hogstedt C. Heavy lifting during pregnancy—A hazard to the fetus? A prospective study. International Journal of Epidemiology 1990, 19: 90–97.
The influence of heavy lifting during pregnancy on gestational age, birthweight and the risk of fetal death (spontaneous abortion or stillbirth) was investigated in a prospective study of 3906 occupationally active women. Information on exposure was collected at the women's first contact with the antenatal care centres in Ōrebro County from October 1980 to June 1983. Logistic and linear regression were used to analyse the data, allowing for several non-occupational factors in the models. Women who reported heavy lifting did not have in general more unfavourable outcomes than other women, although the risk estimates varied between different occupational categories. Lifting of weights ≥12 kg more than 50 times per week increased the risk of pre-term birth (<37 weeks of gestation—odds ratio 1.7), but only among women who stopped working before the 32nd week of pregnancy. Unfavourable outcomes were more common among those who reported chemical exposure during pregnancy. The preventive routines and regulations in Sweden may have helped to reduce possible risks from heavy lifting during pregnancy.
The purpose of this study was to compare maternal cardiopulmonary and fetal responses of lowlander pregnant women in the third trimester to exercise at sea level and at an altitude of 6000 feet.
Seven women at 33.86 +/- 1 weeks' gestation performed a symptom-limited maximal exercise test and a submaximal cardiac output exercise test at sea level at an altitude of 6000 feet. Cardiopulmonary and metabolic variables were measured and compared at sea level and altitude.
Maximal oxygen consumption and work levels were limited by short-term altitude exposure. Ventilatory variables were not significantly influenced by altitude exposure. During submaximal exercise no alteration in exercise efficiency or response was seen for most of the variables when altitude and sea level data were compared. Both cardiac output and stroke volume were elevated at altitude at rest but not during exercise, suggesting a lower reserve for both variables at altitude. Level of plasma glucose, lactate, norepinephrine, and epinephrine were not significantly influenced by altitude exposure. Fetal heart rate responses did not differ between the sea level and altitude conditions.
Lowlander pregnant women in the third trimester have some limitations to maximal aerobic capacity but not submaximal exercise on short-term altitude exposure. No ominous fetal responses have been observed during this study. The results suggest that pregnant women may engage in at least brief moderate exercise bouts at moderate altitude without adverse consequences.
As the opportunities for women to compete in elite sports competition increase, it is inevitable that pregnancy will occur during training and competition. The effect of the high-intensity exercise needed to compete at the elite level will be found in anatomic changes such as ligament relaxation, change in posture, and increased weight. These will all detract from the ability to attain peak performance. The effect of the high-intensity training on the athlete and the fetus must also be considered. The physiological and metabolic changes will have a variable effect; however, awarenees of these changes should prevent problems. There is some evidence suggesting an increase in low birthweight infants but no evidence of preterm birth. Unfortunately, much of our information is based on limited studies, so caution and careful evaluation are essential.
The purpose of this investigation was to determine heart rate (HR)/oxygen consumption (VO2) calibration curves for exercising and sedentary women during pregnancy and the postpartum periods.
Fifty-two women were studied at three time points: 20 wk gestation, 32 wk gestation, and 12 wk postpartum. Subjects were grouped either as regular exercisers (N = 27) or sedentary controls (N = 25). At each time point, each woman had HR and VO2 measured at rest (lying, seated, and standing) as well as during steady-state treadmill exercise performed at three increasing intensities. Flex HRs were defined and calculated by averaging the value seen during the lowest exercise intensity and highest value during rest. Individual HR/VO2 calibration curves were generated for exercise at each time point. Statistical analyses of all dependent variables included comparisons of subject groups (exercise and sedentary) and pregnancy status (20 wk, 32 wk, and 12 wk postpartum).
Resting VO2 (mL.kg-1.min-1) was approximately 6.5% greater during pregnancy compared with postpartum conditions (P < 0.005). Also, both resting and flex HRs were greater during pregnancy compared with postpartum (P < 0.01). Resting HR was lower in exercising women compared with sedentary controls at all time points (P < 0.01). Slopes of HR/VO2 regression curves were flatter during pregnancy (P < 0.005), but there was no difference between groups. Y-intercepts were less at 20 wk compared with 36 wk postpartum.
A woman's HR, VO2, and the relationship between these two parameters are altered during pregnancy. Change in slope of HR/VO2 regression curves indicates less energy expenditure at a given HR as pregnancy progresses, compared with postpartum conditions. A woman's true energy expenditure would be overestimated at rest, and underestimated during physical activity, if these physiological changes are not taken into account.
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This review covers the impact of breastfeeding on maternal postpartum weight loss and micronutrient status. Results regarding the impact on weight loss have been conflicting. This may be due to differences in study quality. Of six observational studies in which postpartum weight change was estimated (rather than measured directly), only one showed an association with breastfeeding. By contrast, six of the seven studies in which postpartum weight change was measured showed greater weight or fat loss in women who breastfed longer, particularly at 3 to 6 months postpartum. The results of the higher quality studies are consistent with two experimental studies conducted in Honduras, which demonstrated that the degree of breastfeeding affects the rate of weight loss. Thus, it appears that breastfeeding does enhance the rate of weight loss postpartum, but the effect is relatively small and may not be detectable in studies that lack adequate statistical power, have imprecise data on postpartum weight change, or do not account for the exclusivity and/or duration of breastfeeding. There is very little information with regard to micronutrient status during lactation. Nutrient requirements for vitamins A, B6, and C, and for iodine and zinc are increased by more than 50%, but lactation may actually be protective against maternal iron deficiency. More research is needed on the effects of lactation on maternal nutritional status and on strategies for optimizing nutrient intake to meet the needs of both the mother and her infant.
The objective was to examine the pregnancy-related changes in physical activity, fitness, and strength in women of varying body mass indices (BMI).
Women (N = 17 low BMI, N = 34 normal BMI, and N = 12 high BMI, mean age +/- SD = 30.7 +/- 4.1 yr) were studied before pregnancy (0 wk) and postpartum (6 and 27 wk) for body composition and for physical activity, fitness, and strength. Physical activity was assessed by questionnaire, fitness by a maximal oxygen consumption (VO2) test on a cycle ergometer, and strength by the one-repetition maximum test. Data were analyzed by repeated measures ANOVA testing for time and BMI group.
Total physical activity differed qualitatively, but not quantitatively, with time. Significant time effects were observed for maximal workload, heart rate, respiration rate, ventilation, VO2, respiratory exchange ratio, and strength. VO2max, adjusted for weight, dropped by approximately 385 mL x min(-1) from 0 to 6 wk postpartum (P < 0.0001) and by approximately 234 mL x min(-1) from 0 to 27 wk postpartum (P < 0.01). The high-BMI group had a lower VO2max (adjusted for weight or fat-free mass) than the normal-BMI group (P < 0.05). Strength decreased for the leg press by 24% (P < 0.02) and for the latissimus pull down by 8% (P < 0.01) from 0 to 6 wk postpartum, and then increased by 44 and 12%, respectively (both P < 0.05), by 27 wk postpartum.
Relative to prepregnancy performance, fitness and strength declined in the early postpartum period but improved by 27 wk postpartum.