No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
Resistance Training During Pregnancy: Safe and Effective Program Design
Abstract
A REGIMENTED PROGRAM OF RESISTANCE TRAINING CAN PROVIDE A MULTITUDE OF BENEFITS FOR THE PREGNANT WOMAN. HOWEVER, A WOMAN UNDERGOES SIGNIFICANT PHYSIOLOGICAL AND MORPHOLOGICAL CHANGES THROUGHOUT THE TERM, AND THESE ISSUES NEED TO BE TAKEN INTO ACCOUNT WHEN DESIGNING A ROUTINE. THEREFORE, THE PURPOSE OF THIS PAPER WILL BE 3-FOLD: (A) REVIEW THE BENEFITS OF MATERNAL RESISTANCE EXERCISE, (B) DISCUSS ITS SAFETY, AND (C) OUTLINE A SPECIFIC RESISTANCE TRAINING PROTOCOL BASED ON THE CURRENT RESEARCH AND PRACTICAL EXPERIENCE TO ENSURE A SAFE, EFFECTIVE MATERNAL WORKOUT EXPERIENCE. SAMPLE ROUTINES WILL BE PROVIDED TO ILLUSTRATE PROGRAM DESIGN.
... Uma outra alteração fisiológica que deve ser considerada na elaboração de programa de exercícios, é o aumento do hormônio relaxina, que promove frouxidão dos ligamentos, podendo levar a instabilidade articular. Isto pode aumentar o risco de lesões articulares, e portanto, devese evitar exercícios de flexibilidade mais intensos, movimentos balísticos e/ou pliométricos (SCHOENFELD, 2011). ...
... Por exemplo, durante o primeiro trimestre é comum a ocorrência de vômitos, náuseas, fadiga excessiva, e estes fatores interferem na habilidade da mulher em realizar exercícios. Desta forma, a intensidade e duração devem ser modificadas sempre que necessário a fim de garantir a segurança e a adesão ao exercício (SCHOENFELD, 2011). ...
Esta obra reúne um conjunto de treze trabalhos que, embora
possua capítulos com temáticas um pouco distintas, se aproximam pela
relação direta ou indireta que expressam com o universo da Educação
Física. Trata-se de uma coletânea que conta com a colaboração de pesquisadores do Brasil e de Portugal, que possuem compreensões muito
pertinentes e que merecem ser compartilhadas sobre a Educação Física, a
Infância e a Saúde, bem como aos temas que a eles se articulam.
A coletânea foi organizada e publicada de maneira a dar continuidade às discussões compartilhadas em sua primeira edição, publicada em
versões eletrônica e digital no início do ano de 2020, também pela Editora Navegando. Esta nova obra pretende, por um lado, apresentar conceitos e discutir aspectos sobre “Educação Física, Infância e Saúde”, e, por
outro lado, almeja contribuir com reflexões e problematizações sobre assuntos que permeiam o mundo, sobremaneira, da ciência, do conhecimento, da educação, da cultura midiática, das subjetividades, do exercício
físico, do pilates, da saúde pública, do jogo, do brincar, do currículo, da
dança, da nutrição, da infância, e outros, como terão a oportunidade de
verificar nas entrelinhas dos capítulos.
Espero que este livro contribua em várias dimensões com o processo de construção e circulação do conhecimento e, por fim, desejo que
ocorra uma estreita relação entre o leitor e as palavras escritas cuidadosamente pelos autores, de maneira a provocar boas reflexões e debates necessários para o avanço da nossa área. Boa leitura
... Strength training is considered appropriate, but it should be very light, or exercises should be isolated (Schoenfeld, 2011). ...
High-intensity functional training (HIFT) is a popular activity that combines high effort and compound exercises. Many women aged 20 to 40 who are expected to become pregnant soon are also fond on it. HIFT is an activity in which the heart rate increases significantly, there is an increase in intra-abdominal pressure, free weights are also used. There is poor evidence of HIFT and its effect on pregnancy or childbirth. The subject of this case study was a healthy woman (31 years old) who has long term experience with HIFT. The aim of the study was to analyze training regime (length, intensity, heart rate) and number of steps in the period from the 1st to the 38th week. The effect on the health of the mother and the fetus, the delivery and the birth weight were monitored. The findings show that with an optimally set training program, HIFT can be a safe activity that has no adverse effect on pregnancy, fetal health or childbirth. This is the first such study, so further research is needed.
... One session of yoga can improve stress and anxiety, but regular yoga practice may be even more beneficial; Newham et al. found anxiety scores decreased following an eight-week yoga program [23]. Beyond this, the physical aspect of yoga can help pregnant women maintain and/or improve physical fitness, which can help them accommodate the increase in weight and shift in center of gravity as pregnancy progresses [24][25][26][27]. Prenatal yoga also benefits developmental and birth outcomes for the fetus [20,28]. ...
Studies have demonstrated that new and expectant mothers experience increased levels of stress and anxiety during the COVID-19 pandemic. Though prenatal yoga is an effective mode of improving mental health during pregnancy, no research has evaluated its effect on mental health during times of extreme stress, such as a global pandemic. The purpose of this study was to determine the influence of a single session and a 10-week prenatal yoga intervention on the mental health of pregnant women during the COVID-19 pandemic. Women (n = 19; 28.52 ± 3.74 years; 20.94 ± 4.69 weeks gestation; BMI 29.33 ± 9.08) were randomized into a yoga or a non-yoga control group. There were no differences in demographic factors or depression/anxiety scores between groups at baseline. Baseline levels of anxiety and depression were high, with an average depression score of 8.10 ± 4.85 (scores > 8 represent possible depression) and an average anxiety score of 39.26 ± 12.99 (scores > 39 represent a clinically significant anxiety). After just one session of yoga, women reported feeling less depressed (p = 0.028), tense (p < 0.001), and fatigued (p = 0.004). After 10 weeks, the yoga group had lower anxiety (p = 0.002), depression (p = 0.032), and total mood disturbance (p = 0.002) scores when compared to the control group. Yoga appears to benefit the mental health of expectant mothers, even in times of extreme stress. The findings of this study provide clinicians with valuable information regarding alternative exercise options for mental health during pregnancy during the COVID-19 pandemic.
... Table 2 provides a summary of sports, exercises, training methods and athlete considerations during the preconception and antenatal period. Although Table 2 includes a large body of research, 1,8,9,18,28,38,43,44,47,53,55,57 research specifically for antenatal sportswomen and practitioners is still emerging. ...
... Uma outra alteração fisiológica que deve ser considerada na elaboração de programa de exercícios, é o aumento do hormônio relaxina, que promove frouxidão dos ligamentos, podendo levar a instabilidade articular. Isto pode aumentar o risco de lesões articulares, e portanto, devese evitar exercícios de flexibilidade mais intensos, movimentos balísticos e/ou pliométricos (SCHOENFELD, 2011). ...
... Regular safe physical exercises are positively indicated for fetal growth 79 and favorable long-term health effects. 80 They also reduce the risk of inadequate birth weight, 81 achieve better maternal and fetal emotional states, 82,83 shorten labor and hospital stays, 84 and decrease pregnancy-related lumbopelvic pain. 85 Recently, guided yoga programs for pregnant women have become prevalent, which is conducive to utero-fetalplacental circulation 86 and improvements in labor and birth outcomes. ...
Despite the fact that Taijiao (traditional Chinese eugenics) has been part of the Chinese obstetrical culture
over the years, there is insufficient scientific evidence for its effectiveness. This literature review analyzes
the discourse on Taijiao associated with physical and psychological maternalefetal symbiosis, together
with relevant peripheral research outcomes. Taijiao combines maternal health and external environment
for benefits in fetal growth through preventive, indirect, and direct measures. Discussing practical implications
and future research directions, this review reveals a modernized Taijiao to be a holistic, noninvasive
pregnancy management system using a multi-disciplinary approach that enhances infantile life quality, reduces negative consequences of pregnancy deficits and child development, and saves public
health expenditure.
... Regular safe physical exercises are positively indicated for fetal growth 79 and favorable long-term health effects. 80 They also reduce the risk of inadequate birth weight, 81 achieve better maternal and fetal emotional states, 82,83 shorten labor and hospital stays, 84 and decrease pregnancy-related lumbopelvic pain. 85 Recently, guided yoga programs for pregnant women have become prevalent, which is conducive to utero-fetalplacental circulation 86 and improvements in labor and birth outcomes. ...
Despite the fact that Taijiao (fetal/embryonic education) has been part of the Chinese obstetrical culture over the years, there is insufficient scientific evidence for its effectiveness. This literature review analyzes the discourse on Taijiao associated with physical and psychological maternal-fetal symbiosis, together with relevant peripheral research outcomes. Taijiao combines maternal health and external environment for benefits in fetal growth through preventive, indirect, and direct measures. Discussing practical implications and future research directions, this review reveals a modernized Taijiao to be a holistic, non-invasive pregnancy management system using a multi-disciplinary approach that enhances infantile life quality, reduces negative consequences of pregnancy deficits and child development, and saves public health expenditure.
Gestational hypertension can lead to fetal complications, and, if untreated, high blood pressure during pregnancy may cause eclampsia and even death in the mother and fetus. Exercise is a strategy for preventing blood pressure disorders. There is little knowledge about the physiological impacts of different physical types of training on blood pressure during pregnancy. For that, this meta-analysis aimed to compare the effects of different physical exercise modalities (i.e., aerobic training—AT, strength training—ST, and combined training—AT + ST) on systolic blood pressure (SBP) and diastolic blood pressure (DBP) of pregnant women. A search was performed on PUBMED, LILACS, CINAHL, Sport discus, EMBASE, SCOPUS, and Cochrane Central Register of Controlled Trials to identify researchers. From 3,450 studies, 20 and 19 were included in the qualitative and quantitative analyses. AT studies presented a medium effect size (ES) on SBP [−0.29 (−2.95 to 2.36) p = 0.83], with substantial heterogeneity (I ² = 64%), and had a large impact on DBP [−1.34 (−2.98 to 0.30) p = 0.11], with moderate heterogeneity (I ² = 30%). ST researchers showed a large ES on SBP [−1.09 (−3.66 to 1.49) p = 0.41], with a reduced heterogeneity (I ² = 0%), and a medium ES on DBP [−0.26 (−2.77 to 2.19) p = 0.83] with moderate heterogeneity (I ² = 38%). AT + ST studies had a large ES on SBP [−1.69 (−3.88 to 0.49) p = 0.13] and DBP [−01.29 (−2.26 to 0.31) p = 0.01] with considerable (I ² = 83%) and moderate heterogeneity (I ² = 47%), respectively. These findings are essential for developing new research protocols to avoid gestational hypertension and preeclampsia. AT + ST had a large impact on the SBP and DBP reduction; however, there is a need for more similar procedures to reduce heterogeneity between studies, promoting consensual results.
Systematic Review Registration: [ PROSPERO ], identifier [CRD42021256509].
Kehamilan merupakan periode penting dalam kehidupan wanita. Selama kehamilan terjadi perubahan secara psikologis dan fisiologis. Untuk tetap mejaga kebugaran, ibu hamil harus merawat diri dengan melakukan latihan fisik secara teratur. Pelaksanaan senam hamil juga masih terbatas karena kurangnya informasi mengenai manfaat senam hamil. Tujuan dalam pengabdian masyarakat ini adalah melatih kader binaan puskesmas Pegandon gerakan senam hamil sehingga mampu mejadi pelatih senam hamil yang ada di masyarakat. Metode yang digunakan dalam pengabdain masyarakat ini adalah ceramah, diskusi dan partisipatif. Kegiatan ini berlangsung pada Bulan Juni 2019, pada 20 kader kesehatan dan 20 ibu hamil. Hasil pengabdian masyarakat didapatkan 20 kader telah memiliki kompetensi untuk membimbing ibu hamil dalam melakukan senam hamil. Gerakan senam hamil yang diajarkan yaitu pada Trimester 1, 2 3 meliputi gerakan pemanasan, peregangan, gerakan inti dan pendinginan. Kesimpulan dari pengabdian masyarakat ini adalah pelatihan ini bermanfaat, kader yang berada di masyarakat dan menjadi partner bidan dapat mengaplikasikan dan membantu ibu hamilPregnancy is an important period in women’s life. During pregnancy occur physicologycal and Physiological changes. To maintenance the fitness, pregnant women should take care their self by doing physical activity regularly. Aim of this activity is to train the cadres in Pegandon Public Health community about pregnancy exercise so that they can guide the pregnant women in community. Methods in this activity are counseling, discussion and partisipative methods. This activity took place in June 2019, with 20 health cadres and 20 pregnant womens. The results of community service found that 20 cadres had the competence to guide pregnant women in doing pregnancy exercises. Pregnancy exercise movements that are taught are in Trimester 1, 2, 3 including warming up, stretching, core movements and cooling down. The conclusion of this community service is that this training is useful, cadres who are in the community and become partners of midwives can apply and help pregnant women.
Pregnancy is a special and empowering time for women as well as an appropriate time to reassess lifestyle choices and adopt positive lifestyle changes. The female body undergoes many metabolic, biochemical, and physiologic changes during pregnancy that may affect a woman’s ability and willingness to exercise. The pelvic floor, in particular, experiences a unique combination of stressors that affect its form and function. Current research suggests that light and even moderate intensity endurance and strength training are appropriate to continue, or even commence, during healthy pregnancies without adverse outcomes for mother or child while high-intensity training and supine exercise should be avoided in second and third trimesters. Specific exercises to maintain the health and function of the pelvic floor may also be recommended during and after pregnancy. It is important to be aware that many pregnant women are not meeting exercise recommendations and/or may not have access to adequate information to maintain satisfactory physical health and function during and after pregnancy. Thus both health care and exercise professionals should be aware of the benefits and potential contraindications to exercise participation in pregnant women as well as the current evidence-based recommendations for exercise prescription in pregnant women.
The present chapter deals with the effect of exercise and nutrition intervention for female fertility. It addresses the evidence-based recommendations on exercise training and a physically active lifestyle approach to improving health and fertility. Furthermore, it addresses the critically important issue of the role of sound nutrition practices with regards to macro and micronutrients intake considered important for optimal fertility. While not a primary focus, elements of these points relative to pregnancy are briefly addressed. Other common aspects of daily life, like the exposure to endocrine disruptors, substances that interfere with the proper functioning of the hormonal system, and therefore may alter human reproductive potential, are also addressed.
Background
More than two-thirds of pregnant women experience low-back pain and almost one-fifth experience pelvic pain. The two conditions may occur separately or together (low-back and pelvic pain) and typically increase with advancing pregnancy, interfering with work, daily activities and sleep.
Objectives
To update the evidence assessing the effects of any intervention used to prevent and treat low-back pain, pelvic pain or both during pregnancy.
Search methods
We searched the Cochrane Pregnancy and Childbirth (to 19 January 2015), and the Cochrane Back Review Groups' (to 19 January 2015) Trials Registers, identified relevant studies and reviews and checked their reference lists.
Selection criteria
Randomised controlled trials (RCTs) of any treatment, or combination of treatments, to prevent or reduce the incidence or severity of low-back pain, pelvic pain or both, related functional disability, sick leave and adverse effects during pregnancy.
Data collection and analysis
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.
Main results
We included 34 RCTs examining 5121 pregnant women, aged 16 to 45 years and, when reported, from 12 to 38 weeks’ gestation. Fifteen RCTs examined women with low-back pain (participants = 1847); six examined pelvic pain (participants = 889); and 13 examined women with both low-back and pelvic pain (participants = 2385). Two studies also investigated low-back pain prevention and four, low-back and pelvic pain prevention. Diagnoses ranged from self-reported symptoms to clinicians’ interpretation of specific tests. All interventions were added to usual prenatal care and, unless noted, were compared with usual prenatal care. The quality of the evidence ranged from moderate to low, raising concerns about the confidence we could put in the estimates of effect.
For low-back pain
Results from meta-analyses provided low-quality evidence (study design limitations, inconsistency) that any land-based exercise significantly reduced pain (standardised mean difference (SMD) -0.64; 95% confidence interval (CI) -1.03 to -0.25; participants = 645; studies = seven) and functional disability (SMD -0.56; 95% CI -0.89 to -0.23; participants = 146; studies = two). Low-quality evidence (study design limitations, imprecision) also suggested no significant differences in the number of women reporting low-back pain between group exercise, added to information about managing pain, versus usual prenatal care (risk ratio (RR) 0.97; 95% CI 0.80 to 1.17; participants = 374; studies = two).
For pelvic pain
Results from a meta-analysis provided low-quality evidence (study design limitations, imprecision) of no significant difference in the number of women reporting pelvic pain between group exercise, added to information about managing pain, and usual prenatal care (RR 0.97; 95% CI 0.77 to 1.23; participants = 374; studies = two).
For low-back and pelvic pain
Results from meta-analyses provided moderate-quality evidence (study design limitations) that: an eight- to 12-week exercise program reduced the number of women who reported low-back and pelvic pain (RR 0.66; 95% CI 0.45 to 0.97; participants = 1176; studies = four); land-based exercise, in a variety of formats, significantly reduced low-back and pelvic pain-related sick leave (RR 0.76; 95% CI 0.62 to 0.94; participants = 1062; studies = two).
The results from a number of individual studies, incorporating various other interventions, could not be pooled due to clinical heterogeneity. There was moderate-quality evidence (study design limitations or imprecision) from individual studies suggesting that osteomanipulative therapy significantly reduced low-back pain and functional disability, and acupuncture or craniosacral therapy improved pelvic pain more than usual prenatal care. Evidence from individual studies was largely of low quality (study design limitations, imprecision), and suggested that pain and functional disability, but not sick leave, were significantly reduced following a multi-modal intervention (manual therapy, exercise and education) for low-back and pelvic pain.
When reported, adverse effects were minor and transient.
Authors' conclusions
There is low-quality evidence that exercise (any exercise on land or in water), may reduce pregnancy-related low-back pain and moderate- to low-quality evidence suggesting that any exercise improves functional disability and reduces sick leave more than usual prenatal care. Evidence from single studies suggests that acupuncture or craniosacral therapy improves pregnancy-related pelvic pain, and osteomanipulative therapy or a multi-modal intervention (manual therapy, exercise and education) may also be of benefit.
Clinical heterogeneity precluded pooling of results in many cases. Statistical heterogeneity was substantial in all but three meta-analyses, which did not improve following sensitivity analyses. Publication bias and selective reporting cannot be ruled out.
Further evidence is very likely to have an important impact on our confidence in the estimates of effect and change the estimates. Studies would benefit from the introduction of an agreed classification system that can be used to categorise women according to their presenting symptoms, so that treatment can be tailored accordingly.
More than two-thirds of pregnant women experience low-back pain (LBP) and almost one-fifth experience pelvic pain. Pain increases with advancing pregnancy and interferes with work, daily activities and sleep.
To assess the effects of interventions for preventing and treating pelvic and back pain in pregnancy.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (18 July 2012), identified related studies and reviews from the Cochrane Back Review Group search strategy to July 2012, and checked reference lists from identified reviews and studies.
Randomised controlled trials (RCTs) of any treatment to prevent or reduce the incidence or severity of pelvic or back pain in pregnancy.
Two review authors independently assessed risk of bias and extracted data. Quality of the evidence for outcomes was assessed using the five criteria outlined by the GRADE Working Group.
We included 26 randomised trials examining 4093 pregnant women in this updated review. Eleven trials examined LBP (N = 1312), four examined pelvic pain (N = 661), and 11 trials examined lumbo-pelvic (LBP and pelvic) pain (N = 2120). Diagnoses ranged from self-reported symptoms to the results of specific tests. All interventions were added to usual prenatal care and unless noted, were compared to usual prenatal care. For LBP, there was low-quality evidence that in general, the addition of exercise significantly reduced pain (standardised mean difference (SMD) -0.80; 95% confidence interval (CI) -1.07 to -0.53; six RCTs, N = 543), and disability (SMD -0.56; 95% CI -0.89 to -0.23; two RCTs, N = 146); and water-based exercise significantly reduced LBP-related sick leave (risk ratio (RR) 0.40; 95% CI 0.17 to 0.92; one RCT, N = 241). Low-quality evidence from single trials suggested no significant difference in pain or function between two types of pelvic support belt, between osteopathic manipulation (OMT) and usual care or sham ultrasound (sham US). Very low-quality evidence suggested that a specially-designed pillow may relieve night pain better than a regular pillow. For pelvic pain, there was moderate-quality evidence that acupuncture significantly reduced evening pain better than exercise; both were better than usual care. Low-quality evidence from single trials suggested that adding a rigid belt to exercise improved average pain but not function; acupuncture was significantly better than sham acupuncture for improving evening pain and function, but not average pain; and evening pain relief was the same following either deep or superficial acupuncture. For lumbo-pelvic pain, there was moderate-quality evidence that an eight- to 20-week exercise program reduced the risk of women reporting lumbo-pelvic pain (RR 0.85; 95% CI 0.73 to 1.00; four RCTs, N = 1344); but a 16- to 20-week training program was no more successful than usual care at preventing pelvic pain (one RCT, N = 257). Low-quality evidence suggested that exercise significantly reduced lumbo-pelvic-related sick leave (RR 0.76; 95% CI 0.62 to 0.94, two RCTs, N = 1062), and improved function. Low-quality evidence from single trials suggested that OMT significantly reduced pain and improved function; either a multi-modal intervention that included manual therapy, exercise and education (MOM) or usual care significantly reduced disability, but only MOM improved pain and physical function; acupuncture improved pain and function more than usual care or physiotherapy; pain and function improved more when acupuncture was started at 26- rather than 20- weeks' gestation; and auricular (ear) acupuncture significantly improved these outcomes more than sham acupuncture.When reported, adverse events were minor and transient.
Moderate-quality evidence suggested that acupuncture or exercise, tailored to the stage of pregnancy, significantly reduced evening pelvic pain or lumbo-pelvic pain more than usual care alone, acupuncture was significantly more effective than exercise for reducing evening pelvic pain, and a 16- to 20-week training program was no more successful than usual prenatal care at preventing pelvic or LBP. Low-quality evidence suggested that exercise significantly reduced pain and disability from LBP.There was low-quality evidence from single trials for other outcomes because of high risk of bias and sparse data; clinical heterogeneity precluded pooling. Publication bias and selective reporting cannot be ruled out.Physiotherapy, OMT, acupuncture, a multi-modal intervention, or the addition of a rigid pelvic belt to exercise seemed to relieve pelvic or back pain more than usual care alone. Acupuncture was more effective than physiotherapy at relieving evening lumbo-pelvic pain and disability and improving pain and function when it was started at 26- rather than 20-weeks' gestation, although the effects were small.There was no significant difference in LBP and function for different support belts, exercise, neuro emotional technique or spinal manipulation (SMT), or in evening pelvic pain between deep and superficial acupuncture.Very low-quality evidence suggested a specially-designed pillow may reduce night-time LBP.Further research is very likely to have an important impact on our confidence in the estimates of effect and is likely to change the estimates. Future research would benefit from the introduction of an agreed classification system that can be used to categorise women according to presenting symptoms.
In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation.
Primary recommendation:
To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. [I (A)]
Objective To examine the association between leisure time physical exercise during pregnancy and the risk of miscarriage.
Design Prospective study with elements of retrospective data collection.
Setting Denmark 1996–2002.
Population A total of 92 671 pregnant women enrolled in the Danish National Birth Cohort and interviewed subsequently.
Methods Data on exercise during pregnancy and potential confounders were obtained through computer-assisted telephone interviews either during pregnancy or after an early miscarriage. Outcome of pregnancy was identified by register linkage. Using Cox regression analysis, we estimated the hazard ratio (HR) of miscarriage according to weekly amount of exercise and the type of exercise. The HR was estimated for <11, 11–14, 15–18, and 19–22 weeks of gestation, respectively.
Main outcome measures Miscarriage, defined as fetal loss before 22 completed weeks of gestation.
Results A stepwise increasing relation was found between amount of exercise and risk of miscarriage, where risk of miscarriage increased by amount of exercise up to HR = 3.7 (95% CI 2.9–4.7) for women who exercised more than 7 hours per week compared with nonexercisers. Particularly ‘high-impact exercise’ was associated with an increased risk of miscarriage. No association was seen between exercise and risk of miscarriage after 18 weeks of gestation.
Conclusions This study suggests that exercise early in pregnancy is associated with an increased risk of miscarriage. The results should, however, be interpreted cautiously as potential bias arising from retrospective data collection may explain part of the association.
We examined the effect of light intensity resistance exercise training performed during the second and third trimester of pregnancy on the newborn's birth size. We also studied the association between maternal body weight prior to pregnancy and newborn's birth size.
Randomised controlled trial.
We randomly assigned 160 sedentary gravidae to either a training (n=80) or a control (n=80) group. The training programme focused on light resistance and toning exercises (three times per week, 35-40 min per session). We recorded the Apgar score, birth weight, birth length, and head circumference of the newborn, as well as gestational age at time of delivery from hospital perinatal records. We also measured maternal weight and height before parity and gestational weight gain.
Maternal characteristics neither differed between groups (all P>0.1) nor newborn characteristics (all P>0.1). Maternal body weight was positively and significantly associated with newborn's birth weight and length only in the control group (beta=19.20 and 0.065, respectively, P<0.01).
Light intensity resistance training performed over the second and third trimester of pregnancy does not have a negative impact on the newborn's body size or overall health. Exercise interventions might attenuate the adverse consequences of maternal body weight before pregnancy on the newborn's birth size.
Anxiety and depressive disorders are major public health problems, and desirable changes in lifestyle, such as physical exercise, can have great potential in prevention and treatment. There is growing evidence that physically active people are at a reduced risk of developing depression, and that exercise interventions are associated with significant benefits for patients with mild to moderate forms of depression as well as in reducing anxiety. These findings have led to the proposal that exercise may serve as an alternative or a supplement to traditional forms of therapy. This paper will present a broad overview of research involving the efficacy of exercise as means to prevent and treat depression and anxiety, and related issues regarding dosage and compliance. Finally, exercise will be discussed in the frame of cognitive-behavioural theory.
The purpose of the study is to examine the effects and feasibility of individual physical activity (PA) counseling in maternity and child health clinics in Finland.
Three clinics including both maternity and child health care signed up for the experimental (EXP) and three for the control group (CON). The participants were 132 pregnant and 92 postpartum primiparas. The nurses in EXP integrated a primary and four booster PA counseling sessions into routine visits. An option for supervised group exercise was offered. In CON former practices, usually including brief PA advice, were continued. Leisure-time PA (LTPA) prior to pregnancy was elicited by questionnaire and followed 16-18 and 36-37 weeks' gestation in maternity clinics and 5 and 10 months postpartum in child health clinics. Feasibility included safety, participant responsiveness, realization of counseling and applicability.
According to analysis of covariance adjusted for baseline LTPA and possible confounders, no relative between-group differences in LTPA were found at the first follow-up in either maternity or child health clinics. At the last follow-up in maternity clinics the weekly number of at least moderate-intensity LTPA days was 43% (95% CI: 9, 87) higher and the weekly duration of at least moderate-intensity LTPA 154% (95% CI: 16, 455) higher in EXP compared with CON. Counseling proved feasible in both maternity and child health clinics.
Counseling encouraged pregnant women to sustain their moderate-intensity LTPA and was feasible in routine practices. No effects were observed if counseling was initiated postpartum.
Current Controlled Trials ISRCTN21512277.
A single center, prospective, randomized, single blinded, controlled study comparing the effects and safety of "sitting pelvic tilt exercise" in relieving back pain during the third trimester in primigravida was carried out. The samples were composed of 67 primigravidas who attended the prenatal clinic at King Chulalongkorn Memorial Hospital. All subjects were selected by the random sampling technique and allocated into two groups for the experimental group and the control group; for 32 and 35 pregnants, respectively. The experimental group received the pelvic tilt exercise program for 8 weeks during the third trimester. Pain intensity was measured by visual analogue scale (VAS) at day 0 and day 56 in both groups. The result of the study revealed 1) The mean VAS of back pain in the experimental group was significantly lower at day 56 than at day 0 and lower than the control group at day 56 (p< 0.05) by unpaired t-test 2) There was no incidence of preterm labor, low birth weight or neonatal complication in the experimental group. In conclusion, the "sitting pelvic tilt exercise" during the third trimester in primigravidas could decrease back pain intensity without incidence of preterm labor, low birth weight or neonatal complication.
To review and update the evidence relating to the personal, social, and environmental factors associated with physical activity (PA) in adults.
Systematic review of the peer-reviewed literature to identify papers published between 1998 and 2000 with PA (and including exercise and exercise adherence). Qualitative reports or case studies were not included.
Thirty-eight new studies were located. Most confirmed the existence of factors already known to be correlates of PA. Changes in status were noted in relation to the influence of marital status, obesity, smoking, lack of time, past exercise behavior, and eight environmental variables. New studies were located which focused on previously understudied population groups such as minorities, middle and older aged adults, and the disabled.
The newly reported studies tend to take a broader "ecological" approach to understanding the correlates of PA and are more focused on environmental factors. There remains a need to better understand environmental influences and the factors that influence different types of PA. As most of the work in this field still relies on cross-sectional studies, longitudinal and intervention studies will be required if causal relationships are to be inferred.
Regular exercise is promoted for its over- all health benefits. Pregnancy is recog- nised as a unique time for behaviour modification and is no longer considered a condition for confinement. It is cur- rently recognised that habits adopted during pregnancy could affect a woman's health for the rest of her life.For the first time the recommendation suggests a possible role for exercise in the preven- tion and management of gestational diabetes. The recommendations also promote exercise for sedentary women and those with medical or obstetric complications, but only after medical evaluation and Sports Medicine (CDC-ACSM) have rec- ommended the accumulation of 30 min- utes or more of moderate intensity physical activity on most, and preferably all,days of the week. 4 Moderate intensity physical activity is defined as activity with an energy requirement of 3-5 metabolic equivalents (METS). For most healthy adults, this is equivalent to brisk walking at 3-4 mph. The CDC-ACSM statement also recognises that more intense exercise performed in 20-60 minute sessions on three to five days a week will result in higher levels of physi- cal fitness. Despite the fact that pregnancy is associated with profound anatomical and physiological changes, there are few instances that should preclude otherwise healthy,pregnant women from following the same recommendations.
Research over the past 20 years has focused on the safety of physical activity during pregnancy. Guidelines for health care providers and pregnant/postpartum women have been developed front the results of these studies. The overwhelming results of most studies have shown few negative effects on the pregnancy of a healthy gravida, but rather, be beneficial to the maternal-fetal unit. Recently, researchers have begun to consider the role of maternal physical activity in a more traditional chronic disease prevention model, for both mother and offspring. To address the key issues related to the role of physical activity during pregnancy and postpartum on chronic disease risk, the American College of Sports Medicine convened a Scientific Roundtable at Michigan State University in East Lansing. MI. Topics included preeclampsia, gestational diabetes, breastfeeding and weight loss, musculoskeletal disorders, mental health, and offspring health and development.
Study Design: A longitudinal, prospective, observational, cohort study. Objectives: To describe the natural history of back pain occurring during pregnancy and immediately after delivery. Summary of Background Data: Back pain during pregnancy is a frequent clinical problem even during the early stages of pregnancy. The cause is unclear. Methods: A cohort of 200 consecutive women attending an antenatal clinic were followed throughout pregnancy with repeated measurements of back pain and possible determinants by questionnaires and physical examinations. Results: Seventy‐six percent reported back pain at some time during pregnancy. Sixty‐one percent reported onset during the present pregnancy. In this group, the prevalence rate increased to 48% until the 24th week and then remained stable and declined to 9.4% after delivery. The reported pain intensity increased by pain duration. The pain score correlated closely to self‐rated disability and days of sickness benefit. Conclusions: Back pain during pregnancy is a common complaint. The 30% with the highest pain score reported great difficulties with normal activities. The back pain started early in pregnancy and increased over time. Young women had more pain than older women. Back pain starting during pregnancy may be a special entity and may have another origin than back pain not related to pregnancy.
Physical activity may play an important role in the management of mild-to-moderate mental health diseases, especially depression and anxiety. Although people with depression tend to be less physically active than non-depressed individuals, increased aerobic exercise or strength training has been shown to reduce depressive symptoms significantly. However, habitual physical activity has not been shown to prevent the onset of depression. Anxiety symptoms and panic disorder also improve with regular exercise, and beneficial effects appear to equal meditation or relaxation. In general, acute anxiety responds better to exercise than chronic anxiety. Studies of older adults and adolescents with depression or anxiety have been limited, but physical activity appears beneficial to these populations as well. Excessive physical activity may lead to overtraining and generate psychological symptoms that mimic depression. Several differing psychological and physiological mechanisms have been proposed to explain the effect of physical activity on mental health disorders. Well controlled studies are needed to clarify the mental health benefits of exercise among various populations and to address directly processes underlying the benefits of exercise on mental health.
The goal of this article is to update the information provided in an article initially written for Clinics in Sports Medicine 5 years ago. 10 It begins with a brief summary of that information followed by a presentation of new data that continue to support its main conclusion—that beginning or continuing a regular program of recreational exercise during pregnancy is safe and beneficial for healthy women and their offspring. The reader is referred to the initial article for the older references. Additional new information includes sections addressing the effect of different training volumes, diet, and additional types of exercise on pregnancy outcome, the short- and long-term maternal cardiovascular benefits of continuing regular exercise during and after pregnancy, and other long-term benefits for mothers and their offspring.
Exercise has become a vital part of many women's lives. However, theoretic concerns have been raised about the safety of some forms of exercise during pregnancy. Because of the physiologic changes associated with pregnancy, as well as the hemodynamic response to exercise, some precautions should be observed. The physician should screen for any contraindications to exercise and encourage patients to avoid overly vigorous activity, especially in the third trimester, when most pregnant women have a decreased tolerance for weight-bearing exercise. Adequate hydration and appropriate ventilation are important in preventing the possible teratogenic effects of overheating. Pregnant women should avoid exercise that involves the risk of abdominal trauma, falls or excessive joint stress, as in contact sports and vigorous racquet sports. In the absence of any obstetric or medical complications, most women can maintain a regular exercise regimen during pregnancy. Some studies have found a greater sense of well-being, shorter labor and fewer obstetric interventions in physically well-conditioned women as compared with other women.
The effects of high- and medium-intensity exercise on the fetus and on the onset and length of labor, birth weight, and Apgar score were studied in healthy athletes who performed a high level of exercise before conception.
Forty-two women were recruited to the study by newspaper ads and through acquaintances. They elected to follow either a high- or a medium-intensity exercise program throughout pregnancy until 6 weeks after delivery. Documentation of their intensity of activity before conception (retrospectively), during pregnancy, and after delivery was obtained.
There were no differences between the high- and medium-intensity exercise group in duration of labor, birth weight, or 1- and 5-minute Apgar scores. The higher level of exercise correlated with a significantly greater maternal weight gain during pregnancy and significantly earlier onset of labor for those women who gave birth to girls but not for those who gave birth to boys.
Our results indicate that healthy and well-conditioned women may take part in exercise during pregnancy without compromising fetal growth and development as judged by birth weight or complicating the course of pregnancy or labor.
Although physical activity can provide health benefits to pregnant women, population-based research on the circumstances surrounding injuries from physical activity during pregnancy is lacking.
Physical activity and subsequent injuries among a cohort of 1469 pregnant women in North Carolina were examined prospectively from the third phase of the Pregnancy, Infection, and Nutrition Study between 2001 and 2005. Chi-square analyses were used to compare distributions of maternal characteristics among women who sustained injuries from physical activity and women who reported no injuries during pregnancy. Injury incidence rates were calculated.
Few pregnant women (N = 34) reported a physical activity-related injury during pregnancy. The rates of physical activity-related and exercise-related injuries during pregnancy were 3.2 per 1000 physical activity hours and 4.1 per 1000 exercise hours, respectively. The most common types of injuries were bruises or scrapes (55%). Among all injuries, 33% resulted from exercise and 67% resulted from nonexercise physical activities. Sixty-four percent of all injuries were due to falls.
The incidence of injury from physical activity was low during pregnancy. Women should continue to be encouraged to maintain involvement in physical activity during pregnancy, while being aware of the potential for injury, particularly falls, from these activities.
We examined the effect of light-intensity resistance exercise training that is performed during the second and third trimester of pregnancy by previously sedentary and healthy women on the type of delivery and on the dilation, expulsion, and childbirth time.
We randomly assigned 160 sedentary women to either a training (n=80) or a control (n=80) group. We recorded several maternal and newborn characteristics, the type of delivery (normal, instrumental, or cesarean), and dilation, expulsion, and childbirth time.
The percentage of women who had normal, instrumental, or cesarean delivery was similar in the training (70.8%, 13.9%, and 15.3%, respectively) and control (71.4%, 12.9%, and 15.7%, respectively) groups. The mean dilation, expulsion, and childbirth time did not differ between groups.
Light-intensity resistance training that is performed over the second and third trimester of pregnancy does not affect the type of delivery.
Gestational diabetes affects approximately 7 percent of all pregnancies in the United States; its prevalence may have increased among all ethnic groups since the early 1990 s. Our study examined whether physical activity during pregnancy reduced the risk of gestational diabetes among women who were physically inactive before pregnancy.
We used data from the 1988 National Maternal and Infant Health Survey (NMIHS), a nationally representative sample of mothers with live births. The NMIHS obtained mothers' gestational diabetes diagnoses from care providers and mothers reported their physical activity before and during pregnancy, including the number of months with physical activity and types of physical activity. We developed a physical activity index, the product of the number of months with physical activity, and average metabolic equivalents for specific activities. The analysis included 4,813 women who reported being physically inactive before pregnancy, with singleton births and no previous diabetes diagnosis.
Gestational diabetes was diagnosed in 3.5 percent of the weighted sample in 1988. About 11.8 percent of these previously inactive women began physical activity during pregnancy. Women who became physically active had 57 percent lower adjusted odds of developing gestational diabetes than those who remained inactive (OR 0.43, 95% CI 0.20-0.93). Women who had done brisk walking during pregnancy had a lower adjusted risk of gestational diabetes (OR 0.44, CI 0.19-1.02) and women with a physical activity index score above the median had 62 percent lower odds of developing gestational diabetes than the inactive women (CI 0.15-0.96).
Results suggest that physical activity during pregnancy is associated with lower risk for gestational diabetes among previously inactive women.
Osgood's semantic differential was used on 340 subjects to determine their body image as compared to their concept of the Ideal American woman. Women who were not pregnant as well as women in the first, second and third trimester were tested. The husbands of the women were also tested.In addition, data was collected to determine if the media may have an influence on the pregnant body image. The results showed that the more obviously pregnant a woman became, the poorer her image of herself. Ten of the eighteen adjectives used in the semantic differential showed significant differences ranging from .05 to .0001. Of the fifteen most popularly read magazines in this group only one had any pictures of pregnant women, and this woman was early in her pregnancy.
This study was designed to test the hypothesis that the thermal response to endurance exercise is altered by the thermal adaptations to pregnancy. Accordingly, rectal temperature was monitored in 18 recreational athletes before, during, and after 20 minutes of continuous exercise before conception and every 6 to 8 weeks during pregnancy. Mean exercise intensity was 64% of VO2 max before conception and did not change during pregnancy. However, the peak rectal temperature reached during exercise decreased by 0.3 degrees C at 8 weeks and then fell at a rate of 0.1 degrees C per lunar month through the thirty-seventh week. This appeared to be related to changes in resting temperature, thermal mass, sweating threshold, and venous capacitance that began early in pregnancy. These data suggest that the magnitude of any exercise-associated thermal stress for the embryo and fetus is markedly reduced by the maternal physiologic adaptations to pregnancy.
The relationship between physical activity during pregnancy, preterm birth, and gestational age-adjusted birth weight was investigated prospectively in a cohort of 7101 women. This study is one of few to evaluate both employment- and non-employment-related physical activity. Prolonged periods of standing were associated with a modestly increased risk of preterm delivery (adjusted odds ratio for greater than or equal to 8 hours/day of standing = 1.31). Heavy work or exercise was not associated with preterm delivery (adjusted odds ratio for greater than or equal to 4 hours per day of heavy work = 1.04). The proportion of infants born preterm did not differ among women working in predominantly standing, active, and sedentary occupations. Physical activity was not associated with gestational age-adjusted birth weight after controlling for confounding variables. These data suggest that unmeasured socioeconomic differences among women reporting different levels of activity may account for previously described associations between physical activity and pregnancy outcome. Most pregnant women who report increased levels of physical activity are not at increased risk of preterm delivery or reduced intrauterine growth. However, these data do not address the role of activity restriction in the management of selected women at high risk for adverse pregnancy outcome.
To determine the association between maternal activity and pregnancy outcome, the authors investigated the separate influences of time, physical effort, and posture at work, both at a job and in the home, on birth weight. Study subjects were 1,507 of 1,889 women appearing consecutively for antenatal care at a district general hospital in inner London, England, in 1982-1984. Data were collected prospectively by interview and examination at several stages of pregnancy. Multivariable linear regression was used to distinguish associations with physical activity from confounding by other factors. The mean birth weight of infants born to women in full-time employment was 49 g less than that for births to women not in paid work (95 percent confidence interval (Cl) 1-97 g). However, the difference was due to confounding, and after adjustment, full-time employment was associated with a 12-g increase in birth weight (95 percent Cl -39 to 63 g). There was little difference in birth weight related to gestational stage at leaving work. Duration, physical effort required, and energy expenditure in paid work and in work at home had no discernible association with birth weight. A small increase in birth weight was associated with increased hours of sleep. These data allow estimates of associations with birth weight as precise as 80 g. Within the range of activities performed by pregnant women in the population studied, birth weight is unlikely to be associated with maternal physical activity.
To assess the relation between leisure time physical activity (LTPA) during the first 20 weeks of pregnancy and the risk of developing pre-eclampsia and gestational hypertension.
Case-control study carried out over a 28 month period with retrospective data collection.
Six hospitals in Quebec City and four hospitals in Montreal.
172 women with pre-eclampsia, 254 with gestational diabetes, 505 controls. All were primiparous, with no history of high blood pressure before pregnancy (unless due to oral contraceptive use), or during the first 20 weeks of gestation. Cases were defined using recognised criteria, and 97% of those eligible agreed to be interviewed. Controls delivered in same hospital immediately after cases and had no more than one reading of elevated blood pressure during pregnancy; 96% of those eligible agreed to be interviewed.
Participants were interviewed in hospital a few days after delivery using a questionnaire. Information was collected on type, frequency and average duration of any LTPA performed regularly during the first 20 weeks of pregnancy, together with medical, obstetric and sociodemographic details. It was found that women who performed regular LTPA had a reduced risk of pre-eclampsia (adjusted RR 0.67, 95% CI 0.46-0.96) and gestational hypertension (aRR 0.75, 95% CI 0.54-1.05), and the relative risks decreased as the average time spent in LTPA increased (aRR for pre-eclampsia among women with low, moderate and high energy expenditure: 1.00, 0.77 and 0.57, p = 0.01). The same trend was present for gestational hypertension (1.00, 0.80 and 0.71, respectively, p = 0.08).
Leisure time physical activity during the first half of pregnancy is likely to reduce the risk of pre-eclampsia and gestational hypertension.
This study was designed to test the hypothesis that vigorous aerobic exercise during both the periconceptional period and early pregnancy increases the incidence of abnormal early pregnancy outcome. Exercise performance was prospectively monitored before and during pregnancy in 47 recreational runners, 40 aerobic dancers, and 28 physically active, fit controls. Pregnancy was diagnosed by an early test for beta-subunit human chorionic gonadotropin and viability was confirmed by ultrasonography at 40 days' conceptional age. Spontaneous abortion occurred in 19% of the pregnancies. The incidence was 17% in the runners, 18% in the aerobic dancers, and 25% in the controls. At term, one congenital abnormality was detected in each of the three groups. Late pregnancy events, potentially related to abnormalities of placentation, were limited to two cases of mild pregnancy-induced hypertension. We conclude that, in physically fit women, continuation of these types of aerobic activity at intensities between 50% and 85% of maximum during the periconceptional period and early pregnancy does not appreciably alter early pregnancy outcome.
Few studies have addressed the effects of resistance training on connective tissue. Inferences from studies investigating the effects of endurance training or "loaded" exercise training can be made. The available data suggest that 1) physical activity can increase connective tissue strength and mass, 2) activation of the antigravity muscles must be accomplished to adequately stimulate connective tissue, and 3) the volume, intensity, and load-bearing nature of the exercise training are important factors in causing connective tissue adaptations. Based on the above factors, a speculative model of training for increased maximum strength of connective tissue has been developed.
Many competitive and recreational athletes perform resistance training as a part of their conditioning programmes. Resistance training in addition to increasing muscular strength and hypertrophy may also aid in the prevention of injuries. Research indicates that resistance training promotes growth and/or increases in the strength of ligaments, tendons, tendon to bone and ligament to bone junction strength, joint cartilage and the connective tissue sheaths within muscle. Studies involving humans and animal models also demonstrate resistance training can cause increased bone mineral content and therefore may aid in prevention of skeletal injuries.
Investigations to date suggest resistance training can aid in injury prevention. The incidence of various types of overuse injuries, such as swimmers shoulder and tennis elbow, may be reduced by the performance of sport and/or motion specific resistance training activities. Screening of athletes for agonist and antagonist muscle strength imbalances can be utilised to identify athletes possessing a predisposition for injury. Resistance training may then be performed to correct the imbalance and therefore reduce the incidence of injury.
This preexperimental study explored the relationships among maternal aerobic exercise, self-esteem, and physical discomforts during pregnancy by comparing groups of exercising and nonexercising pregnant women. The convenience sample was comprised of 31 women who participated in aerobic exercise and 22 women who did not. All subjects, who were at least 27 weeks pregnant, completed three questionnaires: Self-History Form, Pregnancy Discomfort Checklist, and Rosenberg Self-Esteem Scale. The group of women who exercised had statistically significant higher self-esteem and lower physical discomfort scores than the group of women who did not exercise. Statistically significant lower scores were found in the exercise group for the symptoms of backache, headache, fatigue, shortness of breath, and hot flashes. There was a statistically significant inverse relationship between amount of exercise and discomforts reported in the third trimester. These findings suggest that exercise during pregnancy is associated with higher self-esteem and lower discomfort scores. However, interpretation of these findings is limited by a lack of random assignment to groups, which might have resulted in a selection bias.
Research was conducted to investigate postpartal women's attitudes toward their body image; these attitudes were then compared to their pre-pregnant and pregnant body image attitudes. A repeated measures design was used, with data collected at two and six weeks postpartum. Pregnant and pre-pregnant attitudes were collected retrospectively. A nonrandom, convenience sample of 63 multiparas and primiparas was used. The results indicated that the subjects had a slightly positive attitude toward their postpartum body image; multiparas felt more positive about their postpartum body image than did the primiparas; the women felt more positive about their pre-pregnant body image than about their postpartum body image; and the women felt more positive about their postpartum body image than about their pregnant body image.
To characterize maternal thermal balance during pregnancy, the authors recorded the thermal response to moderate weight bearing exercise stress in four aerobically conditioned pregnant women. Studies were performed in a climate-controlled environment in each trimester of pregnancy and postpartum after modifying the exercise protocol for changes in maternal exercise condition. Core, vaginal, and mean skin temperatures were recorded at rest and during maximum exercise. Mean resting skin temperature increased during pregnancy; mean resting core and vaginal temperatures did not change. Core temperatures did not exceed 39C during exercise. Heat storage (heat content/kg) was not increased as a result of exercise with advancing pregnancy. According to these findings, thermal balance can be maintained with advancing gestation when exercise prescriptions are appropriately modified for conditioned women.
An epidemiologic case-control study exploring possible risk factors for preterm delivery was undertaken at Yale-New Haven Hospital during 1977. The study groups consisted of 175 mothers of singleton preterm infants and 313 mothers of singleton term infants. Analysis of questionnaire responses provided no evidence that employment, housework, child care and leisure-time physical activity during pregnancy increased the risk of preterm delivery. Women who participated in sports or physical fitness exercises during pregnancy were found to have a significantly decreased risk of preterm delivery as compared to those who were not similarly active; this finding suggests that certain forms of moderate physical activity may actually protect against preterm delivery.
The histomorphometry of term placentae from women who exercised regularly throughout either the first half or all of pregnancy was compared to that of placentae from matched controls to determine if regular exercise during pregnancy produced histomorphometric evidence of altered development and transport capacity. Conventional stereological techniques were used to estimate placental volumetric composition, surface areas, and villous and vascular configurations in the three groups. Exercise confined to early pregnancy increased the parenchymal component of the placenta, total vascular volume and site-specific capillary volume and surface area. Exercise throughout pregnancy increased these and multiple other histomorphometric parameters associated with the rate of placental perfusion and transfer function. However, significant changes were confined to villi > 80 microns in diameter. The localization of both the timing of the stimulus and the anatomical sites affected indicates that regular, sustained exercise modifies placental development primarily in early and mid-pregnancy. We speculate that the lack of significant changes in the structure and configuration of the smaller villi indicates that other adaptive mechanisms, such as increased rates of placental blood flow, must be well developed by the latter portion of the mid-trimester and adequately maintain fetal oxygenation and substrate delivery throughout the third trimester.
'The Stockholm Pregnancy and Weight Development Study' was conducted to identify risk factors for postpartum weight retention, such as dietary habits, physical activity and socio-demographic factors. The body weight development of 1423 pregnant women was studied prospectively from the beginning of the pregnancy until 1 year postpartum. Data were collected from routine pregnancy records and from questionnaires 6 and 12 months postpartum. Mean weight retention 1 year postpartum was 0.5 kg compared with the prepregnancy body weight. A 'trend method' was constructed to identify a number of pre-defined major patterns of behaviour. The weight retention 1 year postpartum was greater in women who (a) increased their energy intake during and after pregnancy, (b) increased their snack eating after pregnancy to three or more snacks/d, and (c) decreased their lunch frequency starting during or after the pregnancy. Women who had retained > or = 5 kg 1 year postpartum were more seldom physically active in their leisure time throughout the study period compared with women with a smaller weight gain. Postpartum weight retention correlated negatively with the degree of physical activity in the second half year postpartum. These results indicate that postpartum weight retention is more affected by a change in lifestyle during, and above all after, pregnancy than by factors before pregnancy.
The effects of participation in a 6-week aerobic exercise program (AEP) on pregnant adolescents' depression, self-esteem, and physical discomforts of pregnancy were examined. The sample was comprised of 58 ethnically diverse subjects ranging in age from 14 to 20 years. Subjects in the AEP were observed to have a significant decrease in depressive symptoms over time and an increase in total self-esteem; those in the comparison group reported a significant increase in physical discomforts associated with pregnancy. These findings suggest that exercise programs such as the AEP should be considered an important aspect of prenatal self-care for healthy pregnant adolescents.
In the past decade, physical health fitness has become increasingly more important in the lives of women of child-bearing age. Many have made regular, and sometimes vigorous commitments to exercise programs. In 1985, the American College of Obstetricians and Gynecologists (ACOG) developed a set of guidelines for women who plan to exercise during pregnancy. Recommendations were based on available, but somewhat limited, scientific data and common sense. Since that time, researchers have learned a significant amount of new information about how a pregnant woman and her fetus respond to aerobic activity. The objective of this communication is to review recent investigations in this area. Specific topics include a) maternal responses to exercise, b) fetal responses to maternal exercise, c) animal research models, and d) pregnancy and physical conditioning. Our objectives are to present information that will a) stimulate new and innovative research designs for exercise and pregnancy studies, and b) add significantly to our knowledge and ability to develop safe and effective exercise programs for women who wish to remain physically active throughout a normal-term pregnancy.
To review the long-term effects of the diabetic pregnancy on the offspring among the Pima Indians of Arizona.
Studies published by the Phoenix Epidemiology and Clinical Research branch of the National Institute of Diabetes and Digestive and Kidney Diseases, since the inception of the longitudinal diabetes studies in 1965 were reviewed. In addition, pertinent studies from other centers, mentioned as references in these publications, were reviewed. As far as possible, all original articles and abstracts on this aspect of the Pima Indian studies were discussed.
The offspring of women who had diabetes during pregnancy, on average, were more obese and had higher glucose concentrations and more diabetes than the offspring of women who developed diabetes after pregnancy or who remained nondiabetic. Although no new analyses were attempted, several of the older publications were updated by repeating the analyses on later, expanded data sets.
The diabetic pregnancy, in addition to its effects on the newborn, has effects on the subsequent growth and glucose metabolism of the offspring. These effects are in addition to genetically determined traits.
This report describes the prevalence and pattern of exercise during pregnancy among US women. It is based on 9953 randomly selected women who gave birth to live infants in 1988 and participated in the National Maternal and Infant Health Survey, a cross-sectional survey with a stratified systematic sampling in 48 states, the District of Columbia, and New York City. Self-reported exercise before and during pregnancy, specific activities, and number of months of exercise were examined in relation to maternal demographic characteristics, reproductive history, and prenatal care. Forty-two percent of all women reported exercising during pregnancy, half of whom exercised longer than 6 months. Walking was the leading activity (43% of all activities reported), followed by swimming (12%) and aerobics (12%). Older mothers and women who had multiple gestations, previous children, or an unfavorable reproductive history were less likely to exercise during pregnancy. Given this high prevalence of exercise in pregnancy, more research is warranted on both the beneficial and adverse maternal and fetal effects of exercise in pregnancy.
A prospective, consecutive cohort analysis of the regression of the incidence and intensity of back and posterior pelvic pain after delivery in pregnant women was done.
To identify back and posterior pelvic pain from mid-pregnancy to 5 months after delivery and to illustrate differences between these two pain types.
Chronic back pain may start during a pregnancy, and regression of unspecified back pain after delivery may be slow and incomplete. Few studies have distinguished back pain from posterior pelvic pain in pregnancy, and no study has presented follow-up data after delivery with respect to pain types.
One hundred and sixty four of 368 pregnant women studied had back or posterior pelvic pain and were offered individual group physiotherapy and training. The women were observed until 5 months after delivery. Standardized clinical examination protocols and questionnaires were used.
Posterior pelvic pain was experienced by 124 women, and back pain was experienced by 40 women during pregnancy. After delivery, however, back pain was more common. Pain intensity was higher among women with posterior pelvic pain during pregnancy, whereas after delivery pain intensity was higher among women with back pain. A correlation was found between the presence of high pain intensity during pregnancy and little regression of pain after delivery.
One of every three pregnant women studied experienced posterior pelvic pain, and one of every nine women experienced back pain. Posterior pelvic pain was more intense during pregnancy, and back pain was more intense and more common after delivery. High pain intensity in pregnancy indicated a bad prognosis.
To review the current data regarding the safety of exercise in pregnancy.
MEDLINE search was limited to English literature between 1987 and 1995 with the key MeSH words exercise and pregnancy. Other sources included the Sports and Fitness Database between 1991 and 1995 and a manual search for relevant articles. Previous studies on the safety of exercise in pregnancy are limited in many ways and exhibit difficulties in controlling for confounding factors and in establishing associations while maintaining maternal and fetal safety.
Concerns about the effect of exercise on pregnancy include exercise-induced hyperthermia, birth weight changes, fetal heart rate responses, miscarriage, labour patterns, maternal injury, and maternal weight gain. Exercise during pregnancy also has many potential benefits.
Important gaps in our knowledge of exercise and pregnancy remain. Available data suggest, however, that moderate exercise on a regular basis during a healthy pregnancy has minimal risk for women and their fetuses.
Back pain is a common complaint of women during pregnancy. It is frequently dismissed as trivial and inevitable. This article gives an overview of recent research on pregnancy-related back pain that documents the impact of this pain on women's lives, during and beyond the childbearing year. It argues for a more active approach to the prevention and management of back pain during pregnancy. Two common back pain types, lumbar pain and posterior pelvic pain, are described and basic management techniques for the woman and her primary caregiver are suggested. Red flag findings that necessitate specialist referral are also highlighted, as are suggestions for further research.
We examined whether exercise during pregnancy is associated with chromosomally normal spontaneous abortion. We hypothesized that associations would be confined to chromosomally normal losses since only these can be influenced appreciably by experiences during pregnancy. The study population comprises women with chromosomally normal (N = 173) and aberrant (N = 173) losses. Women who exercised during pregnancy had a lower risk of a chromosomally normal spontaneous abortion (OR 0.6; 95% CI 0.3-0.9). Other types of physical activity had little effect.
To investigate if water-gymnastics during pregnancy may reduce the intensity of back/low back pain and the number of days on sick-leave.
A prospective, randomized study. One hundred and twenty-nine women were randomized to participate in water-gymnastics once a week during the second half of pregnancy and 129 were randomized to a control group. The women in both groups filled in questionnaires in gestational weeks 18, 34 and within the first postpartum week. Every day from week 18 to labor they assessed the intensity of back/low back pain.
Back pain intensity increased during pregnancy. No excess risk for the pregnancy associated with water-gymnastics was observed. The women participating in water-gymnastics recorded a lower intensity of back/low back pain. The total number of days on sick-leave because of back/low back pain was 982 in the water-gymnastics group (124 women) compared with 1484 in the control group (120 women). After weeks 32 33, seven women in the water-gymnastics group compared with 17 in the control group were on sickleave because of back/ low back pain (p=0.031).
Intensity of back/low back pain increased with advancing pregnancy. There was no excess risk for urinary or vaginal infections associated with water-gymnastics. Water-gymnastics during the second half of pregnancy significantly reduced the intensity of back/ low back pain. Water-gymnastics decreased the number of women on sick-leave because of back/low back pain. Water-gymnastics during pregnancy can be recommended as a method to relieve back pain and may reduce the need for sick-leave.
Cardiovascular responses to strength conditioning exercises were examined in 12 healthy pregnant women and their unborn fetuses during the third trimester. A group of 12 healthy nonpregnant women of similar ages, parity, body height, and pre-pregnant body mass was also studied. Maternal heart rate and blood pressure and fetal heart rate (FHR) responses were measured in both the supine (30 degrees tilt) and seated postures during handgrip (HG), single-leg extension (SL), and double-leg extension (DL) exercise. Subjects performed 3 sets of 10 reps at 50, 70, and 90% of their 10-repetition maximum (10-RM) for each exercise in both postures. Pregnant subjects exhibited higher heart rates but similar blood pressure responses to control subjects under all experimental conditions. Significant increases were observed for the frequency of FHR accelerations (0.10 to 0.27/min) from rest to DL in the sitting posture at 90% RM. Moderate fetal bradycardia was observed occasionally in the tilted supine posture at rest and both during (SL, DL) and following (HG, SL, DL) exercise, suggesting that this posture should be avoided in late gestation. The results support the safety of moderate strength conditioning exercises in healthy pregnancy.
Exercise has become an integral part of the life styles of many women. However, many women stop exercising during pregnancy because of concerns regarding the well-being of the fetus. Although pregnancy is associated with several physiologic changes and response to exercise is different in the pregnant state than in the nonpregnant state, exercise can be beneficial to the pregnant woman in the absence of obstetric or medical complications. There are certain contraindications to exercise during pregnancy, including pregnancy-induced hypertension, preterm rupture of membranes, preterm labor, incompetent cervix, intrauterine growth retardation, and persistent second- or third-trimester bleeding. In addition, certain guidelines should be followed in order to prevent harmful effects on the fetus. This article reviews the maternal and fetal responses to exercise, benefits and potential risks of exercise during pregnancy, and recent guidelines for exercise during pregnancy. It is important to note, however, that objective data regarding exercise during pregnancy is limited and that further research is warranted regarding this topic.
Our purpose was to test the null hypothesis that beginning regular, moderate-intensity exercise in early pregnancy has no effect on fetoplacental growth. Study Design: Forty-six women who did not exercise regularly were randomly assigned at 8 weeks either to no exercise (n = 24) or to weight-bearing exercise (n = 22) 3 to 5 times a week for the remainder of pregnancy. Outcome variables included antenatal placental growth rate and neonatal and placental morphometric measurements.
The offspring of the exercising women were significantly heavier (corrected birth weight: 3.75 +/- 0.08 kg vs 3.49 +/- 0.07 kg) and longer (51.8 +/- 0.3 cm vs 50.6 +/- 0.3 cm) than those born to control women. The difference in birth weight was the result of an increase in both lean body mass and fat mass. In addition, midtrimester placental growth rate was faster (26 +/- 2 cm(3)/wk vs 21 +/- 1 cm(3)/wk) and morphometric indexes of placental function were greater in the exercise group. There were no significant differences in neonatal percentage body fat, head circumference, ponderal index, or maternal weight gain.
These data indicate that beginning a moderate regimen of weight-bearing exercise in early pregnancy enhances fetoplacental growth.
This study compared the perceptions of body image and psychological well-being between exercising and non-exercising pregnant women. A prospective longitudinal study was conducted with 65 nulliparous women (mean age years = 30.3, range = 23-39) who were allocated to 2 groups based on level of recreational exercise participation; 25 exercisers were compared with 18 non-exercisers. A self-report exercise history questionnaire and a 10 item Body Cathexis Scale were completed on two occasions during the pregnancy, at approximately 17 weeks and 30 weeks of gestation. The General Health Questionnaire (GHQ-28) was administered in late pregnancy. There was a significant difference between the exercise group and the non-exercise group in late pregnancy for some items on the Body Cathexis Scale. The exercise group had a lower level of probable caseness on the GHQ-28 with reduced frequency of somatic symptoms, anxiety and insomnia, and a higher level of psychological well-being.
To evaluate the influence of exercise on maternal and perinatal outcome in a low-risk healthy obstetric population.
We conducted a prospective observational study of low-risk healthy women exercising during their pregnancy. An extensive questionnaire collected antepartum, intrapartum, and postpartum patient information on 750 women. The women were divided into four groups based on exercise level during pregnancy.
There were no differences among groups for maternal demographic characteristics, antenatal illnesses, stress, social support, or smoking. Heavily exercising women were older (P =.042), had higher incomes (P =.001), and were exercising more at conception (P =.001). Women who did more exercise were more likely to need an induction of labor (P =.033, relative risk 1.84, 95% confidence interval 1.05, 3.20), induction or augmentation with oxytocin (P =.015, relative risk 1.53, 95% confidence interval 1.19, 1.97), and had longer first-stage labors (P =.032) resulting in longer total labors (P =.011). The difference in the length of first-stage labor was even greater if the no-exercise group was compared with the strongly exercising group (P =.009, relative risk 1.38, 95% confidence interval 0.16, 2.60). Fewer umbilical cord abnormalities (P =.034) were observed with exercise, but exercising women had more colds and flu (P =.008). Heavily exercising women had smaller infants (mean difference 86.5 g) compared with sedentary women.
Exercise in working women is associated with smaller babies, increased number of inductions and augmentations of labor, and longer labors. Colds and flu are more frequent in exercising women.
The possible association between physical activity and symptoms of depression during pregnancy and post partum has not been examined in Norway. The objectives of this study were to track levels of physical activity of pregnant women and to examine possible differences in symptoms of depression and prenatal complaints.
203 pregnant women in Oslo aged 18 to 40 completed the depression scale of the Hospital Anxiety and Depression Scale (HADS-D) and a self-developed questionnaire.
Their average physical activity was two hours and 36 minutes per week; 70% were active during at least two trimesters. The most popular activities reported were walking, aerobics and swimming. Respondents who had high score on the HADS-D test during pregnancy and/or post partum had significantly more pre-natal complaints than those with a normal score. Pregnant women defined as moderately physically active during the third trimester had significantly lower scores on the HADS-D test six weeks after birth than the not-active. There was also a significant inverse correlation between test score and amount of physical activity.
This study indicates that women who are physically active during pregnancy have lower scores on a test measuring depressive symptoms during pregnancy and post partum. However, randomised controlled prospective studies are necessary in order to confirm the possible association.
To estimate the impact of excess pregnancy weight gain and failure to lose weight by 6 months postpartum on excess weight 8-10 years later.
Seven hundred ninety-five women were observed through pregnancy and 6 months postpartum to examine factors that affect weight loss. Weight was recorded 10 years later through a medical record review to examine the impact of retained weight on long-term obesity. Overall weight change at last follow-up and body mass index (BMI) were examined by pregnancy weight gain appropriateness according to the Institute of Medicine guidelines for weight gain during pregnancy.
Of the original cohort, 540 women had a documented weight beyond 5 years (mean = 8.5 years). The average weight gain from prepregnancy to follow-up was 6.3 kg. There was no difference in weight gain by prepregnancy BMI. Women who gained less than the recommended amount during their pregnancy were 4.1 kg heavier at follow-up, those gaining the recommended amount were 6.5 kg heavier, and those gaining more than recommended were 8.4 kg heavier (P =.01). Women who lost all pregnancy weight by 6 months postpartum were 2.4 kg heavier at follow-up than women with retained weight, who weighed 8.3 kg more at follow-up (P =.01). Women who breast-fed and women who participated in aerobic exercise also had significantly lower weight gains.
Excess weight gain and failure to lose weight after pregnancy are important and identifiable predictors of long-term obesity. Breast-feeding and exercise may be beneficial to control long-term weight.
The potential benefits and risks of physical activity before and during pregnancy are not well studied. We studied the relation between recreational physical activity and the risk of preeclampsia in a case-control study of 201 preeclamptic and 383 normotensive pregnant women. Participants provided information about the type, intensity, frequency, and duration of physical activity performed during the first 20 weeks of pregnancy and during the year before pregnancy. Women who engaged in any regular physical activity during early pregnancy, compared with inactive women, experienced a 35% reduced risk of preeclampsia (odds ratio, 0.65; 95% confidence interval [CI], 0.43 to 0.99). Compared with inactive women, those engaged in light or moderate activities (ie, activities with metabolic-equivalent scores <6) experienced a 24% reduced risk of preeclampsia (95% CI, 0.48 to 1.20). The corresponding reduction for women participating in vigorous activities (metabolic equivalent scores > or =6) was 54% (95% CI, 0.27 to 0.79). Brisk walking (average walking pace > or =3 mi/h), when compared with no walking at all, was associated with a 30% to 33% reduction in preeclampsia risk. Stair climbing was inversely associated with the risk of preeclampsia (P for trend=0.039). Recreational physical activity performed during the year before pregnancy was associated with similar reductions in preeclampsia risk. These data suggest that regular physical activity, particularly when performed during the year before pregnancy and during early pregnancy, is associated with a reduced risk of preeclampsia.
This study aimed to compare ratings of body image satisfaction (BIS) from 6 months prepregnancy to 23-30 weeks' gestation for high exercising and low exercising pregnant women. The authors also aimed to assess and compare expectations of BIS for the post-partum period in high and low exercising women.
A partial prospective approach was implemented.
A total of 71 healthy pregnant women (40 high exercisers and 31 low exercisers) participated.
Participants completed a series of questionnaires at 15-22 weeks' gestation and 23-30 weeks' gestation.
There were two main outcome measures. At 15-22 weeks' gestation there was an exercise inventory and two versions of the Body Cathexis Scale (BCS) (retrospective prepregnancy BIS and current BIS). At 23-30 weeks' gestation there was an exercise inventory and two versions of the BCS (current BIS and projected post-partum BIS).
At 15-22 weeks' gestation, high exercisers demonstrated significantly higher levels of BIS compared to low exercisers. There were no other significant differences between groups. Within groups, high exercisers were significantly more satisfied with their bodies at 15-22 weeks' gestation compared to 6 months prepregnancy, and expected to be less satisfied with their bodies at 6 weeks' post-partum than they were during pregnancy. Low exercisers demonstrated no significant changes over time.
The findings suggest that women are able to assimilate the bodily changes of pregnancy without a negative shift in BIS. However, women who exercise during pregnancy may respond more favourably to changes in their bodies at early pregnancy compared to women who remain sedentary.
Evidence-based guidelines for exercise in pregnancy have been developed in Canada as a result of cooperation between exercise scientists, the CSEP, Health Canada and the SOGC. After medical screening using the PARmed-X for Pregnancy, previously inactive women are encouraged to begin prenatal exercise programs involving both aerobic and muscle conditioning. Aerobic exercise should be performed regularly (at least 2 days per week), and exercise duration can be gradually and progressively increased from 15 to approximately 30 minutes per day over the course of the second trimester. Exercise intensity should be prescribed and monitored using modified heart rate target zones combined with the RPE method. The "talk test" can be used as a final check to prevent overexertion. Muscle conditioning exercises are also suggested to promote general conditioning and good posture, to facilitate labor, and to prevent gestational low back pain, urinary incontinence, diastasis recti, and varicose veins. Women should avoid exercise in the supine posture after the fourth month as well as performance of the Valsalva maneuver during resistance exercise. Static stretching should be used and ballistic movements should be avoided. Advice for postnatal exercise and good nutrition was also provided.