Exercise and Pregnancy

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Exercise and Pregnancy

• What are the common responses and adaptations we
  see in the pregnant exerciser?

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Cardiovascular system

• Cardiac output
• rapid increase in 1st two trimesters
• levels off in 3rd
• 30-50 above normal
• increased stroke volume
• greater strain on heart during exercise

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Cardiovascular system

• Blood flow distribution
• increased flow to surface
• increased renal, pulmonary, and uterine blood
  flow
• decreased total peripheral resistance and
  increased peripheral blood flow
• decreased venous return
• exercise helps with venous return

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Cardiovascular system

• Blood pressure
• decreased SBP and DBP during 1st two trimesters

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Cardiovascular system

• Blood volume
• increases 50 by end of 2nd trimester
• increased plasma volume

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Pulmonary System

• Diaphragm elevates
• FRC decreases by 25 due to decreased ERV and RV
• hyperventilation occurs at rest due to increased
  progesterone levels and changes in the threshold
  of the respiratory centers.

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Metabolic System

• Slight increase in blood acidosis
• Increase in resting VO2 and VCO2

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Metabolic System

• Metabolic rate is increased
• Increased use of carbohydrates as fuel
• result
• increased VO2 at any given workload
• increased O2 debt (EPOC)

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Musculoskeletal System

• Increased joint laxity (relaxin)
• Stretching and thinning of abdominal wall

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Musculoskeletal System

• Forward shift in c of g and anterior rotation of
  pelvis
• Proprioception and coordination are adversely
  effected

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Benefits of Exercise to the Pregnant Woman

• 1. Facilitate a general feeling of well-being.
• 2. Control of body composition.
• 3. Maintenance or development of optimal posture.
• 4. Decrease in the minor discomforts of
  pregnancy.
• 5. Promotes pelvic floor strength.

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Benefits of Exercise to the Pregnant Woman

• 6. Maintain or improve aerobic conditioning.
• 7. Maintain or improve strength and/or
  flexibility.
• 8. Facilitate general recovery after delivery.
• Decrease by 1/2 post partum recovery days.
• 9. Improved tolerance during delivery.

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Benefits of Exercise to the Pregnant Woman

• 10. Improved physiologic adaptations to
  pregnancy.
• 11. Improved ability to dissipate heat.
• 12. Limits the pregnancy related increase in
  peripheral insulin resistance.

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Risks to the Mother

• 1. Risks of injury due to overuse.
• 2. Increased potential for fatigue.
• 3. Joint injury.
• 4. Redistribution of cardiac output.
• 5. Thermoregulatory problems.

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Latest Research

• Most women increase body mass by 20 during
  pregnancy.

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Latest Research

• Supine exercise doesnt create abdominal hernias.
• Abdominal recover within 6 weeks.

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Latest Research

• Cardiac remodeling occurs.
• VO2 Max higher 10-40 weeks post-partum.

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Latest Research

• Birth occurs 5-7 days earlier.
• No increased incidence of premature birth.

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Latest Research

• Higher rate of normal delivery.
• Quicker recovery post-partum.

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Latest Research

• Decreased feelings of stress.

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Latest Research

• Increased fitness and muscle tone.

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Latest Research

• Improved bladder control.

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Risks to the Baby

• A. Heat Stress
• 1. Heat stress and malformation (animal studies).
• 2. Heat stress and malformation in saunas in
  humans during early pregnancy.

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Risks to the Baby

• 3. With exercise there is an increase in skin
  temperature with minor increases in core
  temperature.
• 4. Exercising studies have not shown the
  correlation between heat stress and
  malformation.

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Risks to the Baby

• B. Oxygen Delivery
• 1. Animal studies show conflicting results.
• 2. Body can adapt to make-up for decreased blood
  flow - increase hemoconcentration and better
  extraction.

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Risks to the Baby

• C. Fetal Heart Rate Changes
• 1. Conflicting results.
• 2. Increased HR during start of exercise then it
  levels off.

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Risks to the Baby

• 3. No adverse effects.
• 4. Trained women show less uterine blood flow.

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Risks to the Baby

• D. Decreased Blood Flow
• 1. Animals suggest there is a relationship
  between exercise and low birth weight.

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Risks to the Baby

• 2. This does not seem to be a problem in
  rationally trained women.
• 3. No relationship between exercise and
  miscarriage.

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Guidelines for Exercise

• 1. Medical and exercise history of the
  individual.
• 2. Questions or unusual symptoms
• bleeding, dizziness,
• cramping, joint pain
• faintness, elevated blood pressure,
• STOP exercising and consult physician.

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Guidelines for Exercise

• 3. Listen to your body.
• 4. Expect some discomfort.

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Guidelines for Exercise

• 5. Exercise regularly.
• 6. Do not exercise vigorously in hot humid
  weather.

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Guidelines for Exercise

• 7. Do not exercise at all during an illness with
  fever.

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Guidelines for Exercise

• 8. Avoid high impact activities.
• 9. Drink plenty of fluids.

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Guidelines for Exercise

• 10. Rise slowly from down positions.
• 11. ACOG recommends that the HR not exceed 140
  bpm.

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Guidelines for Exercise

• 12. Avoid the valsalva maneuver.

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Guidelines for Exercise

• 13. Do not begin a new fitness program.
• 14. Follow basic fitness principles.

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