Exercise During Pregnancy

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• Exercise During Pregnancy
• RNDr. Aleš
  Jakubec Ph.D
• Students Tijana Radiša
• Balaban Ljiljana

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Pregnacy and exercise

• Exercise has become a vital part of many women's
  lives
• the physiologic changes associated with pregnancy
  as well as the hemodynamic response to exercise,
  some precautions should be observed

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• If women do not have medical complications and
  can maintain regular exercise duration of
  pregnancy but....
• women should avoid exercise that involves the
  risk of abdominal trauma, falls or excessive
  joint stress, as in contact sports and vigorous
  racquet sports
• Adequate hydration and proper ventilation are
  important to prevent possible effects of
  overheating

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Physiological changes during pregnancy

• Musculoskeletal
• One of the most obvious changes in pregnancy is
  the alteration of the woman's body. Mechanical
  changes related to the weight of growing breasts,
  uterus and fetus, as well as an increase in
  lumbar lordosis, result in a shift in the woman's
  center of gravity, which may cause problems with
  balance.

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• Thermoregulatory adaptations Feotal
  hyperthermia, leading to abnormal foetal
  development, is a concern if the mothers core
  temperature is elevated following exercise. In
  addressing this concern the mothers resting body
  temperature is reduced and her ability to get rid
  of the heat the skin is improved.

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• Hemodynamic
• Exercise acts in concert with pregnancy to
  increase heart rate, stroke volume and cardiac
  output. However, during exercise, blood is
  diverted from abdominal viscera, including the
  uterus, to supply exercising muscle.
• Measurements of the effect of exercise on fetal
  heart rate demonstrate either no significant
  change or short-term increases of five to 15
  beats per minute.

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• Oxygen Demands
• With mild exercise, pregnant women have a
  greater increase in respiratory frequency and
  oxygen consumption to meet their greater oxygen
  demand. As exercise increases to moderate and
  maximal levels, however, pregnant women
  demonstrate decreased respiratory frequency,
  lower tidal volume and maximal oxygen consumption

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• Energy Demands
• Both exercise and pregnancy are associated with
  a high demand for energy. In the first two
  trimesters, an increased intake of 150 calories
  per day is recommended an increase of 300
  calories per day is required in the third
  trimester.Caloric demands with exercise are even
  higher, although no studies have focused on exact
  requirements. The competing energy demands of the
  exercising mother and the growing fetus raise the
  theoretic concern that excessive exercise might
  adversely affect fetal development.

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• Hormonal adaptations
• Oestrogen stimulates the growth of the uterus
  and breasts, and high level of oestrogen can
  result in excess water retention, nausea
  (specially in the first trimester) and joint
  looseness.Progestrone Thickens and develops the
  walls of the uterus, controlling and relaxing to
  stop contracting excessively.Relaxin Softens
  ligaments, cartilage and the cervix, allowing
  these tissues to spread during deliver. This is a
  major area you should be careful whilst doing
  stretching exercises.Insulin resistance
  increases during pregnancy, this make the
  pregnant womens pattern of energy utilization
  similar to that of a mild diabetic. In mid and
  late pregnancy insulin resistance serves to
  utilize more fat for maternal energy and rest
  during exercise.

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Impact of Pregnancy on Exercise Performance

• In the third trimester women go through
  major changes, and have to be careful with
  exercises
• Of the sixth month of pregnancy intensity
  exercise are decreases
• exercises such as cycling or swimming are very
  helpful
• Rresearch has shown that moderate exercise in
  late pregnancy does not influence on premature
  birth, shooting membranes or damage to fetuses

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Recommended exercise
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• Walking

• One of the best cardiovascular exercises for
  pregnant women, walking keeps you fit without
  jarring your knees and ankles. It is safe
  throughout the nine months of pregnancy and can
  be built into your day-to-day schedule.

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• Jogging - Running

• Going for a jog is the quickest and most
  efficient way to work your heart and your body.
  You can tailor it to your schedule -- running 15
  minutes one day when that's all you can fit in
  and 30 the next when you have the time.

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• Swimming

• Healthcare providers and fitness experts hail
  swimming as the best and safest exercise for
  pregnant women. Swimming is ideal because it
  exercises both large muscle groups (arms and
  legs), provides good cardiovascular benefits, and
  allows pregnant women to feel weightless despite
  the extra weight of pregnancy.

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• Aquanatal classes

• Many women find aquanatal classes enjoyable
  during pregnancy. Exercising while standing in
  water is gentle on joints and can help lessen
  swelling in legs, which is a common symptom in
  late pregnancy.

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• Yoga and stretching

• Yoga and stretching can help maintain muscle
  tone and keep you flexible with little if any
  impact on your joints. However, you may have to
  augment a yoga regime by walking a few times a
  week to give your heart a workout. Be careful not
  to overdo the stretching. You will be more supple
  as a result of the effects of relaxin, which
  causes your ligaments to be more pliable. Don't
  hold the stretches for too long or try to develop
  your flexibility too much.

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• Pilates

• Pilates is a form of exercise which combines
  flexibility and strength training with body
  awareness, breathing and relaxation. The
  exercises are based on certain movement patterns
  performed with your tummy and pelvic floor
  muscules -- known in Pilates as the "stable core"
  or base. These muscles are also known as deep
  stabilizing muscles. Because Pilates targets the
  tummy and pelvic floor muscles and these muscles
  can weaken during pregnancy, Pilates exercises
  can be useful.

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• Low-impact aerobics

• One good thing about an aerobics class is that
  it's a consistent time slot when you know you'll
  get some exercise. If you sign up for a class
  specifically designed for pregnant women, you'll
  get to enjoy the camaraderie of others just like
  you, and can feel reassured that each movement
  has been deemed safe for you and the baby.

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Contraindications to Exercise
Pulmonary disease

• women with medical complications should be
  encouraged to avoid vigorous physical activity

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Recommendations

• Studies have not documented a significant rise in
  core temperature with exercise, but thermal
  stressors present a theoretic risk of congenital
  anomalies in early pregnancy
• Women can minimize thermal stress by performing
  exercise in the early morning or late evening to
  improve heat dissipation when it is hot outside
• May be used during stationary cycling or other
  indoor exercise, and swimming may be an option to
  improve conductive heat loss
• The intensity, duration and frequency of exercise
  should start at a level that does not result in
  pain, shortness of breath or excessive fatigue
• Physical conditioning and well-being, including
  hydration, caloric intake, and quality of rest
• Exercises performed in the supine position are
  inadvisable after the first trimester, as are
  prolonged periods of motionless standing

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Final Comment

• The physiologic interactions between pregnancy
  and exercise are not fully understood. Although
  some theoretic concerns remain about exercise in
  pregnancy, the data thus far have been reassuring
• It should be kept in mind, however, that there
  are major deficits in our knowledge
• Some studies have shown positive effects of
  exercise and some do not because they are not
  included in all social economic categories of
  women
• Whether exercise is harmful or whether it
  improves the course and outcome of pregnancy is
  largely unknown

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• Therefore, no definitive recommendation can be
  made to promote exercise during pregnancy
• Nevertheless, there appears to be no reason that
  most women cannot continue with exercise during
  pregnancy and reap the possible benefits of
  improvement in well-being.

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The Authors

• THOMAS W. WANG, M.D., is director of the Primary
  Care Sports Medicine Fellowship at the Department
  of Family Practice at MacNeal Hospital, Berwyn,
  Ill. Dr. Wang graduated from the Medical College
  of Ohio, Toledo, and served his residency in
  family practice at the University of Michigan,
  Ann Arbor, Medical School.
• BARBARA S. APGAR, M.D., is a clinical associate
  professor in the Department of Family Practice at
  the University of Michigan Medical School. She is
  a graduate of Texas Tech University School of
  Medicine, Lubbock, where she served a family
  practice residency. Dr. Apgar also completed a
  master's program at the University of Michigan
  and a faculty development fellowship at Michigan
  State University, East Lansing.
• Address correspondence to Thomas W. Wang, M.D.,
  MacNeal Family Practice, 3231 S. Euclid Avenue,
  Berwyn, IL 60402. Reprints are not available from
  the authors.

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• REFERENCES
• American College of Obstetricians and
  Gynecologists. Exercise during pregnancy and the
  postpartum period. ACOG Technical Bulletin 189.
  Washington, D.C. American College of
  Obstetricians and Gynecologists, 1994.
• Calguneri M, Bird HA, Wright V. Changes in joint
  laxity occurring during pregnancy. Ann Rheum Dis
  198241126-8.
• Clapp JF 3d. Exercise in pregnancy a brief
  clinical review

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Thank you for your attention