(마더세이프 라운드) exercise in pregnancy
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Moderate exercise during pregnancy provides health benefits such as maintaining fitness, managing weight gain, and improving mood. Regular exercise can help prevent excessive weight gain, back pain, gestational diabetes, and preeclampsia. While vigorous exercise has greater risks, moderate exercise does not increase risks of preterm birth or low birthweight. Guidelines recommend 30 minutes per day of moderate exercise on most days for healthy pregnant women. Exercise should be tailored based on a woman's medical history and condition and stopped if concerning symptoms arise.
![Exercise prescription - Type of exercise
• High risk of falling or abdominal trauma
ice hockey, soccer, basketball, gymnastics, horseback riding,
downhill skiing, water skiing, vigorous racquet sports, skydiving
• Scuba diving
the fetus : increased risk for decompression sickness secondary to the
inability of the fetal pulmonary circulation to filter bubble formation
• Exercise during the first few days of exposure to moderate to high altitude
(above 6000 ft [2500 m]) the reduction in oxygen availability](https://image.slidesharecdn.com/20050526exerciseinpregnancy-150527003138-lva1-app6891/85/exercise-in-pregnancy-18-320.jpg)
(마더세이프 라운드) exercise in pregnancy
- 1. Exercise in pregnancy 제일병원 전임의 이정민
- 3. INTRODUCTION • Pregnancy is recognized as a unique time for lifestyle modifications. • Regular exercise during pregnancy promote for its overall health benefits : maintain or improve physical fitness help with weight management enhance psychological well-being
- 4. BENEFITS OF EXERCISE DURING PREGNANCY-I • maintain or improve fitness Obstet Gynecol. 2012 • prevent excessive gestational weight gain Cochrane Database Syst Rev. 2012 • prevent or reduce low back pain Int J Gynaecol Obstet. 2011 • reduce the risk of developing GDM and preeclampsia • reduce having a cesarean delivery
- 5. BENEFITS OF EXERCISE DURING PREGNANCY-I • Moderate exercise : not a direct cause of any adverse pregnancy outcome • Physical activity/exercise : not increase the risk of preterm delivery Med Sci Sports Exerc. 2012 • No strong evidence of clinically significant improvements in other pregnancy outcomes (duration of labor) Acta Obstet Gynecol Scand. 2014 • Greater risk of joint injuries, falling and abdominal trauma during exercise ;; abdominal trauma placental abruption ( lead to fetal death or morbidity)
- 6. BENEFITS OF EXERCISE DURING PREGNANCY-II • The fetus : tolerate maternal exercise in uncomplicated pregnancies Any fetal responses : transient with no lasting adverse effects • Standard tests of fetal well-being : generally reassuring after short-duration, strenuous exercise in both active and inactive pregnant women Am J Obstet Gynecol. 2012 • Transient maternal hypoxia transient fetal tachycardia , a transient increase in fetal blood pressure fetal protective mechanisms ( increase blood flow and facilitate exchange of the respiratory gases across the placenta)
- 7. BENEFITS OF EXERCISE DURING PREGNANCY- II • Maternal exercise increase of FHR by 10 ~ 30 bpm : not deleterious to the fetus ( independent of GA and intensity of exercise) Am J Obstet Gynecol. 1986 • The increase in rate may be accompanied by a reactive FHR pattern (ie, FHR accelerations); postexercise reactivity is generally achieved within 20 minutes. Biophysical profile scores were reassuring. Obstet Gynecol. 2012
- 8. BENEFITS OF EXERCISE DURING PREGNANCY-II • The Effect of Supervised Prenatal Exercise on Fetal Growth: A Meta-analysis Obstet Gynecol. 2015 - Prenatal exercise reduced the odds of having a large newborn by 31% without altering the risk of having a small newborn or gestational age at delivery. - Newborns of mothers assigned to exercise : lighter than nonexercising controls - Maternal gestational weight gain and cesarean delivery : reduced - CONCLUSION : structured prenatal exercise reduces the risk of having a large newborn without a change in the risk of having a small newborn
- 9. GUIDELINES - United States The American College of Obstetricians and Gynecologists (ACOG) 2009 - reaffirmed 2002 guideline for exercise during pregnancy and the postpartum - recommend ( in the absence of either medical or obstetric complications) pregnant women exercise at a moderate level for 30 minutes or more per day on most, if not all, days of the week. - Vigorous exercise is not recommended during pregnancy ( not studied sufficiently)
- 11. GUIDELINES - Canada • The Canadian Society for Exercise Physiology (CSEP) Canadian Physical Activity Guidelines 2011 : 18 to 64 years : at least 150 minutes of moderate- to vigorous-intensity aerobic physical activity per week, in bouts of 10 minutes or more, and stated that muscle-and bone- strengthening activities using major muscle groups on at least two days per week were also beneficial : pregnant women should consult a health professional to understand the types and amounts of physical activity appropriate for them based on their individual clinical circumstances.
- 12. GUIDELINES - United Kingdom • The Royal College of Obstetricians and Gynecologists (RCOG) : all pregnant women participate in aerobic and strength-conditioning exercise as part of a healthy lifestyle during their pregnancy • Previously sedentary women should begin with 15 minutes of continuous exercise three times a week, gradually increasing the frequency and duration to 30-minute sessions 4 to 7 times a week. • The National Institute for Health and Clinical Excellence (NICE) ; moderate-intensity physical activity at least 30 minutes per day
- 13. Pre-exercise medical screening Obstet Gynecol. 2002 • General physical condition • Exercise history • History of heart disease and risk factors for coronary heart disease • Orthopedic history and musculoskeletal risks • Medication use • History of pulmonary disease • Anticipated type of exercise • Handicaps or disabilities
- 14. Obstetrical screening • Some obstetrical conditions : exercise restricted or contraindicated. • Obstetrical complications : intractable hyperemesis, premature labor, preeclampsia, FGR • Some Doppler arterial waveforms deteriorate after exercise in women with suspected uteroplacental insufficiency, which supports avoidance of exercise in women with preeclampsia or fetal growth restriction J Perinat Med. 2004, Am J Obstet Gynecol. 2005
- 15. From Exercise during pregnancy and the postpartum period. ACOG Committee Opinion No.267. American College of Obstetricians and Gynecologists. Obstet Gynecol 2002;99:171–173; reaffirmed 2009b.
- 16. Exercise prescription • Most pregnant women : routine prenatal care • Women performing higher-intensity exercise : assess the nutritional, cardiovascular, musculoskeletal status, pregnancy risks, NST & USO (fetal growth and well-being) 1. Types of exercise to include/avoid 2. Intensity, progression in difficulty over time 3. Quantity and duration (time) 4. Frequency
- 17. Exercise prescription - Type of exercise • Flexibility exercise individualized to reduce susceptibility to joint injury ( Because of increased relaxation of ligaments during pregnancy, joints are supported less effectively) • Water exercise a good for pregnant women since during immersion • Edema is reduced Obstet Gynecol. 1988 • The forces across weight-bearing joints are reduced • Body heat is readily dissipated into the water • Pilates, yoga, circuit-type resistance training, weight training
- 18. Exercise prescription - Type of exercise • High risk of falling or abdominal trauma ice hockey, soccer, basketball, gymnastics, horseback riding, downhill skiing, water skiing, vigorous racquet sports, skydiving • Scuba diving the fetus : increased risk for decompression sickness secondary to the inability of the fetal pulmonary circulation to filter bubble formation • Exercise during the first few days of exposure to moderate to high altitude (above 6000 ft [2500 m]) the reduction in oxygen availability
- 19. Exercise prescription - Type of exercise • Supine position predisposes pregnant women to hypotensive episodes ; exercising in this position after the first trimester should be avoided, particularly in the second half of pregnancy • Thermoregulatory control is altered in pregnancy • Basal metabolic rate and heat production : increased during pregnancy • Hyperthermia is a concern because of its potential effects on the developing fetus Birth Defects Res A Clin Mol Teratol. 2006
- 20. Exercise prescription - Type of exercise • ACOG recommends that pregnant women avoid exercises and conditions that are likely to lead to dehydration and overheating Obstet Gynecol. 2002 • For aquatic exercise, the Royal College of Obstetricians and Gynecologists (RCOG) water temperature : not exceed 90º Fahrenheit (32º Celsius) hydrotherapy pool temperatures : not exceed 90º Fahrenheit (35º Celsius)
- 21. Exercise prescription - Type of exercise Safe Avoid Aerobic exercise Progressive resistive strengthening Stretching exercises Yoga Stationary bicycling Jogging Walking Stair climbing Treadmill use Water exercise Swimming Supine position Motionless standing Ice hockey baseball horseback riding gymnastics scuba dive Camporesi et al. 1996, ACOG 2002
- 22. Exercise prescription - Intensity of exercise • Prescription of exercise intensity in pregnancy is individually tailored to the individual’s level of physical ability, ideally involves easily quantified activities (eg, walking, swimming, stationary cycling), and is increased gradually • Women who were regular exercisers before pregnancy and who have uncomplicated, healthy pregnancies should be able to engage in high- intensity exercise programs (eg, jogging, aerobics) with no adverse effects Adv Exp Med Biol. 2014
- 23. Exercise prescription - Intensity of exercise • Metabolic equivalent task (MET) (energy used by the body while sitting) 1 MET = 3.5ml O2/kg/min
- 24. Exercise prescription - Intensity of exercise • Intensity based on METs : Nonpregnant individuals are advised to participate in regular moderate-intensity exercise routines defined as exercise of 3 to 4 metabolic equivalents (METs) or any activity that is equivalent in difficulty to brisk walking : Moderate exercise appears to be an appropriate goal for the two-thirds of pregnant women who have not been engaging in regular exercise prior to pregnancy. : exercise intensity can be safely increased to 6 to 7 METs in well-conditioned healthy mothers (walking 3.5 mph uphill is 6 METs)
- 25. Exercise prescription - Frequency and duration of exercise • Most guidelines : 30 minutes of exercise daily, 5 to 7 days per week Obstet Gynecol. 2002 • Exercise should be performed in a thermo-neutral environment or in controlled environmental conditions (air conditioning). • Caloric costs of fitness exercise are estimated and balanced by appropriate caloric intakes.
- 26. Exercise prescription - Progression of exercise • Pregnant women who have not been regular exercisers should follow a gradual progression of increasing exercise, up to an accumulation of 30 minutes or more per day. • Previously sedentary women who began exercising at 12-14 wk improved fitness and delivery outcomes. Clin Obstet Gynecol. 2003, Med Sci Sports Exerc. 2012
- 27. Exercise prescription - When to stop exercising • Warning signs of potential impending complications • The pregnant woman should stop exercising and call her healthcare provider if she has any of the following . Obstet Gynecol. 2002 • Vaginal bleeding • Leakage of amniotic fluid • Lightheadedness or dizziness • Unusual shortness of breath or dyspnea prior to exertion • Chest pain, Headache, Muscle weakness • Calf pain or swelling, Uterine contractions • Decreased fetal movement
- 28. DM (GDM) • Exercise is increasingly promoted as part of the therapeutic regimen for nonpregnant individuals with diabetes mellitus. • In addition to its cardiovascular benefits, exercise can also improve glycemic control, which largely results from increased tissue sensitivity to insulin. • Exercise may also help to reduce the risk of developing gestational diabetes or improve glucose control in women with gestational diabetes.
- 29. Preeclampsia • Women with preeclampsia are advised to avoid exercise since it increases blood pressure and increases blood flow to muscle and potentially away from the uteroplacental circulation, which already may be compromised. Am J Epidemiol. 2004 • In women without preeclampsia, observational data suggest that regular physical activity prepregnancy and in early pregnancy reduces the risk of developing preeclampsia Med Sci Sports Exerc. 2005
- 30. Obesity • Excessive weight gain in pregnancy has been associated with obesity in later life. • Clinical trials under medical supervision have proven that lifestyle intervention of weight-gain restriction and moderate exercise can be safely prescribed in pregnancy, with favorable maternal and fetal outcomes Am J Clin Nutr. 2011 /Appl Physiol Nutr Metab. 2007
- 31. Risk for FGR • low risk women(2015 systematic review of randomized trials ) : regular participation in a supervised prenatal exercise program resulted in a clinically insignificant reduction in birthweight compared with usual care and no increase in small for gestational age newborns Obstet Gynecol. 2015
- 32. EXERCISE IN THE POSTPARTUM PERIOD • Exercise and a healthy diet postpartum promote weight loss, which can improve or prevent many future obesity-related risks, such as diabetes mellitus and hypertension • A decreased frequency of postpartum depression has been associated with return to physical activity following pregnancy, but only if the exercise is stress-relieving and not stress-provoking J Sports Med Phys Fitness. 1997
- 33. EXERCISE IN THE POSTPARTUM PERIOD - Breastfeeding • Breastfeeding women should consider feeding their infants before exercising to avoid the discomfort of engorged breasts while exercising. • Nursing before exercise will avoid the potential problems associated with increased acidity of milk secondary to any build-up of lactic acid.
- 34. Thank you for your attention !!