Movement, Nutrition, and Social Media

NURS546

How might knowing the amount of mets someone can tolerate be helpful in caring for pregnant patients?

We can gage their current fitness level and see what counseling or limitations they may need.

What is classified as “light exercise” and what subjective information is an indicator for this?

Casual walk, stretching, bicycling (less than 5mph), slow dancing, light weight training, light yard and housework, table tennis/catch/fishing. “I can sing” is a indicator for light exercise.

What is classified as “moderate exercise” and what subjective information is an indicator for this?

Brisk walk, hiking, bicycling (5-9 mph), low impact aerobics, moderate dancing, competitive tennis and volleyball, yoga, weight training. “I can talk” indicates this.

What is classified as “high intensity exercise” and what subjective information is an indicator for this?

Walking more than 4mph, jogging/running, mountain climbing, bicycling (more than 10mph), high impact or step aerobics, vigorous dancing, martial arts, basketball, soccer, football, swimming laps. “Can only say a few words before taking a breath” indicates this.

For adults age 18-64 yrs, what is the CDC recommendation for exercise.

150 minutes of moderate-intesity aerobic activity each week and muscle strethengthening activities that work all major muscle groups on > 2 days per week OR 75 mins of vigorous aerobic activity each week and muscle-strengthening activities on > 2 days per week OR equivalent mix of moderate- and vigorous aerobic activity and muscle-strengthening activities that work all muscle groups on > 2 days per week

How does exercise impact the muscles?

Causes injury to the muscle and an inflammatory response → activates genes that regulate metabolism and mitochondria, t cell activates→reducing inflammation

In simple terms, what is the role of T cells in exercise?

They clean up muscle injury and inflammation after exercise.

What are some benefits of movement for your health?

Prevention of premature death, decreased risk of heart disease, DM2, all cancer, dementia, cognitive decline, falls, fractures and osteoporosis. Increases survivability in cancer

How are exercise and fertility related?

Exercise is associated with decreased levels of infertility.

What does exercise help with in the HPO axis?

Reduces gonadotropin levels (LH and FSH), decreases inflammation, and inhibits excess circulating sex hormones.

How is exercise beneficial in menopause?

Decreases vasomotor symptoms, improves sleep, and improves mood.

What is the recommendation for exercise in pregnancy?

150 minutes of moderate intensity exercise per week. Vigorous exercise can be continued if the patient engaged in vigorous exercise before.

What are some benefits of exercise for the baby of a pregnant person?

Enhanced neurogenesis, language development, cognitive function. Decreased risk of macrosomia, obesity and cardio-metabolic disease.

What is a major benefit of exercise for the pregnant person?

Increased physical comfort

How does a fetus respond to exercise?

Fetal heart rate may increase, increased fetal hgb, better diffusion of oxygen and nutrients across the placenta, and increase metabolic use of lipids for energy

What are some contraindications for exercise in pregnancy?

Cerclage, placenta previa >26 weeks, PTL, ROM, severe anemia, pre-e or hypertensive disorders, and multiple gestation/risk for PTB

When should a pregnant patient stop exercising and report to triage/call the midwife?

Vaginal bleeding, abdominal pain, regular painful contractions, ROM, dyspnea before exertion, dizziness, headache, chest pain, muscle weakness, and calf pain or swelling.

What are some barriers of exercising in pregnancy?

Fatigue, lack of time, pregnancy discomforts, work, other children, lack of knowledge and negative social cues.

What are some enablers of exercising in pregnancy?

Maternal and fetal health benefits, social support, pregnancy specific programs, and experienced benefits.

What are some sources of carbohydrates?

Whole grains, fruits, vegetables, legumes, and dairy products.

What are the recommendations for carbohydrate intake in pregnant women?

Depends on age, physical activity level, and overall health status. 175g/day for singleton pregnancy, 330g/day for multiple pregnancy, and 210g/day during lactation

Is protein needed in pregnancy?

Yes, its needed for the growth and development of the baby

What are some sources of protein?

Lean meats, plant based sources (legums, nuts and seeds, and soy products), dairy products, eggs.

What are the recommendations for protein intake in pregnancy?

0.8-1.0 grams per kilogram of body weight or 10%-35% of total calories.

What are the types of fats?

Saturated-solid at room temp: meat fats, butter, coconut oil (linked to worsening serum lipoprotein)

Unsaturated-liquid at room temp: vegetable oils, nuts and seeds (improves serum cholesterol, reduce inflammation and stabilize heart rhythms)

Trans fats-avoid; largely found in commercially made products

What are some sources of fats?

monounsaturated fats: avocados, olices and olive oil, pecans, almonds, pumpkin seeds, and sunflower seeds

omega 3 fatty acids: salmon mackerel, anchovies, sardines, algae, walnuts, chia seeds, and flax seeds

saturated fats: meat fats, butter, coconut oil (a source of medium chain triglycerides) , palm oil

What is the recommendation of fat intake for pregnancy people?

Between 20-35% of daily calories. 200-300 mg of DXA. Avoid trans fats and limit saturated fats.

What are some fat soluble vitamins?

Vitamin A: night vision, immunity, and cell growth. Can get from yellow and orange fruits and vegetable

Vitamin D:promotes calcium and phosphate absoprtion, regulates glucose, insulin and BP, and modulates immune system. Can get from sunlight exposyre, only fish liver oils

Vitamin E: primarily an antioxidant (heart, skin, eye health); immune function. Can get from nut and vegetable oils.

Vitamin K: blood clotting, bone health (calcium regulation and bone mineralization). Can get from leafy greens, brussel sprouts, fermented foods.

What can put someone at risk for folate deficiency?

Poor diet, high consumption of ETOH and malabsorption disorders.

Where is folate found in foods?

Liver, leafy greens and fortified cereals.

What can a B12 deficiency lead to?

Anemia, neurologic and cognitive dysfunction, including depression

What is the purpose of B12?

B12 plays a role in RBS production, nerve function, and neurologic health, energy metabolism, DNA synthesis and cell division

What are the major and trace minerals found in the body?

Major: Calcium, magnesium, phosphorus, potassium and sodium. Trace: cobalt, iron, manganes, copper, iodine, molybdenum and selenium.

Who are at greater risk for iron deficiency in pregnancy?

Pregnant people with malabsorption disorders (IBD) or those who have undergone bypass surgery.

What are the two type of irons and what are food sources for them?

Heme iron: absorbed more efficiently than non-heme iron. Can get heme iron from lean meats, fish and liver.

Non-heme iron: beans and lentils, tofu, and leafy greens

What do people need to take to absorb iron better?

Vitamin C, not calcium (inhibits Fe absorption)

What is calcium and iodine for?

Calcium: healthy bone and teeth formation, nerve conduction, muscle contraction and blood clotting. Pregnant women should aim for 1300 mg of Ca/day

Iodine: vital for thyroid function.

How do we counsel for preconception nutrition?

People who want to get pregnant should be getting 400mcg/day of folate (4mg for those with prior risk of NTD), ensure they have adequate iron intake, take DHA supplement, screen for vitamin D deficiency/put on supplement, and manage a healthy weight.

What are major food safety precautions in pregnancy?

Wash hands thoroughly before handling food and after handling raw meat, using the bathroom and handling pets.

Cook all meats and eggs thoroughly, use food thermometer to ensure food is cooked thoroughly.

Avoid unpasteurized food products, raw or underscooked seafood, and deli ments or hot dogs.

Thoroughly wash all fruits and vegetable.

Refrigerate perishable foods promptly and make sure fridge is set to appropriate temperature.

Avoid high-mercury fish.

What is the optimal diet for postpartum healing, recovery and lactation?

Balanced diet, hydration, protein, iron, vitamin C, D and healthy fats. Optimize intake of calories, fluids and omega 3 fatty acids.

What can we consider about diet for PPD and anxiety?

Eat at regular intervals, stay hydrated, have a balanced diet, avoid caffeine and alcohol, and omega 3 fatty acids.

What are the general dietary guidelines for pregnancy?

Weight gain: pre pregnancy BMI: <18.5 (+28-40 lbs); 18.5-24.9 (+25-35lbs); 25-29.9 (+15-25lbs); >30 (+11-20lbs)

Increase in caloric needs: 1st trimester: No increase; 2nd trimester: +340kcal/day; 3rd trimester: +452kcal/day

What are the guidelines for seafood, alcohol and caffeine?

Seafood: avoid high methylmercury fish

Alcohol: No safe amount in pregnancy

Caffeine: limit to 300mg or less per day