Clinical - Exercise For Pregnant Women

Notes to study for our quiz on Monday

Exercise may decrease the risk of developing:

Pregnancy-induced hypertension and gestational diabetes.

Only _% of pregnant women meet current exercise guidelines ​

15%

Exercise provides health/fitness benefits to:

Mother & Child

Healthy women without exercise contraindications are encouraged to:

exercise throughout pregnancy

Estrogen:

Repairs uterine lining before pregnancy​ & increases breast size​

Progestone

Maintain uterine lining during pregnancy & Limits (unwanted) contractions​ ​

Human Chorionic Gonadotrophin (HCG):

Regulates estrogen & progesterone​

Relaxin:

Limits contractions & makes your joints more flexible but less stable ​​

Prolactin:

Increases milk production

Oxytocin:

Stimulates contractions at delivery

Why do you need the peak in human chorionic gonadotropin (HCG)?

Results in the peak of estrogen & progestrone

Changes that occur during the 1st trimester:

• Hormone levels fluctuate,

  • nausea

• Breast swells & become tender

• Increases perspiration (sweat) (messes with your hydration levels)​

• Fetus enlarges and puts pressure on urinary bladder​

  • ↑ frequency of urination ​

How long does Placenta last?

38 weeks

What happens to the health of the infant if you do not deliver them until 40 weeks?

If you wait longer then 38 weeks to deliver your baby you risk putting the baby health at risk because they are not getting the nutrients they need​

Changes that occur during the 2nd trimester:

• The body adjusts to hormone levels

  • Nausea subsides

• Enlarging fetus​

  • Back pain​

  • COM (center of mass) changes

• Joints become less stable​

• Uterus and fetus are displaced out of pelvis​

  • Reflux (Acid)

• Edema: Swelling/fluid buildup in places that are not common​

Changes that occur during the 3rd trimester:

• Fetus continues to grow, organs crowded out

  • Frequent urination and constipation

• ↑ weight strain on heart and lungs​

  • Fatigue

• Braxton-Hicks contractions: irregular contractions that start midway through pregnancy and continue until the end of pregnancy (false labor)​​

Being underweight, overweight or obese pre-pregnancy is associated with:​

• ↑ Difficulty in conceiving​

• ↑ risk of complications during pregnancy​

Risk factors ↑ linearly as BMI ↑​

• Gestational diabetes​

• Hypertension​

• Preeclampsia: High blood pressure and excessive swelling and excessive protein in your urine​

  • If you are older, if it is your first pregnancy, if you have an high BMI, or if your mother had it you can get preeclampsia​

  • Idiopathic: Doctors do not know the cause or why preeclampsia happens​

• As BMI increases so does the risk factors ​

Healthy Weight Gain ​Single Fetus:

• 25-35 lb​

• 3.5 lb during 1st trimester, 1 lb / week thereafter

Healthy Weight Gain Multiple fetus:​

35-45 lb

Greatest predictor of infant health:

birth weight​

Birth weight correlates with:

maternal weight gain​

Rapid weight gain: ​

Physician needed​

Distribution of Weight Gain (Increase 7.5 lbs):

Average baby’s weight

Distribution of Weight Gain (Increase 7 lbs):

Extra stored protein, fat, other nutrients

Distribution of Weight Gain (Increase 4 lbs):

• Extra blood

• Additional body fluids

Distribution of Weight Gain (Increase 2 lbs):

• ↑ breast size​

• ↑ size of uterus and supporting muscles ​

• Amniotic fluid surrounding fetus​

Distribution of Weight Gain (Increase 1.5 lbs):

Placenta ​

Physiologic Responses to Acute Exercise During Pregnancy vs. Prepregnancy: VO2 (during weight-bearing exercise)​, HR, SV, Q, TV, V_E ,V^_E/VO₂ , V_E/VCO₂

↑​ (increase)

Physiologic Responses to Acute Exercise During Pregnancy vs. Prepregnancy: SBP (important) (Wide spread vasodilation​) (Way for the body to protect the fetus), and DBP (important)​

↔ or ↓​

Pregnancy and Exercise: Recommended to engage in-

• > or equal to 150 min of moderate-intensity exercise over 3+ days/week

  • Reduces odds of developing complications​

  • Does not increase odds of miscarriage, early delivery​

  • Reduces odds of developing depression by 67%​​

Exercise Testing: Max testing _______be performed​

• should not

  • Unless medically necessary ​

  • Physician supervision ​

Exercise Testing: _________ may be used to predict VO2max ​:

• Submaximal exercise testing

  • < 75% HRR​

  • Ex: If they have heart problems, organ issue​

Exercise Testing: Medical clearance needed if:​

• Previously sedentary ​

• Other chronic conditions​

Aerobic Exercise Programming:

• Exercises ​

  • Treadmill walking ​

  • Cycling

• Intensity​

  • Moderate:​

    • 40-60% VO2R​

    • Target HR​

    • 12-14 on Borg scale ​

    • Talk test

• Frequency

  • 3-7 days/week​

• Duration

  • At least 15 min/day to start

  • ​Gradually increase to 30 min/day

Strength Exercise Programming:

• Exercise

  • Free weights​

  • Machines ​

• Intensity

  • Moderate

    • 12-14 on Borg scale ​

    • Talk test

• Frequency

  • Min 2 days/week

• Duration

  • 8-10 exercises​

  • 8-12 reps

Flexibility Exercise Programming:

• Exercises

  • Stretching through ROM

• Duration

  • Before and after any exercise

Moderate-Intensity HR Ranges​:

• Prepregnancy BMI < 25 kg/m2​

  • Age: < 20

  • Heart Rate Range (beats/min): 140-155

Moderate-Intensity HR Ranges​: Age (20-29)

• Fitness Level

  • Unfit: 129-144 b/min

  • Active: 135-150​ b/min

  • Fit: 145-160​ b/min

Moderate-Intensity HR Ranges​: Age (30-39)

• Fitness Level

  • Unfit: 128-144 b/min

  • Active: 130-145 b/min

  • Fit: 140-156 b/min

Moderate-Intensity HR Ranges​: Prepregnancy BMI > 25 kg/m2​

• Age: 20-29

  • Heart Rate Range: 102-124

• Age: 30-39

  • 101-120

Sample Resistance Training Session​: Upper Body

• Exercise

  • Press Ups​ (standing against a wall)

    • Duration: 2 x 10 reps

  • Tricep Dips​ (from a chair with knees bent)

    • Duration: 2 x 10 reps

  • Upright Row​ (with band or light weight)

    • Duration: 2 x 10 reps

Sample Resistance Training Session​: Low Body

• Exercise

  • Body Weight Squat​ (or sit-to-stand from chair)

    • Duration: 2 x 15 reps

  • Lunge​ (with support if needed)

    • Duration: 2 x 10 reps each leg

  • Calf Raises​ (with support if needed)

    • Duration: 2 x 15 reps

Potential Risks of Exercise​

• ↑ Core body temp​

  • Neural tube defect- folic acid can prevent neural tube defect​

• Interrupted blood flow to fetus​

  • Blood flow distribution ​

• ↓ O2 delivery to fetus

  • Maternal cells require O2 during exercise​

• Low birth weight ​

  • Mother requires ↑ EE (Energy expenditure) to sustain activity

  • The risk of exercise increases as intensity increases ​​

Special Considerations ​

• Avoid contact sports or activities that may cause loss of balance​

• Avoid exercising in supine position after 1st trimester​

  • ↓ Q, ↓ BP, ↓ O2 flow to fetus

• Exercise in a thermoneutral environment​

  • Well hydrated ​

• Metabolic demand ↑ by 300 kcal/day​

  • ↑ caloric intake ​​

Special Considerations ​

• A strength-training program should:​

  • Include all major muscle groups​

  • Include multiple reps (12-15)​

  • Be performed to moderate fatigue ​

  • Avoid isometric (same length-the muscle does not change length) contractions​

  • Avoid Valsalva maneuver ​

• Exercise in postpartum may begin 4-6 weeks after delivery.​