exercise during pregnancy

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Exercise During Exercise During Pregnancy Pregnancy Antoin M. Alexander Antoin M. Alexander Maj USAF MC Maj USAF MC Family Medicine Sports Fellow Family Medicine Sports Fellow Adopted from Dr. Fred Brennan Adopted from Dr. Fred Brennan

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Exercise During Pregnancy. Antoin M. Alexander Maj USAF MC Family Medicine Sports Fellow Adopted from Dr. Fred Brennan. Case. 24 y.o. G1P0 presents at 9 wks EGA for 1 st obstetrical visit Competes routinely in triathlons and road races - PowerPoint PPT Presentation

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Page 1: Exercise During Pregnancy

Exercise During Exercise During PregnancyPregnancy

Antoin M. AlexanderAntoin M. AlexanderMaj USAF MCMaj USAF MC

Family Medicine Sports FellowFamily Medicine Sports FellowAdopted from Dr. Fred BrennanAdopted from Dr. Fred Brennan

Page 2: Exercise During Pregnancy
Page 3: Exercise During Pregnancy

CaseCase

• 24 y.o. G1P0 presents at 9 wks EGA for 124 y.o. G1P0 presents at 9 wks EGA for 1stst obstetrical visitobstetrical visit

• Competes routinely in triathlons and road Competes routinely in triathlons and road racesraces

• Curious about the benefits & risk of Curious about the benefits & risk of continuing to train & possibly competing continuing to train & possibly competing while pregnantwhile pregnant

• Will her performance suffer?Will her performance suffer?• Will she put her baby at risk?Will she put her baby at risk?• Can she exercise & breastfeed in the Can she exercise & breastfeed in the future?future?

Page 4: Exercise During Pregnancy

OverviewOverview

• Physiology of Physiology of Exercise and Exercise and PregnancyPregnancy

• Risks and BenefitsRisks and Benefits• Guidelines for Guidelines for Exercise in Exercise in PregnancyPregnancy

• The Pregnant The Pregnant AthleteAthlete

• Injury PatternsInjury Patterns• College athleteCollege athlete

Page 5: Exercise During Pregnancy

Useful ReferencesUseful References

• ACOG CommitteeACOG Committee. Opinion no. 267: . Opinion no. 267: exercise during pregnancy and the exercise during pregnancy and the postpartum period. postpartum period. Obstet GynecolObstet Gynecol 2002;2002;9999:171–3 :171–3

• Artal RArtal R. Exercise during pregnancy. . Exercise during pregnancy. Safe and beneficial for most. Safe and beneficial for most. Phys Phys and Sports Med and Sports Med 1999;1999;2727:51–60 :51–60

Page 6: Exercise During Pregnancy

Useful ReferencesUseful References

• Kelly AK. Practical exercise advice during Kelly AK. Practical exercise advice during pregnancy. Guidelines for active and inactive pregnancy. Guidelines for active and inactive women. women. Phys and Sports Med June Phys and Sports Med June 2005;33(6)2005;33(6)

• Davies GA. Joint SOGC/CSEP clinical practice Davies GA. Joint SOGC/CSEP clinical practice guideline: exercise in pregnancy and the guideline: exercise in pregnancy and the postpartum period.postpartum period. Can J Appl PhysiolCan J Appl Physiol 2003; 2003; 28(3): 330-4128(3): 330-41

• Morris SN. Exercise during pregnancy: a Morris SN. Exercise during pregnancy: a critical appraisal of the literature. critical appraisal of the literature. J J Reprod MedReprod Med 2005; 50(3):181-8 2005; 50(3):181-8

Page 7: Exercise During Pregnancy

Physiologic Adaptations to Pregnancy & Interactions with Exercise

Page 8: Exercise During Pregnancy

Physiology OverviewPhysiology Overview

• Significant physiologic changes Significant physiologic changes occur in pregnancyoccur in pregnancy

• Objective data on the impact of Objective data on the impact of exercise on the mother, fetus, and exercise on the mother, fetus, and course of pregnancy are limitedcourse of pregnancy are limited

• Theoretical concerns must be Theoretical concerns must be understood to allow physicians to understood to allow physicians to advise women who wish to exercise advise women who wish to exercise in pregnancyin pregnancy

Page 9: Exercise During Pregnancy

Fetal Response To Fetal Response To ExerciseExercise

• 45 healthy pregnany woman studied45 healthy pregnany woman studied– 15 nonexercisers, 15 regularly active,15 highly 15 nonexercisers, 15 regularly active,15 highly activeactive

– Tested 28- 33 weeks gestationTested 28- 33 weeks gestation– Treadmil #1 to volitional fatigueTreadmil #1 to volitional fatigue– Treadmill #2 to 40-59% HR reserve for 30 minTreadmill #2 to 40-59% HR reserve for 30 min– Treadmill #2 to 60-84% HR reserve for 30 minTreadmill #2 to 60-84% HR reserve for 30 min– Measure Umbilical artery Doppler, FHR tracing, Measure Umbilical artery Doppler, FHR tracing, biophysical profilebiophysical profile

All doppler similar pre and post exerciseAll doppler similar pre and post exercise

Post exercise FHR tracing reactive < 20 minutesPost exercise FHR tracing reactive < 20 minutes

BPP scores all reassuringBPP scores all reassuringObstet Gynecol 2012; 119 (3) : 603-10Obstet Gynecol 2012; 119 (3) : 603-10

Page 10: Exercise During Pregnancy

CardiovascularCardiovascular

• Both exercise and pregnancy increase:Both exercise and pregnancy increase:– Heart rateHeart rate– Stroke volumeStroke volume– Cardiac outputCardiac output

• Theoretical risk:Theoretical risk: Competing effects Competing effects on regional blood flow distributionon regional blood flow distribution– Exercise decreases splanchnic blood flowExercise decreases splanchnic blood flow

• Doppler US not shown changes in uterine or Doppler US not shown changes in uterine or umbilical artery flowumbilical artery flow

– Both glucose and oxygen delivery to Both glucose and oxygen delivery to placental site is reducedplacental site is reduced

Page 11: Exercise During Pregnancy

Cardiovascular IICardiovascular II

• Women who perform regular Women who perform regular weight bearing exerciseweight bearing exercise– Augment pregnancy associated Augment pregnancy associated increases in plasma volumeincreases in plasma volume

– Increase placental volumeIncrease placental volume– Increase cardiac outputIncrease cardiac output

• What does this suggest?What does this suggest?– Increased rate of placental blood Increased rate of placental blood flow at restflow at rest

– Increase in 24 h glucose & oxygen Increase in 24 h glucose & oxygen deliverydelivery

Page 12: Exercise During Pregnancy

Substrate Delivery & Substrate Delivery & UtilizationUtilization

• Non-pregnant athleteNon-pregnant athlete– Wt-bearing exercise increases glucose Wt-bearing exercise increases glucose oxidationoxidation

– Sympathetic response mobilizes glucose stores Sympathetic response mobilizes glucose stores & stimulates gluconeogenesis& stimulates gluconeogenesis

– ResultResult: rise in glucose levels for at least : rise in glucose levels for at least the first hourthe first hour

• Pregnant athletePregnant athlete– Sympathetic response bluntedSympathetic response blunted– Glucose oxidation & lipogenesis are increasedGlucose oxidation & lipogenesis are increased– ResultResult: fall in glucose levels during & after : fall in glucose levels during & after exerciseexercise

Page 13: Exercise During Pregnancy

Oxygen DeliveryOxygen Delivery

• Pre-pregnancy sustained exercisePre-pregnancy sustained exercise– oxygen delivery to muscles & skinoxygen delivery to muscles & skin– oxygen delivery to most visceraoxygen delivery to most viscera

• During pregnancy oxygen delivery During pregnancy oxygen delivery during exercise appears to be during exercise appears to be maintained bymaintained by– Maternal hemoconcentrationMaternal hemoconcentration– Improved perfusion at the placental Improved perfusion at the placental interphaseinterphase

– ConclusionConclusion: No evidence for compromised : No evidence for compromised OO2 2 deliverydelivery

Page 14: Exercise During Pregnancy

PulmonaryPulmonary

• Both exercise and pregnancy increase Both exercise and pregnancy increase – Minute ventilationMinute ventilation– Oxygen consumptionOxygen consumption

• During pregnancyDuring pregnancy– Resting energy expenditure is increased Resting energy expenditure is increased – Augmented work of breathing during Augmented work of breathing during exerciseexercise

– ResultResult: exercise requires higher VO: exercise requires higher VO22 (oxygen uptake) compared with that (oxygen uptake) compared with that required in a nonpregnancy staterequired in a nonpregnancy state

• VOVO2 2 max decreases because body weight max decreases because body weight increases with pregnancyincreases with pregnancy

Page 15: Exercise During Pregnancy

ThermoregulatoryThermoregulatory• Both exercise and pregnancy increase Both exercise and pregnancy increase

– Metabolic rate Metabolic rate – Increased heat productionIncreased heat production

• Theoretical concerns:Theoretical concerns:– Elevation in maternal core temperature due to Elevation in maternal core temperature due to exercise could reduce fetal heat dissipationexercise could reduce fetal heat dissipation

– Possible teratogenic effect at temp>102.6Possible teratogenic effect at temp>102.6

• Healthy, fit pregnant women have Healthy, fit pregnant women have been shown to tolerate thermal been shown to tolerate thermal stressstress

Page 16: Exercise During Pregnancy

Changing Thermal Response Changing Thermal Response to Endurance Exercise in to Endurance Exercise in

PregnancyPregnancy• 18 well-trained recreational 18 well-trained recreational athletesathletes

• 20 minutes of cycling at room 20 minutes of cycling at room temperature & 60-65% VOtemperature & 60-65% VO22 max max

• Maximum core temperature achieved Maximum core temperature achieved during cycling decreased throughout during cycling decreased throughout gestationgestation

• Appear to be related to a increased Appear to be related to a increased vasodilation & increased sweatingvasodilation & increased sweating

Am J Obstet Gynecol. 1991; 165;: 1684-9.

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NeuroendocrineNeuroendocrine

• Exercise increases circulating levels ofExercise increases circulating levels of– NorepinephrineNorepinephrine– EpinephrineEpinephrine

• Theoretical concernsTheoretical concerns: excess : excess catecholamines and prostanglandins will catecholamines and prostanglandins will result in contractions & preterm laborresult in contractions & preterm labor– Cochran review 2010 of 14 trials- 1014 womenCochran review 2010 of 14 trials- 1014 women

• No statistically significant change in gestation No statistically significant change in gestation at deliveryat delivery

Page 18: Exercise During Pregnancy

Mechanical EffectsMechanical Effects

• Altered center of Altered center of gravity gravity – growing breast, growing breast, uterus and fetusuterus and fetus

– increased lumbar increased lumbar lordosislordosis

• Increased risk of Increased risk of fallfall

• Increased joint Increased joint laxitylaxity– Theoretic increased Theoretic increased risk for risk for strains/sprainsstrains/sprains

Page 19: Exercise During Pregnancy

Risks and Benefits

Page 20: Exercise During Pregnancy

RisksRisks

• Theoretical risks:Theoretical risks:– Hypoxemia/HypoglycemiaHypoxemia/Hypoglycemia– Fetal teratogenesisFetal teratogenesis– Preterm laborPreterm labor– Low birth weightsLow birth weights– Sprains/strainsSprains/strains

• Negative outcomes Negative outcomes have have notnot been been identified:identified:– SABSAB– Pregnancy complicationsPregnancy complications– PTL/preterm birthPTL/preterm birth– Altered birth weightAltered birth weight– Higher injury ratesHigher injury rates

Page 21: Exercise During Pregnancy

Sour Milk?Sour Milk?

• Neither Neither quantityquantity nor nor qualityquality of of breast milk breast milk produced appears produced appears to be affected to be affected by moderate by moderate exerciseexercise

Page 22: Exercise During Pregnancy

BenefitsBenefits

• Improved cardiovascular fitnessImproved cardiovascular fitness• Control of maternal weight gainControl of maternal weight gain• Reduced subjective discomforts of pregnancyReduced subjective discomforts of pregnancy

– Swelling, leg cramps, fatigue, SOBSwelling, leg cramps, fatigue, SOB

• Positive influence of labor & delivery Positive influence of labor & delivery (Clapp et al)(Clapp et al)– Decreased risk of operative or assisted Decreased risk of operative or assisted deliveriesdeliveries

– Shorter active laborShorter active labor– Increased fetal tolerance of laborIncreased fetal tolerance of labor

• Possible reduced risk of preeclampsia, GDMPossible reduced risk of preeclampsia, GDM

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Course of Labor after Course of Labor after Endurance Exercise in Endurance Exercise in

PregnancyPregnancyExercExerciseise(n=87)(n=87)

ContrControlol(n=44)(n=44)

Incidence of PTLIncidence of PTL 9%9% 9%9%

Length of GestationLength of Gestation 277 d277 d 282 d282 d

Incidence of c-sectionIncidence of c-section 6%6% 30%30%

Incidence of operative Incidence of operative vaginal deliveryvaginal delivery

6%6% 20%20%

Duration of laborDuration of labor 264 264 minmin

382 382 minmin

Clinical evidence of Clinical evidence of fetal distressfetal distress

26%26% 50%50%Am J Obstet Gynecol 163: 1799-1805, 1990.

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Psychological Well-Psychological Well-BeingBeing

• Improved moodImproved mood• Decreased stressDecreased stress• Improved self-Improved self-imageimage

• Increased sense Increased sense of control and of control and relief of relief of tensiontension

Semin Perinatol 20: 70-76, 1996.

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Postpartum Well-BeingPostpartum Well-Being

• Improved weight lossImproved weight loss• Improved psychological well-beingImproved psychological well-being• No adverse impact on No adverse impact on breastfeeding.breastfeeding.

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Neonatal & Childhood Neonatal & Childhood BenefitsBenefits• Clapp JF: Morphometric and Clapp JF: Morphometric and neurodevelopment outcomes at neurodevelopment outcomes at age 5 years of offspring of age 5 years of offspring of women who continued to women who continued to exercise regularly throughout exercise regularly throughout pregnancy.pregnancy.– Less body fat at birth and Less body fat at birth and 5 yrs5 yrs

– Similar motor, integrative Similar motor, integrative & academic readiness as & academic readiness as control groupscontrol groups

– Higher scores on Wechsler Higher scores on Wechsler scales and tests of oral scales and tests of oral language skills.language skills.

J. Pediatr 129: 856-863, 1996.

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Preventing & Treating Preventing & Treating GDMGDM

• Exercise may be beneficial in the Exercise may be beneficial in the primary prevention of GDM, especially primary prevention of GDM, especially in morbidly obese women (BMI > 33)in morbidly obese women (BMI > 33)

• Resistance training may reduce need Resistance training may reduce need for insulin therapy in overweight for insulin therapy in overweight women (BMI > 25)women (BMI > 25)

• ADA endorsed exercise as helpful ADA endorsed exercise as helpful adjunctive therapy with GDM when adjunctive therapy with GDM when euglycemia is not achieved by diet euglycemia is not achieved by diet alone.alone.

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Expert Guidance

Page 29: Exercise During Pregnancy

Guidelines for Exercise in Guidelines for Exercise in PregnancyPregnancy

• ACOG in evolutionACOG in evolution– 19851985: HR : HR <<140 BPM with maximum duration 140 BPM with maximum duration of exercise = 15 minutesof exercise = 15 minutes

– 19941994: Less cautious and began to stress : Less cautious and began to stress the health benefits of exercisethe health benefits of exercise

– 20022002: 30 minutes or more of moderate : 30 minutes or more of moderate exercise a day recommendedexercise a day recommended

• SOGC/CSEPSOGC/CSEP– 2003: 2003: All women without All women without contraindications should participate in contraindications should participate in aerobic & strength-conditioning exercise.aerobic & strength-conditioning exercise.

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ACOG 2002ACOG 2002

• Recognition that Recognition that regular exercise regular exercise is beneficial to is beneficial to even pregnant even pregnant women and should women and should be encouraged.be encouraged.

• All women should All women should be evaluated be evaluated clinically before clinically before recommendations recommendations made.made.

Obstet Gynecol 2002; 99: 171-173.

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Absolute Absolute ContraindicationsContraindications

• Hemodynamically significant heart diseaseHemodynamically significant heart disease• Restrictive lung diseaseRestrictive lung disease• Incompetent cervix/cerclageIncompetent cervix/cerclage• Multiple gestation at risk for premature Multiple gestation at risk for premature laborlabor

• Persistent second- or third-trimester Persistent second- or third-trimester bleedingbleeding

• Placenta previa after 26 weeksPlacenta previa after 26 weeks• Premature labor during current pregnancyPremature labor during current pregnancy• Ruptured membranesRuptured membranes• Preeclampsia/pregnancy induced Preeclampsia/pregnancy induced hypertensionhypertension

Obstet Gynecol 2002; 99: 171-173

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Relative Relative ContraindicationsContraindications

• Severe anemiaSevere anemia• Unevaluated maternal Unevaluated maternal cardiac arrhythmiacardiac arrhythmia

• Chronic bronchitisChronic bronchitis• Poorly controlled Poorly controlled type 1 diabetestype 1 diabetes

• Extreme morbid Extreme morbid obesityobesity

• Extreme underweight Extreme underweight (BMI < 12)(BMI < 12)

• Heavy smokerHeavy smoker

• History of extremely History of extremely sedentary lifestylesedentary lifestyle

• IUGR in current IUGR in current pregnancypregnancy

• Poorly controlled Poorly controlled hypertensionhypertension

• Orthopedic Orthopedic limitationslimitations

• Poorly controlled Poorly controlled seizure disorderseizure disorder

• Poorly controlled Poorly controlled hyperthyroidismhyperthyroidism

Obstet Gynecol 2002; 99: 171-173

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ACOG 2002ACOG 2002

• Acknowledges the potential of Acknowledges the potential of exercise to prevent & treat exercise to prevent & treat gestational diabetes mellitusgestational diabetes mellitus

• Recommends avoiding exercise Recommends avoiding exercise involving bothinvolving both– the supine position “as much as the supine position “as much as possible”possible”

– prolonged periods of motionless standingprolonged periods of motionless standing• Notes that strenuous activity has not Notes that strenuous activity has not been linked to poor fetal growth or been linked to poor fetal growth or outcomesoutcomes

Obstet Gynecol 2002; 99: 171-173

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ACOG & SafetyACOG & Safety

• Safety of each sport determined Safety of each sport determined by the “specific movements by the “specific movements required by that sport.”required by that sport.”

• Scuba diving is contraindicatedScuba diving is contraindicated• Exertion above 6000 feet carries Exertion above 6000 feet carries risks.risks.

• Hyperthermia associated with Hyperthermia associated with exercise has not be shown to be exercise has not be shown to be teratogenicteratogenic

Obstet Gynecol 2002; 99: 171-173

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Higher Risk ActivitiesHigher Risk Activities

• Contact sports Contact sports with risk of with risk of abdominal traumaabdominal trauma– HockeyHockey– BasketballBasketball– SoccerSoccer

• High Risk Sports High Risk Sports with risk of with risk of both falls and both falls and traumatrauma– Gymnastics Gymnastics – Horseback ridingHorseback riding– Downhill SkiingDownhill Skiing– Vigorous racquet Vigorous racquet sportsport

Obstet Gynecol 2002; 99: 171-173

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Warning Signs to Terminate Warning Signs to Terminate ExerciseExercise

• Vaginal bleedingVaginal bleeding• Dyspnea prior to Dyspnea prior to exertionexertion

• DizzinessDizziness• HeadacheHeadache• Chest painChest pain• Muscle weaknessMuscle weakness• Calf pain or swellingCalf pain or swelling• Preterm laborPreterm labor• Decreased fetal Decreased fetal movementmovement

• Amniotic fluid leakageAmniotic fluid leakage

Obstet Gynecol 2002; 99: 171-173

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Postpartum ExercisePostpartum Exercise

• ““Prepregancy exercise routines may Prepregancy exercise routines may be resumed gradually as soon as it be resumed gradually as soon as it is physically and medically safe.”is physically and medically safe.”

• No adverse effects noted for even No adverse effects noted for even rapid return to activity.rapid return to activity.

• Moderate weight reduction while Moderate weight reduction while nursing does not compromise infant nursing does not compromise infant weight gain.weight gain.

• Associated with decreased incidence Associated with decreased incidence of postpartum depression.of postpartum depression.

Obstet Gynecol 2002; 99: 171-173

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Advising the Pregnant Advising the Pregnant AthleteAthlete

• Will her athletic performance suffer?Will her athletic performance suffer?– Will she lose a significant amount of Will she lose a significant amount of aerobic fitness?aerobic fitness?

– Will her submaximal performance be Will her submaximal performance be affected?affected?

• Can she safely continue resistance Can she safely continue resistance exercises?exercises?

• Should she stop competing?Should she stop competing?• How soon can she return to competition?How soon can she return to competition?• Are breastfeeding and competitive Are breastfeeding and competitive athletics mutually exclusive?athletics mutually exclusive?

Page 39: Exercise During Pregnancy

Orthopedic Considerations for the Pregnant Athlete

Page 40: Exercise During Pregnancy

Orthopedic ConcernsOrthopedic Concerns

• No injury pattern No injury pattern has been has been definitely definitely associated with associated with exercise in exercise in pregnancypregnancy

• Increased joint Increased joint laxity + weight laxity + weight gain = increased gain = increased risk of joint risk of joint discomfortdiscomfort

Page 41: Exercise During Pregnancy

Common Orthopedic Common Orthopedic ConditionsConditions

• Low back painLow back pain

Page 42: Exercise During Pregnancy

Common Orthopedic Common Orthopedic ConditionsConditions

• Low back painLow back pain• Pelvic/hip painPelvic/hip pain

Page 43: Exercise During Pregnancy

Common Orthopedic Common Orthopedic ConditionsConditions

• Low back painLow back pain• Pelvic/hip painPelvic/hip pain• Pubic painPubic pain

Page 44: Exercise During Pregnancy

Common Orthopedic Common Orthopedic ConditionsConditions

• Low back painLow back pain• Pelvic/hip painPelvic/hip pain• Pubic painPubic pain• Knee painKnee pain• Leg crampsLeg cramps

Page 45: Exercise During Pregnancy

Common Orthopedic Common Orthopedic ConditionsConditions

• Low back painLow back pain• Pelvic/hip painPelvic/hip pain• Pubic painPubic pain• Knee painKnee pain• Leg crampsLeg cramps• Carpal Tunnel Carpal Tunnel SyndromeSyndrome

• DeQuervain’s DeQuervain’s TenosynovitisTenosynovitis

Page 46: Exercise During Pregnancy

Exercise PrescriptionExercise Prescription

• Goal: Maintain Goal: Maintain maternal fitness maternal fitness levels and minimize levels and minimize risk to fetus.risk to fetus.

• Points to considerPoints to consider– Current fitness levelCurrent fitness level– Goals for exerciseGoals for exercise– Job/occupational Job/occupational requirementsrequirements

– Gestational ageGestational age

• Intensity: Intensity: Perceived exertionPerceived exertion

• Safety is key!Safety is key!

Page 47: Exercise During Pregnancy

Previously Sedentary Moderately Active Elite Athlete

Start with 15 min of exercise, 3 d-wk

Start with 30 min of exercise, 4 d-wk

Start with 30 min of exercise, 4 d-wk

Aerobic exercise, 65%-75% of maximum heart rate

Aerobic exercise, 65%-85% of maximum heart rate

Aerobic exercise, 75%-85% of maximum heart rate

Walking Running Continuation of previous sports should be discussed with coach/trainer/physician and should be adjusted based upon previous activity level

Swimming Cycling/Spinning Taper down or modify protocol in third trimester

Aerobics Aerobics May return to competition within 4-6 wk of delivery depending upon method

Stationary cycling Swimming Avoid trauma and avoid cutting sports after first trimester

Goal 30 min, 4 dIwkj1 Goal 30 min 5 d-wk Goal 30-40 min, 6-7 d-wk

Page 48: Exercise During Pregnancy

NutritionNutrition

• Energy intake needs Energy intake needs to be sufficient to to be sufficient to meet energy meet energy expenditure and expenditure and promote weight promote weight gain.gain.

• Gestational weight Gestational weight gain (total & rate) gain (total & rate) good indicator of good indicator of adequate nutritionadequate nutrition

• Quality of diet Quality of diet should be assessed should be assessed periodicallyperiodically

Page 49: Exercise During Pregnancy

Practical AdvicePractical Advice

Page 50: Exercise During Pregnancy

Practical AdvicePractical Advice

• Begin discussions at the first Begin discussions at the first visitvisit

• Structure each regimen Structure each regimen individuallyindividually– safe upper limit of exercise will be safe upper limit of exercise will be dictated by a women’s fitness status dictated by a women’s fitness status prior to entering pregnancyprior to entering pregnancy

• Encourage rest-activity cyclesEncourage rest-activity cycles• Promote exercise as relaxationPromote exercise as relaxation

Page 51: Exercise During Pregnancy

More Practical AdviceMore Practical Advice

• Assure adequate Assure adequate hydration and hydration and calories to support calories to support activityactivity

• In mid to late In mid to late pregnancy, monitor pregnancy, monitor for 2-3 fetal for 2-3 fetal movements in first movements in first 30 minutes after 30 minutes after exerciseexercise

• Do not ignore pain Do not ignore pain or fatigueor fatigue

• Routine prenatal Routine prenatal care key!care key!

Maternity Support Binder

Page 52: Exercise During Pregnancy

ACOG & the Competitive ACOG & the Competitive AthleteAthlete

• First opinion statement to First opinion statement to acknowledge the competitive acknowledge the competitive athlete & pregnancyathlete & pregnancy

• Highlighted concerns:Highlighted concerns:– The potential effect of pregnancy on The potential effect of pregnancy on competitive abilitycompetitive ability

– The effects of strenuous training and The effects of strenuous training and competition on pregnancy and the competition on pregnancy and the fetusfetus

• ““Such athletes may require close Such athletes may require close obstetric supervision.”obstetric supervision.”

Obstet Gynecol 2002; 99: 171-173

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NCAA & PregnancyNCAA & Pregnancy• Guideline published 2002Guideline published 2002• Acknowledges lack of research addressing Acknowledges lack of research addressing intense physical exercise & pregnancyintense physical exercise & pregnancy

• Cite expert opinion recommending avoid Cite expert opinion recommending avoid participation in contact sports after 14 participation in contact sports after 14 wks EGAwks EGA

• Team physician job is to advise student-Team physician job is to advise student-athlete:athlete:– Risk, benefits, effects on competitive abilityRisk, benefits, effects on competitive ability– One-year extension of 5 yr eligibility period One-year extension of 5 yr eligibility period for reasons of pregnancy ??for reasons of pregnancy ??

• Signed informed consent recommended if Signed informed consent recommended if athlete chooses to compete. May or may not athlete chooses to compete. May or may not protect the universityprotect the university

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College athlete College athlete dilemmasdilemmas

• Athletes required to notify Athletes required to notify athletic department when they athletic department when they become pregnant?become pregnant?

• Allowed to play while pregnant Allowed to play while pregnant and for how long?and for how long?

• Should pregnancy be protected Should pregnancy be protected medical condition protected from medical condition protected from scholarship revocation?scholarship revocation?

• Should colleges develop programs Should colleges develop programs for pregnant athletes?for pregnant athletes?

Page 55: Exercise During Pregnancy

College athlete College athlete dilemmasdilemmas

• Athletes may:Athletes may:– Hide pregnancyHide pregnancy– Drop out of schoolDrop out of school– Elect to have an abortionElect to have an abortion– Delay prenatal careDelay prenatal care

• Many colleges have no written Many colleges have no written policiespolicies

• Need safe environmentNeed safe environment• NCAA: “Stand up” to prevent NCAA: “Stand up” to prevent revocation of scholarshipsrevocation of scholarships

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Take Home PointsTake Home Points

• Healthy women should be encouraged to Healthy women should be encouraged to exercise before, during, and after exercise before, during, and after pregnancypregnancy

• Knowledge of theoretical risks and known Knowledge of theoretical risks and known benefits are key to advising womenbenefits are key to advising women

• Individualized exercise prescription Individualized exercise prescription promotes a safe, healthy pregnancy promotes a safe, healthy pregnancy

• Potential benefits typically outweigh Potential benefits typically outweigh any risksany risks

• Colleges need to adopt written “athlete Colleges need to adopt written “athlete friendly” policies to “assist” pregnant friendly” policies to “assist” pregnant athletesathletes

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Questions?

Page 58: Exercise During Pregnancy