Exercise as it relates to Disease/Exercise prescription for pregnant women

Over time, the attitude towards pregnancy has changed. Going from beliefs that women should not put undue stress on their body to accepting that exercise could positively affect the health of the mother and child is part of that change. However many expectant mothers are still inactive or not meeting minimum exercise recommendations with a main reason being due to concerns about potential adverse effects on themselves and their unborn child.

Pregnancy and Exercise

Exercise has many benefits including reducing the risk for coronary heart disease, metabolic syndrome, cardiovascular disease, metabolic syndrome and systemic inflammation. The effects of exercise also apply to pregnant women who also see a decrease in the risk of developing gestational diabetes mellitus and preeclampsia, helps with pregnancy related musculoskeletal conditions, limited weight gain during pregnancy and improved mental state.

Risks

• Too much vigorous activity could lead to reduced birth weights
• May be an increased risk of injury due to changes in centre of gravity and increased joint and ligament laxity
• May increase foetal temperature

Benefits

As well as normal benefits of exercise, the following can also occur:

• Reduces the risk of complications in preterm deliveries
• Reduces the risk of a complicated delivery
• May reduce duration of labour
• May enhance weight loss postpartum
• Positive birth outcomes
• Improve foetal and baby health
• Decreases in arterial stiffness
• Cardiovascular Improvements
• Increases both mother and foetal metabolism

Considerations

• Women should seek medical advice before starting an exercise program whilst pregnant and should have regular check-ups.
• Women should be aware that due to changes in the body their centre of mass will change and they are at an increased risk of falling due to this
• Women with pre-existing medical conditions should definitely seek medical advice before beginning an exercise program whilst pregnant. This particularly applies to women with diabetes or chronic hypertension.
• Women should also be aware of when to stop exercising. Exercise should be stopped immediately if any of the following symptoms are experienced:
• High heart rate
• Dizziness
• Headache
• Uterine contractions
• Vaginal bleeding
• Amniotic fluid leakage
• Nausea
• Shortness of breath
• Faintness
• Back or pelvic pain
• Decreased foetal movements
• Sudden swelling of ankles, hands and face

Recommendations

The American College of Obstetricians and Gynaecologists recommends 30 minutes or more of moderate exercise on most, if not all, days for expectant mothers with no contraindications and should avoid contact sports. For most healthy adults, moderate exercise is defined by the ACOG as 3-5 metabolic equivalents (METS) which is approximately a brisk walk at 3-5 mph (4-8kmph). They also recommend that athletes will require closer monitoring by an obstetrician as the athlete will either have reduced athletic performance or the effects of a strenuous training program could be detrimental.

Whereas the Society of Obstetricians and Gynaecologists of Canada recommended progress from 15min to 30min of continuous aerobic exercise 3-4 times per week also for expectant mothers with no contraindications.

Sports Medicine Australia recommends that it is safe to continue exercise for healthy women who have uncomplicated pregnancies, as long as they discuss it with their doctor first.

Also, aquatic activities are a great alternative to weight bearing exercise as it has minimal impact and reduces pressure on joints and muscles.

Further reading

The link to Sports Medicine Australia fact sheet for pregnant women: http://sma.org.au/wp-content/uploads/2009/10/WIS-ExPreg.pdf

The link to the American College of Sports Medicine's current comment on exercise for pregnant women: http://www.acsm.org/docs/current-comments/exerciseduringpregnancy.pdf

References

Bauer, P., Broman, C., & Pivarnik, J. (2010). Exercise and pregnancy knowledge among healthcare providers. Journal Of Women's Health (15409996), 19(2), 335-341. doi:10.1089/jwh.2008.1295

Melzer, K., Schutz, Y., Boulvain, M., & Kayser, B. (2010). Physical Activity and Pregnancy: Cardiovascular Adaptations, Recommendations and Pregnancy Outcomes. Sports Medicine, 40(6), 493-507.

Zavorsky, G. S., & Longo, L. D. (2011). Exercise Guidelines in Pregnancy. Sports Medicine, 41(5), 345-360.

Gaston, A., Cramp, A., & Prapavessis, H. (2012). Pregnancy—Should Women Put Up Their Feet or Lace Up Their Running Shoes?: Self-Presentation and the Exercise Stereotype Phenomenon During Pregnancy. Journal Of Sport & Exercise Psychology, 34(2), 223-237.

Jones, J., Housman, J., & McAleese, W. (2010). Exercise, nutrition, and weight management during pregnancy. American Journal Of Health Studies, 25(3), 120-128.

Doustan, M., Seifourian, M., Zarghami, M., & Azmsha, T. (2012). Relationship between physical activity of mothers before and during pregnancy with the newborn health and pregnancy outcome. Journal Of Physical Education & Sport, 12(2), 222-229.

Mottola, M. F., & McLaughlin, R. (2011). Exercise and Pregnancy: Canadian Guidelines for Health Care Professionals. Wellspring, 22(4), A1-A4.

Vladutiu, C. J., Evenson, K. R., & Marshall, S. W. (2010). Physical Activity and Injuries During Pregnancy. Journal Of Physical Activity & Health, 7(6), 761-769.

Evenson, K., & Pompeii, L. (2010). Obstetrician practice patterns and recommendations for physical activity during pregnancy. Journal Of Women's Health (15409996), 19(9), 1733-1740. doi:10.1089/jwh.2009.1833

Artal, R., & O’Toole, M. (2003). Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. British Journal of Sports Medicine, 37, 6-12. doi: 10.1136/bjsm.37.1.6

Kawabata, I., Nakai, A., Sekiguchi, A., Inoue, Y., & Takeshita, T. (2012). The effect of regular exercise training during pregnancy on postpartum brachial-ankle pulse wave velocity, a measure of arterial stiffness. Journal Of Sports Science & Medicine, 11(3), 489-494.

Sports Medicine Australia (2002) SMA Statement: the benefits and risks of exercise during pregnancy. J Sci Med Sport, 5, 11-19