Professional Documents
Culture Documents
Alex Tieri
Advanced Health and Fitness Specialist
American Council on Exercise
Highest certification, 1 of 1000 in U.S.
Specializing in:
To Be Discussed:
Benefits and Risks of exercise during pregnancy.
Physiological changes during pregnancy
Programming guidelines and considerations for
prenatal exercise
Biomechanical considerations for the pregnant
mother
Nutritional considerations
Psychological considerations
Benefits and risks following pregnancy
Programming guidelines and considerations
following pregnancy
Introduction
There is a growing trend of women who are not
physically active to view pregnancy as a time
to modify their lifestyles to include more health
conscious decisions, including exercise.
Aerobic and strength training during
pregnancy, have shown no increase in early
pregnancy loss, late pregnancy complications,
abnormal fetal growth, or adverse neonatal
outcomes, suggesting previous
recommendations have been overly
conservative (Clapp, 1989; ONeil, 1996).
Gestational Diabetes(GDM)
Is when glucose intolerance is first recognized during pregnancy.
Maternal muscular insulin resistance is normal during midpregnancy, to ensure adequate glucose regulation for fetal growth
and development.
Women with GDM the insulin increase is exacerbated, resulting in
maternal hyperglycemia, resulting in complications in labor and
delivery, as well as Caesarean section.
Risk factors include: Hispanic, Asian, African Descent; age >35;
overweight BMI >25; obese BMI >30; or a history of insulin
resistance.
Participation in recreational activities within the first 20 weeks of
gestation decreases risk of GDM by almost 50% (Dempsey et al.,
2004)
GDM is treated primarily through nutritional management by a
registered dietician, and exercise.
Preeclampsia
Is usually diagnosed 20 weeks after pregnancy is characterized by persistent
hypertension (140/90 mmHg) and proteinuria >0.3g (ACOG, 2002a).
Associated complications: preterm birth, abruptio placentae, renal failure,
pulmonary edema, cerebral hemorrhage, circulatory collapse, eclampsia, and
immediate delivery.
Associated risk factors: abnormal placental development, predisposing maternal
constitutional factors, oxidative stress, immune maladaptation, and genetic
susceptibility.
Regular leisure-time physical activity in early pregnancy is associated with a
reduced incidence of preeclamsia (Weissgerber et al., 2004)
Several protective mechanisms from exercise are thought to play a role in
preeclampsia prevention, including enhanced placental growth and vascularity,
enhanced antioxidant defense systems, reduction of the systematic
inflammatory response, and improved endothelial function (Weissgerber et al.,
2006).
Ambulatory management is the norm with treatment for preeclampsia, while
exercise intervention is unclear of positive affects, exercise should be physician
monitored.
Maternal Obesity
In the U.S. the percentage of women aged 20-39, who are
overweight has climbed to 49% amongst white women and 70%
among African-American women (Okosun et al., 2004).
Ovulatory infertility increases progressively with increasing BMI,
as so the risks of polycystic ovarian syndrome and menstrual
irregularities.
In a study of two year infertile obese women losing between 1022 lbs, 77% were able to conceive (Clark et al., 1998)
Authors hypothesized improved fertility resulted from reduced
insulin resistance and lower insulin concentrations on
reproductive hormone profiles.
Risk of fetal complications, preeclampsia, GDM, large-forgestational-age infants requiring C-section increase with degree
of overweight and obesity (Rooney & Schauberger, 2002).
Continued:
Absolute contraindications: Relative contraindications:
Hemodynamically significant
heart disease
Restrictive lung disease
Incompetent cervix/Cerclage
Multiple gestation at risk for
premature labor
Persistent 2nd or 3rd trimester
bleeding
Placenta previa after the 26th
week
Premature labor during
current pregnancy
Ruptured membranes
Preeclampsia
Severe anemia
Unevaluated arrhythmia
Chronic bronchitis
Poorly controlled T1Diabetes
Extreme morbid obesity
Extreme underweight BMI<12
Extremely sedentary lifestyle
Intrauterine growth restriction
in current pregnancy
Poorly controlled hypertension
Orthopedic limitations
Poorly controlled
hyperthyroidism
Heavy smoker
Continued:
Respiratory at rest, an increase in the depth of each
breath increases the amount of air inhaled by up to 50%
(Artal et al., 1986).
Progesterone increases the brains sensitivity to Co2, stimulating
over-breathing, improving the efficiency of O2 uptake from the
lungs and eliminating Co2.
10-20% improvement to baseline O2 consumption, creates a
training effect that can be carried over after birth(Pivarnik et al.,
1992).
Exercise Considerations
Avoid activities prolonged motionless standing, laying in the
supine position, activities with falling risks, and activities that
put repetitive excessive stress on the joints until cleared by
physician.
Pregnancy requires an additional 300 cals daily and whatever
cals may be lost through exercise.
During the 3rd trimester, increase carbs 30-50g/day to prevent
hypoglycemia during exercise.
Wear appropriate clothing and hydrate to prevent hyperthermia.
Use low weights with high reps.
Limit excessive stretching due to joint laxity from hormones
Use the Borg scale of RPE 1-10, between fairly light to
somewhat hard since heart rate is hormonally elevated.
Previously sedentary women should begin with 15 min of
continuous exercise 3x per week, and gradually increase it to 30
min 4x per week.
Biomechanical
Considerations
Low-back pain(LBP) happens as the abdominal muscles are
stretched, and lose their ability to help maintain a neutral
spine position. Joint laxity in the lumbar spine weakens the
ability of static support muscles to withstand the shearing
forces bringing pain in the facet joints.
Exercises to help: ROM and stretching of the back extensors, hip
flexors, scapulae protractors, internal shoulder rotators, and neck
flexors; strengthen: abdominals, gluteals, and scapulae retractors.
Continued
Pubic pain is caused by increased motion at the joint called
symphysitis, resulting in pain in the pubic region, groin, and
medial aspects of the thigh, during weightbearing activities
that usually involve lifting one leg, may be accompanied by a
grinding or clicking sound of the joint. This may result in a
waddling walk.
Treatment is usually to avoid weight bearing activities that
aggravate the joint, and a pelvic belt to limit motion of the
symphysis may be prescribed.
Continued
Diastasis recti is a partial or complete separation between the left
and right sides of the rectus abdominal muscle, during the later
stages of pregnancy the uterus can be seen bulging out of the
abdominal wall. Testing can be done by placing two fingers
between the abdominal muscles during a curl-up, an indicator is if
the gap is wider than two fingers. This can remain after pregnancy.
Treatment: abdominal compression exercises and curl-ups in a semi
recumbent position.
Nutritional Considerations
After the thirteenth week of pregnancy an additional 300
calories is needed to maintain homeostasis, and an additional
for calories used during exercise.
Pregnant women should consume between 2500-2700
calories per day.
Increasing carbohydrates is especially important as pregnant
women use more at rest and exercise (Artal & Wiswell, 1996).
To avoid hypoglycemia small meals and snacks should be
eaten throughout the day especially before and after exercise.
Women considering getting pregnant should consume
adequate: folic acid, iron, calcium, vitamin D, and water to
sustain health before, during, and after pregnancy.
Normal weight women should gain 25-35 lbs; underweight
women should gain 28-40 lbs; overweight women should gain
15-25 lbs; and obese women should gain at least 15 lbs.
Psychological
Considerations
Physiological Changes
Postpartum
The hormone relaxin elevates 10x its normal level during
pregnancy, which promotes laxity in ligaments for
growth, this can lead to overstretching and strains, and
can last up to 8 months postpartum.
Cardiac output increases as much 40% and plasma
volume can increase 40-50% during pregnancy, levels
will return to normal within 6-8 weeks of delivery.
Minute ventilations can increase by 50%, along with
increases in tidal volume, and respiratory rate, values
return to normal 6-12 weeks postpartum.
There are no known maternal complications associated
with the resumption of exercise training postpartum
(Hale & Milne, 1996).
Postnatal Exercise
Programming
Begin slowly increase gradually.