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Exercise in pregnancy
제일병원 전임의
신유정
Table of contents
 Physiologic changes in pregnancy
 Type, intensity, and frequency of exercise
 Benefit of exercise in...
Physiologic changes in pregnancy
 Nutritional requirement
 Cardiovascular changes
 Respiratory changes
 Mechanical cha...
Nutritional requirement
 After the 13th weeks of pregnancy, about 300kcal per day
are required to meet the metabolic need...
Cardiovascular changes
 Pregnancy induces
– increase in maternal blood volume, cardiac output, and
resting pulse
– decrea...
Respiratory changes
 During pregnancy minute ventilation increases by almost
50%, largely as a result of increased tidal ...
Mechanical changes
 The enlargement of uterus and breasts that occurs
during normal pregnancy results in a shift in the
p...
Thermoregulatory changes
 Both basal metabolic rate and heat production
increase during pregnancy
 Teratogenecity
– 39.2...
2002 ACOG recommendation
Exercise in pregnancy
 In the absence of either medical or obstetric
complications during pregna...
Type of exercise
Safe Avoid
Aerobic exercise
Progressive resistive strengthening
Stretching exercises
Yoga
Stationary bicy...
Intensity of exercise
 ACSM(American college of sports medicine) recommend that
intensity should be 60-90% of maximal hea...
Intensity of exercise
Daries et al, 2003
Frequency of exercise and rate of progression
 Previously sedentary women
– Start with 15 min of exercise three times a w...
Benefits of exercise and activity during pregnancy
 Decreased chance of preeclampsia, second leading
cause of maternal de...
Pre-eclamapsia
Tanya et al., 2003
Pre-eclamapsia
Kasawara et al., 2012
Tinoloy et al., 2014
Deomendoz et al., 20140
Exercise intervention (cesarean delivery)
Deomendoz et al., 2014
Birthweight
Juhl, et al, 2010
Gestational diabetes mellitus
 Epidemiologic data suggest that exercise may be
beneficial in the primary prevention of ge...
ACOG contraindications to exercise in pregnancy
 Hemodynamically significant heart disease
 Restrictive lung disease
 I...
ACOG relative contraindications to aerobic
exercise during pregnancy
 Severe anemia
 Unevaluated maternal cardiac arrhyt...
Warning signs to terminate exercise while pregnancy
 Vaginal bleeding
 Dyspnea prior to exertion
 Dizziness
 Headache
...
Maternal advice after exercise
recommendation
 Should aware of uterine contractions
 Less than the fetal movements in 12...
Exercise in postpartum
 Many of the physiologic and morphologic changes of
pregnancy persist 4-6 weeks postpartum.
 Thus...
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1exercise in pregnancy

  1. 1. Exercise in pregnancy 제일병원 전임의 신유정
  2. 2. Table of contents  Physiologic changes in pregnancy  Type, intensity, and frequency of exercise  Benefit of exercise in pregnancy  Contraindications of exercise in pregnancy  Warning signs to terminate exercise while pregnant  Maternal advice after exercise recommendation  Exercise in postpartum
  3. 3. Physiologic changes in pregnancy  Nutritional requirement  Cardiovascular changes  Respiratory changes  Mechanical changes  Thermoregulatory changes  Metabolic changes
  4. 4. Nutritional requirement  After the 13th weeks of pregnancy, about 300kcal per day are required to meet the metabolic needs of pregnancy  This energy requirement is increased through exercise.  In weight bearing exercise, such as walking, the energy requirement progressively increases with the increase in weight during the course of the pregnancy.  A related consideration to nutrition and exercise during pregnancy is adequate carbohydrate intake. Artal et al, 2003
  5. 5. Cardiovascular changes  Pregnancy induces – increase in maternal blood volume, cardiac output, and resting pulse – decrease in maternal systemic vascular resistance. – Hemodynamics depends on position – Cardiac output in third-trimester pregnancy is maximal – in the left or right lateral recumbent position. – Decreased cardiac output – Supine position – Motionless standing Clark et al, 1991 Jovanovic-Peterson et al, 1989
  6. 6. Respiratory changes  During pregnancy minute ventilation increases by almost 50%, largely as a result of increased tidal volume. – increase in arterial oxygen tension to 106-108 mmHg in the first trimester, decreasing to a mean of 101-106 mmHg by the third trimester. – increase in oxygen uptake, and a 10-20% increase in baseline O2 consumption. – Because of the increased resting oxygen requirements and the increased work of breathing brought about by physical effects of the enlarged uterus on the diaphragm, there is decreased oxygen available for the performance of aerobic exercise during pregnancy. – in some fit women, there do not appear to be associated changes in maximum aerobic power or acid-base balance during exercise in pregnancy when compared with the nonpregnant state Artal et al. 1986, Prowse et al.1965 Templeton et al,1976
  7. 7. Mechanical changes  The enlargement of uterus and breasts that occurs during normal pregnancy results in a shift in the physical center of gravity in the pregnant woman. – loss of balance may prove dangerous  Hormonal influences may result in generalized increases in joint laxity, predisposing the pregnant woman to mechanical trauma or sprains. Calguneri et al. 1982, Artal etal.1991
  8. 8. Thermoregulatory changes  Both basal metabolic rate and heat production increase during pregnancy  Teratogenecity – 39.2°C, with hot tub use in early pregnancy – an increase in maternal core body temperature during embryogenesis exceeding 1.5°C has been observed to cause cessation of neuronal mitotic cell growth in the ependymal layer of the developing brain. – Nonpregnant women exercising at 70% of maximal effort on a treadmill for 20 minutes, the core body temperature rose by an average of 1.5°C. – Fit individuals are known to thermoregulate their core temperature more efficiently. Hytten et al.1980, Artal et al.1991, Edwards et al.1986, Milunsky et al.1992
  9. 9. 2002 ACOG recommendation Exercise in pregnancy  In the absence of either medical or obstetric complications during pregnancy  women should perform 30 minutes or more of moderate-intensity exercise on most, if not all, days of the weeks.  Moderate exercise – Defined as activity for 30 or more minutes a day, 5 or more days a week – ex. : Brisk walking, bicycling, vacuuming, gardening, or any activity that causes small increases in breathing or heart rate ACOG, 2002 Centers for Disease Control, US physical activity statistics: definitions. 2006
  10. 10. Type of exercise Safe Avoid Aerobic exercise Progressive resistive strengthening Stretching exercises Yoga Stationary bicycling Jogging Walking Stair climbing Treadmill use Water exercise Swimming Supine position after the first trimester Motionless standing Recreational sports with a high potential for contact, such as ice hockey and baseball Increased risk of falling, such as horseback riding and gymnastics Advised not to scuba dive because the fetus is at risk of decompression sickness Artal et al. 1991, Clark et al.1991, Camporesi et al. 1996 , ACOG 2002
  11. 11. Intensity of exercise  ACSM(American college of sports medicine) recommend that intensity should be 60-90% of maximal heart rate or 50-85% of either maximal oxygen uptake or heart rate reserve.  60 % of maximal heart rate or 50% of maximal oxygen uptake – for most pregnant women who did not engage in regular exercise before pregnancy  70% of maximal heart rate or 60% of maximal oxygen uptake – for those who wish to continue to maintain fitness during pregnancy. Artal et al, 2003
  12. 12. Intensity of exercise Daries et al, 2003
  13. 13. Frequency of exercise and rate of progression  Previously sedentary women – Start with 15 min of exercise three times a week – Gradually increase to 30 min four times a weeks at low to moderate intensity  Active women – Keep their routine exercise or perform at least moderate- to- vigorous exercise – Four times a week in sessions of 30min or more  Atheletes or women who have higher fitness status – Evaluated individually – The intensity of exercise like running should be reduced Davies et al, 2003
  14. 14. Benefits of exercise and activity during pregnancy  Decreased chance of preeclampsia, second leading cause of maternal death  Decreased chance of operative delivery  Decreased chance of developing gestational diabetes  Improved mood  Reduction of pregnancy discomforts- backache and lower extremity edema  Possible prevention of type II diabetes  Possible prevention of chronic hypertension ACOG, 2002
  15. 15. Pre-eclamapsia Tanya et al., 2003
  16. 16. Pre-eclamapsia Kasawara et al., 2012
  17. 17. Tinoloy et al., 2014
  18. 18. Deomendoz et al., 20140
  19. 19. Exercise intervention (cesarean delivery) Deomendoz et al., 2014
  20. 20. Birthweight Juhl, et al, 2010
  21. 21. Gestational diabetes mellitus  Epidemiologic data suggest that exercise may be beneficial in the primary prevention of gestational diabetes, particularly in morbidly obese women (BMI >33)  The American Diabetes Association has endorsed exercise as “a helpful adjunctive therapy” for gestational diabetes mellitus when euglycemia is not achieved by diet alone  Vigorous activity : RR, 0.77 (95% CI, 0.69-0.94).  Brisk walking pace : RR, 0.66 (95% CI, 0.46-0.95) compared with an easy pace. Dye et al, 1997 Jovanovic-Peterson et al 1996, Bung et al.,1996 Zhang et al, 2006
  22. 22. ACOG contraindications to exercise in pregnancy  Hemodynamically significant heart disease  Restrictive lung disease  Incomplete cervix/cerclarge  Multiple gestation at risk for premature labor  Persistent second- or third trimester bleeding  Placenta previa after 26weeks of gestation  Premature labor during current pregnancy  Ruptured membranes  Preeclampsia ACOG,2002
  23. 23. ACOG relative contraindications to aerobic exercise during pregnancy  Severe anemia  Unevaluated maternal cardiac arrhythmia  Chronic bronchitis  Poorly controlled type 1 diabetes  Extreme morbid obesity  Extreme underweight (BMI < 12)  History of extremely sedentary lifestyle  IUGR in current pregnancy  Poorly controlled hypertension  Orthopedic limitations  Poorly controlled seizure disorder  Poorly controlled hyperthyroidism  Heavy smoker ACOG,2002
  24. 24. Warning signs to terminate exercise while pregnancy  Vaginal bleeding  Dyspnea prior to exertion  Dizziness  Headache  Chest pain  Muscle weakness  Calf pain or swelling (need to rule out thrombophlebitis)  Preterm labor  Decreasing fetal movement  Amniotic fluid leakage ACOG,2002
  25. 25. Maternal advice after exercise recommendation  Should aware of uterine contractions  Less than the fetal movements in 12 hours is an indication that further investigation at a hospital is warranted  No longer suggest the routine counting of fetal movements in the second half of a woman’s pregnancy NICE Guideline, 2004
  26. 26. Exercise in postpartum  Many of the physiologic and morphologic changes of pregnancy persist 4-6 weeks postpartum.  Thus, prepregnancy exercise routines should be resumed gradually based on a woman’s physical capability.  No known maternal complications are associated with resumption  Decreased incidence of postpartum depression and stress relieving Hale et al, 1996 Koltyn et al, 1997 ACOG, 1994; ACOG 2002
  27. 27. Thank you for your attention

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