Download Exercise in Pregnancy

Exercise in Pregnancy
Karen Fleming
Sunnybrook Health
Science Centre
Many Choices!
Our Challenge
“The doctor of the future will give no
medicine but will interest his patients in
the care of the human frame, in diet, and
in the cause and prevention of disease”
- Thomas Edison
Barriers to Exercise
Time
Energy
Motivation
Cost
Illness
Facilities
Discomfort
Transportation
Skills
Partner
Stages of Change and
Corresponding Intervention Tasks
Exercise and Pregnancy Research
Studies are limited due to ethical concerns
Studies often do not define F.I.T.T.
Concern has traditionally been related to fetal
well-being
The state of pregnancy is physical training and
has not been evaluated separately
Level evidence
Fetal Implications
Exercise and miscarriage
Exercise induced hyperthermia
Exercise, blood redistribution and glucose
availability.
Exercise and preterm labour.
Exercise and fetal stress
Exercise and birth weight
Maternal Benefits
Fewer physical symptoms
Decreased depression/anxiety
Weight management
Prevention and/ or control gestational diabetes
Improved cardiovascular fitness
Benefits to entire family ( imprinting )
Physiology
&
Anatomy
Physical Changes
Weight Gain
Cardiovascular Changes
Blood volume increases 45%, HR increases by 15 bpm
Respiration
11-15 kg. Gain with 6.5 kg of water retention
20% increase in baseline oxygen
Thermoregulation
MSK changes
Hormonal changes (estrogen/progesterone/relaxin)
Canadian Guidelines
Joint SOGC/CSEP Clinical Practice Guideline:
Exercise in Pregnancy and Post Partum Period.
Canadian Journal of Applied Physiology. 2003;
28(3): 329-341
Canadian Academy Sports Medicine :Exercise
and Pregnancy Position Statement
(revised and updated 2008)
Canadian Guideline Summary
Sedentary women , with low risk pregnancy,
can safely start exercise program in T2
Active women, with low risk pregnancy, can
continue mild to moderate exercise throughout.
Mild to moderate aerobic activity within
guidelines is considered safe.
(PARmed-X for Pregnancy)
Muscle conditioning , with precautions ,is
considered safe.
CSEP
Health
Canada
CASM
Physical Activity Readiness Medical
Examination for Pregnancy
Medical prescreening
Aerobic conditioning guidelines
Muscle conditioning guidelines
Safety considerations
www.csep.ca
PARmed-X for pregnancy
Aerobic Conditioning Guidelines
FITT
F : Frequency (3-4 times per week)
I : Intensity (Target HR)
T : Time (15-30 minutes)
T : Low impact (swimming/walking/cycling)
New Target Heart Rate Zones
Based on age and fitness
60-80% of max aerobic capacity
20-29 (129-144 ;140-155 ;145-160 )
30-39 (128-144 ; 130-144 ;140-156)
Not applicable to overweight/obese population
where 20-39% VO2 reserve suggested (ACSM2005)
Mottola et al 2006
Defining Intensity
Perceived exertion
Borg’s Index Scale of 6-20
Recommend 12-14
Talk Test
Self-Pacing
Self-Awareness
Strengthening
Effect of relaxin and
prolactin on ligament
stability can be initiated in
pregnancy and unresolved
until 3-6 months post
partum (stability)
Muscle conditioning
Upper body
Absolute Contraindications
Restrictive Heart or Lung Disease
Incompetent Cervix
Multiple Gestation
Placenta Previa after 26 weeks
Persistent Vaginal Bleeding
Ruptured membranes
Pregnancy Induced Hypertension
Relative Contraindications
Severe Anemia
Poorly controlled Type I Diabetes
Morbid Obesity
Underweight
Poorly controlled hypertension
IUGR
Thyroid disease
Exercise Type
Lumbar Friendly Back Exercises
Correct Posture
Pelvic Tilt plus
Functional Strengthening
Supportive Bracing
No Supine exercise after 4th month
Stationary Bicycle and Swimming are safest
Walking has many benefits
Warning Signs to Discontinue Exercise
Dizziness
Headache
Chest Pain
Muscle Weakness
Preterm Labour
Decreased Fetal Movements
Approach to Athletic Woman
Paula Radcliffe
Dara Torres
Female Athlete Issues
Exercise in Pregnancy is generally safe but
often limitations need to be applied.
Key Questions
Active or Inactive
Low risk or High Risk
Non-Contact or Contact
Altitude
Healthy or Unhealthy Weight
Healthy History or Health Problems
Optimal Training vs Overtraining
Training Modifications
Modify Frequency
Modify Intensity
Build in recovery time
Build in Nutrition
Monitor Mom
Monitor Baby
Creative Cross Training
Post Partum Advice
Readiness for Exercise
-
Early (the first 2-4 weeks)
Mid (1 –6 months)
Late ( 6-12 months)
Screening Tests:
-
Diastasis
Joint Stability
Functional Abilities
Post Partum Issues
Exercise and Lactation
Pelvic floor exercises /urinary incontinence
Hormonal induced ligament Instability / MSK
Weight management
Self esteem
Prevention PPD
Disease Prevention (NIDDM / GDM / CVD / BP )
FITT FORMULA
F- 2-3 x week
I- Light to Moderate
T- 30-60 minutes
T- Aerobic and strengthening, weight bearing
for bone health
Customize to MSK History, Lactation schedule,
Aerobic capacity
Exercise and the Evolving Family
Pre Pregnancy
Pregnancy
Post Partum
Framingham Children's Study
Active Mother: 2.0 x
Greater
Active Father: 3.5
Both Parents Active: 5.8
Childhood Physical Activity
Modelling active lifestyle
Empowerment of Physical Activity
Leadership Development
Fun and motivating
What Can You do ?
Assess your own attitudes regarding exercise
Are your resigned to GDM,HTN, CS?
Be an agent for change!
Assess your community resources
Plan for future pregnancies
Plan for future by risk factor modification
Pregnancy is window into the future……
Available Resources
1-800-363-9353 Sport Care Hotline
PARmed X for Pregnancy
Active Pregnancy Clinic at Sport Care WCH
416 323-6479
Questions?
Pregnant Hiking Club