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Claiborne A, Jevtovic F, May LE. A narrative review of exercise dose during pregnancy. Birth Defects Res 2023; 115:1581-1597. [PMID: 37735993 DOI: 10.1002/bdr2.2249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 09/23/2023]
Abstract
The current recommendations for prenatal exercise dose align with those from the American College of Sports Medicine; 150 min of moderate intensity every week of pregnancy. However, recent works suggest there may be a dose-dependent beneficial effect for mother and offspring; maternal and offspring health outcomes respond differently to low, medium, and high doses of prenatal exercise. It is, therefore, our aim to summarize the published evidence (years 1950-2023) for five metrics of prenatal exercise training commonly reported, that is, "FITT-V": Frequency (number of sessions), Intensity (metabolic equivalents "METs"), Time (duration of sessions), Type (exercise mode), Volume (exercise MET*mins). The target audience includes clinicians and health care professionals, as well as exercise professionals and physiologists. Data suggest that moderate exercise frequency (3-4 times weekly) appears safe and efficacious for mother and offspring, while there is contradictory evidence for the safety and further benefit of increased frequency beyond 5 sessions per week. Moderate (3-6 METs) and vigorous (>6 METs) intensity prenatal exercise have been shown to promote maternal and offspring health, while little research has been performed on low-intensity (<3 METs) exercise. Exercise sessions lasting less than 1 hr are safe for mother and fetus, while longer-duration exercise should be carefully considered and monitored. Taken together, aerobic, resistance, or a combination of exercise types is well tolerated at medium-to-high volumes and offers a variety of type-specific benefits. Still, research is needed to define (1) the "minimum" effective dose of exercise for mother and offspring health, as well as (2) the maximum tolerable dose from which more benefits may be seen. Additionally, there is a lack of randomized controlled trials addressing exercise doses during the three trimesters of pregnancy. Further, the protocols adopted in research studies should be more standardized and tested for efficacy in different populations of gravid women.
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Affiliation(s)
- Alex Claiborne
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina, USA
| | - Filip Jevtovic
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina, USA
| | - Linda E May
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina, USA
- Department of Obstetrics and Gynecology, East Carolina University, Greenville, North Carolina, USA
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A Delphi Study to Identify Research Priorities Regarding Physical Activity, Sedentary Behavior and Sleep in Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052909. [PMID: 35270601 PMCID: PMC8909963 DOI: 10.3390/ijerph19052909] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/12/2022] [Accepted: 02/17/2022] [Indexed: 12/10/2022]
Abstract
This study aimed to produce a list of the top 10 research priorities regarding physical activity, sedentary behavior, and sleep in pregnancy. Using the Delphi methodology, pregnant/postpartum individuals (N = 118), exercise professionals and healthcare providers (N = 55) listed up to 10 questions perceived as unanswered regarding physical activity, sedentary behavior, and sleep in pregnancy (Round 1). Respondents rated the proposed questions on a Likert importance scale (Round 2), and the sum of ratings received were totaled. Questions of priority regarding physical activity among pregnant/postpartum individuals (N = 67), healthcare providers and exercise professionals (N = 22) pertained to exercise prescription, impact of exercise on maternal and fetal outcomes and impact of exercise on pregnancy conditions, special population groups and clinical education and access to information. Sedentary behavior priorities included the impact of sedentary behavior on maternal and fetal outcomes, sedentary recommendations and exercise and sedentary positioning. Sleep research priorities included the impact of pregnancy on sleep, safety, sleeping aids and the effect of exercise on sleep. Pregnant/postpartum women, healthcare providers and exercise professionals prioritized questions that have in part been addressed by existing research, highlighting a need for improved knowledge translation from research to practice. They have also identified novel questions that warrant prioritization within future research.
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Boisseau N, Isacco L. Substrate metabolism during exercise: sexual dimorphism and women's specificities. Eur J Sport Sci 2021; 22:672-683. [PMID: 34134602 DOI: 10.1080/17461391.2021.1943713] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this review is to discuss sexual dimorphism of energy metabolism, and to describe the impact of women's hormonal status on substrate oxidation during exercise. Many evidences indicate that sex steroids play a pivotal role in the sex-related differences of body composition and energy substrate storage. Compared with men, women rely more on fat and less on carbohydrates at the same relative exercise intensity. Scientific data suggest that 17-β oestradiol is a key hormone for the regulation of body composition and substrate metabolism. However, in women, measurements with stable isotopic tracers did not highlight any difference in whole-body substrate oxidation rates between the follicular and luteal phases of the menstrual cycle during endurance exercise. The remaining discrepancies about the effect of menstrual cycle-related hormone fluctuations on substrate oxidation could be partly explained by the exercise intensity, which is an important regulator of substrate oxidation. Due to their specific nature and concentration, the synthetic ovarian hormones contained in oral contraceptives also influence substrate metabolism during endurance exercise. However, more studies are needed to confirm that oral contraceptives increase lipolytic activity during endurance exercise without any substantial (or detectable) effect on substrate utilization. Pregnancy and menopause also modify body composition and substrate utilization during exercise through specific hormonal fluctuations.This review highlights that the hormonal status is likely to affect substrate oxidation during exercise in women emphasizing the need to take it into consideration to optimize their health and performance.
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Affiliation(s)
- Nathalie Boisseau
- Laboratory of Metabolic Adaptations to Exercise under Physiological and Pathological conditions (AME2P), University Clermont Auvergne (UCA), EA 3533, Clermont-Ferrand, France
| | - Laurie Isacco
- Laboratory of Metabolic Adaptations to Exercise under Physiological and Pathological conditions (AME2P), University Clermont Auvergne (UCA), EA 3533, Clermont-Ferrand, France.,EA3920 Prognostic Markers and Regulatory Factors of Cardiovascular Diseases and Exercise Performance Health Innovation (EPSI) platform, Univ. Bourgogne Franche-Comté, Besançon, France
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Physical Activity and Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion, Number 804. Obstet Gynecol 2020; 135:e178-e188. [PMID: 32217980 DOI: 10.1097/aog.0000000000003772] [Citation(s) in RCA: 284] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Exercise, defined as physical activity consisting of planned, structured, and repetitive bodily movements done to improve one or more components of physical fitness, is an essential element of a healthy lifestyle, and obstetrician-gynecologists and other obstetric care providers should encourage their patients to continue or to commence exercise as an important component of optimal health. Women who habitually engaged in vigorous-intensity aerobic activity or who were physically active before pregnancy can continue these activities during pregnancy and the postpartum period. Observational studies of women who exercise during pregnancy have shown benefits such as decreased gestational diabetes mellitus, cesarean birth and operative vaginal delivery, and postpartum recovery time. Physical activity also can be an essential factor in the prevention of depressive disorders of women in the postpartum period. Physical activity and exercise in pregnancy are associated with minimal risks and have been shown to benefit most women, although some modification to exercise routines may be necessary because of normal anatomic and physiologic changes and fetal requirements. In the absence of obstetric or medical complications or contraindications, physical activity in pregnancy is safe and desirable, and pregnant women should be encouraged to continue or to initiate safe physical activities. This document has been revised to incorporate recent evidence regarding the benefits and risks of physical activity and exercise during pregnancy and the postpartum period.
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Abstract
Exercise is one of the most physiologically challenging stressors requiring the coordination of metabolic, respiratory, and cardiovascular responses to meet increased energy requirements of the working muscle. During pregnancy, all women without contraindication are encouraged to exercise as part of a healthy lifestyle. Pregnancy itself is associated with profound physiological adaptations to the maternal cardiovascular, respiratory, and metabolic systems, which serve to support the needs of the growing fetus. Therefore the physiological adaptations to exercise during pregnancy are more pronounced and critically important. This review provides an overview of our current understanding of the physiological adaptations to acute prenatal exercise.
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Bø K, Artal R, Barakat R, Brown W, Davies GAL, Dooley M, Evenson KR, Haakstad LAH, Henriksson-Larsen K, Kayser B, Kinnunen TI, Mottola MF, Nygaard I, van Poppel M, Stuge B, Khan KM. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1-exercise in women planning pregnancy and those who are pregnant. Br J Sports Med 2017; 50:571-89. [PMID: 27127296 DOI: 10.1136/bjsports-2016-096218] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Kari Bø
- Norwegian School of Sport Sciences, Oslo, Norway
| | - Raul Artal
- Department of Obstetrics/Gynecology and Women's Health, Saint Louis University, St Louis, Missouri, USA
| | - Ruben Barakat
- Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - Wendy Brown
- Centre for Research on Exercise, School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - Gregory A L Davies
- Department of Maternal-Fetal Medicine, Queens University, Kingston, Ontario, Canada
| | - Michael Dooley
- The Poundbury Clinic Dorchester-The Poundbury Suite, King Edward VII Hospital London, London, UK
| | - Kelly R Evenson
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Lene A H Haakstad
- Department of Sport Sciences, Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Bengt Kayser
- Faculty of Biology and Medicine, Institute of Sports Science, University of Lausanne, Lausanne, Switzerland
| | - Tarja I Kinnunen
- University Lecturer, School of Health Sciences, University of Tampere, Tampere, Finland Department of Children, Young People and Families, The National Institute for Health and Welfare, Helsinki, Finland
| | - Michelle F Mottola
- R Samuel McLaughlin Foundation-Exercise and Pregnancy Lab, The University of Western Ontario London, London, Ontario, Canada
| | - Ingrid Nygaard
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, USA
| | | | - Britt Stuge
- Oslo University Hospital, Ullevål, Oslo, Norway
| | - Karim M Khan
- Department of Family Practice & Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
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Bø K, Artal R, Barakat R, Brown W, Dooley M, Evenson KR, Haakstad LAH, Larsen K, Kayser B, Kinnunen TI, Mottola MF, Nygaard I, van Poppel M, Stuge B, Davies GAL. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 2-the effect of exercise on the fetus, labour and birth. Br J Sports Med 2016; 50:1297-1305. [PMID: 27733352 DOI: 10.1136/bjsports-2016-096810] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 11/03/2022]
Abstract
This is Part 2 of 5 in the series of evidence statements from the IOC expert committee on exercise and pregnancy in recreational and elite athletes. Part 1 focused on the effects of training during pregnancy and on the management of common pregnancy-related symptoms experienced by athletes. In Part 2, we focus on maternal and fetal perinatal outcomes.
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Affiliation(s)
- Kari Bø
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Raul Artal
- Department of Obstetrics/Gynecology and Women's Health, Saint Louis University, St Louis, Missouri, USA
| | - Ruben Barakat
- Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - Wendy Brown
- Centre for Research on Exercise Physical Activity and Health, School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - Michael Dooley
- The Poundbury Clinic, King Edward VII Hospital London, Dorchester, UK
| | - Kelly R Evenson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Lene A H Haakstad
- Department of Sport Sciences, Norwegian School of Sport Sciences, Oslo, Norway
| | - Karin Larsen
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Bengt Kayser
- Faculty of Biology and Medicine, Institute of Sport Science, University of Lausanne, Lausanne, Switzerland
| | - Tarja I Kinnunen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Michelle F Mottola
- R. Samuel McLaughlin Foundation-Exercise and Pregnancy Lab, The University of Western Ontario, London, Ontario, Canada
| | - Ingrid Nygaard
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, USA
| | | | - Britt Stuge
- Division of Orthopaedic Surgery, Oslo University Hospital, Ullevål, Oslo, Norway
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ACOG Committee Opinion No. 650: Physical Activity and Exercise During Pregnancy and the Postpartum Period. Obstet Gynecol 2016; 126:e135-e142. [PMID: 26595585 DOI: 10.1097/aog.0000000000001214] [Citation(s) in RCA: 475] [Impact Index Per Article: 59.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Physical activity in all stages of life maintains and improves cardiorespiratory fitness, reduces the risk of obesity and associated comorbidities, and results in greater longevity. Physical activity in pregnancy has minimal risks and has been shown to benefit most women, although some modification to exercise routines may be necessary because of normal anatomic and physiologic changes and fetal requirements. Women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength-conditioning exercises before, during, and after pregnancy. Obstetrician-gynecologists and other obstetric care providers should carefully evaluate women with medical or obstetric complications before making recommendations on physical activity participation during pregnancy. Although frequently prescribed, bed rest is only rarely indicated and, in most cases, allowing ambulation should be considered. Regular physical activity during pregnancy improves or maintains physical fitness, helps with weight management, reduces the risk of gestational diabetes in obese women, and enhances psychologic well-being. An exercise program that leads to an eventual goal of moderate-intensity exercise for at least 20-30 minutes per day on most or all days of the week should be developed with the patient and adjusted as medically indicated. Additional research is needed to study the effects of exercise on pregnancy-specific outcomes and to clarify the most effective behavioral counseling methods, and the optimal intensity and frequency of exercise. Similar work is needed to create an improved evidence base concerning the effects of occupational physical activity on maternal-fetal health.
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Bae JY, Hong SY. Guideline for exercise in pregnancy. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2016. [DOI: 10.5124/jkma.2016.59.7.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jin Young Bae
- Department of Obstetrics and Gynecology, Catholic University of Daegu College of Medicine, Daegu, Korea
| | - Seong Yeon Hong
- Department of Obstetrics and Gynecology, Catholic University of Daegu College of Medicine, Daegu, Korea
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Abstract
In 1980 I came to Loma Linda to study maternal exercise, with Dr. Longo as my mentor. For millennia strenuous exercise was considered harmful for the fetus. Early studies reinforced that idea, by showing that exercise reduced uterine blood flow and fetal PO2 by up to 40 and 29 %, respectively. But utero-placental reserve is ~50 %. So why was fetal PO2 so much reduced during exercise?Methods proved to be important. It took chronically instrumented animals accustomed to the laboratory environment, experiments standardized to fitness of the individual (%VO2max), measurement of total uterine blood flow, and blood gas values corrected for body temperature. The results were simple and hold till this day. Uterine blood flow decreases linearly with maternal heart rate increase, which depends on exercise intensity and duration. Maximal reduction in uterine blood flow is ~20 % and uterine O2-uptake remains unaltered because blood flow reduction is compensated by increases in hematocrit and uterine O2-extraction. Fetal body temperature increases with that of the mother by ~2 °C at maximal exercise and fetal blood gas values are little affected by exhaustive maternal exercise, if properly corrected for temperature. So I left Loma Linda knowing that pregnant sheep can exercise to exhaustion without harm to the fetus, thanks to effective compensatory mechanisms.After returning to Erasmus University Rotterdam further studies in humans showed that physical fitness is unaffected by pregnancy, weight-gain affects performance, and strenuous exercise in healthy pregnant women does not harm the fetus. Thus, the millennia-old perspective has changed.
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The potential impact of physical activity during pregnancy on maternal and neonatal outcomes. Obstet Gynecol Surv 2012; 67:99-110. [PMID: 22325300 DOI: 10.1097/ogx.0b013e318242030e] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Pregnancy is a critical period of body weight regulation. Maternal obesity and excessive gestational weight gain have become increasingly common and contribute to poor obstetrical outcomes for mother and baby. Regular participation in physical activity may improve risk profiles in pregnant women. PURPOSE AND METHODS Our objectives were to provide an overview of maternal-fetal exercise physiology, summarize current evidence on the effects of physical activity during pregnancy on maternal-fetal outcomes, and review the most recent clinical practice guidelines. In addition, we summarize the findings in the context of the current obesity epidemic and discuss implications for clinical practice. A literature review was completed in which we queried OVID (Medline), EMBASE, and PSYCHINFO databases with title words "exercise or physical activity" and "pregnancy or gestation" from 1950 to March 1, 2010. A total of 212 articles were selected for review. RECOMMENDATIONS Care providers should recommend physical activity to most pregnant women (i.e., those without contraindications) and view participation as a safe and beneficial component of a healthy pregnancy. TARGET AUDIENCE Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES After participating in this CME activity, physicians should be better able to classify the potential impact of physical activity on maternal glycemic control and fetal growth outcomes. Assess maternal lifestyle and provide recommendations on appropriate gestational weight gain, evaluate pregnant women for contraindications to physical activity participation, make individualized recommendations for exercise participation, and educate patients on the merits of physical activity for health benefit.
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Abstract
BACKGROUND During pregnancy, women are at particular risk for sleep deprivation and snoring because of the physiologic and hormonal changes of pregnancy. There is limited evidence for the association between sleep patterns in pregnancy and adverse birth outcomes. We examined the association of sleep duration and snoring in late pregnancy with the risk of preterm birth and fetal growth restriction. METHODS We used data from the prospective mother-child cohort "Rhea" study in Crete, Greece 2007-2009. The analysis included 1091 women with singleton pregnancies, providing complete data on sleeping habits at the third trimester of gestation and birth outcomes. Fetal growth restriction was based on a customized model, and multivariate log-binomial regression models were used to adjust for confounders. RESULTS Women with severe snoring were at high risk for low birth weight (relative risk = 2.6 [95% confidence interval = 1.2-5.4]), and fetal-growth-restricted neonates (2.0 [1.0-3.9]) after adjusting for maternal age, education, smoking during pregnancy, and prepregnancy body mass index (BMI). Women with sleep deprivation (≤5 hours sleep) were at high risk for preterm births (1.7 [1.1-2.8]), with the highest risk observed for medically indicated preterm births (2.4 [1.0-6.4]) after adjusting for maternal age, education, parity, smoking during pregnancy, and prepregnancy BMI. CONCLUSIONS These findings suggest that women with severe snoring in late pregnancy have a higher risk for fetal-growth-restricted neonates; and women with sleep deprivation have a higher risk for preterm births. The mechanisms underlying these associations remain unclear.
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Charlesworth S, Foulds HJ, Burr JF, Bredin SS. Evidence-based risk assessment and recommendations for physical activity clearance: pregnancy1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process. Appl Physiol Nutr Metab 2011; 36 Suppl 1:S33-48. [DOI: 10.1139/h11-061] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Recommendations for physical activity during pregnancy have progressed significantly in the last 30 years and continue to evolve as an increasing body of scientific evidence becomes available. In addition, there is an increasing number of women who wish to either maintain physical fitness levels during the prenatal period or initiate exercise for a healthier lifestyle during pregnancy. As such, consistent evaluation of the risks associated with exercise during pregnancy is warranted for maternal and fetal well-being. The primary purpose of this systematic review was to evaluate the scientific information available regarding maternal and fetal responses as it relates to the occurrence of adverse exercise-related events in pregnant women without contraindications to exercise. A systematic and evidence-based approach was used to analyze critically the level of evidence for risks associated with acute and chronic exercise during pregnancy in healthy pregnant women. All articles were screened according to standardized evaluation criteria developed by a panel of experts. A total of 74 investigations that involved 3766 pregnant women were included in the analysis. Of the 74 studies, only 35 studies documented the presence or absence of adverse events. The serious adverse event rate for these studies was 1.4 per 10 000 h of exercise. The adverse event rate increased to 6.8 per 10 000 h of exercise when including the occurrence of more mild events and exercise-related fetal bradycardia and tachycardia. Previously inactive or active women (without contraindications) are at a low risk for adverse fetal or maternal events if they participate in routine physical activity during pregnancy.
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Affiliation(s)
- Sarah Charlesworth
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Physical Activity and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Heather J.A. Foulds
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Physical Activity and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jamie F. Burr
- Physical Activity Line, Canadian Society for Exercise Physiology Health and Fitness Program of BC, Vancouver, BC V6T 1Z3, Canada
| | - Shannon S.D. Bredin
- Cognitive and Functional Learning Laboratory, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Physical Activity and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Abstract
This section reviews anatomic and functional changes of the respiratory system during pregnancy. Pulmonary function during exercise in pregnancy and in the obese gravida, sleep-disordered breathing during pregnancy, and pulmonary changes in the pregnant woman living at altitude are discussed in detail. Assessment of pulmonary function and interpretation of the arterial blood gas during pregnancy are also discussed.
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Aerobic exercise during pregnancy influences fetal cardiac autonomic control of heart rate and heart rate variability. Early Hum Dev 2010; 86:213-7. [PMID: 20356690 DOI: 10.1016/j.earlhumdev.2010.03.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 03/05/2010] [Accepted: 03/08/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Previous studies using ultrasound technology showed that fetal heart rate (HR) may be responsive to maternal aerobic exercise. Although it is recognized that cardiac autonomic control may be influenced by the intrauterine environment, little is known about how maternal exercise affects fetal heart development. AIMS This study tested the hypothesis that regular maternal exercise throughout gestation influences fetal cardiac autonomic control of HR and heart rate variability (HRV) when compared to fetuses of non-exercising women. STUDY DESIGN Magnetocardiograms (MCGs) were recorded using a dedicated fetal biomagnetometer at 28, 32 and 36 weeks gestational age (GA) from 26 regularly exercising (>30 min of aerobic exercise, 3x per week) and 35 healthy, non-exercising pregnant women. Fetal MCG was isolated and normal R-peaks were marked to derive fetal HR and HRV in the time and frequency domains. We applied a mixed-effects model to investigate the effects of exercise, GA and fetal activity state. RESULTS At 36 weeks GA, during the active fetal state, fetal HR was significantly lower in the exercise group (p=<0.0006). Post-hoc comparisons showed significantly increased HRV in the exercise group during the active fetal state at 36 weeks GA for both time and frequency domain measures. CONCLUSION These results indicate that regular maternal exercise throughout gestation results in significantly lower fetal HR and increased HRV.
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6-Minute walk distance in healthy North Africans older than 40 years: Influence of parity. Respir Med 2009; 103:74-84. [DOI: 10.1016/j.rmed.2008.07.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Revised: 07/16/2008] [Accepted: 07/28/2008] [Indexed: 10/21/2022]
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Wolfe LA, Charlesworth SA, Glenn NM, Heenan AP, Davies GAL. Effects of Pregnancy on Maternal Work Tolerance. ACTA ACUST UNITED AC 2005; 30:212-32. [PMID: 15981789 DOI: 10.1139/h05-116] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This review summarizes current information on the tolerance of healthy pregnant women and their fetuses to acute strenuous exertion. Maximal aerobic power, expressed in L•min−1, is not significantly affected in women who maintain an active lifestyle, whereas values expressed in mlùkg−1ùmin−1 decline with advancing gestational age in relation to maternal/fetal weight gain. Efficiency during standard exercise testing and the ventilatory anaerobic threshold (Tvent) also appear to be unaffected by pregnancy, but the ability to utilize carbohydrate and exercise anaerobically during brief strenuous exercise may be reduced. Fetal responses to short strenuous exercise are usually moderate and revert to baseline values within approximately 30 min postexercise. Future studies should examine alveolar gas exchange kinetics at the start of exercise and during recovery from both moderate and strenuous exertion. Existing studies of the responses of pregnant women to prolonged exercise have focused primarily on substrate utilization and glucose homeostasis. Other maternal responses to prolonged exercise that should be examined include acid-base regulation, temperature regulation, fluid and electrolyte balance, and perception of effort. Fetal reactions should also be examined in relation to maternal responses. Until evidence-based, occupation-specific guidelines become available, it is recommended that pregnant women use the Joint SOGC/CSEP Clinical Practice Guideline: Exercise in Pregnancy and the Postpartum Period, published by the Society of Obstetricians and Gynaecologists of Canada and the Canadian Society for Exercise Physiology (2003). Key words: human gestation, maximal exercise, prolonged exercise, fetal well-being
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Affiliation(s)
- Larry A Wolfe
- School of Physical and Health Education, Queen's University, Kingston, Ontario, K7L 3N6
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Bahhady IJ, Ernst A. Risks of and recommendations for flexible bronchoscopy in pregnancy: a review. Chest 2005; 126:1974-81. [PMID: 15596701 DOI: 10.1378/chest.126.6.1974] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Imad J Bahhady
- Division of Pulmonary Medicine, Tufts-New England Medical Center, Boston, MA, USA
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Affiliation(s)
- Jolie C Holschen
- University of Michigan, Department of Orthopaedic Surgery, Ann Arbor, MI, USA
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Abstract
PURPOSE OF REVIEW Sleep disturbances are frequent during pregnancy. The spectrum of association between pregnancy and sleep disturbances ranges from an increased incidence of insomnia, nocturnal awakenings, and parasomnias (especially restless legs syndrome) to snoring and excessive sleepiness. These disturbances occur as a result of physiologic, hormonal, and physical changes associated with pregnancy. Although the timing and occurrence of different sleep disorders varies, they are most prevalent during the third trimester. Despite reports of the various sleep problems, the exact nature and incidence of sleep disorders in pregnancy is not known. Given that limitation, we are presenting an up-to-date review of the current understanding of the relation between sleep and pregnancy. RECENT FINDINGS Studies suggest that pregnancy affects sleep in multiple ways. There are hormonal changes, physiologic changes, physical factors, and behavioral changes in a pregnant woman-all of which may affect her sleep. They may affect the duration and quality of sleep and lead to a variety of sleep disorders. Pregnancy may also affect an existing sleep disorder. Particular attention may be given to obese pregnant women who would gain more weight during pregnancy or those who develop hypertensive conditions (eg, preeclampsia). Snoring may be more common in women with preeclampsia and the pressor responses to obstructive respiratory events during sleep may be enhanced in preeclamptic women when compared with those with obstructive sleep apnea alone. Several investigators have suggested that obstructive sleep apnea (OSA) may be common in pregnant women despite the presence of intrinsic mechanisms that seem to be geared towards preventing sleep apnea. However, the exact incidence and prevalence of sleep apnea in pregnant women is uncertain. In addition, it is unclear if criteria that are used to define sleep apnea in the general population should be applied to pregnant women. Further investigations are needed to determine if lower thresholds for management of OSA should be used in pregnant women to prevent harm to the fetus. SUMMARY In conclusion, sleep disturbances are common during pregnancy though the full extent of this relation remains undefined. Large, multi-center, prospective studies are needed for better understanding.
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Affiliation(s)
- Pradeep K Sahota
- Department of Neurology and University of Missouri-Sleep Disorders Center, University of Missouri Health Care, Columbia, Missouri 65212, USA.
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Affiliation(s)
- Mary L O'Toole
- Department of Obstetrics, Gynecology & Women's Health and Women's Exercise Research Laboratory, Saint Louis University, Missouri 63117, USA.
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Wolfe LA, Weissgerber TL. Clinical physiology of exercise in pregnancy: a literature review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2003; 25:473-83. [PMID: 12806449 DOI: 10.1016/s1701-2163(16)30309-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To review the existing literature on the physiology of exercise in pregnancy as a basis for clinical practice guidelines for prenatal exercise prescription. METHODS MEDLINE search for English language abstracts and articles published between 1966 and 2003 related to physiological adaptations to pregnancy, effects of pregnancy on responses to acute exercise and aerobic conditioning, effects of acute maternal exercise on indexes of fetal well-being, impact of physical conditioning on birth weight and other pregnancy outcomes, and use of exercise to prevent or treat gestational diabetes mellitus and preeclampsia. RESULTS Maximal aerobic power (VO(2)max, L/min) is well-preserved in pregnant women who remain physically active, but anaerobic working capacity may be reduced in late gestation. The increase in resting heart rate, reduction in maximal heart rate, and resulting smaller heart rate reserve render heart rate a less precise way of estimating exercise intensity. As rating of perceived exertion (RPE) is not altered by pregnancy, the use of revised pulse rate target zones along with Borg's RPE scale is recommended to prescribe exercise intensity during pregnancy. Responses to prolonged submaximal exercise (>30 min) in late gestation include a moderate reduction in maternal blood glucose concentration, which may transiently reduce fetal glucose availability. The normal response to sustained submaximal exercise is an increase in fetal heart rate (FHR) baseline. Transient reductions in FHR reactivity, fetal breathing movements, and FHR variability may also occur in association with more strenuous exercise. Controlled prospective studies have demonstrated that moderate prenatal exercise during the second and third trimesters is useful to improve aerobic fitness and maternal-fetal physiological reserve without affecting fetal growth. CONCLUSIONS The Physical Activity Readiness Medical Examination for Pregnancy is recommended for use by physicians and midwives to provide medical clearance for prenatal exercise. Evidence-based prenatal exercise guidelines are needed to counsel healthy and fit pregnant women on the safety of involvement in more strenuous physical conditioning. Future study is also recommended to determine the usefulness of prenatal exercise in the prevention and treatment of gestational diabetes mellitus and preeclampsia.
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Affiliation(s)
- Larry A Wolfe
- School of Physical and Health Education and Department of Physiology, Queen's University, Kingston, ON, Canada
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Bessinger RC, McMurray RG. Substrate utilization and hormonal responses to exercise in pregnancy. Clin Obstet Gynecol 2003; 46:467-78. [PMID: 12808396 DOI: 10.1097/00003081-200306000-00025] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Raymond C Bessinger
- Department of Human Nutrition, Winthrop University, Rock Hill, South Carolina 29733, USA.
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Artal R, O'Toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med 2003; 37:6-12; discussion 12. [PMID: 12547738 PMCID: PMC1724598 DOI: 10.1136/bjsm.37.1.6] [Citation(s) in RCA: 407] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- R Artal
- Saint Louis University, St Louis, MO, USA.
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Bessinger RC, McMurray RG, Hackney AC. Substrate utilization and hormonal responses to moderate intensity exercise during pregnancy and after delivery. Am J Obstet Gynecol 2002; 186:757-64. [PMID: 11967503 DOI: 10.1067/mob.2002.122093] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was undertaken to examine substrate utilization and hormonal responses to moderate intensity exercise in the same group of women across gestation. STUDY DESIGN Glucose, triglyceride, insulin, glucagon, cortisol, growth hormone, and blood urea nitrogen levels were measured in 12 women at rest and after exercise. Heart rate, oxygen uptake, and respiratory exchange ratio were measured at rest and during exercise. Urine urea nitrogen levels, urine volume, and creatinine levels were measured 24 hours before and after exercise. Each woman completed a 30-minute treadmill walk at 65% of her predicted maximal heart rate at the same time of day during the 22nd and 33rd weeks of gestation and at 14 weeks after delivery. RESULTS There were no significant differences between exercise trials in oxygen uptake, respiratory exchange ratio, or heart rate. Pregnancy elevated resting triglyceride levels but lowered plasma glucose levels. Exercise during pregnancy caused a reduction in plasma glucose levels but elevated circulating triglyceride levels (P <.05). Resting levels of cortisol, growth hormone, and insulin were elevated during pregnancy compared with after delivery, but resting glucagon levels were not affected by pregnancy. Exercise caused circulating levels of cortisol, growth hormone, and glucagon to increase (P <.05). The exercise-induced change in the cortisol level was greater during pregnancy than that after delivery. The exercise-induced changes in growth hormone and glucagon levels were greatest after delivery compared with those during pregnancy (P <.05). Exercise reduced insulin levels (P <.05), with the greatest reduction at 33 weeks' gestation. There were no significant differences in urine urea nitrogen excretion as a result of exercise. CONCLUSIONS Certain substrate and hormonal responses to exercise are altered as pregnancy progresses. Quantitatively, protein appears to be a relatively unimportant fuel during a 30-minute bout of moderate intensity exercise in this group of women evaluated during pregnancy and after delivery. Furthermore, a 30-minute bout of moderate intensity exercise would not be expected to compromise fetal amino acid availability.
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Maximal Exercise Testing in Late Gestation. Obstet Gynecol 2001. [DOI: 10.1097/00006250-200101000-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Exercise has become an integral part of the life styles of many women. However, many women stop exercising during pregnancy because of concerns regarding the well-being of the fetus. Although pregnancy is associated with several physiologic changes and response to exercise is different in the pregnant state than in the nonpregnant state, exercise can be beneficial to the pregnant woman in the absence of obstetric or medical complications. There are certain contraindications to exercise during pregnancy, including pregnancy-induced hypertension, preterm rupture of membranes, preterm labor, incompetent cervix, intrauterine growth retardation, and persistent second- or third-trimester bleeding. In addition, certain guidelines should be followed in order to prevent harmful effects on the fetus. This article reviews the maternal and fetal responses to exercise, benefits and potential risks of exercise during pregnancy, and recent guidelines for exercise during pregnancy. It is important to note, however, that objective data regarding exercise during pregnancy is limited and that further research is warranted regarding this topic.
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Ohtake PJ, Wolfe LA. Physical conditioning attenuates respiratory responses to steady-state exercise in late gestation. Med Sci Sports Exerc 1998; 30:17-27. [PMID: 9475640 DOI: 10.1097/00005768-199801000-00004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To study the ventilatory effects of closely monitored cycle ergometer conditioning (HR target, 145-150 beats x min(-1); 25 min/session; three sessions per week) during the second and third pregnancy trimesters (TMs) in healthy human pregnancy. METHODS Subjects were 27 previously sedentary pregnant women (exercised group, EG). A sedentary control group (CG, N = 20) was also studied. Subjects were tested at rest and during upright cycle ergometry at three steady-state power outputs (approximately 20, 45, and 65 W) at the start of the second TM (ENTRY), at the end of the second and third TMs (post-training), and 3 months postpartum (PP, nonpregnant control). RESULTS Significant reductions in exercise HR were observed in the EG at each exercise level, confirming achievement of an aerobic conditioning effect. In both groups the ventilatory equivalent for oxygen (VE/O2) was significantly higher at all work rates during pregnancy compared with that during PP. This effect was caused by significantly higher exercise tidal volumes (VT) at each work rate in both groups during pregnancy versus PP. Respiratory sensitivity as reflected by the ventilatory equivalent for carbon dioxide (E/VECO2) and calculated arterial carbon dioxide tension (PaCO2) was significantly increased at all three work rates in late gestation versus PP and increased slightly with advancing gestational age in both groups. The main effects of physical conditioning were attenuation of increases in VE/VO2 observed at all exercise levels between the end of TM2 and TM3 and reductions in respiratory perception of effort (RPEr) between ENTRY and the end of TM3. Attenuation of increases in VE/VO2 during TM3 in the EG was attributed to the combined effects of enhanced fat versus carbohydrate utilization (resulting in reduced CO2 output and drive to ventilate) and attenuation of pregnancy-induced increases in dead space ventilation in late gestation. CONCLUSION The study results support the hypothesis that physical conditioning reduces both ventilatory demand and respiratory perception of effort in late gestation.
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Affiliation(s)
- P J Ohtake
- School of Physical and Health Education and Department of Physiology, Queen's University, Kingston, Ontario, Canada
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Khodiguian N, Jaque-Fortunato SV, Wiswell RA, Artal R. A comparison of cross-sectional and longitudinal methods of assessing the influence of pregnancy on cardiac function during exercise. Semin Perinatol 1996; 20:232-41. [PMID: 8888449 DOI: 10.1016/s0146-0005(96)80016-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
To evaluate the influence of pregnancy on resting and exercise cardiac function, we studied 16 nonpregnant and 26 pregnant females in a two-phase study. During phase I, all pregnant subjects (P1) (mean gestational age = 29.5 +/- 7 weeks) were compared with 16 control (C) subjects. In phase II, 8 of the pregnant subjects (P2) (mean gestational age = 32.6 +/- 6 weeks) were evaluated again at 12.5 +/- 7 weeks postpartum (PP). Using Collier's CO2 rebreathing technique, exercise cardiac output (Q) was measured on a cycle ergometer during rest and at three submaximal work levels (25, 50, and 75 W), during the last minute of 5 to 7 minutes of steady-level power output. Metabolic parameters [ventilation (VE), heart rate (HR) and oxygen consumption (VO2)] were measured during the submaximal tests and throughout the progressive increase in work after the last measure of Q, until peak VO2 was achieved. The results from the phase I comparison indicated (as expected) higher resting heart rates [(90.0 +/- 3 P1; 81.8 +/- 3 bpm C), ventilation (9.5 +/- 0.3 P1; 7.5 +/- 0.5 L min-1 C), and resting oxygen consumption (0.263 +/- 0.07 P; 0.221 +/- 0.01 L min-1 C) associated with pregnancy, and these findings were similar when the pregnant subjects were compared with their postpartum values. Analysis of the various indices of cardiac function [Q, stroke volume (SV), and arteriovenous oxygen difference (A-VO2 diff)] resulted in statistically higher resting Q in pregnancy when compared with C and PP conditions. No resting differences were observed for SV or A-VO2 diff in either phase of the study. The results of the submaximal exercise tests indicated no significant differences in HR nor VO2 between P1 and C; however, P2 had significantly higher submaximal heart rates and oxygen consumption when compared with PP. Further, no significant differences were observed between P1 and C for Q, SV or A-VO2 diff, whereas P2 versus PP resulted in significantly lower SV and higher A-VO2 diff in the pregnant subjects. These findings suggest that pregnancy/control versus pregnancy/ postpartum studies yield statistically different results and that an effort needs to made by the research community to develop standardized methodologies to evaluate physiological processes in pregnancy.
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Affiliation(s)
- N Khodiguian
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, USA
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35
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Jaque-Fortunato SV, Wiswell RA, Khodiguian N, Artal R. A comparison of the ventilatory responses to exercise in pregnant, postpartum, and nonpregnant women. Semin Perinatol 1996; 20:263-76. [PMID: 8888452 DOI: 10.1016/s0146-0005(96)80019-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
To evaluate the influence of pregnancy on resting and exercise pulmonary function, we studied 16 nonpregnant and 26 pregnant females in a two-phase study. During phase I, all pregnant subjects (P1) (mean gestational age = 29.5 +/- 7 weeks [X +/- SD]) were compared with 16 control (C) subjects. In phase II, 8 of the pregnant subjects (P2) (mean gestational age = 32.6 +/- 6 weeks) were evaluated again at 12.5 +/- 7 weeks' postpartum (PP). Exercise respiratory function was measured during work on a cycle ergometer during rest and at three submaximal work levels (25, 50, and 75 W), during the last minute of 5 to 7 minutes of steady-level power output. Ventilatory parameters [ventilation (VE), ventilatory frequency (VF), tidal volume (TV), ventilatory equivalent for oxygen (VE/VO2) and ventilatory equivalent for carbon dioxide (VE/VCO2)] and metabolic parameters [oxygen consumption (VO2), oxygen pulse, carbon dioxide production (VCO2), respiratory exchange ratio (RER), and plasma lactate (HLA)] were measured during the submaximal tests and throughout the progressive increase in work after the 75 W work load, until peak VO2 was achieved. The results from the phase I comparison indicated (as expected) higher resting ventilation, tidal volume, oxygen consumption, carbon dioxide production, and respiratory exchange ratio associated with pregnancy, and these findings were similar when the pregnant subjects were compared with their postpartum values. Plasma lactate levels, although similar in the phase I comparison, were significantly higher during pregnancy when compared with postpartum values. No resting differences were observed for VF, O2 pulse, VE/VO, or VE/VCO2 in either phase of the study. The results of the submaximal exercise tests indicated higher submaximal levels of VE, VF, VE/VO2, VE/VCO2 in P1 versus C; however, P2 had significantly higher VE, TV, VO2, VE/VCO2, when compared with PP. The influence of pregnancy on VCO2 and RER differed by workload in both sets of comparisons. Furthermore, no significant differences were observed between P1 and C and P2 and PP for plasma lactate levels. These findings suggest that pregnancy/control versus pregnancy/postpartum studies yield different results in both ventilatory and metabolic comparisons. Consideration must be given to the type of study when discussing and applying the findings.
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Affiliation(s)
- S V Jaque-Fortunato
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles 90033, USA
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36
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Soultanakis HN, Artal R, Wiswell RA. Prolonged exercise in pregnancy: glucose homeostasis, ventilatory and cardiovascular responses. Semin Perinatol 1996; 20:315-27. [PMID: 8888457 DOI: 10.1016/s0146-0005(96)80024-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study was designed to assess glucose homeostasis in pregnant women in their third trimester of gestation in response to exercise. Specifically, this study was designed to (1) compare the extend and rate at which blood glucose levels decrease in pregnant (22 to 33 weeks of gestation) versus that which occurs in nonpregnant women; and (2) determine the pattern of changes of the substrates (glucose, lactate, beta-hydroxybutyrate, and free fatty acids, and hormones (insulin), that contribute to the glucose homeostasis of pregnant (N = 10), and nonpregnant (N = 10) women in response to 1-hour prolonged moderate intensity exercise (at 55% of their VO2max). Each subject was tested for the determination of their maximal oxygen consumption (VO2max) and, based on their VO2max, they performed 60 minutes of prolonged moderate intensity exercise. Blood was collected before, during, and after the exercise bout. The results indicated that blood glucose levels of pregnant women decrease at a faster rate and to a significantly lower level post exercise (P < .05). Insulin levels of pregnant women also decreased to a significantly lower level post exercise, and lactate levels were maintained at a lower level 15 minutes after exercise. beta-hydroxybutyrate level was not different between the two groups, but demonstrated a different pattern of changes during exercise (P < .05). Furthermore, the results suggest that blood glucose levels of the late pregnant women decrease lower than those of nonpregnant women; also, there are differences in the rate and kinetics of blood glucose between pregnant and nonpregnant women. The results also indicate significant differences in the level of circulating substrates and hormones between pregnant and nonpregnant women in response to exercise.
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Affiliation(s)
- H N Soultanakis
- Department of Exercise Sciences, University of Southern California, Los Angeles, USA
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37
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Abstract
As the opportunities for women to compete in elite sports competition increase, it is inevitable that pregnancy will occur during training and competition. The effect of the high-intensity exercise needed to compete at the elite level will be found in anatomic changes such as ligament relaxation, change in posture, and increased weight. These will all detract from the ability to attain peak performance. The effect of the high-intensity training on the athlete and the fetus must also be considered. The physiological and metabolic changes will have a variable effect; however, awarenees of these changes should prevent problems. There is some evidence suggesting an increase in low birthweight infants but no evidence of preterm birth. Unfortunately, much of our information is based on limited studies, so caution and careful evaluation are essential.
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Affiliation(s)
- R W Hale
- American College of Obstetricians and Gynecologists, Washington, DC 20024-2188, USA
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38
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García Río F, Pino García JM, Alvarez-Sala R, Díaz Lobato S, Casadevall J, Villasante C. [Respiratory adaptation during pregnancy]. Arch Bronconeumol 1995; 31:172-80. [PMID: 7743063 DOI: 10.1016/s0300-2896(15)30945-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Artal R, Fortunato V, Welton A, Constantino N, Khodiguian N, Villalobos L, Wiswell R. A comparison of cardiopulmonary adaptations to exercise in pregnancy at sea level and altitude. Am J Obstet Gynecol 1995; 172:1170-8; discussion 1178-80. [PMID: 7726252 DOI: 10.1016/0002-9378(95)91475-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The purpose of this study was to compare maternal cardiopulmonary and fetal responses of lowlander pregnant women in the third trimester to exercise at sea level and at an altitude of 6000 feet. STUDY DESIGN Seven women at 33.86 +/- 1 weeks' gestation performed a symptom-limited maximal exercise test and a submaximal cardiac output exercise test at sea level at an altitude of 6000 feet. Cardiopulmonary and metabolic variables were measured and compared at sea level and altitude. RESULTS Maximal oxygen consumption and work levels were limited by short-term altitude exposure. Ventilatory variables were not significantly influenced by altitude exposure. During submaximal exercise no alteration in exercise efficiency or response was seen for most of the variables when altitude and sea level data were compared. Both cardiac output and stroke volume were elevated at altitude at rest but not during exercise, suggesting a lower reserve for both variables at altitude. Level of plasma glucose, lactate, norepinephrine, and epinephrine were not significantly influenced by altitude exposure. Fetal heart rate responses did not differ between the sea level and altitude conditions. CONDITIONS Lowlander pregnant women in the third trimester have some limitations to maximal aerobic capacity but not submaximal exercise on short-term altitude exposure. No ominous fetal responses have been observed during this study. The results suggest that pregnant women may engage in at least brief moderate exercise bouts at moderate altitude without adverse consequences.
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Affiliation(s)
- R Artal
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, USA
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Koniak-Griffin D. Aerobic exercise, psychological well-being, and physical discomforts during adolescent pregnancy. Res Nurs Health 1994; 17:253-63. [PMID: 8036273 DOI: 10.1002/nur.4770170404] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The effects of participation in a 6-week aerobic exercise program (AEP) on pregnant adolescents' depression, self-esteem, and physical discomforts of pregnancy were examined. The sample was comprised of 58 ethnically diverse subjects ranging in age from 14 to 20 years. Subjects in the AEP were observed to have a significant decrease in depressive symptoms over time and an increase in total self-esteem; those in the comparison group reported a significant increase in physical discomforts associated with pregnancy. These findings suggest that exercise programs such as the AEP should be considered an important aspect of prenatal self-care for healthy pregnant adolescents.
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Affiliation(s)
- D Koniak-Griffin
- School of Nursing, University of California, Los Angeles 90024-6919
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41
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Lebrun CM. The Effect of the Phase of the Menstrual Cycle and the Birth Control Pill on Athletic Performance. Clin Sports Med 1994. [DOI: 10.1016/s0278-5919(20)30339-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lebrun CM. Effect of the different phases of the menstrual cycle and oral contraceptives on athletic performance. Sports Med 1993; 16:400-30. [PMID: 8303141 DOI: 10.2165/00007256-199316060-00005] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The female athlete, during her reproductive years, has a complex and ever-changing milieu of female steroid hormones, whether it is the endogenous variations in estradiol and progesterone of a regular menstrual cycle, or the exogenous synthetic hormones of the oral contraceptives. Both estrogens and progestins have individual, interactive and sometimes opposing physiological actions with potential implications for the exercising female. In retrospective surveys on the menstrual cycle and performance, from 37 to 63% of athletes did not report any cycle 'phase' detriment, while 13 to 29% reported an improvement during menstruation. The best performances were generally in the immediate postmenstrual days, with the worse performances during the premenstrual interval and the first few days of menstrual flow. However, this type of study has an inherent built-in bias, and is further limited by the lack of substantiation of cycle phase. Many of the women studied associated premenstrual symptoms, such as fluid retention, weight gain, mood changes, and dysmenorrhoea with performance decrement. Such factors have also been causally linked with an increase in traumatic musculoskeletal injuries during the premenstrual and menstrual period. Neuromuscular coordination, manual dexterity, judgement and reaction time for complex tests have been shown to be adversely affected in women with premenstrual syndrome or symptoms, but confounding variables may include nutrition status and blood sugar levels. In addition, not all women suffer to the same level with premenstrual symptoms. Fluctuations in many physiological functions occur throughout the normal menstrual cycle. Results of early studies are difficult to interpret owing to the small numbers of women studied, wide range of fitness levels, and variability in the definitions of cycle phase. Nevertheless, investigators did not document any significant changes in measures of athletic performance as a function of timing of testing during the menstrual cycle. Swimmers have shown a premenstrual worsening of performance times, with improvement during the menstrual phase and on the eighth day of the cycle. An increase in perceived exertion was noted premenstrually and during the early menstrual stage with very intense exercise. In cross-country skiers, the best times were recorded in the postovulatory and postmenstrual phases, prompting the recommendation that training loads be selected according to cycle phase to achieve maximum benefit. Investigations using estradiol and progesterone levels as a confirmatory index of ovulation have not generally found significant differences across the cycle in either maximal or submaximal exercise responses, although a slight decrease in aerobic capacity during the luteal phase has been reported.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- C M Lebrun
- Allan McGavin Sports Medicine Centre, University of British Columbia, Vancouver, Canada
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43
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Wolfe LA, Mottola MF. Aerobic exercise in pregnancy: an update. CANADIAN JOURNAL OF APPLIED PHYSIOLOGY = REVUE CANADIENNE DE PHYSIOLOGIE APPLIQUEE 1993; 18:119-47. [PMID: 8513287 DOI: 10.1139/h93-011] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The endocrine effects of pregnancy cause striking changes in maternal metabolism, cardiovascular regulation, acid-base balance, and thermoregulation at rest and during standard submaximal exercise. The apparent purpose of these changes is to accommodate fetal needs in addition to those of the exercising woman. A significant body of evidence supports the hypothesis that healthy women can perform acute exercise of moderate intensity and duration without jeopardizing fetal well-being. Compiled studies also suggest that maximal oxygen uptake (VO2max, L.min-1) and the work rate at the onset of blood lactate accumulation (OBLA) are not significantly altered during the course of a normal pregnancy. However, some evidence suggests that maximal anaerobic power may be reduced. More information is needed on maternal cardiorespiratory function, carbohydrate metabolism, and acid-base balance at exercise intensities above OBLA and on fetal adaptability to strenuous maternal exercise. Recent studies support the view that moderate fitness conditioning can augment maternal metabolic and cardiopulmonary capacities without altering fetal development or pregnancy outcome. Implications of recent scientific studies for the design of aerobic exercise programs for pregnant women are discussed.
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Affiliation(s)
- L A Wolfe
- School of Physical and Health Education, Queen's University, Kingston, Ontario
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44
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45
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15. Mechanical efficiency and statistical summary. BJOG 1992. [DOI: 10.1111/j.1471-0528.1992.tb16195.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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46
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4. Ventilation. BJOG 1992. [DOI: 10.1111/j.1471-0528.1992.tb16184.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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48
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Affiliation(s)
- R Artal
- Department of Obstetrics/Gynecology, University of Southern California, School of Medicine, Los Angeles
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49
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Huch R, Erkkola R. Pregnancy and exercise--exercise and pregnancy. A short review. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1990; 97:208-14. [PMID: 2185821 DOI: 10.1111/j.1471-0528.1990.tb01782.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- R Huch
- Department of Obstetrics, University Hospital, Zurich, Switzerland
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50
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Abstract
Increasing numbers of women include exercise even during pregnancy as an essential part of their daily routines. Because of the additional physiological demands imposed by pregnancy, health-care practitioners must determine whether or not aerobic exercise is, in fact, healthy for the expectant mother and developing fetus. This article examines whether or not the traditional advice that women receive regarding exercise during pregnancy is supported by the existing scientific literature.
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Affiliation(s)
- E G Fishbein
- Georgetown University, School of Nursing, Washington, DC 20007
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