1
|
O'Rourke N, Dervis S, da Silva DF, Geurts C, Haman F, Adamo KB. Heat production during exercise in pregnancy: discerning the contribution of total body weight. Pflugers Arch 2024; 476:769-778. [PMID: 38433124 DOI: 10.1007/s00424-024-02929-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/23/2023] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
Studies have reported enhanced thermoregulatory function as pregnancy progresses; however, it is unclear if differences in thermoregulation are attributed to weight gain or other physiological changes. This study aimed to determine if total body weight will influence thermoregulation (heat production (Hprod)), heart rate, and perceptual measurements in response to weight-bearing exercise during early to late pregnancy. A cross-sectional design of healthy pregnant women at different pregnancy time points (early, T1; middle, T2; late, T3) performed a 7-stage weight-bearing incremental exercise protocol. Measurements of Hprod, HR, and RPE were examined. Two experimental groups were studied: (1) weight matched and (2) non-weight matched, in T1, T2, and T3. During exercise, equivalent Hprod at T1 (326 ± 88 kJ), T2 (330 ± 43 kJ), and T3 (352 ± 52 kJ) (p = 0.504); HR (p = 0.830); and RPE (p = 0.195) were observed in the WM group at each time point. In the NWM group, Hprod (from stages 1-6 of the exercise) increased across pregnancy time points, T1 (291 ± 76 kJ) to T2 (347 ± 41 kJ) and T3 (385 ± 47 kJ) (p < 0.001). HR increased from T1 to T3 in the warm-up to stage 6 (p = 0.009). RPE did not change as pregnancy time point progressed (p = 0.309). Total body weight, irrespective of pregnancy time point, modulates Hprod and HR during exercise. Therefore, accounting for total body weight is crucial when comparing thermoregulatory function during exercise across pregnancy.
Collapse
Affiliation(s)
- Nicholas O'Rourke
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Lees Campus, 518E, 200 Lees Ave, Ottawa, ON, K1N 6N5, Canada
| | - Sheila Dervis
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Lees Campus, 518E, 200 Lees Ave, Ottawa, ON, K1N 6N5, Canada
| | - Danilo F da Silva
- Sports Studies Department, Faculty of Arts and Science, Bishop's University, Sherbrooke, QC, Canada
| | - Carla Geurts
- Fontys University of Applied Sciences, Venlo, Netherlands
| | - François Haman
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Lees Campus, 518E, 200 Lees Ave, Ottawa, ON, K1N 6N5, Canada
| | - Kristi Bree Adamo
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Lees Campus, 518E, 200 Lees Ave, Ottawa, ON, K1N 6N5, Canada.
| |
Collapse
|
2
|
Cowell W, Ard N, Herrera T, Medley EA, Trasande L. Ambient temperature, heat stress and fetal growth: A review of placenta-mediated mechanisms. Mol Cell Endocrinol 2023; 576:112000. [PMID: 37460007 DOI: 10.1016/j.mce.2023.112000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/24/2023]
Abstract
Pregnancy is increasingly considered a period of vulnerability for extreme heat exposure. Multiple lines of evidence support that heat stress is associated with placental insufficiency, poor fetal growth and decreased birth weight. In this narrative review, we first summarize evidence linking ambient temperature or experimentally-induced heat stress with fetal and placental growth outcomes in humans, ruminants and murine species. We then synthesize the literature on putative underlying biological pathways with a focus on the placenta. Reviewed mechanisms include: reduced uterine-placental blood flow, impaired supply of metabolic substrates to the fetus, activation of the maternal stress-response system, and disruption of other endocrine and immune system endpoints. Taken together, this body of evidence supports that exposure to extreme ambient heat likely has adverse consequences for placental development and function. However, research investigating placenta-mediated pathophysiological mechanisms in humans remains extremely limited.
Collapse
Affiliation(s)
- Whitney Cowell
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA; Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Natasha Ard
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Teresa Herrera
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Eleanor A Medley
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Leonardo Trasande
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA; Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
| |
Collapse
|
3
|
Guinhouya BC, Duclos M, Enea C, Storme L. Beneficial Effects of Maternal Physical Activity during Pregnancy on Fetal, Newborn, and Child Health: Guidelines for Interventions during the Perinatal Period from the French National College of Midwives. J Midwifery Womens Health 2022; 67 Suppl 1:S149-S157. [PMID: 36480665 PMCID: PMC10107927 DOI: 10.1111/jmwh.13424] [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: 04/12/2022] [Accepted: 05/10/2022] [Indexed: 12/13/2022]
Abstract
The objective of this work is to synthesize current knowledge about the effects of maternal physical activity during pregnancy on children's health. During the prenatal and postnatal periods, maternal physical activity has protective effects against the risks of macrosomia, obesity, and other associated cardiometabolic disorders. Even though longitudinal studies in humans are still necessary to validate them, these effects have been consistently observed in animal studies. A remarkable effect of maternal physical activity is its positive role on neurogenesis, language development, memory, and other cognitive functions related to learning.
Collapse
Affiliation(s)
| | - Martine Duclos
- Department of Sport Medicine and Functional Explorations, University-Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand, Clermont-Ferrand, F-63003, France.,INRAE, UNH, CRNH Auvergne, Clermont-Ferrand, F-63000, France.,Clermont University, University of Auvergne, UFR Médecine, BP 10448, Clermont-Ferrand, F-63000, France
| | - Carina Enea
- Laboratoire MOVE (EA6314), Université de Poitiers, Faculté des sciences du sport, 8 allée Jean Monnet - TSA 31113 - 96073 Poitiers cedex 9
| | - Laurent Storme
- Univ. Lille, ULR 2694 METRICS, Lille, F-59000, France.,Department of Neonatology, CHU Lille, Lille, F-59000, France
| |
Collapse
|
4
|
Samuels L, Nakstad B, Roos N, Bonell A, Chersich M, Havenith G, Luchters S, Day LT, Hirst JE, Singh T, Elliott-Sale K, Hetem R, Part C, Sawry S, Le Roux J, Kovats S. Physiological mechanisms of the impact of heat during pregnancy and the clinical implications: review of the evidence from an expert group meeting. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2022; 66:1505-1513. [PMID: 35554684 PMCID: PMC9300488 DOI: 10.1007/s00484-022-02301-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 05/09/2023]
Abstract
Many populations experience high seasonal temperatures. Pregnant women are considered vulnerable to extreme heat because ambient heat exposure has been linked to pregnancy complications including preterm birth and low birthweight. The physiological mechanisms that underpin these associations are poorly understood. We reviewed the existing research evidence to clarify the mechanisms that lead to adverse pregnancy outcomes in order to inform public health actions. A multi-disciplinary expert group met to review the existing evidence base and formulate a consensus regarding the physiological mechanisms that mediate the effect of high ambient temperature on pregnancy. A literature search was conducted in advance of the meeting to identify existing hypotheses and develop a series of questions and themes for discussion. Numerous hypotheses have been generated based on animal models and limited observational studies. There is growing evidence that pregnant women are able to appropriately thermoregulate; however, when exposed to extreme heat, there are a number of processes that may occur which could harm the mother or fetus including a reduction in placental blood flow, dehydration, and an inflammatory response that may trigger preterm birth. There is a lack of substantial evidence regarding the processes that cause heat exposure to harm pregnant women. Research is urgently needed to identify what causes the adverse outcomes in pregnancy related to high ambient temperatures so that the impact of climate change on pregnant women can be mitigated.
Collapse
Affiliation(s)
- Louisa Samuels
- Department of Obstetrics and Gynaecology, Guy's and St Thomas' NHS Trust, London, UK.
| | - Britt Nakstad
- Division of Paediatric and Adolescent Health, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Nathalie Roos
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Ana Bonell
- Medical Research Council Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Centre On Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew Chersich
- Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Hillbrow, Johannesburg, 2001, South Africa
| | - George Havenith
- Environmental Ergonomics Research Centre, Loughborough Design School, Loughborough University, Loughborough, UK
| | - Stanley Luchters
- Department of Population Health, Aga Khan University, East Africa, Nairobi, Kenya
| | - Louise-Tina Day
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane E Hirst
- Nuffield Department of Women's and Reproductive Health and the George Institute for Global Health, University of Oxford, Oxford, UK
| | - Tanya Singh
- Climate Change Research Centre, University of New South Wales, Sydney, Australia
| | - Kirsty Elliott-Sale
- Department of Sport Science, Sport, Health and Performance Enhancement (SHAPE) Research Centre, Nottingham Trent University, Nottingham, UK
| | - Robyn Hetem
- School of Animal, Plant and Environmental Sciences, Faculty of Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Cherie Part
- Centre On Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Shobna Sawry
- School of Animal, Plant and Environmental Sciences, Faculty of Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Jean Le Roux
- School of Animal, Plant and Environmental Sciences, Faculty of Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Sari Kovats
- Centre On Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
5
|
Dervis S, Dobson KL, Nagpal TS, Geurts C, Haman F, Adamo KB. Heat loss responses at rest and during exercise in pregnancy: A scoping review. J Therm Biol 2021; 99:103011. [PMID: 34420641 DOI: 10.1016/j.jtherbio.2021.103011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/07/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The teratogenic risk associated with maternal hyperthermia (i.e., core temperature ≥39.0 °C) has been a crucial motive in understanding thermoregulatory responses in pregnancy. To date, a substantial number of studies have focused on core temperature responses in a wide range of exercise intensities, duration, and ambient temperatures. Fortunately, none have reported core temperatures exceeding 39.0 °C. Nonetheless, there are limited studies that have provided substantial insight into both dry and evaporative heat loss mechanisms involved in facilitating the maintenance of core temperature (≥39.0 °C) during heat stress in pregnant women. The purpose of this scoping review was to summarize the available literature that has assessed heat loss responses in studies of human pregnancy. METHODS A search strategy was developed combining the terms pregnancy, thermoregulation, and adaptation. A systematic search was performed in the following databases: PubMed, Embase, Scopus, and ProQuest. Studies eligible for inclusion included pregnant women between the ages of 18-40 years old, and at least one measurement of the following: sweating, blood flow, skin temperature, and behavioural responses. Retrieved data were categorized as evaporative (sweating), dry or behavioural heat loss responses and summarized narratively. RESULTS Thirty-three studies were included in this review (twenty-nine measured physiological responses and four measured behavioural responses). Studies suggest that during exercise, evaporative (sweating) and dry (skin blood flow and temperature) heat loss responses increase from early to late pregnancy in addition to greater cardiac output, blood volume and reduced vascular resistance. Behavioural practices related to heat loss responses are also influenced by cultural/religious expectations, personal preferences and sociodemographics. CONCLUSION The findings from this review suggest that pregnancy modifies evaporative (sweating), dry and behavioural heat loss. However, future studies have an opportunity to compare heat loss measurements accounting for gestational weight gain and thermal sensation/comfort scale to associate physiological responses with perceptual responses across pregnancy.
Collapse
Affiliation(s)
- Sheila Dervis
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
| | - Kayla Lerher Dobson
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
| | - Taniya Singh Nagpal
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
| | - Carla Geurts
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
| | - François Haman
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
| | - Kristi Bree Adamo
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
| |
Collapse
|
6
|
Davenport MH, Yoo C, Mottola MF, Poitras VJ, Jaramillo Garcia A, Gray CE, Barrowman N, Davies GA, Kathol A, Skow RJ, Meah VL, Riske L, Sobierajski F, James M, Nagpal TS, Marchand AA, Slater LG, Adamo KB, Barakat R, Ruchat SM. Effects of prenatal exercise on incidence of congenital anomalies and hyperthermia: a systematic review and meta-analysis. Br J Sports Med 2018; 53:116-123. [PMID: 30337347 DOI: 10.1136/bjsports-2018-099653] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To investigate the relationships between exercise and incidence of congenital anomalies and hyperthermia. DESIGN Systematic review with random-effects meta-analysis . DATA SOURCES Online databases were searched from inception up to 6 January 2017. STUDY ELIGIBILITY CRITERIA Studies of all designs were eligible (except case studies and reviews) if they were published in English, Spanish or French, and contained information on population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone ["exercise-only"] or in combination with other intervention components [e.g., dietary; "exercise + co-intervention"]), comparator (no exercise or different frequency, intensity, duration, volume or type of exercise) and outcome (maternal temperature and fetal anomalies). RESULTS This systematic review and meta-analysis included 'very low' quality evidence from 14 studies (n=78 735) reporting on prenatal exercise and the odds of congenital anomalies, and 'very low' to 'low' quality evidence from 15 studies (n=447) reporting on maternal temperature response to prenatal exercise. Prenatal exercise did not increase the odds of congenital anomalies (OR 1.23, 95% CI 0.77 to 1.95, I2=0%). A small but significant increase in maternal temperature was observed from pre-exercise to both during and immediately after exercise (during: 0.26°C, 95% CI 0.12 to 0.40, I2=70%; following: 0.24°C, 95% CI 0.17 to 0.31, I2=47%). SUMMARY/CONCLUSIONS These data suggest that moderate-to-vigorous prenatal exercise does not induce hyperthermia or increase the odds of congenital anomalies. However, exercise responses were investigated in most studies after 12 weeks' gestation when the risk of de novo congenital anomalies is negligible.
Collapse
Affiliation(s)
- Margie H Davenport
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Courtney Yoo
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle F Mottola
- R Samuel McLaughlin Foundation-Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, Children's Health Research Institute, The University of Western Ontario, London, Ontario, Canada
| | | | | | - Casey E Gray
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Gregory A Davies
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Amariah Kathol
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Rachel J Skow
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Victoria L Meah
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Laurel Riske
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Frances Sobierajski
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Marina James
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Taniya S Nagpal
- R Samuel McLaughlin Foundation-Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, Children's Health Research Institute, The University of Western Ontario, London, Ontario, Canada
| | - Andree-Anne Marchand
- Department of Anatomy, Universite du Quebec a Trois-Rivieres, Trois-Rivieres, Quebec, Canada
| | - Linda G Slater
- John W Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Kristi B Adamo
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Ruben Barakat
- Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Universite du Quebec a Trois-Rivieres, Trois-Rivieres, Quebec, Canada
| |
Collapse
|
7
|
Ravanelli N, Casasola W, English T, Edwards KM, Jay O. Heat stress and fetal risk. Environmental limits for exercise and passive heat stress during pregnancy: a systematic review with best evidence synthesis. Br J Sports Med 2018; 53:799-805. [PMID: 29496695 DOI: 10.1136/bjsports-2017-097914] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Pregnant women are advised to avoid heat stress (eg, excessive exercise and/or heat exposure) due to the risk of teratogenicity associated with maternal hyperthermia; defined as a core temperature (Tcore) ≥39.0°C. However, guidelines are ambiguous in terms of critical combinations of climate and activity to avoid and may therefore unnecessarily discourage physical activity during pregnancy. Thus, the primary aim was to assess Tcore elevations with different characteristics defining exercise and passive heat stress (intensity, mode, ambient conditions, duration) during pregnancy relative to the critical maternal Tcore of ≥39.0°C. DESIGN Systematic review with best evidence synthesis. DATA SOURCES EMBASE, MEDLINE, SCOPUS, CINAHL and Web of Science were searched from inception to 12 July 2017. STUDY ELIGIBILITY CRITERIA Studies reporting the Tcore response of pregnant women, at any period of gestation, to exercise or passive heat stress, were included. RESULTS 12 studies satisfied our inclusion criteria (n=347). No woman exceeded a Tcore of 39.0°C. The highest Tcore was 38.9°C, reported during land-based exercise. The highest mean end-trial Tcore was 38.3°C (95% CI 37.7°C to 38.9°C) for land-based exercise, 37.5°C (95% CI 37.3°C to 37.7°C) for water immersion exercise, 36.9°C (95% CI 36.8°C to 37.0°C) for hot water bathing and 37.6°C (95% CI 37.5°C to 37.7°C) for sauna exposure. CONCLUSION The highest individual core temperature reported was 38.9°C. Immediately after exercise (either land based or water immersion), the highest mean core temperature was 38.3°C; 0.7°C below the proposed teratogenic threshold. Pregnant women can safely engage in: (1) exercise for up to 35 min at 80%-90% of their maximum heart rate in 25°C and 45% relative humidity (RH); (2) water immersion (≤33.4°C) exercise for up to 45 min; and (3) sitting in hot baths (40°C) or hot/dry saunas (70°C; 15% RH) for up to 20 min, irrespective of pregnancy stage, without reaching a core temperature exceeding the teratogenic threshold.
Collapse
Affiliation(s)
- Nicholas Ravanelli
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - William Casasola
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,Exeter Medical School, University of Exeter, Exeter, UK
| | - Timothy English
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Kate M Edwards
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Ollie Jay
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.,Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
8
|
Davies GAL, Wolfe LA, Mottola MF, MacKinnon C. N o 129-L'exercice physique pendant la grossesse et le postpartum. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:e66-e73. [PMID: 29447727 DOI: 10.1016/j.jogc.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIF Énoncer une directive canadienne visant à informer les fournisseurs de soins obstétricaux des répercussions, pour la mère, le fœtus et le nouveau-né, des exercices de conditionnement aerobique et musculaire pendant la grossesse. RéSULTATS ATTENDUS: Effets sur la morbidité maternelle, fœtale et néonatale et mesures de la forme physique maternelle. PREUVES Une recherche sur MEDLINE des articles, publiés en anglais de 1966 à 2002, appartenant aux catégories suivantes : études sur le conditionnement aérobique et musculaire chez des femmes ne faisant pas jusque-là d'exercice et chez des femmes actives avant leur grossesse, ainsi que des études sur les répercussions du conditionnement aérobique et musculaire sur les issues précoces et tardives de la grossesse ou sur les issues néonatales; rapports de synthèse et méta-analyses portant sur l'exercice pendant la grossesse. VALEURS Les résultats recueillis ont été revus par la Société des obstétriciens et gynécologues du Canada (Comité de la pratique clinique - obstétrique), avec la participation de la Société canadienne de physiologie de l'exercice, et ils ont été classés suivant les critères d'évaluation des preuves établis par le Groupe de travail canadien sur l'examen de santé périodique. RECOMMANDATIONS VALIDATION: Cette directive a été approuvée par le Comité de pratique clinique - obstétrique de la SOGC, par le Comité exécutif et par le Conseil de la SOGC, ainsi que par le Conseil d'administration de la Société canadienne de physiologie de l'exercice. PARRAINé PAR: la Société des obstétriciens et gynécologues du Canada et par la Société canadienne de physiologie de l'exercice.
Collapse
|
9
|
No. 129-Exercise in Pregnancy and the Postpartum Period. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:e58-e65. [DOI: 10.1016/j.jogc.2017.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
10
|
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
| |
Collapse
|
11
|
Origins in the Womb: Potential Role of the Physical Therapist in Modulating the Deleterious Effects of Obesity on Maternal and Offspring Health Through Movement Promotion and Prescription During Pregnancy. Phys Ther 2017; 97:114-123. [PMID: 27417168 PMCID: PMC6396816 DOI: 10.2522/ptj.20150678] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 07/07/2016] [Indexed: 02/06/2023]
Abstract
Maternal obesity and associated metabolic disease contribute to adverse outcomes in women and their offspring, and many of these outcomes have significant acute and chronic implications for both mother and neonate. Targeted movement (ie, physical activity or exercise training) during pregnancy has been shown to be safe and effective for improving many of these outcomes in women at a healthy weight and women who are obese. However, movement prescription and advice during pregnancy are often not addressed by health care providers; this situation creates a unique opportunity for physical therapists to use their expertise in movement with patients who are pregnant. The objective of this article is to briefly review the adverse maternal and neonatal outcomes associated with maternal obesity, the benefits of intentional maternal movement during pregnancy for women who are obese, the evidence-based guidelines for prescribing intentional movement during pregnancy for women who are obese, and the potential for physical therapists to become the driving force behind a necessary increase in movement levels in women who are pregnant. Physical therapists can play a significant role in encouraging movement in women who are healthy and women who have metabolic challenges during pregnancy and thus assist in combating the vicious cycle of obesity by improving maternal and offspring health.
Collapse
|
12
|
|
13
|
Charkoudian N, Stachenfeld N. Sex hormone effects on autonomic mechanisms of thermoregulation in humans. Auton Neurosci 2016; 196:75-80. [DOI: 10.1016/j.autneu.2015.11.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/28/2015] [Accepted: 11/30/2015] [Indexed: 11/26/2022]
|
14
|
Mottola MF, Inglis S, Brun CR, Hammond JA. Physiological and metabolic responses of late pregnant women to 40 min of steady-state exercise followed by an oral glucose tolerance perturbation. J Appl Physiol (1985) 2013; 115:597-604. [DOI: 10.1152/japplphysiol.00487.2013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
We examined the physiological and metabolic responses of 24 active late pregnant women to 40 min of vigorous (95% ventilatory threshold) steady-state treadmill exercise followed by a metabolic perturbation [oral glucose tolerance test (OGTT), 75 g] after exercise. Heart rate and respiratory measures were taken throughout exercise, and blood samples were collected during exercise and every 30 min during the 2-h OGTT. Values were compared with those for a group of physically active nonpregnant women ( n = 16) in the luteal phase of the menstrual cycle. Although late pregnant women were heavier, they performed the same work rate (182 vs. 208 W, P > 0.05), with the same oxygen pulse, but responded to the exercise with a blunted heart rate and relative oxygen consumption, with less carbon dioxide expired, possibly due to pregnancy-related adaptations in heart efficiency. Resting glucose concentrations were the same between groups, but by 40 min of exercise (3.8 ± 0.1 vs. 4.6 ± 0.1 mmol/l) and into 15 min of recovery (4.3 ± 0.2 vs. 5.0 ± 0.1 mmol/l), glucose concentrations were diminished in late pregnant women ( P ≤ 0.05, respectively). The pregnancy-induced delay of glucose uptake was seen in response to the postexercise OGTT compared with the nonpregnant women, but insulin sensitivity (ISI) remained (7.4 ± 0.9 vs. 9.7 ± 1.4 ISI, P > 0.05, respectively), with the preservation of the sensitivity of lipolysis inhibition of nonesterified free fatty acids to insulin. These adaptations may be fetoprotective, because our research suggests that 40 min of continuous treadmill exercise is well tolerated by physically active pregnant women. No adverse effects on birth outcome (3.53 ± 0.08 kg birth weight; 39.6 ± 0.33 wk gestational age) were observed.
Collapse
Affiliation(s)
- Michelle F. Mottola
- R. Samuel McLaughlin Foundation - Exercise & Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, The University of Western Ontario, London, Canada
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Canada; and
- Children's Health Research Institute, The University of Western Ontario, London, Canada
| | - Stuart Inglis
- R. Samuel McLaughlin Foundation - Exercise & Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, The University of Western Ontario, London, Canada
| | - Chantale R. Brun
- R. Samuel McLaughlin Foundation - Exercise & Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, The University of Western Ontario, London, Canada
| | - Jo-Anne Hammond
- R. Samuel McLaughlin Foundation - Exercise & Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, The University of Western Ontario, London, Canada
- Department of Family Medicine, The University of Western Ontario, London, Canada
| |
Collapse
|
15
|
Lotgering FK, Pivarnik JM. Commentaries on Viewpoint: Are there valid concerns for completing a marathon at 39 weeks of pregnancy? J Appl Physiol (1985) 2012; 113:1166. [PMID: 23027826 DOI: 10.1152/japplphysiol.01008.2012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Fred K Lotgering
- Radboud University Nijmegen Medical Centre Nijmegen, The Netherlands
| | | |
Collapse
|
16
|
Nagashima K, Tokizawa K, Uchida Y, Nakamura-Matsuda M, Lin CH. Exercise and thermoregulation. THE JOURNAL OF PHYSICAL FITNESS AND SPORTS MEDICINE 2012. [DOI: 10.7600/jpfsm.1.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Hartgill TW, Bergersen TK, Pirhonen J. Core body temperature and the thermoneutral zone: a longitudinal study of normal human pregnancy. Acta Physiol (Oxf) 2011; 201:467-74. [PMID: 21087419 DOI: 10.1111/j.1748-1716.2010.02228.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Using a longitudinal study design, we investigated changes in maternal core temperature and ambient temperatures before and after a localized cooling procedure to the right hand. METHODS Fifteen pregnant women participated. The experiments were sequentially performed for 21 month periods on each subject: from the 8th week of gestation to 1 year after delivery on seven separate occasions (gestational weeks 8, 16, 26, 36 and 12, 24, 52 weeks post-partum). The experiments were conducted in a climactic chamber, allowing ambient temperature adjustment to each subjects' thermoneutral zone determined using Doppler ultrasound of the digital artery. RESULTS Maternal core temperature decreased from 37.1 °C (week 8) towards term, reaching a nadir (36.4 °C) at 12 weeks post-partum (P < 0.001). The ambient temperature required to reach the thermoneutral zone changed significantly from 26.5 °C (week 8) falling to its lowest point: 23.0 °C (week 36) (P < 0.001), then stabilized from 24 weeks post-partum. CONCLUSION Maternal core temperature is highest in the first trimester but falls during pregnancy to a nadir 3 months post-partum. The ambient temperature required to reach the thermoneutral zone was 4 °C lower at 36 weeks of gestation compared with early pregnancy and late post-partum. Human temperature regulation is altered in pregnancy and for at least 3 months post-partum.
Collapse
Affiliation(s)
- T W Hartgill
- Department of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway.
| | | | | |
Collapse
|
19
|
Gollenberg AL, Pekow P, Bertone-Johnson ER, Freedson PS, Markenson G, Chasan-Taber L. Physical Activity and Risk of Small-for-Gestational-Age Birth Among Predominantly Puerto Rican Women. Matern Child Health J 2010; 15:49-59. [DOI: 10.1007/s10995-009-0563-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
20
|
Harris HE, Ellison GTH. Do the changes in energy balance that occur during pregnancy predispose parous women to obesity? Nutr Res Rev 2007; 10:57-81. [DOI: 10.1079/nrr19970005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractThe aim of this review was to re-assess whether the changes in energy balance that accompany pregnancy predispose parous women to obesity. A number of cross-sectional studies have sought to answer this question by examining the relationship between parity and maternal body weight. However, these studies were unable to control for the large number of sociobehavioural confounders that might be responsible for the apparent effect of parity on body weight. Longitudinal studies that examine changes in maternal body weight before and after regnancy avoid these problems by using each mother as her own control. Nevertheless, these studies have to overcome three methodological constraints: They must obtain an accurate measure of prepregnant body weight, they must give each mother sufficient time to lose any weight retained following delivery, and they must take into account the effect of ageing on maternal weight gain during pregnancy and the follow-up period. More than 90% of the studies reviewed found body weight to be greater after pregnancy than it was before (by 0.2–10.6kg). and previous researchers who have examined the evidence for pregnancy-related weight gains suggest that body weight increases by an average of 04–4.8kg following pregnancy. However, only three of the 71 longitudinal studies examined in the present review complied with the three methodological criteria. These studies concluded that mothers gain, on average, 0.9–3.3kg more weight following pregnancy than nonpregnant controls, and that mean body weight remained 0.4–3.0kg higher, even after controlling for a number of sociobehavioural confounders. This apparently modest increase in mean maternal body weight for women having one or two children conceals the fact that some mothers experience a substantial increase in body weight and become obese following pregnancy. It remains unclear whether these increases are simply the result of changes in energy metabolism during pregnancy and lactation, or whether they are influenced by inherent changes in lifestyle that accompany pregnancy and motherhood. Understanding the relative importance of these alternatives might help to explain the aetiology of maternal obesity.“Clover was a stout motherly mare approaching middle life, who had never quite got her figure back after her fourth foal”George Well (1945) Animal Farm. London: Secker and Warburg.
Collapse
|
21
|
Mottola MF, Vanderspank D, Schachter CL, VanHeest J, Tanguay RM. Cellular accumulation of heat shock protein (Hsp) 72i in fetuses of trained rats. Cell Stress Chaperones 2007; 12:101-5. [PMID: 17688188 PMCID: PMC1949329 DOI: 10.1379/csc-223r.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Forty-five Sprague-Dawley rats (60-80 days old) were randomly placed into one of three groups: sedentary pregnant control (PC); prepregnancy trained animals that exercised throughout pregnancy (PR); and nonpregnant trained animals (NPR). Each exercising animal ran at approximately 60-70% aerobic capacity (VO2max) for 1 hour/day up to and including day 18 of gestation (term = 21 days). On day 20 of gestation, fetuses were excised from each pregnant animal and scrutinized for gross abnormalities. In 3 randomly chosen fetuses from each litter, brain, heart, kidney, hind limb, and placental tissues were removed to assess the accumulation of the inducible isoform of the 70-kilodalton heat shock protein (Hsp 72i). No significant differences were detected between fetal hearts, hind limbs, or placental tissues of PC or PR groups. No Hsp 72i signal could be detected in fetal kidney or brain tissues from either pregnant group. Results indicate that maternal core temperature did not reach the threshold that would induce either gross fetal abnormalities or a fetal heat shock protein response. However, fetal and placental growth was reduced by the exercise protocol.
Collapse
Affiliation(s)
- Michelle F Mottola
- School of Kinesiology, Faculty of Health Sciences, The University of Western Ontario, London, ON N6A 3K7, Canada.
| | | | | | | | | |
Collapse
|
22
|
Charlesworth SA, Wolfe LA, Davies GAL. Physicochemical analysis of acid–base responses to prolonged moderate exercise in late gestation. Appl Physiol Nutr Metab 2006; 31:744-52. [PMID: 17213890 DOI: 10.1139/h06-084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Stewart’s physicochemical approach was employed to investigate the safety of an average recreational and occupational activity (prolonged moderate exercise) on maternal acid–base homeostasis. The responses of 10 healthy, physically active pregnant women (PG, gestational age 34–38 weeks) were compared with those of 10 non-pregnant female controls (CG). Subjects cycled for 40 min at 85% of their measured ventilatory threshold (VT). During the transition from rest to exercise, hydrogen ion concentration ([H+]) increased significantly and bicarbonate concentration ([HCO3–]) decreased significantly in both groups. Total weak acid ([Atot]) increased significantly with exercise in both groups, whereas the strong ion difference ([SID]) and CO2 tension (PaCO2) did not change significantly with exercise. Values for [H+], [HCO3–], PaCO2, [Atot] and [SID] were significantly lower in the PG vs. CG under all experimental conditions. Acid–base responses to prolonged moderate exercise are quantitatively similar in the pregnant vs. non-pregnant state. However, pregnant women maintain a lower plasma [H+] (approximately 3 neq/L (1 neq/L = 1 nmol/L)) throughout rest, exercise, and recovery, as a result of lower values for PaCO2 and [Atot], which is partly offset by a lower [SID]. The results indicate that prolonged moderate exercise appears to be well tolerated by healthy recreationally and occupationally active pregnant women.
Collapse
Affiliation(s)
- Sarah A Charlesworth
- School of Physical and Health Education, Queen's University, Kingston, ON K7L 3N6, Canada.
| | | | | |
Collapse
|
23
|
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
Collapse
Affiliation(s)
- Larry A Wolfe
- School of Physical and Health Education, Queen's University, Kingston, Ontario, K7L 3N6
| | | | | | | | | |
Collapse
|
24
|
Abstract
BACKGROUND Exercise is an important part of many women's lives. Women are often advised to refrain from physical exercise during pregnancy. The reason given is mainly safety, i.e. fear of maternal hyperthermia, which is known to be related to neural tube defects. However, exercise during pregnancy has not been shown to be related to hyperthermia. OBJECTIVE To study temperature and oxygen saturation responses to low-impact exercise in healthy pregnant women. METHODS Forty pregnant women and 11 controls participating in low-impact aerobic exercise were monitored before exercise, at maximum-exercise level, and after exercise with regard to core temperature, heart rate, and oxygen saturation level. RESULTS The core temperature among the pregnant women did not increase significantly at maximum exercise or after exercise (36.5 versus 36.7 or 36.5 degrees C, P = 0.1, P = 0.5). None of the pregnant women were even close to approaching a dangerous body temperature at an intensity level of 69% of their maximum heart rate. As compared with pre-exercise values, oxygen saturation among pregnant women was significantly reduced at both maximum-exercise and postexercise measurements, but no measurement was below 95% in oxygen saturation. CONCLUSION Low-impact aerobics at about 70% of one's maximum heart rate appears to be safe in terms of risk of maternal hyperthermia.
Collapse
Affiliation(s)
- Linnea Larsson
- Department of Obstetrics and Gynecology, Malmö University Hospital, MAS, Malmö, Sweden
| | | |
Collapse
|
25
|
|
26
|
|
27
|
Davies GAL, Wolfe LA, Mottola MF, MacKinnon C. Joint SOGC/CSEP Clinical Practice Guideline: Exercise in Pregnancy and the Postpartum Period. ACTA ACUST UNITED AC 2003. [DOI: 10.1139/h03-024] [Citation(s) in RCA: 256] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: To design Canadian guidelines advising obstetric care providers of the maternal, fetal, and neonatal implications of aerobic and strength-conditioning exercises in pregnancy. Outcomes: Knowledge of the impact of exercise on maternal, fetal, and neonatal morbidity, and of the maternal measures of fitness. Evidence: MEDLINE search from 1966 to 2002 for English-language articles related to studies of maternal aerobic and strength conditioning in a previously sedentary population, maternal aerobic and strength conditioning in a previously active population, impact of aerobic and strength conditioning on early and late pregnancy outcomes, impact of aerobic and strength conditioning on neonatal outcomes, as well as for review articles and meta-analyses related to exercise in pregnancy. Values: The evidence collected was reviewed by the Society of Obstetricians and Gynaecologists of Canada (SOGC Clinical Practice Obstetrics Committee) with representation from the Canadian Society for Exercise Physiology, and quantified using the evaluation of evidence guidelines developed by the Canadian Task Force on the Periodic Health Exam.Recommendations:1. All women without contraindications should be encouraged to participate in aerobic and strength-conditioning exercises as part of a healthy lifestyle during their pregnancy. (II-1,2B)2. Reasonable goals of aerobic conditioning in pregnancy should be to maintain a good fitness level throughout pregnancy without trying to reach peak fitness or train for an athletic competition. (II-1,2C)3. Women should choose activities that will minimize the risk of loss of balance and fetal trauma. (III-C)4. Women should be advised that adverse pregnancy or neonatal outcomes are not increased for exercising women. (II-1,2B)5. Initiation of pelvic floor exercises in the immediate postpartum period may reduce the risk of future urinary incontinence. (II-1C)6. Women should be advised that moderate exercise during lactation does not affect the quantity or composition of breast milk or impact infant growth. (I-A)Validation: This guideline has been approved by the SOGC Clinical Practice Obstetrics Committee, the Executive and Council of SOGC, and the Board of Directors of the Canadian Society for Exercise Physiology. Sponsors: This guideline has been jointly sponsored by the Society of Obstetricians and Gynaecologists of Canada and the Canadian Society for Exercise Physiology. Key words: fetus, neonate, outcomes, aerobic, strength
Collapse
|
28
|
|
29
|
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.
Collapse
Affiliation(s)
- Larry A Wolfe
- School of Physical and Health Education and Department of Physiology, Queen's University, Kingston, ON, Canada
| | | |
Collapse
|
30
|
Davies GAL, Wolfe LA, Mottola MF, MacKinnon C, Arsenault MY, Bartellas E, Cargill Y, Gleason T, Iglesias S, Klein M, Martel MJ, Roggensack A, Wilson K, Gardiner P, Graham T, Haennel R, Hughson R, MacDougall D, McDermott J, Ross R, Tiidus P, Trudeau F. Exercise in pregnancy and the postpartum period. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2003; 25:516-29. [PMID: 12806453 DOI: 10.1016/s1701-2163(16)30313-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To design Canadian guidelines advising obstetric care providers of the maternal, fetal, and neonatal implications of aerobic and strength-conditioning exercises in pregnancy. OUTCOMES Knowledge of the impact of exercise on maternal, fetal, and neonatal morbidity, and of the maternal measures of fitness. EVIDENCE MEDLINE search from 1966 to 2002 for English-language articles related to studies of maternal aerobic and strength conditioning in a previously sedentary population, maternal aerobic and strength conditioning in a previously active population, impact of aerobic and strength conditioning on early and late pregnancy outcomes, and impact of aerobic and strength conditioning on neonatal outcomes, as well as for review articles and meta-analyses related to exercise in pregnancy. VALUES The evidence collected was reviewed by the Society of Obstetricians and Gynaecologists of Canada (SOGC Clinical Practice Obstetrics Committee) with representation from the Canadian Society for Exercise Physiology, and quantified using the evaluation of evidence guidelines developed by the Canadian Task Force on the Periodic Health Exam. RECOMMENDATIONS 1. All women without contraindications should be encouraged to participate in aerobic and strength-conditioning exercises as part of a healthy lifestyle during their pregnancy. (II-1,2B) 2. Reasonable goals of aerobic conditioning in pregnancy should be to maintain a good fitness level throughout pregnancy without trying to reach peak fitness or train for an athletic competition. (II-1,2C) 3. Women should choose activities that will minimize the risk of loss of balance and fetal trauma. (III-C) 4. Women should be advised that adverse pregnancy or neonatal outcomes are not increased for exercising women. (II-1,2B) 5. Initiation of pelvic floor exercises in the immediate postpartum period may reduce the risk of future urinary incontinence. (II-1C) 6. Women should be advised that moderate exercise during lactation does not affect the quantity or composition of breast milk or impact infant growth. (I-A) VALIDATION: This guideline has been approved by the SOGC Clinical Practice Obstetrics Committee, the Executive and Council of SOGC, and the Board of Directors of the Canadian Society for Exercise Physiology. SPONSORS This guideline has been jointly sponsored by the Society of Obstetricians and Gynaecologists of Canada and the Canadian Society for Exercise Physiology.
Collapse
|
31
|
Affiliation(s)
- Vern L Katz
- Sacred Heart Medical Center, Eugene, Oregon, USA.
| |
Collapse
|
32
|
Clapp JF, Stepanchak W, Tomaselli J, Kortan M, Faneslow S. Portal vein blood flow-effects of pregnancy, gravity, and exercise. Am J Obstet Gynecol 2000; 183:167-72. [PMID: 10920326 DOI: 10.1067/mob.2000.105902] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to test the hypotheses that pregnancy increases portal vein blood flow and that regular exercise training during pregnancy limits the flow redistribution away from the splanchnic and uterine circulations in response to either gravitational or exercise-induced hemodynamic stress. STUDY DESIGN Portal vein blood flow, which probably reflects changes in uterine blood flow, was estimated with ultrasonography in 6 regularly exercising and 6 physically active control subjects before and during pregnancy after 15 minutes of rest in the left lateral recumbent position, after 5 minutes of standing rest, and immediately and 5 minutes after 20 minutes of treadmill exercise at 55% +/- 3% of maximal aerobic capacity. RESULTS Portal vein blood flow rose significantly during early and mid pregnancy at recumbent rest (from 660 +/- 110 to 1090 +/- 120 mL/min), standing rest (580 +/- 70 to 790 +/- 120 mL/min), immediately after exercise (160 +/- 30 to 360 +/- 60 mL/min), and at 5 minutes of recovery (520 +/- 60 to 760 +/- 110 mL/min). Before pregnancy, exercise training did not blunt the decremental effects of either gravity or exercise on portal vein blood flow. During mid and late pregnancy, exercise training had no effect on the fall in portal vein blood flow with gravitational stress, but it markedly reduced the decremental effects of exercise (average for the 2 time points, -510 +/- 80 vs -840 +/- 100 mL/min) and improved recovery at 5 minutes after exercise (940 +/- 140 vs 600 +/- 130 mL/min). CONCLUSIONS Portal vein blood flow rises significantly during pregnancy, and flow redistribution away from the splanchnic and uterine circulations in response to severe hemodynamic stress is reduced by exercise training in mid and late pregnancy.
Collapse
Affiliation(s)
- J F Clapp
- Department of Obstetrics and Gynecology and the Schwartz Center for Metabolism and Nutrition, MetroHealth Medical Center Campus of Case Western Reserve University, Cleveland, OH 44109, USA
| | | | | | | | | |
Collapse
|
33
|
Warren MP, Shantha S. The female athlete. BAILLIERE'S BEST PRACTICE & RESEARCH. CLINICAL ENDOCRINOLOGY & METABOLISM 2000; 14:37-53. [PMID: 10932809 DOI: 10.1053/beem.2000.0052] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Over the past 30 years, the number of women participating in organized sports has grown dramatically. Several forms of menstrual irregularities have been described in the female athlete: primary and secondary amenorrhoea, oligomenorrhoea, short luteal phases and anovulation. The incidence of menstrual irregularities is much higher in activities where a thin body is required for better performance. The hormonal pattern seen in these athletes is a hypothalamic amenorrhoea profile. There appears to be a decrease in gonadotrophin-releasing hormone (GnRH) pulses from the hypothalamus, which in turn decreases the pulsatile secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) and shuts down stimulation of ovary. Recently, another type of amenorrhoea has been described in swimmers which is characterized by mild hyperandrogenism. Athletes with low weight are at risk of developing the female athletic triad, which includes amenorrhoea, osteoporosis and disordered eating. Athletes with this triad are susceptible to stress fractures. Other issues include the pregnant athlete. Intensive exercise during pregnancy can cause bradycardia. Safe limits of aerobic exercise in pregnancy depend on previous exercise habits. Infertility, which may develop with exercise, is probably reversible with reduction of exercise or weight gain. High impact sports activities may produce urinary incontinence. Oestrogen replacement therapy is often prescribed in amenorrhoeic athletes, but bone loss may not be completely reversible.
Collapse
Affiliation(s)
- M P Warren
- Department of Obstetrics and Gynecology, Columbia Presbyterian Hospital, Columbia University, New York, NY 10032, USA
| | | |
Collapse
|
34
|
Clapp JF, Simonian S, Lopez B, Appleby-Wineberg S, Harcar-Sevcik R. The one-year morphometric and neurodevelopmental outcome of the offspring of women who continued to exercise regularly throughout pregnancy. Am J Obstet Gynecol 1998; 178:594-9. [PMID: 9539531 DOI: 10.1016/s0002-9378(98)70444-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Our purpose was to test the hypothesis that continuing regular exercise throughout pregnancy alters morphometric and neurodevelopmental outcome at 1 year. STUDY DESIGN The offspring of 52 women who exercised were compared with those of 52 control subjects who were similar in terms of multiple prenatal and postnatal variables known to influence outcome. All women were enrolled before pregnancy and had clinically normal antenatal and postnatal courses. Neurodevelopment was assessed by blinded examiners at 1 year of age, and morphometrics were obtained at birth and at 1 year of age. RESULTS At birth, the offspring of the exercising women weighed less (3.38 +/- 0.06 kg vs 3.58 +/- 0.07 kg) and had less body fat (9.5% +/- 0.8% vs 12.6% +/- 0.6%). However, at 1 year, all morphometric parameters were similar, and no clinically significant between-group differences were observed in performance on either the Bayley psychomotor (108 +/- 1 vs 101 +/- 2) or mental (120 +/- 1 vs 118 +/- 1) scales. CONCLUSIONS These data indicate that the offspring of exercising mothers have normal growth and development during the first year of life.
Collapse
Affiliation(s)
- J F Clapp
- Department of Reproductive Biology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio 44109, USA
| | | | | | | | | |
Collapse
|
35
|
Abstract
Women's participation in sporting activities is now diverse with new opportunities arising yearly. As a result, care of the the female athlete's unique medical concerns has become an important challenge and issue to the primary care physician. The major focus when caring for the female athlete should be the diagnosis and treatment of the female athlete triad. The components of the triad--disordered eating, amenorrhea, and osteoporosis--can have serious implications for the health of the female athlete. Appropriate prevention and screening methods for early diagnosis of the female athlete triad require future study and improvement. Healthy pregnant, postpartum, and breastfeeding women can continue to maintain physical activity. Musculoskeletal injuries from sports are, in general, not gender specific but are more often sport specific. One exception is the increased prevalence of anterior cruciate ligament injuries occurring in women soccer and basketball players. The exact cause of this is unknown but is continuing to be investigated.
Collapse
Affiliation(s)
- D L Wiggins
- Department of Obstetrics and Gynecology, Brown University School of Medicine, Providence, Rhode Island, USA
| | | |
Collapse
|
36
|
Clapp JF. Morphometric and neurodevelopmental outcome at age five years of the offspring of women who continued to exercise regularly throughout pregnancy. J Pediatr 1996; 129:856-63. [PMID: 8969727 DOI: 10.1016/s0022-3476(96)70029-x] [Citation(s) in RCA: 168] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To test the hypothesis that continuing regular, vigorous, sustained exercise throughout pregnancy adversely affects morphometric and neurodevelopmental outcome in offspring at 5 years of age. STUDY DESIGN The offspring of 20 women who exercised were compared with those of 20 physically active control subjects. The women and their offspring were matched for multiple prenatal and postnatal variables known to influence outcome. All women were enrolled before the index pregnancy, monitored throughout, and had clinically normal antenatal, intrapartum, and postnatal courses. Morphometric measures were obtained at birth and at 5 years of age by a single, trained observer. Neurodevelopment was assessed by developmental psychologists masked to maternal exercise status. Data were analyzed with an unpaired Student t test. RESULTS At birth, head circumference and length were similar, but the offspring of the exercising women weighed less (3.40 +/- 0.80 vs 3.64 +/- 0.70 kg) and had less fat (10.5% +/- 0.9% vs 15.1% +/- 0.6%). At 5 years of age, head circumference and height were similar, but the offspring of the women who exercised weighed less (18.0 +/- 0.5 vs 19.5 +/- 0.6 kg) and had a lower sum (sigma) of five site skinfolds (37 +/- 1 vs 44 +/- 2 mm). Motor, integrative, and academic readiness skills were similar. However, the exercise offspring performed significantly better on the Wechsler scales (125 +/- 2 vs 116 +/- 3) and tests of oral language skills (119 +/- 2 vs 109 +/- 3). CONCLUSIONS These data refute the hypothesis and suggest that exercise during pregnancy reduces the subcutaneous fat mass of the offspring.
Collapse
Affiliation(s)
- J F Clapp
- Department of Reproductive Biology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio 44109, USA
| |
Collapse
|
37
|
Abstract
Exercise in the water offers several physiological advantages to the pregnant woman. The hydrostatic force of water pushes extravascular fluid into the vascular spaces, producing an increase in central blood volume that may lead to increased uterine blood flow. This force is proportional to the depth of immersion. The increase in blood volume is proportional to the woman's edema. A marked diuresis and natriuresis accompanies the fluid shifts. The buoyancy of water supports the pregnant women. Water is thermoregulating. Studies of pregnant women exercising in the water have shown less fetal heart rate changes in the water than on land in response to exertion. Pregnant women's heart rates and blood pressures during water exercise are lower than on land exercise, reflecting the immersion-induced increase in circulating blood volume. The physiology of water exercise offers some compensation for the physiological changes of exercise on land that may beneficially affect pregnancy.
Collapse
Affiliation(s)
- V L Katz
- Department of Maternal-Fetal Medicine, Sacred Heart Medical Center, Eugene, OR 97401, USA
| |
Collapse
|
38
|
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.
Collapse
Affiliation(s)
- R W Hale
- American College of Obstetricians and Gynecologists, Washington, DC 20024-2188, USA
| | | |
Collapse
|
39
|
O'Neill ME. Maternal rectal temperature and fetal heart rate responses to upright cycling in late pregnancy. Br J Sports Med 1996; 30:32-5. [PMID: 8665115 PMCID: PMC1332262 DOI: 10.1136/bjsm.30.1.32] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To assess maternal rectal temperature and fetal heart rate responses to dynamic exercise. METHODS 11 healthy women with low risk pregnancies completed three separate upright cycling tests at 34 to 37 weeks gestation: 15 min at 62.5 W (mean maternal heart rate [MHR] 138 beats.min-1 (test A); 15 min at 87.5 W (MHR 156 beats.min-1) (test B); and 30 min at 62.5 W (MHR 142 beats.min-1) (test C). Rectal temperature and fetal heart rate were measured. RESULTS Mean temperature increase after tests B and C [by 0.4(SD 0.1) degrees C] was greater than after test A [0.2(0.1) degrees C] (P < 0.001). Fetal heart rate, measured in the recovery period immediately after exercise, increased significantly only after tests B and C (P < 0.01). Exercise related changes in temperature and fetal heart rate weakly correlated in tests B (P < 0.02) and C (P < 0.01). CONCLUSIONS Temperature and fetal heart rate changes were more marked after higher intensity (test B) or longer duration exercise (test C) compared with moderate exercise, but none of the tests caused adverse fetal heart rate changes (decrease in accelerations, bradycardia, or decelerations) or individual temperatures above 38 degrees C.
Collapse
|
40
|
Abstract
There is concern that the thermal, cardiovascular, metabolic, and biophysical changes which accompany physical activity may have detrimental effects on both mother and fetus. Research focused on physical activity in the workplace has identified four specific physical stresses (quiet standing, long hours, protracted ambulation, and heavy lifting) that are associated with an increased incidence of both prematurity and low birth weight. The physiological basis for these is believed to be that these activities cause intermittent but protracted reductions in uterine blood flow. Research focused on recreational physical activity during pregnancy has not identified similar associations. Indeed, these data indicate that the overall impact of regular recreational exercise on pregnancy outcome is positive for both mother and fetus. The physiological basis for these beneficial effects is believed to be that the interaction between the physiological adaptations to both exercise and pregnancy improve maternal cardiovascular reserve, maternal mechanisms for heat dissipation, and placental growth and functional capacity. Finally, there is preliminary evidence suggesting that the vibratory and auditory stimuli associated with regular recreational exercise may enhance functional maturation of the fetal brain.
Collapse
Affiliation(s)
- J F Clapp
- Department of Reproductive Biology, Case Western Reserve University, Cleveland, OH 44106, USA
| |
Collapse
|
41
|
Clapp JF, Little KD. The interaction between regular exercise and selected aspects of women's health. Am J Obstet Gynecol 1995; 173:2-9. [PMID: 7631681 DOI: 10.1016/0002-9378(95)90160-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The public health initiative to increase women's participation in regular recreational exercise to the 90% level raises multiple theoretic concerns about its impact on the reproductive health of women. However, at all points in a woman's life the overall effect of regular exercise to appetite appears to be beneficial rather than harmful, and in the absence of other stressors, exercise performance must significantly exceed usual recreational levels to have an adverse effect on any aspect of a woman's reproductive life. Therefore even in elite athletes abnormalities of any part of the reproductive process (puberty, menstrual cyclicity, pregnancy, lactation, and menopause) should not be attributed solely to exercise without complete evaluation. While generally beneficial, the interaction between exercise and skeletal integrity is influenced by hormonal status and multiple exercise variables. Thus, whereas regular exercise at all ages appears to provide both short- and long-term benefit, the characteristics of the exercise regimen need to vary at different time points.
Collapse
Affiliation(s)
- J F Clapp
- Department of Reproductive Biology, Case Western Reserve University, Cleveland, OH, USA
| | | |
Collapse
|
42
|
Sasaki J, Yamaguchi A, Nabeshima Y, Shigemitsu S, Mesaki N, Kubo T. Exercise at high temperature causes maternal hyperthermia and fetal anomalies in rats. TERATOLOGY 1995; 51:233-6. [PMID: 7570364 DOI: 10.1002/tera.1420510407] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Hyperthermia is thought to be a teratogen in many animal species and also in humans. It has been reported that hyperthermia caused by sauna, hot tub, or fever during the early stages of pregnancy is related to an increased risk for neural tube defects. During exercise, especially in hot conditions, body temperature can also rise to fairly high levels. Thus, we can surmise that hyperthermia induced by exercise can also cause fetal malformation. To investigate this hypothesis, pregnant rats at 9 days of gestation were divided into four groups. In the first group, the animals were made to swim for 30 minutes in water at a temperature of 40.5 degrees C. In the second group, they were restrained and immersed in water for the same time at the same temperature. In the third group, the rats were forced to swim in water at 36.0 degrees C. The fourth group were controls. The core temperature of the rats was measured during these procedures. On the 18th gestational day, fetuses were extracted by cesarean section. The elevation of maternal core temperature was significantly greater in the first group than in the other groups. In the first group, 69% of fetuses had various external anomalies. No anomalies were found in the other groups. Our results show that exercise in hot conditions caused the elevation of core temperature and resulted in fetal anomalies in rats.
Collapse
Affiliation(s)
- J Sasaki
- Department of Obstetrics and Gynecology, University of Tsukuba, Ibaraki, Japan
| | | | | | | | | | | |
Collapse
|
43
|
Fukai K, Holmes SA, Lucchese NJ, Siu VM, Weleber RG, Schnur RE, Spritz RA. Autosomal recessive ocular albinism associated with a functionally significant tyrosinase gene polymorphism. Nat Genet 1995; 9:92-5. [PMID: 7704033 DOI: 10.1038/ng0195-92] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Autosomal recessive ocular albinism (AROA) is a disorder characterized by reduced pigmentation of the retina and iris, hypoplastic fovea, variably reduced visual acuity and nystagmus. Pigmentation of the skin and hair is normal, but is usually slightly lighter than in unaffected sibs. We analysed 12 unrelated patients with AROA, and found that two had abnormalities of the tyrosinase (TYR) gene. These two patients were each a compound heterozygote for a different pathologic mutant allele and an allele containing a 'normal' polymorphism, Arg402Gln, which results in a tyrosinase polypeptide with reduced thermal stability. In these patients, AROA thus appears to represent a clinically mild form of OCA1, with a fixed visual deficit resulting from low tyrosinase activity during fetal development but with normal pigmentation of the skin and hair postnatally.
Collapse
Affiliation(s)
- K Fukai
- Department of Medical Genetics and Pediatrics, University of Wisconsin, Madison 53706
| | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
The effects of pregnancy on the maternal cardiorespiratory system include increases in oxygen consumption, cardiac output, heart rate, stroke volume, and plasma volume. The increase in oxygen reserve seen in early pregnancy is reduced later, suggesting that maternal exercise may present a greater physiologic stress in the third trimester. Evidence suggests that weight-bearing exercise produces a greater decrease in oxygen reserve than nonweight-bearing exercise. Furthermore, to maintain a heart rate below 140 beats per minute during pregnancy, the intensity of weight-bearing exercise must be reduced. Nonweight-bearing, water-based exercise results in smaller fetal heart rate changes and a lower maternal heart rate than the same exercise performed on land. Exercising in the supine position in late pregnancy has raised concerns because cardiac output in the supine position is lower than in the lateral position at rest, presumably because the gravid uterus partially obstructs the inferior vena cava. Sustained exercise produces a training effect on the mother, although reported associations between this effect and the experience of labor are not consistent. Short-term changes in fetal heart rate provide circumstantial evidence that physical activity can influence the fetus. Acute effects of exercise that can potentially affect the fetus include hyperthermia, changes in uteroplacental flow, reduced levels of maternal glucose, and increased uterine contractions. Moderate to high levels of sustained maternal exercise have been associated with reduced birthweight. Much research remains to be done on the effects of specific exercise regimens during pregnancy, the effects on previously sedentary women, and the long-term health consequences to the offspring of women who perform vigorous exercise during pregnancy.
Collapse
|
45
|
|
46
|
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.
Collapse
Affiliation(s)
- L A Wolfe
- School of Physical and Health Education, Queen's University, Kingston, Ontario
| | | |
Collapse
|
47
|
Clapp JF, Capeless EL, Little KD. The effect of sustained exercise on follicular phase levels of 17 beta-estradiol in recreational athletes. Am J Obstet Gynecol 1993; 168:581-4. [PMID: 8438932 DOI: 10.1016/0002-9378(93)90498-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Our purpose was to test the hypothesis that sustained exercise elevates circulating levels of 17 beta-estradiol in an intensity-dependent manner. STUDY DESIGN Blood samples were obtained in the follicular phase of the menstrual cycle from 75 female recreational athletes before and immediately after 20 minutes of aerobics or running at their usual exercise intensity. RESULTS The levels of 17 beta-estradiol rose after exercise 97% of the time. At exercise intensities between 50% and 88% of maximum capacity there was a direct linear relationship (r = 0.57) between exercise intensity and magnitude of increase in estradiol levels. A similar relationship was not present for cortisol. CONCLUSION Sustained exercise produces an intensity-dependent increase in the levels of 17 beta-estradiol that probably reflects decreased hepatic clearance caused by the fall in splanchnic blood flow. Thus the magnitude of the increase in the level of 17 beta-estradiol can be used as a rough index of the exercise-induced decrease in splanchnic blood flow.
Collapse
Affiliation(s)
- J F Clapp
- Department of Reproductive Biology, Case Western Reserve University, Cleveland, OH
| | | | | |
Collapse
|
48
|
Clapp JF, Little KD, Capeless EL. Fetal heart rate response to sustained recreational exercise. Am J Obstet Gynecol 1993; 168:198-206. [PMID: 8420327 DOI: 10.1016/s0002-9378(12)90914-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE We aimed to test the hypotheses that fetal heart rate increases during and after sustained exercise and that the magnitude of the increases is related to gestational age and the duration, intensity, and type of exercise. STUDY DESIGN Maternal oxygen uptake and fetal heart rate were monitored in 120 regularly exercising women in association with routine 20-minute workouts between 16 and 39 weeks' gestation. RESULTS In 97% of the studies fetal heart rate increased during and after exercise. This was significant at all gestational ages and with all forms of exercise with an overall increase of 15 +/- 11 beats.min-1 at 60% +/- 12% of maximal aerobic capacity (mean +/- SD). The magnitude increased with gestational age (10 +/- 8 to 20 +/- 11 beats.min-1), exercise intensity (8 +/- 7 to 21 +/- 13 beats.min-1), and exercise duration (8 +/- 4 to 16 +/- 7 beats.min-1). CONCLUSION We concluded that the hypothesis is correct and speculate that these changes represent a maturing fetal response to a reduction in Po2.
Collapse
Affiliation(s)
- J F Clapp
- Department of Reproductive Biology, MetroHealth Medical Center, Cleveland, OH 44109-1998
| | | | | |
Collapse
|