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Jaques LA, Stermer PRR, de Oliveira AKB, Marães VRFDS, Jácomo RH, Alves AT, Cunha KDC, da Silva ML. Autonomic modulation of heart rate during physical activity in pregnant women: A systematic review of literature. Pacing Clin Electrophysiol 2024; 47:802-814. [PMID: 38577940 DOI: 10.1111/pace.14976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/05/2024] [Accepted: 03/16/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND There are important physiological changes in the heart rate autonomic modulation in pregnant women and these changes may affect the way their bodies respond to exercise stimulus. The objective of this review is to verify the physical exercise influence on autonomic modulation of heart rate in pregnant women. METHODS This study is a Systematic Review. The electronic databases used to search for the studies were Cochrane Library, MEDLINE via PUBMED, Regional Health Portal and EMBASE. Experimental studies that evaluated heart-rate variability in pregnant women practicing physical exercises were included. And articles that addressed only fetal heart-rate variability, case reports, congress abstracts, clinical trial protocols without results, preprints, and gray literature were excluded. There were no language or publication year restrictions. The descriptors used in the Search were Cardiac Chronotropism, Sympathetic Nervous System, Pregnancy, and Physical Exercise. For statistical analysis, the fixed effect model was used. RESULTS A total of 3106 articles were found, and 12 studies were included, which 5 were nonrandomized clinical trials, 4 were randomized clinical trials, and 3 were cross-sectional studies. Three hundred and four pregnant women were included in the studies. The application of physical exercise was varied, but in general they used aerobic exercises and with increased variability of the heart rate and reflex on the autonomic modulation of heart rate. CONCLUSION Most studies demonstrate benefits heart rate in pregnant women, but limited research makes it hard to compare specific types of exercise and larger studies are needed to identify the best exercise.
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Affiliation(s)
- Lucas Alves Jaques
- Center of Biological and Health Sciences, State University of Pará, Marabá, Pará State, Brazil
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2
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Carmichael RD. Considerations for the Pregnant Endurance Athlete. Strength Cond J 2021. [DOI: 10.1519/ssc.0000000000000655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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3
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Campos MDSB, Buglia S, Colombo CSSDS, Buchler RDD, Brito ASXD, Mizzaci CC, Feitosa RHF, Leite DB, Hossri CAC, Albuquerque LCAD, Freitas OGAD, Grossman GB, Mastrocola LE. Position Statement on Exercise During Pregnancy and the Post-Partum Period - 2021. Arq Bras Cardiol 2021; 117:160-180. [PMID: 34320089 PMCID: PMC8294738 DOI: 10.36660/abc.20210408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Susimeire Buglia
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil.,Hospital do Coração (HCOR), São Paulo, SP - Brasil
| | | | - Rica Dodo Delmar Buchler
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil.,Ergometria DASA, São Paulo, SP - Brasil
| | | | | | | | - Danielle Batista Leite
- Real Hospital Português, Recife, PE - Brasil.,Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE - Brasil
| | | | | | | | - Gabriel Blacher Grossman
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil.,Clínica Cardionuclear, Porto Alegre, RS - Brasil
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Kim JW, Seok HS, Shin H. Is Ultra-Short-Term Heart Rate Variability Valid in Non-static Conditions? Front Physiol 2021; 12:596060. [PMID: 33859568 PMCID: PMC8042416 DOI: 10.3389/fphys.2021.596060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/10/2021] [Indexed: 11/20/2022] Open
Abstract
In mobile healthcare, heart rate variability (HRV) is increasingly being used in dynamic patient states. In this situation, shortening of the measurement time is required. This study aimed to validate ultra-short-term HRV in non-static conditions. We conducted electrocardiogram (ECG) measurements at rest, during exercise, and in the post-exercise recovery period in 30 subjects and analyzed ultra-short-term HRV in time and frequency domains by ECG in 10, 30, 60, 120, 180, and 240-s intervals, and compared the values to the 5-min HRV. For statistical analysis, null hypothesis testing, Cohen’s d statistics, Pearson’s correlation coefficient, and Bland-Altman analysis were used, with a statistical significance level of P < 0.05. The feasibility of ultra-short-term HRV and the minimum time required for analysis showed differences in each condition and for each analysis method. If the strict criteria satisfying all the statistical methods were followed, the ultra-short-term HRV could be derived from a from 30 to 240-s length of ECG. However, at least 120 s was required in the post-exercise recovery or exercise conditions, and even ultra-short-term HRV was not measurable in some variables. In contrast, according to the lenient criteria needed to satisfy only one of the statistical criteria, the minimum time required for ultra-short-term HRV analysis was 10–60 s in the resting condition, 10–180 s in the exercise condition, and 10–120 s in the post-exercise recovery condition. In conclusion, the results of this study showed that a longer measurement time was required for ultra-short-term HRV analysis in dynamic conditions. This suggests that the existing ultra-short-term HRV research results derived from the static condition cannot applied to the non-static conditions of daily life and that a criterion specific to the non-static conditions are necessary.
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Affiliation(s)
- Jin Woong Kim
- Department of Biomedical Engineering, Chonnam National University, Yeosu-si, South Korea
| | - Hyeon Seok Seok
- Department of Biomedical Engineering, Chonnam National University, Yeosu-si, South Korea
| | - Hangsik Shin
- Department of Biomedical Engineering, Chonnam National University, Yeosu-si, South Korea
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Dobson KL, da Silva DF, Dervis S, Mohammad S, Nagpal TS, Adamo KB. Physical activity and gestational weight gain predict physiological and perceptual responses to exercise during pregnancy. Birth Defects Res 2020; 113:276-286. [PMID: 32969175 DOI: 10.1002/bdr2.1808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/25/2020] [Accepted: 09/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Exercise is known to improve the health of the pregnant woman and her child. Studies that have evaluated physiological parameters during prenatal exercise have conflicting results. Better understanding of these physiological responses can modify exercise prescriptions, safety, and monitoring strategies. We examined the association between age, prepregnancy body mass index (BMI), gestational weight gain (GWG), and physical activity (PA) levels, factors that may influence a change in physiological (HR, VO2 responses) and perceptual (RPE) responses to acute exercise throughout pregnancy. METHODS Twenty-two healthy pregnant women (31.4 ± 3.7 years) performed a Submaximal incremental Walking Exercise Test (SWET). Early- (13-18 weeks), mid- (24-28 weeks), and late-pregnancy (34-37 weeks) were compared. VO2 (L/min; ml/kg/min), HR (bpm), and RPE were collected at the end of each test stage. PA was determined by accelerometry. We associated PA levels, GWG, prepregnancy BMI, and age with HR, RPE, and VO2 responses. RESULTS HR, RPE, and absolute VO2 were higher in late-pregnancy compared to earlier time points (p < .05; η2 = 0.299-0.525). Regression models were built for HR (all time points), RPE (early- and late-pregnancy), and VO2 (L/min; late-pregnancy). HR (late-pregnancy) was predicted by time in vigorous PA, GWG, age, and prepregnancy BMI (r2 = 0.645; SEE = 5.84). RPE (late-pregnancy) was predicted by sedentary time, GWG, prepregnancy BMI, and age (r2 = 0.662; SEE = 1.21). CONCLUSION Physiological/perceptual responses were higher in late-pregnancy compared to other time points and associated with combined PA, GWG, prepregnancy BMI, and age. These findings can be used to modify exercise prescriptions and designs for future PA interventions in pregnant women.
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Affiliation(s)
- Kayla L Dobson
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Danilo F da Silva
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Sheila Dervis
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Shuhiba Mohammad
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Taniya S Nagpal
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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6
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Guerra DD, Hurt KJ. Gasotransmitters in pregnancy: from conception to uterine involution. Biol Reprod 2020; 101:4-25. [PMID: 30848786 DOI: 10.1093/biolre/ioz038] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/14/2019] [Accepted: 03/06/2019] [Indexed: 12/13/2022] Open
Abstract
Gasotransmitters are endogenous small gaseous messengers exemplified by nitric oxide (NO), carbon monoxide (CO), and hydrogen sulfide (H2S or sulfide). Gasotransmitters are implicated in myriad physiologic functions including many aspects of reproduction. Our objective was to comprehensively review basic mechanisms and functions of gasotransmitters during pregnancy from conception to uterine involution and highlight future research opportunities. We searched PubMed and Web of Science databases using combinations of keywords nitric oxide, carbon monoxide, sulfide, placenta, uterus, labor, and pregnancy. We included English language publications on human and animal studies from any date through August 2018 and retained basic and translational articles with relevant original findings. All gasotransmitters activate cGMP signaling. NO and sulfide also covalently modify target protein cysteines. Protein kinases and ion channels transduce gasotransmitter signals, and co-expressed gasotransmitters can be synergistic or antagonistic depending on cell type. Gasotransmitters influence tubal transit, placentation, cervical remodeling, and myometrial contractility. NO, CO, and sulfide dilate resistance vessels, suppress inflammation, and relax myometrium to promote uterine quiescence and normal placentation. Cervical remodeling and rupture of fetal membranes coincide with enhanced oxidation and altered gasotransmitter metabolism. Mechanisms mediating cellular and organismal changes in pregnancy due to gasotransmitters are largely unknown. Altered gasotransmitter signaling has been reported for preeclampsia, intrauterine growth restriction, premature rupture of membranes, and preterm labor. However, in most cases specific molecular changes are not yet characterized. Nonclassical signaling pathways and the crosstalk among gasotransmitters are emerging investigation topics.
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Affiliation(s)
- Damian D Guerra
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA
| | - K Joseph Hurt
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA.,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA
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Tsakiridis I, Bakaloudi DR, Oikonomidou AC, Dagklis T, Chourdakis M. Exercise during pregnancy: a comparative review of guidelines. J Perinat Med 2020; 48:519-525. [PMID: 32619194 DOI: 10.1515/jpm-2019-0419] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/27/2020] [Indexed: 11/15/2022]
Abstract
Exercise during pregnancy may be beneficial provided that there are no contraindications. The aim of this study was to summarize and compare recommendations regarding exercise in pregnancy. Thus, a comparative descriptive review was conducted and included guidelines by the American College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynaecologists of Canada and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. All compared guidelines recommend that pregnant women without contraindications should undertake physical activities regularly, however, the type of workout performed should be adjusted based on the previous exercise experience and the physical condition of each pregnant woman. A variation among the reviewed guidelines was identified on appropriate and inappropriate activities and on indications to interrupt exercise. To summarize, the adoption of an international up-to-date consensus regarding appropriate exercise during pregnancy may be beneficial in ensuring the safety of the pregnant women while promoting their physical and mental health.
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Affiliation(s)
- Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, Department of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitra Rafailia Bakaloudi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Facutly of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Artemis Christina Oikonomidou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Facutly of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynaecology, Department of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Facutly of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Russo LM, Whitcomb BW, Freeman JR, Mumford SL, Sjaarda LA, Perkins NJ, Schliep KC, Grewal J, Silver RM, Schisterman EF. Physical activity and incidence of subclinical and clinical pregnancy loss: a secondary analysis in the effects of aspirin in gestation and reproduction randomized trial. Fertil Steril 2020; 113:601-608.e1. [PMID: 32192592 PMCID: PMC7994027 DOI: 10.1016/j.fertnstert.2019.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/04/2019] [Accepted: 10/13/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the association between physical activity and risk of subclinical and clinical pregnancy loss among women with a history of pregnancy loss. DESIGN Prospective cohort study as a secondary analysis of the Effects of Aspirin in Gestation and Reproduction randomized controlled trial of preconception-initiated low-dose aspirin among women with one or two prior pregnancy losses. SETTING Four U.S. clinical centers, 2007-2011. PATIENT(S) Women with confirmed pregnancy (n = 785) as determined from hCG testing in longitudinally collected biospecimens. MAIN OUTCOME MEASURE(S) Subclinical loss of pregnancy detected only by hCG testing and clinically recognized loss. RESULT(S) Among 785 women (mean [SD] age, 28.7 [4.6] years) with an hCG-confirmed pregnancy, 188 (23.9%) experienced pregnancy loss. In multivariable models adjusted for confounders, compared with the first tertile of physical activity (median = 7.7 metabolic equivalent of task hours/week), there was a roughly twofold higher risk of subclinical loss in the second (risk ratio = 2.06; 95% confidence interval, 1.03-4.14) and third tertiles (risk ratio = 1.92; 95% confidence interval, 0.94-3.90), with median metabolic equivalent of task hours/week of 27.8 and 95.7, respectively. No relations were observed between physical activity and clinically recognized loss. CONCLUSION(S) Risk related to physical activity is different for pregnancy failure close to the time of implantation compared with that for later, clinical pregnancy loss. Higher physical activity levels were associated with an elevated risk of subclinical loss (i.e., pregnancies detected only by hCG, n = 55); however, no relationship was observed with clinically recognized loss. Further work is required to confirm these findings, assess generalizability to women without prior losses, and evaluate mechanisms. ETHICAL APPROVAL Each participating center's Institutional Review Board approved the study, and participants provided written informed consent. The trial was registered on ClinicalTrials.gov (NCT00467363), and a Data Safety and Monitoring Board provided oversight.
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Affiliation(s)
- Lindsey M Russo
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts.
| | - Joshua R Freeman
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts; Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Sunni L Mumford
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Lindsey A Sjaarda
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Neil J Perkins
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Karen C Schliep
- Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah
| | - Jagteshwar Grewal
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Enrique F Schisterman
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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Brooks VL, Fu Q, Shi Z, Heesch CM. Adaptations in autonomic nervous system regulation in normal and hypertensive pregnancy. HANDBOOK OF CLINICAL NEUROLOGY 2020; 171:57-84. [PMID: 32736759 DOI: 10.1016/b978-0-444-64239-4.00003-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
There is an increase in basal sympathetic nerve activity (SNA) during normal pregnancy; this counteracts profound primary vasodilation. However, pregnancy also impairs baroreflex control of heart rate and SNA, contributing to increased mortality secondary to peripartum hemorrhage. Pregnancy-induced hypertensive disorders evoke even greater elevations in SNA, which likely contribute to the hypertension. Information concerning mechanisms is limited. In normal pregnancy, increased angiotensin II acts centrally to support elevated SNA. Hypothalamic sites, including the subfornical organ, paraventricular nucleus, and arcuate nucleus, are likely (but unproven) targets. Moreover, no definitive mechanisms for exaggerated sympathoexcitation in hypertensive pregnancy have been identified. In addition, normal pregnancy increases gamma aminobutyric acid inhibition of the rostral ventrolateral medulla (RVLM), a key brainstem site that transmits excitatory inputs to spinal sympathetic preganglionic neurons. Accumulated evidence supports a major role for locally increased production and actions of the neurosteroid allopregnanolone as one mechanism. A consequence is suppression of baroreflex function, but increased basal SNA indicates that excitatory influences predominate in the RVLM. However, many questions remain regarding other sites and factors that support increased SNA during normal pregnancy and, more importantly, the mechanisms underlying excessive sympathoexcitation in life-threatening hypertensive pregnancy disorders such as preeclampsia.
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Affiliation(s)
- Virginia L Brooks
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, OR, United States.
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, United States; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Zhigang Shi
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, OR, United States
| | - Cheryl M Heesch
- Department of Biomedical Sciences and Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, United States
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Purdy GM, James MA, Wakefield PK, Skow RJ, Van Diepen S, May LE, Davenport MH, Steinback CD. Maternal cardioautonomic responses during and following exercise throughout pregnancy. Appl Physiol Nutr Metab 2018; 44:263-270. [PMID: 30138571 DOI: 10.1139/apnm-2018-0397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Blood pressure regulation during pregnancy is poorly understood. Cardiovagal baroreflex gain (BRG) is an important contributor to blood pressure regulation through its influence on heart rate. Heart rate fluctuations occur in response to various physiological stimuli and can be measured using heart rate variability (HRV). It is unclear how these mechanisms operate during pregnancy, particularly with regard to exercise. We examined BRG and HRV prior to, during, and following prenatal exercise. Forty-three pregnant (n = 10 first trimester (TM1), n = 17 second trimester (TM2), n = 16 third trimester (TM3)) and 20 nonpregnant (NP) women underwent an incremental peak exercise test. Beat-by-beat blood pressure (photoplethysmography) and heart rate (lead II electrocardiogram) were measured throughout. BRG (the slope of the relationship between fluctuations in systolic blood pressure and the R-R interval) and HRV (root mean square of the successive differences; RMSSD) were assessed at rest, during steady-state exercise (EX), and during active recovery. BRG decreased with gestation and was lower in the TM3 group than in the NP group (17.9 ± 6.9 ms/mm Hg vs 24.8 ± 7.4 ms/mm Hg, p = 0.017). BRG was reduced during EX in all groups. Resting HRV (RMSSD) also decreased with gestation and was lower in the TM3 group than in the NP group (29 ± 17 ms vs 48 ± 20 ms, p < 0.001). RMSSD was blunted during EX in all groups compared with rest. During active recovery, RMSSD was further blunted compared with EX in the NP group but not during pregnancy (TM1, TM2, and TM3). Compared with the nonpregnant controls, the pregnant women had lower BRG and HRV at rest, but comparable cardioautonomic control during both exercise and active recovery following peak exercise.
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Affiliation(s)
- Graeme M Purdy
- a Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.,b Women and Children's Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Marina A James
- a Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.,b Women and Children's Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Paige K Wakefield
- a Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.,b Women and Children's Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada.,c Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Rachel J Skow
- a Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.,b Women and Children's Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada.,c Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Sean Van Diepen
- d Faculty of Medicine and Dentistry, Department of Critical Care and Division of Cardiology, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - Linda E May
- e Division of Foundational Sciences and Research, East Carolina University, Greenville, NC 27858, USA
| | - Margie H Davenport
- a Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.,b Women and Children's Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada.,c Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Craig D Steinback
- a Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.,b Women and Children's Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada.,c Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
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11
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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.
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12
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Michael S, Jay O, Graham KS, Davis GM. Influence of exercise modality on cardiac parasympathetic and sympathetic indices during post-exercise recovery. J Sci Med Sport 2018; 21:1079-1084. [PMID: 29449080 DOI: 10.1016/j.jsams.2018.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 01/23/2018] [Accepted: 01/26/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study investigated indirect measures of post-exercise parasympathetic reactivation (using heart-rate-variability, HRV) and sympathetic withdrawal (using systolic-time-intervals, STI) following upper- and lower-body exercise. DESIGN Randomized, counter-balanced, crossover. METHODS 13 males (age 26.4±4.7years) performed maximal arm-cranking (MAX-ARM) and leg-cycling (MAX-LEG). Subsequently, participants undertook separate 8-min bouts of submaximal HR-matched exercise of each mode (ARM and LEG). HRV (including natural-logarithm of root-mean-square-of-successive-differences, Ln-RMSSD) and STI (including pre-ejection-period, PEP) were assessed throughout 10-min seated recovery. RESULTS Peak-HR was higher (p=0.001) during MAX-LEG (182±7beatsmin-1) compared with MAX-ARM (171±12beatsmin-1), while HR (p<0.001) and Ln-RMSSD (p=0.010) recovered more rapidly following MAX-ARM. PEP recovery was similar between maximal bouts (p=0.106). HR during submaximal exercise was 146±7 (LEG) and 144±8beatsmin-1 (LEG) (p=0.139). Recovery of HR and Ln-RMSSD was also similar between submaximal modalities, remaining below baseline throughout recovery (p<0.001). PEP was similar during submaximal exercise (LEG 70±6ms; ARM 72±9ms; p=0.471) although recovery was slower following ARM (p=0.021), with differences apparent from 1- to 10-min recovery (p≤0.036). By 10-min post-exercise, PEP recovered to baseline (132±21ms) following LEG (130±21ms; p=0.143), but not ARM (121±17ms; p=0.001). CONCLUSIONS Compared with submaximal lower-body exercise, HR-matched upper-body exercise elicited a similar recovery of HR and HRV indices of parasympathetic reactivation, but delayed recovery of PEP (reflecting sympathetic withdrawal). Exercise modality appears to influence post-exercise parasympathetic reactivation and sympathetic withdrawal in an intensity-dependent manner. These results highlight the need for test standardization and may be relevant to multi-discipline athletes and in clinical applications with varying modes of exercise testing.
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Affiliation(s)
- Scott Michael
- Discipline of Exercise & Sports Science, Faculty of Health Sciences, University of Sydney, Australia.
| | - Ollie Jay
- Discipline of Exercise & Sports Science, Faculty of Health Sciences, University of Sydney, Australia
| | - Kenneth S Graham
- Discipline of Exercise & Sports Science, Faculty of Health Sciences, University of Sydney, Australia; New South Wales Institute of Sport, Australia
| | - Glen M Davis
- Discipline of Exercise & Sports Science, Faculty of Health Sciences, University of Sydney, Australia
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13
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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]
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14
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Garnæs KK, Mørkved S, Salvesen KÅ, Salvesen Ø, Moholdt T. Exercise training during pregnancy reduces circulating insulin levels in overweight/obese women postpartum: secondary analysis of a randomised controlled trial (the ETIP trial). BMC Pregnancy Childbirth 2018; 18:18. [PMID: 29310617 PMCID: PMC5759335 DOI: 10.1186/s12884-017-1653-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 12/29/2017] [Indexed: 11/17/2022] Open
Abstract
Background The primary aim was to investigate if supervised exercise training during pregnancy could reduce postpartum weight retention (PPWR) three months after delivery in overweight and obese women. We also measured circulating markers of cardiometabolic health, body composition, blood pressure, and physical activity level. Methods This was a secondary analysis of a randomised controlled trial in which 91 women with BMI ≥ 28 kg/m2 were allocated 1:1 to an exercise program or a control group. Women in the exercise group were prescribed three weekly, supervised sessions of 35 min of moderate intensity walking/running followed by 25 min of resistance training. The control group received standard maternal care. Assessments were undertaken in early pregnancy, late pregnancy, and three months postpartum. PPWR was defined as postpartum body weight minus early pregnancy weight. Results Seventy women participated three months after delivery, and PPWR was −0.8 kg in the exercise group (n = 36) and −1.6 in the control group (n = 34) (95% CI, −1.83, 3.84, p = 0.54). Women in the exercise group had significantly lower circulating insulin concentration; 106.3 pmol/l compared to the control group; 141.4 pmol/l (95% CI, −62.78, −7.15, p = 0.01), and showed a tendency towards lower homeostatic measurement of insulin resistance (HOMA2-IR) (3.5 vs. 5.0, 95% CI, −2.89, 0.01, p = 0.05). No women in the exercise group compared to three women in the control group were diagnosed with type 2 diabetes postpartum (p = 0.19). Of the women in the exercise group, 46.4% reported of exercising regularly, compared to 25.0% in the control group (p = 0.16). Conclusions Offering supervised exercise training during pregnancy among overweight/obese women did not affect PPWR three months after delivery, but reduced circulating insulin levels. This was probably due to a higher proportion of women being active postpartum in the exercise group. Trial registration ClinicalTrials.gov (NCT01243554), registration date: September 6, 2010. Electronic supplementary material The online version of this article (10.1186/s12884-017-1653-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kirsti K Garnæs
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Box 8905, 7491, Trondheim, Norway
| | - Siv Mørkved
- Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Research Department, St. Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Kjell Å Salvesen
- Institute of clinical and molecular medicine, Norwegian University of Science and Tecnology, Trondheim, Norway.,Department of Obstetrics and Gynaecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Box 8905, 7491, Trondheim, Norway. .,Department of Obstetrics and Gynaecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
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15
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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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16
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Michael S, Graham KS, Davis GM. Cardiac Autonomic Responses during Exercise and Post-exercise Recovery Using Heart Rate Variability and Systolic Time Intervals-A Review. Front Physiol 2017; 8:301. [PMID: 28611675 PMCID: PMC5447093 DOI: 10.3389/fphys.2017.00301] [Citation(s) in RCA: 304] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/25/2017] [Indexed: 12/19/2022] Open
Abstract
Cardiac parasympathetic activity may be non-invasively investigated using heart rate variability (HRV), although HRV is not widely accepted to reflect sympathetic activity. Instead, cardiac sympathetic activity may be investigated using systolic time intervals (STI), such as the pre-ejection period. Although these autonomic indices are typically measured during rest, the “reactivity hypothesis” suggests that investigating responses to a stressor (e.g., exercise) may be a valuable monitoring approach in clinical and high-performance settings. However, when interpreting these indices it is important to consider how the exercise dose itself (i.e., intensity, duration, and modality) may influence the response. Therefore, the purpose of this investigation was to review the literature regarding how the exercise dosage influences these autonomic indices during exercise and acute post-exercise recovery. There are substantial methodological variations throughout the literature regarding HRV responses to exercise, in terms of exercise protocols and HRV analysis techniques. Exercise intensity is the primary factor influencing HRV, with a greater intensity eliciting a lower HRV during exercise up to moderate-high intensity, with minimal change observed as intensity is increased further. Post-exercise, a greater preceding intensity is associated with a slower HRV recovery, although the dose-response remains unclear. A longer exercise duration has been reported to elicit a lower HRV only during low-moderate intensity and when accompanied by cardiovascular drift, while a small number of studies have reported conflicting results regarding whether a longer duration delays HRV recovery. “Modality” has been defined multiple ways, with limited evidence suggesting exercise of a greater muscle mass and/or energy expenditure may delay HRV recovery. STI responses during exercise and recovery have seldom been reported, although limited data suggests that intensity is a key determining factor. Concurrent monitoring of HRV and STI may be a valuable non-invasive approach to investigate autonomic stress reactivity; however, this integrative approach has not yet been applied with regards to exercise stressors.
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Affiliation(s)
- Scott Michael
- Discipline of Exercise and Sports Science, Faculty of Health Sciences, University of SydneySydney, NSW, Australia
| | - Kenneth S Graham
- Discipline of Exercise and Sports Science, Faculty of Health Sciences, University of SydneySydney, NSW, Australia.,New South Wales Institute of SportSydney, NSW, Australia
| | - Glen M Davis
- Discipline of Exercise and Sports Science, Faculty of Health Sciences, University of SydneySydney, NSW, Australia
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17
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Bianchi C, Battini L, Aragona M, Lencioni C, Ottanelli S, Romano M, Calabrese M, Cuccuru I, De Bellis A, Mori ML, Leopardi A, Sabbatini G, Bottone P, Miccoli R, Trojano G, Salerno MG, Del Prato S, Bertolotto A. Prescribing exercise for prevention and treatment of gestational diabetes: review of suggested recommendations. Gynecol Endocrinol 2017; 33:254-260. [PMID: 28084847 DOI: 10.1080/09513590.2016.1266474] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Exercise has been proved to be safe during pregnancy and to offer benefits for both mother and fetus; moreover, physical activity may represent a useful tool for gestational diabetes prevention and treatment. Therefore, all women in uncomplicated pregnancy should be encouraged to engage in physical activity as part of a healthy lifestyle. However, exercise in pregnancy needs a careful medical evaluation to exclude medical or obstetric contraindications to exercise, and an appropriate prescription considering frequency, intensity, type and duration of exercise, to carefully balance between potential benefits and potential harmful effects. Moreover, some precautions related to anatomical and functional adaptations observed during pregnancy should be taken into consideration. This review summarized the suggested recommendations for physical activity among pregnant women with focus on gestational diabetes.
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Affiliation(s)
- Cristina Bianchi
- a U.O. Malattie Metaboliche e Diabetologia, Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
| | - Lorella Battini
- b U.O. Ginecologia ed Ostetricia, Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
| | - Michele Aragona
- a U.O. Malattie Metaboliche e Diabetologia, Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
| | - Cristina Lencioni
- c U.O.C. Diabetologia e Malattie Metaboliche, Ospedale di Livorno , Livorno , Italy
| | - Serena Ottanelli
- d U.O. Ostetricia e Ginecologia, Ospedale di Arezzo , Pisa , Italy
| | - Matilde Romano
- b U.O. Ginecologia ed Ostetricia, Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
| | | | - Ilaria Cuccuru
- f U.O.S. Diabetologia, Ospedale di Lucca , Lucca , Italy
| | | | - Mary Liana Mori
- h U.O.S. Diabetologia, Ospedale di Carrara , Carrara , Italy
| | - Anna Leopardi
- i U.O.S. Diabetologia e Malattie Metaboliche, Nuovo Ospedale San Giovanni di Dio , Firenze , Italy
| | | | - Pietro Bottone
- b U.O. Ginecologia ed Ostetricia, Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
| | - Roberto Miccoli
- k Dipartimento di Medicina Clinica e Sperimentale , Università di Pisa , Pisa , Italy
| | - Giuseppe Trojano
- b U.O. Ginecologia ed Ostetricia, Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
| | - Maria Giovanna Salerno
- b U.O. Ginecologia ed Ostetricia, Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
| | - Stefano Del Prato
- k Dipartimento di Medicina Clinica e Sperimentale , Università di Pisa , Pisa , Italy
| | - Alessandra Bertolotto
- a U.O. Malattie Metaboliche e Diabetologia, Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
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18
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Dietz P, Watson ED, Sattler MC, Ruf W, Titze S, van Poppel M. The influence of physical activity during pregnancy on maternal, fetal or infant heart rate variability: a systematic review. BMC Pregnancy Childbirth 2016; 16:326. [PMID: 27784276 PMCID: PMC5081933 DOI: 10.1186/s12884-016-1121-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 10/21/2016] [Indexed: 12/03/2022] Open
Abstract
Background Physical activity (PA) during pregnancy has been shown to be associated with several positive effects for mother, fetus, and offspring. Heart rate variability (HRV) is a noninvasive and surrogate marker to determine fetal overall health and the development of fetal autonomic nervous system. In addition, it has been shown to be significantly influenced by maternal behavior. However, the influence of maternal PA on HRV has not yet been systematically reviewed. Therefore, the aim of this systematic review was to assess the influence of regular maternal PA on maternal, fetal or infant HRV. Methods A systematic literature search following a priori formulated criteria of studies that examined the influence of regular maternal PA (assessed for a minimum period of 6 weeks) on maternal, fetal or infant HRV was performed in the databases Pubmed and SPORTDiscus. Quality of each study was assessed using the standardized Quality Assessment Tool for Quantitative Studies (QATQS). Results Nine articles were included into the present systematic review: two intervention studies, one prospective longitudinal study, and six post-hoc analysis of subsets of the longitudinal study. Of these articles four referred to maternal HRV, five to fetal HRV, and one to infant HRV. The overall global rating for the standardized quality assessment of the articles was moderate to weak. The articles regarding the influence of maternal PA on maternal HRV indicated contrary results. Five of five articles regarding the influence of maternal PA on fetal HRV showed increases of fetal HRV on most parameters depending on maternal PA. The article referring to infant HRV (measured one month postnatal) showed an increased HRV. Conclusions Based on the current evidence available, our overall conclusion is that the hypothesis that maternal PA influences maternal HRV cannot be supported, but there is a trend that maternal PA might increase fetal and infant HRV (clinical conclusion). Therefore, we recommend that further, high quality studies addressing the influence of maternal PA on HRV should be performed (methodological conclusion).
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Affiliation(s)
- Pavel Dietz
- Department of Physical Activity and Public Health, Institute of Sports Science, University of Graz, Mozartgasse 14, Graz, 8010, Austria.
| | - Estelle D Watson
- Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of Witwatersrand, Private Bag 3, Johannesburg, 2050, South Africa
| | - Matteo C Sattler
- Department of Physical Activity and Public Health, Institute of Sports Science, University of Graz, Mozartgasse 14, Graz, 8010, Austria
| | - Wolfgang Ruf
- Department of Physical Activity and Public Health, Institute of Sports Science, University of Graz, Mozartgasse 14, Graz, 8010, Austria
| | - Sylvia Titze
- Department of Physical Activity and Public Health, Institute of Sports Science, University of Graz, Mozartgasse 14, Graz, 8010, Austria
| | - Mireille van Poppel
- Department of Physical Activity and Public Health, Institute of Sports Science, University of Graz, Mozartgasse 14, Graz, 8010, Austria.,Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands
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19
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Nakagaki A, Inami T, Minoura T, Baba R, Iwase S, Sato M. Differences in autonomic neural activity during exercise between the second and third trimesters of pregnancy. J Obstet Gynaecol Res 2016; 42:951-9. [PMID: 27121772 DOI: 10.1111/jog.12990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 02/01/2016] [Accepted: 02/14/2016] [Indexed: 11/29/2022]
Abstract
AIM To test the hypothesis that autonomic neural activity in pregnant women during exercise varies according to gestational age. METHODS This cross-sectional study involved 20 healthy women in their second (n = 13) or third (n = 7) trimester of pregnancy. Incremental cardiopulmonary exercise testing was performed with an electromagnetic cycle ergometer. Heart rate variability was analyzed by frequency analysis software. RESULTS The low-frequency to high-frequency (LF/HF) ratio, an indicator of the sympathetic nervous system, was significantly higher in third trimester than in second trimester subjects (P < 0.05) at 1, 2, and 3 min of incremental exercise testing. In contrast, the HF/total power ratio, an indicator of rapidly acting parasympathetic activity, was significantly higher in second trimester than in third trimester subjects (P < 0.05) at 2 and 3 min. In addition, a negative correlation was found between gestational age and the 'accumulation half-time' of the LH/HF ratio, the time point at which the sum of the LF/HF ratio reached 50% of that accumulated in the total 6 min of exercise testing (r = -0.49, P = 0.028). CONCLUSIONS The autonomic response to exercise in pregnant women differs between the second and third trimesters. These differences should be considered when prescribing exercise to pregnant women.
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Affiliation(s)
- Akemi Nakagaki
- School of Nursing/Graduate School of Nursing, Nagoya City University, Nagoya, Japan.,Department of Physiology, Aichi Medical University, Nagakute, Japan
| | - Takayuki Inami
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Tetsuji Minoura
- School of Nursing & Health, Aichi Prefectural University, Nagoya, Japan
| | - Reizo Baba
- Department of Cardiology, Aichi Children's Health and Medical Centre, Obu, Japan
| | - Satoshi Iwase
- Department of Physiology, Aichi Medical University, Nagakute, Japan
| | - Motohiko Sato
- Department of Physiology, Aichi Medical University, Nagakute, Japan
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20
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Level and intensity of objectively assessed physical activity among pregnant women from urban Ethiopia. BMC Pregnancy Childbirth 2012; 12:154. [PMID: 23244057 PMCID: PMC3543321 DOI: 10.1186/1471-2393-12-154] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 12/11/2012] [Indexed: 11/12/2022] Open
Abstract
Background Women in low-income countries are generally considered to have a high physical workload which is sustained during pregnancy. Although most previous studies have been based on questionnaires a recent meta-analysis of doubly labeled water data has raised questions about the actual amount of physical activity performed. In this study we report objectively assessed levels of physical activity, cardiorespiratory fitness and muscular fitness among pregnant urban Ethiopian women, and their association with demographic characteristics and anthropometric measures. Methods Physical activity was measured for seven consecutive days in 304 women using a combined uniaxial accelerometer and heart rate sensor. Activity energy expenditure was determined using a group calibration in a branched equation model framework. Type and duration of activities were reported using a 24-hour physical activity recall and grip strength was assessed using a dynamometer. Results Median (interquartile-range, IQR) activity energy expenditure was 31.1 (23.7-42.0) kJ/kg/day corresponding to a median (IQR) physical activity level of 1.46 (1.39-1.58). Median (IQR) time in sedentary, light, and moderate-to-vigorous intensity was 1100 (999–1175), 303 (223–374) and 40 (22–69) min/day, respectively. Mean (standard deviation) sleeping heart rate was 73.6 (8.0) beats/min and grip strength was 21.6 (4.5) kg. Activity energy expenditure was 14% higher for every 10 cm2 difference in arm muscle area and 10% lower for every 10 cm2 difference in arm fat area and 10-week difference in gestational age. Conclusion The level and intensity of physical activity among pregnant women from urban Ethiopia is low compared to non-pregnant women from other low income countries as well as pregnant European women from high-income countries.
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21
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Hellgren C, Akerud H, Jonsson M, Sundström Poromaa I. Sympathetic reactivity in late pregnancy is related to labour onset in women. Stress 2011; 14:627-33. [PMID: 21936686 DOI: 10.3109/10253890.2011.614662] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Stress regulation during pregnancy is considered to be connected to the timing of labour initiation. Although increasing knowledge is emerging on the regulation of parturition, there is currently no way to predict the start of spontaneous labour in women. The main aim of this study was to assess pain threshold and the sympathetic nervous system response to cold pain in relation to the onset of labour in healthy pregnant women. Ninety-three pregnant women were recruited and assessed for skin conductance (SC) activity during a cold pressor test in gestational week 38. Pain threshold and cold endurance were also measured and the results were compared with data obtained from hospital records. Seventy-four women had a spontaneous labour onset and a valid SC measurement. SC activity during the cold pressor test decreased significantly with the number of days left to spontaneous parturition. This may indicate a gradual decrease in sympathetic autonomic nervous system reactivity even during the last weeks of pregnancy. Measuring SC activity during mild stress provocation is a rapid and non-invasive means to study variation in sympathetic reactivity during pregnancy, and may be useful in research on stress regulation in pregnancy and its relation to labour initiation.
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Affiliation(s)
- Charlotte Hellgren
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Grindheim G, Toska K, Estensen ME, Rosseland LA. Changes in pulmonary function during pregnancy: a longitudinal cohort study. BJOG 2011; 119:94-101. [DOI: 10.1111/j.1471-0528.2011.03158.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Peña MA, Echeverría JC, García MT, Ortiz MR, Martínez A, Vargas-Garcia C, González-Camarena R. Short-term heart rate dynamics of pregnant women. Auton Neurosci 2010; 159:117-22. [PMID: 20933481 DOI: 10.1016/j.autneu.2010.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 06/08/2010] [Accepted: 09/13/2010] [Indexed: 10/19/2022]
Abstract
Aiming to detect the stage of gestation where dynamical changes of the RR fluctuations may occur, we assessed short-term fluctuations of low risk pregnant women. Ninety six, 10min ECG recordings were collected along gestation (7 to 39 weeks). Corresponding RR fluctuations series were analysed to obtain the RMSSD, α(1), α(1(mag)) and α(1(sign)) parameters. Four groups covering first, second and last trimesters of gestation were conformed. No significant changes in α(1), which was close to unit, and α(1(sign)) among gestational groups were identified. But, in accordance with previous findings, we did find a significant reduction of RMSSD along gestation, and significant short-term changes that indicate a higher degree of nonlinearity after about 26 weeks of gestation (α(1(mag))>0.5)). These results suggest that the short-term heart rate dynamics of low risk pregnant women do not become compromised during gestation, despite the increased haemodynamic demands and other ongoing adaptations. Yet the complexity of the mechanisms involved in the cardiac regulation of pregnant women does seem to increase from mid-pregnancy, possibly owing to new short-term control influences or to modifications regardless the strength of the regulatory interactions.
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Affiliation(s)
- M A Peña
- Electrical Engineering Department, Universidad Autónoma Metropolitana-Izt., Mexico City, Mexico.
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Stutzman SS, Brown CA, Hains SMJ, Godwin M, Smith GN, Parlow JL, Kisilevsky BS. The effects of exercise conditioning in normal and overweight pregnant women on blood pressure and heart rate variability. Biol Res Nurs 2010; 12:137-48. [PMID: 20798154 DOI: 10.1177/1099800410375979] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pre-pregnancy obesity is a risk factor for preeclampsia, gestational diabetes, and hypertension. Regular exercise during pregnancy has been shown to decrease the risk of these obstetrical complications. The purpose of this prospective study was to measure the effects of an exercise program in normal-weight and overweight/obese pregnant women on blood pressure (BP) and cardiac autonomic function, determined by heart rate variability (HRV) and baroreflex sensitivity (BRS). Twenty-two sedentary pregnant women, recruited at 20 weeks gestational age (GA), were grouped as normal weight or overweight/obese. They were systematically assigned to an exercise (walking) group or control (nonwalking) group after the first participants were randomly assigned. Women in the walking groups participated in a 16-week, low-intensity walking program. BP, HRV, and BRS were measured at rest and during exercise at the beginning (20 weeks GA) and end (36 weeks GA) of the walking program. Results indicated that women in the control groups (especially overweight women) showed changes in BP, HRV, and BRS over pregnancy that were not seen in the walking group. Overweight women in the control group increased resting systolic BP by 10 mmHg and diastolic BP by 7 mmHg. HRV declined in the control group but not in the walking group. A reduction in BRS and R-R interval at rest was found in all groups except the walking normal-weight group. The results suggest that an exercise program could attenuate the increase in BP and the loss of parasympathetic tone associated with pregnancy, especially in overweight women.
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Brooks VL, Dampney RAL, Heesch CM. Pregnancy and the endocrine regulation of the baroreceptor reflex. Am J Physiol Regul Integr Comp Physiol 2010; 299:R439-51. [PMID: 20504907 PMCID: PMC2928618 DOI: 10.1152/ajpregu.00059.2010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 05/19/2010] [Indexed: 02/07/2023]
Abstract
The purpose of this review is to delineate the general features of endocrine regulation of the baroreceptor reflex, as well as specific contributions during pregnancy. In contrast to the programmed changes in baroreflex function that occur in situations initiated by central command (e.g., exercise or stress), the complex endocrine milieu often associated with physiological and pathophysiological states can influence the central baroreflex neuronal circuitry via multiple sites and mechanisms, thereby producing varied changes in baroreflex function. During pregnancy, baroreflex gain is markedly attenuated, and at least two hormonal mechanisms contribute, each at different brain sites: increased levels of the neurosteroid 3alpha-hydroxy-dihydroprogesterone (3alpha-OH-DHP), acting in the rostral ventrolateral medulla (RVLM), and reduced actions of insulin in the forebrain. 3alpha-OH-DHP appears to potentiate baroreflex-independent GABAergic inhibition of premotor neurons in the RVLM, which decreases the range of sympathetic nerve activity that can be elicited by changes in arterial pressure. In contrast, reductions in the levels or actions of insulin in the brain blunt baroreflex efferent responses to increments or decrements in arterial pressure. Although plasma levels of angiotensin II are increased in pregnancy, this is not responsible for the reduction in baroreflex gain, although it may contribute to the increased level of sympathetic nerve activity in this condition. How these different hormonal effects are integrated within the brain, as well as possible interactions with additional potential neuromodulators that influence baroreflex function during pregnancy and other physiological and pathophysiological states, remains to be clearly delineated.
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Affiliation(s)
- Virginia L Brooks
- Dept. of Physiology and Pharmacology, L-334, Oregon Health & Science Univ., 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
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MIYAZATO K, MATSUKAWA K. Decreased cardiac parasympathetic nerve activity of pregnant women during foot baths. Jpn J Nurs Sci 2010; 7:65-75. [DOI: 10.1111/j.1742-7924.2010.00136.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cankar K, Potocnik N, Strucl M. Alteration of skin laser-Doppler flux response to local cooling in gestational hypertension. Clin Auton Res 2010; 20:183-90. [DOI: 10.1007/s10286-009-0050-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 12/22/2009] [Indexed: 11/29/2022]
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Kisilevsky BS, Hains SMJ. Exploring the relationship between fetal heart rate and cognition. INFANT AND CHILD DEVELOPMENT 2010. [DOI: 10.1002/icd.655] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Brooks VL, Mulvaney JM, Azar AS, Zhao D, Goldman RK. Pregnancy impairs baroreflex control of heart rate in rats: role of insulin sensitivity. Am J Physiol Regul Integr Comp Physiol 2009; 298:R419-26. [PMID: 19939977 DOI: 10.1152/ajpregu.00441.2009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recent studies in rabbits suggest that insulin resistance and reduced brain insulin contribute to impaired baroreflex control of heart rate (HR) during pregnancy; however, the mechanisms are unknown. The rat model is ideal to investigate these mechanisms because much is known about rat brain baroreflex neurocircuitry and insulin receptor locations. However, it is unclear in rats whether pregnancy impairs the HR baroreflex or whether insulin resistance is involved. Therefore, this study tested the hypothesis that in rats pregnancy decreases HR baroreflex sensitivity (BRS) and that this decrease is related to concurrent decreases in insulin sensitivity (IS). BRS was quantified before, during, and after pregnancy using complementary methods: 1) spontaneous BRS (sBRS) derived from sequence method analysis of telemetric, continuous arterial pressure recordings; and 2) maximal BRS of complete sigmoidal baroreflex relationships. IS was measured (hyperinsulinemic euglycemic clamp) to determine whether BRS and IS change in parallel. sBRS was reduced at midgestation [pregnancy day 10 (P10)], returned to nonpregnant (NP) levels on P18, and fell again at late gestation (P20) (sBRS in ms/mmHg: NP, 1.66 + or - 0.04; P10, 1.17 + or - 0.11; P18, 1.55 + or - 0.12; P20, 1.31 + or - 0.05; n = 5; P < 0.05). Similar triphasic patterns were observed for both maximal BRS [in beats x min(-1) x mmHg(-1): NP, 4.45 + or - 0.52 (n = 10); P11-12, 2.76 + or - 0.11 (n = 7); P17-18, 3.79 + or - 0.14 (n = 5); P19-20, 2.32 + or - 0.40 (n = 8); P < 0.0001] and previous and current measurements of IS (in mg glucose x kg(-1) x min(-1): NP, 32 + or - 2; P19-20, 15 + or - 1; P < 0.0005). Furthermore, during pregnancy, the standard deviation (SD) of MAP increased, and the SD of HR decreased, indirectly suggesting baroreflex impairment. sBRS increased transiently during parturition, and sBRS, maximal BRS, and IS normalized 3-4 days postpartum. In conclusion, pregnancy decreases HR BRS in rats. The parallel temporal changes in BRS and IS suggest a mechanistic link.
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Affiliation(s)
- Virginia L Brooks
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, OR 97239, USA
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Baciuk EP, Pereira RI, Cecatti JG, Braga AF, Cavalcante SR. Water aerobics in pregnancy: Cardiovascular response, labor and neonatal outcomes. Reprod Health 2008; 5:10. [PMID: 19025579 PMCID: PMC2613131 DOI: 10.1186/1742-4755-5-10] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 11/21/2008] [Indexed: 12/16/2022] Open
Abstract
Background To evaluate the association between water aerobics, maternal cardiovascular capacity during pregnancy, labor and neonatal outcomes. Methods A randomized, controlled clinical trial was carried out in which 34 pregnant women were allocated to a water aerobics group and 37 to a control group. All women were submitted to submaximal ergometric tests on a treadmill at 19, 25 and 35 weeks of pregnancy and were followed up until delivery. Oxygen consumption (VO2 max), cardiac output (CO), physical fitness, skin temperature, data on labor and delivery, and neonate outcomes were evaluated. Frequency distributions of the baseline variables of both groups were initially performed and then analysis of the outcomes was carried out. Categorical data were compared using the chi-square test, and numerical using Student's t or Mann-Whitney tests. Wilk's Lambda or Friedman's analysis of repeat measurements were applied for comparison of physical capacity, cardiovascular outcomes and maternal temperature. Results VO2 max and physical fitness were higher in both groups in the second trimester, returning to basal levels in the third trimester. In both groups, CO increased as pregnancy progressed and peak exercise temperature was higher than resting temperature, increasing further after five minutes of recovery and remaining at this level until 15 minutes after exercise completion. There was no difference between the two groups regarding duration (457.9 ± SD 249.6 vs 428.9 ± SD 203.2 minutes) or type of delivery. Labor analgesia was requested by significantly fewer women in the water aerobics group (27% vs 65%; RR = 0.42 95%CI 0.23–0.77). Neonatal results were similar in both groups. Conclusion The regular practice of moderate water aerobics by sedentary and low risk pregnant women was not detrimental to the health of the mother or the child. There was no influence on maternal cardiovascular capacity, duration of labor or type of delivery; however, there were fewer requests for analgesia during labor in the water aerobics group.
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Affiliation(s)
- Erica P Baciuk
- Department of Obstetrics and Gynecology, University of Campinas, Sao Paulo, Brazil.
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Helmreich RJ, Hundley V, Varvel P. The effect of obesity on heart rate (heart period) and physiologic parameters during pregnancy. Biol Res Nurs 2008; 10:63-78. [PMID: 18647761 DOI: 10.1177/1099800408321077] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Obesity and excess gestational weight gain (EGWG) in pregnancy increase the risk for adverse maternal and infant outcomes. Along with careful monitoring of weight gain during pregnancy, early identification of a maladaptive response to the changes of pregnancy may help to avoid adverse outcomes. Simple physiologic markers such as resting heart rate (HR), heart period (HP), and blood pressure (BP) may be powerful predictors of cardiovascular adaptation to pregnancy. This article summarizes the current state of the science regarding the effect of obesity (body mass index [BMI] > or =30 kg/m(2)) and EGWG in pregnant women at rest in laboratory settings. The impact of differences in weight gain (kg and BMI) on pregnancy outcomes is also examined. A search was conducted for articles published from 1985 to 2006 reporting data on body weight and HR or HP at rest from randomized controlled trials or controlled trials conducted in laboratory settings involving pregnant women at low or high risk for adverse pregnancy outcomes who were obese or had EGWG. A meta-analysis was conducted on the 23 studies meeting inclusion criteria to explore the relation of BMI to HR, HP, and physiologic parameters. Autonomic responsiveness was found to be diminished in obese women with a BMI > 30 kg/m(2) and in women with high risk for adverse pregnancy outcomes, which may indicate a maladaptive autonomic response that is imbalanced and disorganized and that reduces adaptation to environmental demands.
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Brown CA, Lee CT, Hains SMJ, Kisilevsky BS. Maternal Heart Rate Variability and Fetal Behavior in Hypertensive and Normotensive Pregnancies. Biol Res Nurs 2008; 10:134-44. [DOI: 10.1177/1099800408322942] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The relation between maternal heart rate variability (HRV) and fetal behavior was examined in hypertensive and normotensive pregnant women. A total of 40 mother—fetal pairs (n = 20 normotensive mothers; n = 20 hypertensive mothers) at 33—41 weeks' gestation were observed using a standardized procedure lasting approximately 50 min. It included the following measurements: maternal beat-by-beat arterial blood pressure and HRV; spontaneous fetal heart rate (HR), body and breathing movements; and an estimate of amniotic fluid volume. The women in the hypertensive group had higher average body mass index (BMI) (33.7 vs. 28.8 kg/m2) than the normotensive group. In the normotensive group, there was no association between maternal HRV and fetal gestational age, HR, body or breathing movements. In the hypertensive group, maternal HRV measures of low-frequency, high-frequency, and total power were associated with fetal gestational age; also, there was an association between maternal autonomic modulation of HR and fetal spontaneous HR. These findings suggest that the maternal autonomic system influences fetal cardiac function in pregnancies complicated by hypertension.
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Affiliation(s)
- C. Ann Brown
- Queen's University School of Nursing, Kingston, Ontario,
| | - Charlotte T. Lee
- Queen's University School of Nursing, Kingston, Ontario, University of Toronto, Ontario, Canada
| | | | - Barbara S. Kisilevsky
- Queen's University School of Nursing, Kingston, Ontario, Kingston General Hospital, Kingston, Ontario
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Jensen D, Webb KA, Davies GAL, O'Donnell DE. Mechanical ventilatory constraints during incremental cycle exercise in human pregnancy: implications for respiratory sensation. J Physiol 2008; 586:4735-50. [PMID: 18687714 DOI: 10.1113/jphysiol.2008.158154] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
UNLABELLED The aim of this study was to identify the physiological mechanisms of exertional respiratory discomfort (breathlessness) in pregnancy by comparing ventilatory (breathing pattern, airway function, operating lung volumes, oesophageal pressure (P(oes))-derived indices of respiratory mechanics) and perceptual (breathlessness intensity) responses to incremental cycle exercise in 15 young, healthy women in the third trimester (TM(3); between 34 and 38 weeks gestation) and again 4-5 months postpartum (PP). During pregnancy, resting inspiratory capacity (IC) increased (P < 0.01) and end-expiratory lung volume decreased (P < 0.001), with no associated change in total lung capacity (TLC) or static respiratory muscle strength. This permitted greater tidal volume (V(T)) expansion throughout exercise in TM(3), while preserving the relationship between contractile respiratory muscle effort (tidal P(oes) swing expressed as a percentage of maximum inspiratory pressure (P(Imax))) and thoracic volume displacement (V(T) expressed as a percentage of vital capacity) and between breathlessness and ventilation . At the highest equivalent work rate (HEWR = 128 +/- 5 W) in TM(3) compared with PP: , tidal P(oes)/P(Imax) and breathlessness intensity ratings increased by 10.2 l min(-1) (P < 0.001), 8.8%P(Imax) (P < 0.05) and 0.9 Borg units (P < 0.05), respectively. Pulmonary resistance was not increased at rest or during exercise at the HEWR in TM(3), despite marked increases in mean tidal inspiratory and expiratory flow rates, suggesting increased bronchodilatation. Dynamic mechanical constraints on V(T) expansion (P < 0.05) with associated increased breathlessness intensity ratings (P < 0.05) were observed near peak exercise in TM(3) compared with PP. IN CONCLUSION (1) pregnancy-induced increases in exertional breathlessness reflected the normal awareness of increased and contractile respiratory muscle effort; (2) mechanical adaptations of the respiratory system, including recruitment of resting IC and increased bronchodilatation, accommodated the increased V(T) while preserving effort-displacement and breathlessness-VE relationships; and (3) dynamic mechanical ventilatory constraints contributed to respiratory discomfort near the limits of tolerance in late gestation.
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Affiliation(s)
- Dennis Jensen
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada.
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Nierop A, Wirtz PH, Bratsikas A, Zimmermann R, Ehlert U. Stress-buffering effects of psychosocial resources on physiological and psychological stress response in pregnant women. Biol Psychol 2008; 78:261-8. [DOI: 10.1016/j.biopsycho.2008.03.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Revised: 03/12/2008] [Accepted: 03/20/2008] [Indexed: 10/22/2022]
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The effect of depression on heart rate variability during pregnancy. Clin Auton Res 2008; 18:203-12. [DOI: 10.1007/s10286-008-0480-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 05/13/2008] [Indexed: 11/27/2022]
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Mottola MF, Davenport MH, Brun CR, Inglis SD, Charlesworth S, Sopper MM. V̇O2peak Prediction and Exercise Prescription for Pregnant Women. Med Sci Sports Exerc 2006; 38:1389-95. [PMID: 16888450 DOI: 10.1249/01.mss.0000228940.09411.9c] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The present study was designed to develop and validate a prediction equation for peak oxygen consumption VO2peak) using a progressive treadmill test and to refine the current target HR exercise guidelines for pregnancy (PARmed-X for Pregnancy). METHODS One hundred fifty-six women between 16 and 22 wk of gestation performed the test to volitional fatigue (peak exercise test). Data from every fourth subject were used to form the cross-validation group. The women were separated into two age groups; 20-29 (N = 60) and 30-39 (N = 96) yr of age and then further separated into fit (VO2peak at the top 25th percentile), unfit (VO2peak at the bottom 25th percentile), and active (between these two ranges). HR and VO2peak values were used in the regression equation to predict target HR ranges at 60 and 80% VO2peak. RESULTS The prediction equation (R2 = 0.72, R2adjusted = 0.71 and SEE = 2.7) was compared with cross validation (N = 39; P = 0.78). Fit women had a VO2peak > or = 27.2 mL.kg(-1).min(-1) and > or = 26.1 mL.kg.min for ages 20-29 and 30-39 yr, respectively, representing the top 25th percentile. Unfit women had a VO2peak of < or = 21.0 mL.kg(-1).min(-1) and < or = 19.6 mL.kg(-1).min(-1), respectively, representing the bottom 25th percentile. HR/VO2peak regression lines for each fitness level were used to generate the target HR zones in each age group. CONCLUSION This is the first study to provide a validated prediction equation of VO2peak for pregnant women using a progressive treadmill exercise test. The defined target HR zones based on age and the appropriate fitness levels can be used for exercise prescription in healthy pregnant women.
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Affiliation(s)
- Michelle F Mottola
- Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.
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Wirch JL, Wolfe LA, Weissgerber TL, Davies GAL. Cold pressor test protocol to evaluate cardiac autonomic function. Appl Physiol Nutr Metab 2006; 31:235-43. [PMID: 16770350 DOI: 10.1139/h05-018] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The primary objective of this study was to develop a cold pressor test (CPT) protocol to evaluate cardiac autonomic function. Secondary objectives were to assess CPT protocol reliability and to examine gender differences in response to orthostatic stress and the CPT. Healthy, normotensive men and women (n = 12 per group) completed 2 trials on different days in the left lateral decubitus and standing postures and during a 6 min CPT (hand immersion while seated). Measurements included R-R interval, blood pressure, ventilatory responses, spontaneous baroreflex sensitivity, and heart rate variability indices. During the CPT, blood pressure and the sympathetic nervous system (SNS) indicator increased significantly and low-frequency power, high-frequency power (normalized for tidal volume), and the parasympathetic nervous system (PNS) indicator decreased significantly. Standing caused significant increases in the SNS indicator and decreases in the R-R interval in both genders. The PNS indicator was higher in women than in men in the left lateral decubitus posture. The 6 min hand-immersion CPT provoked cardiac sympathetic activation and parasympathetic withdrawal; however, it is best suited to studies with a repeated measures design, as analysis of reliability suggests that responses are highly variable between individuals. Performing the CPT in the left lateral decubitus position may prevent vasovagal responses.Key words: cold pressor test, sympathetic nervous system, parasympathetic nervous system, gender, posture.
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Affiliation(s)
- Jennifer L Wirch
- Physical and Health Education, Queen's University, Kingston, ON, Canada
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Abstract
Insulin sensitivity decreases for the first time in females at the time of menarche. A much more profound decrease in insulin sensitivity is observed at the end of pregnancy. This physiological insulin resistance is not accompanied by a rise in overall sympathetic activity as reflected in plasma noradrenaline levels, but there is evidence of moderate sympathetic overactivity in muscle and the heart. Pre-eclampsia is characterized by increased insulin resistance, sympathetic overactivity and a particular lipid profile. Thus it is the first manifestation of metabolic syndrome. Women with a history of pre-eclampsia have persistent insulin resistance after pregnancy associated with increased sympathetic activity of the cardiovascular system, and coronary artery disease later in life. Aging is accompanied by a greater increase in sympathetic traffic in women than in men, and inflammation (measured via C-reactive protein) seems to be more strongly related to metabolic syndrome in women than in men. The clinical relevance of these observations remains to be shown. As the key factors of metabolic syndrome, such as insulin resistance and sympathetic overactivity, are closely inter-related, treatment should be aimed at cutting the vicious circle at many points: lifestyle modification (diet, increasing exercise) as a basis of therapy, use of insulin sensitizers (e.g. metformin) to decrease insulin resistance, central sympatholytics (e.g. moxonidine), and AT-receptor blockers or angiotensin-converting enzyme (ACE) inhibitors to overcome sympathetic overactivity, hypertension and inflammation.
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Affiliation(s)
- Risto J Kaaja
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Haartmaninkatu, Helsinki, Finland.
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Walther T, Wessel N, Baumert M, Stepan H, Voss A, Faber R. Longitudinal analysis of heart rate variability in chronic hypertensive pregnancy. Hypertens Res 2005; 28:113-8. [PMID: 16025737 DOI: 10.1291/hypres.28.113] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the US, it is currently estimated that 3% of pregnant women have chronic hypertension, or more than 100,000 pregnant women each year. The aim of our study was to investigate the adaptation of autonomic control during pregnancy based on heart rate variability analysis and to determine whether chronic hypertension during pregnancy has an impact on this adaptation. Sixteen pregnant women with chronic hypertension (CH group; mean age, 30 years; range, 25-33 years) and 35 healthy pregnant women serving as controls (CON group; mean age, 28 years; range, 24-30 years) were recruited for this longitudinal study. Beginning at the 20th week of pregnancy, the women were monitored every 4th week until delivery. For the analysis of heart rate variability, Portapres signals (200 Hz) were recorded for 30 min under resting conditions. Women in the CH group had significantly elevated blood pressure compared to controls (CON, 111 mmHg [105-132]; CH, 140 mmHg [132-148]; p<0.001). An increased heart rate was found in both groups during the second half of pregnancy. Consequently, decreased heart rate variability was observed, but was more pronounced in the CON group. There was a shift in the frequency bands indicated by an elevation of the low-to-high frequency ratio (LF/HF) in both groups due to a decrease in HF, and thus a significant increase in LFn (LF power in normalized units). However, VLF (power of very low frequency range) increased exclusively in the CON pregnancies. Our data showed no significant difference in heart rate variability between the subjects of the CH and CON groups. Longitudinal variations were detectable in normal pregnancies and also, albeit to a lesser degree, in chronic hypertensive pregnant women. Thus, our data indicate that patients with long-term hypertension are still able to respond to the physiological changes occurring during pregnancy.
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Affiliation(s)
- Thomas Walther
- Department of Cardiology, Charité, Campus Benjamin Franklin, Berlin, Germany.
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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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Weissgerber TL, Wolfe LA, Davies GAL. The role of regular physical activity in preeclampsia prevention. Med Sci Sports Exerc 2005; 36:2024-31. [PMID: 15570135 DOI: 10.1249/01.mss.0000147627.35139.dc] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Preeclampsia affects 2-7% of pregnancies and is a leading cause of maternal and fetal morbidity and mortality. Despite extensive study, the etiology of preeclampsia is poorly understood. Abnormal placental development, predisposing maternal constitutional factors, oxidative stress, immune maladaptation, and genetic susceptibility have all been hypothesized to contribute to the development of preeclampsia. Physical conditioning and preeclampsia have opposite effects on critical physiological functions. This suggests that regular prenatal exercise may prevent or oppose the progression of the disease. Epidemiologic studies show that occupational and leisure-time physical activity is associated with a reduced incidence of preeclampsia. We hypothesize that this protective effect results from one of more of the following mechanisms: 1) stimulation of placental growth and vascularity, 2) reduction of oxidative stress, and 3) exercise-induced reversal of maternal endothelial dysfunction. Future research should include prospective epidemiological case-control studies that accurately measure occupational and leisure-time physical activity. Controlled randomized clinical trials examining the effects of prenatal exercise on biochemical markers for endothelial dysfunction, placental dysfunction, and oxidative stress are also needed. If future research supports the idea that exercise effectively protects against preeclampsia, this would provide a low-cost intervention that could dramatically improve prenatal care for women at risk of this disease.
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Affiliation(s)
- Tracey L Weissgerber
- School of Physical and Health Education, Queen's University, Kingston, ON K7L 3N6, Canada
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Heenan AP, Wolfe LA, Davies GAL, McGrath MJ. Effects of human pregnancy on fluid regulation responses to short-term exercise. J Appl Physiol (1985) 2003; 95:2321-7. [PMID: 12959950 DOI: 10.1152/japplphysiol.00984.2002] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study tested the hypothesis that human pregnancy alters fluid and electrolyte regulation responses to acute short-term exercise. Responses of 22 healthy pregnant women (PG; gestational age, 37.0 +/- 0.2 wk) and 17 nonpregnant controls (CG) were compared at rest and during cycling at 70 and 110% of the ventilatory threshold (VT). At rest, ANG II concentration was significantly (P < 0.05) higher in PG vs. CG, whereas plasma osmolality and concentrations of AVP, sodium, and potassium were significantly lower. Atrial natriuretic peptide concentration at rest was similar between groups. ANG II and AVP concentrations increased significantly from rest to 110% VT in CG only, whereas increases in atrial natriuretic peptide concentration were similar between groups. Increases in osmolality, and total protein and albumin concentrations from rest to both work rates were similar between the two groups. PG and CG exhibited similar shifts in fluid during acute short-term exercise, but the increases in ANG II and AVP were absent and attenuated, respectively, during pregnancy. This was attributed to the significantly augmented fluid volume state already present at rest in late gestation.
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Affiliation(s)
- Aaron P Heenan
- School of Physical and Health Education, Queen's University, Kingston, Ontario, Canada K7L 3N6
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O'Hagan KP, Alberts JA. Uterine artery blood flow and renal sympathetic nerve activity during exercise in rabbit pregnancy. Am J Physiol Regul Integr Comp Physiol 2003; 285:R1135-44. [PMID: 12869366 DOI: 10.1152/ajpregu.00258.2003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The uterine artery blood flow (UtBF) and renal sympathetic nerve activity (SNA) responses to treadmill exercise were evaluated in 12 nonpregnant (NP) and 17 term pregnant (P) rabbits. UtBF was monitored continuously with a Transonic flowprobe. Rabbits underwent three exercise trials (5-min duration) that varied in absolute workload. The rise in renal SNA with exercise was intensity related. Pregnancy did not affect the average steady-state renal SNA response expressed relative to maximum activity (P 24 +/- 1% vs. NP 23 +/- 2% of maximum smoke-elicited activity) and increased the average renal SNA response expressed relative to resting activity (P +155 +/- 19% vs. NP +84 +/- 23% from rest, P = 0.03) At rest, UtBF (P 13 +/- 3 vs. NP 1.9 +/- 0.3 ml/min) and uterine artery conductance (UtC; P 22 +/- 5 vs. NP 2.8 +/- 0.5 ml. min-1.mmHg-1 x 10-2) were elevated in the P rabbits. The average exercise-related decreases in UtBF (P -16 +/- 4% vs. NP -48 +/- 4%) and UtC (P -27 +/- 4% vs. NP -54 +/- 4%) were attenuated in the P rabbits. Pregnancy does not impair the ability to raise renal SNA but attenuates the uterine artery constrictor response to moderate to heavy dynamic exercise in rabbits. Under normal conditions, the pregnant uterine circulatory bed may be relatively protected from exercise-related redistribution of blood flow.
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Affiliation(s)
- Kathleen P O'Hagan
- Dept of Physiology, Midwestern Univ., 555 31st St., Downers Grove, IL 60515, USA.
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45
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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
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Affiliation(s)
- Larry A Wolfe
- School of Physical and Health Education, Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada.
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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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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.
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Abstract
Cardiac diseases are present in 0.5-4% of pregnancies, and they remain a frequent cause of death during pregnancy. Pregnancy per se imposes significant hemodynamic changes, placing a major burden on the cardiovascular system. The early recognition and close follow-up of patients with cardiac diseases will improve maternal tolerance to the cardiovascular burden imposed by pregnancy, promote fetal growth and neonatal survival. Rheumatic heart disease remains the most frequent heart disease in the pregnant population with pulmonary edema as the most frequent complication. Atrial septal defect is the most frequent congenital heart disease in the adult population, whereas tetralogy of Fallot is the most common cyanotic congenital heart disease. An improvement in modern techniques of monitoring, a better understanding of the pathophysiology of cardiac disease, as well as multidisciplinary care has led to a substantial improvement in outcome of the pregnant cardiac patient. Management should be initiated before conception as it will provide optimal clinical conditions and sufficient information on the underlying pathophysiology.
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Affiliation(s)
- Chakib M Ayoub
- Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon.
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Pivarnik JM, Stein AD, Rivera JM. Effect of pregnancy on heart rate/oxygen consumption calibration curves. Med Sci Sports Exerc 2002; 34:750-5. [PMID: 11984290 DOI: 10.1097/00005768-200205000-00004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this investigation was to determine heart rate (HR)/oxygen consumption (VO2) calibration curves for exercising and sedentary women during pregnancy and the postpartum periods. METHODS Fifty-two women were studied at three time points: 20 wk gestation, 32 wk gestation, and 12 wk postpartum. Subjects were grouped either as regular exercisers (N = 27) or sedentary controls (N = 25). At each time point, each woman had HR and VO2 measured at rest (lying, seated, and standing) as well as during steady-state treadmill exercise performed at three increasing intensities. Flex HRs were defined and calculated by averaging the value seen during the lowest exercise intensity and highest value during rest. Individual HR/VO2 calibration curves were generated for exercise at each time point. Statistical analyses of all dependent variables included comparisons of subject groups (exercise and sedentary) and pregnancy status (20 wk, 32 wk, and 12 wk postpartum). RESULTS Resting VO2 (mL.kg-1.min-1) was approximately 6.5% greater during pregnancy compared with postpartum conditions (P < 0.005). Also, both resting and flex HRs were greater during pregnancy compared with postpartum (P < 0.01). Resting HR was lower in exercising women compared with sedentary controls at all time points (P < 0.01). Slopes of HR/VO2 regression curves were flatter during pregnancy (P < 0.005), but there was no difference between groups. Y-intercepts were less at 20 wk compared with 36 wk postpartum. CONCLUSIONS A woman's HR, VO2, and the relationship between these two parameters are altered during pregnancy. Change in slope of HR/VO2 regression curves indicates less energy expenditure at a given HR as pregnancy progresses, compared with postpartum conditions. A woman's true energy expenditure would be overestimated at rest, and underestimated during physical activity, if these physiological changes are not taken into account.
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Affiliation(s)
- James M Pivarnik
- Department of Kinesiology, Michigan State University, East Lansing, MI 48824, USA.
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