Exercise and Pregnancy Flashcards
Goal is to improve the _____ ____ of pregnant and postpartum women and their _____.
- lifelong health
- children
Guidelines for exercise during pregnancy prior to 1985:
no guidelines. Rest and relax
Guidelines for exercise during pregnancy 1985:
- ACOG
- no exercise above 140 bpm
Guidelines for exercise during pregnancy 1994:
- ACOG
- no HR guidelines (common sense)
Guidelines for exercise during pregnancy 2003:
latest Canadian guidelines
Critical outcomes of exercising while pregnant:
- miscarriage
- stillbirth
- neonatal death
- preterm birth
- gestational diabetes mellitus
- gestational hypertension
- maternal mental health
Important outcomes of exercising while pregnant:
- inadequate gestational weight gain
- birth defects
- lower back pain
- pelvic girdle pain
- urinary incontinence
- induction of labour
- adverse outcomes
- birth weight
Recommendations ____ is the gold standard, based on ….
- 1-5
- randomized controlled trials (exercise vs no exercise)
Recommendation 6 based on….
any study design
What to do if there are absolute contraindications:
- exercise should be avoided
- ADLs may be continued as directed by their health care professional
What to do if there are relative contraindications:
speak with health care professional
Absolute contraindications:
- ruptured membranes, premature labour
- unexplained persistent vaginal bleeding
- placenta praevia after 28 weeks gestation
- pre-eclampsia
- incompetent cervix
- intrauterine growth restriction
- high-order multiple pregnancy (eg. triplets)
- uncontrolled T1D, hypertension, thyroid disease
- other serious CV, respiratory or systemic disorder
Relative contraindications:
- recurrent pregnancy loss
- history of spontaneous preterm birth
- gestational hypertension
- symptomatic anemia
- malnutrition
- eating disorder
- twin pregnancy after 28th week
- mild/moderate CV or respiratory disease
Recommendation 1:
- all women without contraindication should be physically active throughout pregnancy
- strong recommendation, moderate quality evidence
Recommendation 1 for women who were previously inactive:
- strong recommendation
- moderate quality evidence
Recommendation 1 for women diagnosed with gestational diabetes mellitus:
- weak recommendation
- low quality evidence
Recommendation 1 for women categorized as overweight or obese (prepregnancy BMI > or equal to ____ kg/m^2):
- 25
- strong recommendation
- low quality evidence
Exercise reduces the risk of gestational diabetes by ____%.
38
Exercise reduces the risk of gestational hypertension by ____%.
39
Exercise reduces the risk of preeclampsia by ____%.
41
Pregnancy unmasks future ____ ____ risk.
chronic disease
If prenatal exercise reduces ____ and ____, long term risk for ____ may be decreased.
- GDM
- PE
- CVD
Exercise reduces the risk of excessive gestational weight gain by _____%.
32%
Exercise reduces the risk of depressive symptoms by _____.
moderate
Exercise reduces the risk of depression by ____%
67%
Recommendation 2:
- pregnant women should accumulate at least 150 min of moderate intensity PA each week to achieve clinically meaningful reductions in pregnancy complications
- strong recommendation, moderate quality evidence
Recommendation 2: dose response between an increasing volume of _____ and _____ outcomes.
- exercise
- pregnancy
The threshold for recommendation 2 is a ____% reduction in the odds of developing an outcome.
25%
Light intensity HR range for <29 maternal age:
102-124 bpm
Moderate intensity HR range for <29 maternal age:
125-146 bpm
Vigorous intensity HR range for <29 maternal age:
147-169
Light intensity HR range for 30+ maternal age:
101-120
Moderate intensity HR range for 30+ maternal range:
121-141
Vigorous intensity HR range for 30+ maternal range:
142-162
Moderate intensity PA should be ____% heart rate reserve (HRR).
40-59% HRR
Vigorous intensity PA should be ____% HRR.
60-80%
As there is minimal info regarding the impact of vigorous PA, women wishing to be active at this intensity are encouraged to …
consult their obstetric care provider
Recommendation 3:
- PA should be accumulated over a minimum of 3 days/week
- however, being active every day is encouraged
- strong recommendation, moderate-quality evidence
In order to see a ___% reduction in the odds of pregnancy complications, need at least ___ days/week.
- 25%
- 3
The higher the ______ the greater the benefits (exercise).
frequency (days)
Recommendation 4:
- pregnant women should incorporate a variety of aerobic exercise and resistance training exercises to achieve greater benefits
- adding yoga and/or gentle stretching may also be beneficial
- strong recommendation, high quality evidence
Type of exercise has ____ _____ evidence.
very limited
Yoga and gentle stretching is on top of _____ min.
150
Yoga was primarily used for ____ health. Not enough info to suggest if it will prevent other _____.
- mental
- complications
Recommendation 5:
- PFMT (eg. Kegel exercises) may be performed on a daily basis to reduce the odds of urinary incontinence
- instruction on the proper technique is recommended to obtain optimal benefits
- weak recommendation, low quality evidence
Urinary incontinence (UI):
involuntary leakage of urine
What can increase the risk of UI?
- hormones
- increased weight of the uterus
Stress UI can occur with…
higher impact activities
Up to ____% of pregnant women experience UI, often persisting into the _____ period.
postpartum
Prenatal ____ alone, or in combination with ____ exercise decreases the odds of UI during pregnancy by ____%.
- PFMT
- aerobic
- 51%
Prenatal _____ alone, or in combination with ____ exercise decreases the odds of UI during postpartum by ____%.
- PFMT
- aerobic
- 47%
Recommendation 6:
- pregnant women who experience light-headedness, nausea or feel unwell when they exercise flat on their back should modify their exercise position to avoid the supine position
- weak recommendation, very low quality evidence
Concerns regarding supine exercise:
- compression of the IVC when supine
- decrease in venous return and CO
- can result in symptomatic hypotension
- removed 16 weeks: symptoms at any time during pregnancy require modification
Very little information regarding ____ exercise.
supine
Some evidence of ______ ____ ____ during and following acute supine exercise.
non-reactive fetal HR
Avoid PA in excessive _____, especially with high _____.
- heat
- humidity
Avoid activities which involve ____ ____ or danger of _____.
- physical contact
- falling
Avoid ____ ____.
scuba diving
Lowlander women (ie living below 2500m) should avoid PA at ____ _____.
high altitude (>2500m)
Those considering athletic _____ or exercising significantly above the recommended guidelines should seek _____.
- competition
- supervision
Maintain adequate ____ and _____. Drink _____ before, during, and after PA.
- nutrition
- hydration
- water
Know the reasons to ____ PA and consult a qualified ___ immediately if they occur.
- stop
- HCP
Removed ___ _____ restriction: global caution re: exercise in excessive _____.
- first trimester
- heat
Pregnant women appear to be able to ____ heat in warm environments.
dissipate
With heat, _____ and _____ is a real concern.
- dehydration
- fainting
Reasons to stop PA and consult a HCP:
- persistent excessive shortness of breath that does not resolve on rest
- severe chest pain
- regular and painful uterine contractions
- vaginal bleeding
- persistent loss of fluid from the vagina indicating rupture of the membranes
- persistent dizziness or faintness that does not resolve on rest
4 traditional concerns about prenatal exercise:
- increase early pregnancy loss
- premature delivery
- increased core body temperature leading to congenital anomalies
- fetal growth restriction
____ increased risk for miscarriage, possible ____ effect.
- no
- protective
Premature:
< 37 weeks
1 in ___ babies born premature worldwide.
10
Short term prematurity:
- underdeveloped lungs
- NICU
Long term prematurity:
- cognitive impairments
- developmental delay
- chronic health issues
____ increased risk of premature delivery.
no
Hot tub use during ______ early in pregnancy increases ____ ____ defects.
- embryogenesis
- neural tube
Maternal core temperature ____ degrees during embryogenesis.
+2.0
Non-RCT evidence did not support an increased risk of _____ anomalies for exercising throughout pregnancy.
congenital
Why do we care about having a small baby?
- redistribute oxygen and nutrients away from baby
- barker demonstrated SGA (small for gestational age) was a risk for CV disease later in life
Exercise was ____ associated with increased risk of a small baby.
not
Macrosomia:
birthweight > 4000g
Exercise reduces the risk of macrosomia by ____%.
39%
Other exercise benefits to the fetus:
- healthier CV system
- decreased adiposity at birth
- lower risk of childhood obesity and diabetes
- higher cognition
Screening for pre-exercise for pregnant women:
- PARmed-X for pregnancy
- 4 pages
- includes contraindications, exercise prescription, precautions
- update in 2019
What to do if you were physically active prior to pregnancy:
- continue but HCP follows
- modify routine as needed
- effects of strenuous exercise is virtually unknown = avoid
- active women with a Hx of preterm labour or growth restriction: reduce activity in 2nd and 3rd trimester
What to do if you were not physically active prior to pregnancy:
- medical screening by HCP
- start in 2nd trimester (or after discomfort of 1st trimester has subsided)
- progress gradually
- additional benefits for GDM
PARmed-X for pregnancy is a _____ tool.
pre-screening
PARmedX is writtenfor maternity _____ to increase communication between ____ and _____.
- HCP
- patient
- clinician
If doing an assessment, need ____ from the woman but remember you are dealing with…
- consent
- 2 (or 3/4 +) individuals not 1
Need to understand the impact of what you are doing to the _____, not just the ____.
- baby
- woman
When pre-screening, pregnant woman have higher ____ but may have lower ____.
- HR (+15%)
- BP
With PARmedX, we should discuss _____ and _____ contraindications to exercise.
- relative
- absolute
Aerobic exercise assessment:
- modified balke
- use Borg scale
- eat 1 hour prior to test
- measure blood sugars and BP before and after test
Why use the modified balke assessment?
- longer warm up/cool down and stages to reduce injury
- pregnant women have increased dyspnea
____ blood sugars following aerobic assessment is common.
low
Why check BP before doing an aerobic assessment?
pregnant women are typically low (increased risk of fainting)
There are currently no guidelines for _____ assessment.
musculoskeletal
How can we err on the side of caution when training a pregnant woman for musculoskeletal health?
- progress slowly
- posture and breathing is critical
- pros/cons of free weights vs machines
- avoid all exercises which risk trauma to abdomen
- lax joints = high risk of injury with quick movements
Purpose of upper and lower back muscular strengthening:
promotion of good posture
Exercises for upper back:
- shoulder shrugs
- shoulder blade pinch
Exercises for lower back:
modified standing opposite leg and arm lifts
Purpose of abdominal muscular strengthening:
- promotion of good posture
- prevent low back pain
- prevent diastasis recti
- strengthen muscles of labour
Exercises for abdomen:
- abdominal tightening
- abdominal curl ups
- head raises lying on side or standing position
Purpose of PF (kegels) strengthening:
- promotion of good bladder control
- prevention of UI
PF (Kegels) exercises:
- wave
- elevator
Purpose of upper body strengthening:
improve muscular support for breasts
Exercises for upper body:
- shoulder rotations
- modified push ups against a wall
Purpose of buttocks, lower limb strengthening:
- facilitation of weight bearing
- prevention of varicose veins
Exercises for buttocks, lower limbs:
- buttocks squeeze
- standing leg lefts
- heel raises
Precautions for muscular conditioning during pregnancy:
- body position
- joint laxity
- abdominal muscles
- posture
Ligaments become relaxed due to ….
increasing hormone levels
Precautions for resistance exercise:
- emphasis must be placed on continuous breathing throughout exercise
- exhale on exertion, inhale on relaxation
- high reps, low weights
- valsalva manoevre causes change in BP, should be avoided
- avoid exercise in supine position past 4 months gestation
_____ of _____ tissue while doing abdominal exercises. Not recommended when ____ ____ develops.
- bulging
- connective
- diastasis recti
How is posture a precaution?
- inc. weight of breasts and uterus results in forward shift of centre of gravity
- increased arch in lower back, shoulders slump forward
- may result in back pain
When can exercise be resumed in postpartum period?
- as soon as it is medically safe
- vaginal delivery: can resume after bleeding stops
- cesarean delivery: wait for clearance at 6 week postpartum check up but gentle walking is okay
_____ exercises can be initiated in the immediate postpartum period.
PF
Postpartum: when starting to exercise….
- take it slow
- listen to your body
Postpartum: moderate intensity exercise does not alter ….
breast milk taste or supply
Postpartum: in order to minimize discomfort, recommend _____ prior to exercise.
breastfeeding
Postpartum depression affects up to ____% of women.
22%
Depressive symptoms affect up to ___% of all postpartum women.
50%
____ exercise is best for reducing depressive symptoms but even ____ ____ on your own is beneficial for mild to moderate depressive symptoms.
- supervised/group
- daily walking
Pregnant athletes are highly _____ population.
understudied
