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KIN 311 > Exercise and Pregnancy > Flashcards

Exercise and Pregnancy Flashcards

1
Q

Goal is to improve the _____ ____ of pregnant and postpartum women and their _____.

A
  • lifelong health

- children

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2
Q

Guidelines for exercise during pregnancy prior to 1985:

A

no guidelines. Rest and relax

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3
Q

Guidelines for exercise during pregnancy 1985:

A
  • ACOG

- no exercise above 140 bpm

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4
Q

Guidelines for exercise during pregnancy 1994:

A
  • ACOG

- no HR guidelines (common sense)

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5
Q

Guidelines for exercise during pregnancy 2003:

A

latest Canadian guidelines

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6
Q

Critical outcomes of exercising while pregnant:

A
  • miscarriage
  • stillbirth
  • neonatal death
  • preterm birth
  • gestational diabetes mellitus
  • gestational hypertension
  • maternal mental health
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7
Q

Important outcomes of exercising while pregnant:

A
  • inadequate gestational weight gain
  • birth defects
  • lower back pain
  • pelvic girdle pain
  • urinary incontinence
  • induction of labour
  • adverse outcomes
  • birth weight
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8
Q

Recommendations ____ is the gold standard, based on ….

A
  • 1-5

- randomized controlled trials (exercise vs no exercise)

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9
Q

Recommendation 6 based on….

A

any study design

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10
Q

What to do if there are absolute contraindications:

A
  • exercise should be avoided

- ADLs may be continued as directed by their health care professional

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11
Q

What to do if there are relative contraindications:

A

speak with health care professional

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12
Q

Absolute contraindications:

A
  • 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
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13
Q

Relative contraindications:

A
  • 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
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14
Q

Recommendation 1:

A
  • all women without contraindication should be physically active throughout pregnancy
  • strong recommendation, moderate quality evidence
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15
Q

Recommendation 1 for women who were previously inactive:

A
  • strong recommendation

- moderate quality evidence

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16
Q

Recommendation 1 for women diagnosed with gestational diabetes mellitus:

A
  • weak recommendation

- low quality evidence

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17
Q

Recommendation 1 for women categorized as overweight or obese (prepregnancy BMI > or equal to ____ kg/m^2):

A
  • 25
  • strong recommendation
  • low quality evidence
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18
Q

Exercise reduces the risk of gestational diabetes by ____%.

A

38

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19
Q

Exercise reduces the risk of gestational hypertension by ____%.

A

39

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20
Q

Exercise reduces the risk of preeclampsia by ____%.

A

41

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21
Q

Pregnancy unmasks future ____ ____ risk.

A

chronic disease

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22
Q

If prenatal exercise reduces ____ and ____, long term risk for ____ may be decreased.

A
  • GDM
  • PE
  • CVD
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23
Q

Exercise reduces the risk of excessive gestational weight gain by _____%.

A

32%

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24
Q

Exercise reduces the risk of depressive symptoms by _____.

A

moderate

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25
Q

Exercise reduces the risk of depression by ____%

A

67%

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26
Q

Recommendation 2:

A
  • 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
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27
Q

Recommendation 2: dose response between an increasing volume of _____ and _____ outcomes.

A
  • exercise

- pregnancy

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28
Q

The threshold for recommendation 2 is a ____% reduction in the odds of developing an outcome.

A

25%

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29
Q

Light intensity HR range for <29 maternal age:

A

102-124 bpm

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30
Q

Moderate intensity HR range for <29 maternal age:

A

125-146 bpm

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31
Q

Vigorous intensity HR range for <29 maternal age:

A

147-169

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32
Q

Light intensity HR range for 30+ maternal age:

A

101-120

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33
Q

Moderate intensity HR range for 30+ maternal range:

A

121-141

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34
Q

Vigorous intensity HR range for 30+ maternal range:

A

142-162

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35
Q

Moderate intensity PA should be ____% heart rate reserve (HRR).

A

40-59% HRR

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36
Q

Vigorous intensity PA should be ____% HRR.

A

60-80%

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37
Q

As there is minimal info regarding the impact of vigorous PA, women wishing to be active at this intensity are encouraged to …

A

consult their obstetric care provider

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38
Q

Recommendation 3:

A
  • PA should be accumulated over a minimum of 3 days/week
  • however, being active every day is encouraged
  • strong recommendation, moderate-quality evidence
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39
Q

In order to see a ___% reduction in the odds of pregnancy complications, need at least ___ days/week.

A
  • 25%

- 3

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40
Q

The higher the ______ the greater the benefits (exercise).

A

frequency (days)

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41
Q

Recommendation 4:

A
  • 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
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42
Q

Type of exercise has ____ _____ evidence.

A

very limited

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43
Q

Yoga and gentle stretching is on top of _____ min.

A

150

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44
Q

Yoga was primarily used for ____ health. Not enough info to suggest if it will prevent other _____.

A
  • mental

- complications

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45
Q

Recommendation 5:

A
  • 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
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46
Q

Urinary incontinence (UI):

A

involuntary leakage of urine

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47
Q

What can increase the risk of UI?

A
  • hormones

- increased weight of the uterus

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48
Q

Stress UI can occur with…

A

higher impact activities

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49
Q

Up to ____% of pregnant women experience UI, often persisting into the _____ period.

A

postpartum

50
Q

Prenatal ____ alone, or in combination with ____ exercise decreases the odds of UI during pregnancy by ____%.

A
  • PFMT
  • aerobic
  • 51%
51
Q

Prenatal _____ alone, or in combination with ____ exercise decreases the odds of UI during postpartum by ____%.

A
  • PFMT
  • aerobic
  • 47%
52
Q

Recommendation 6:

A
  • 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
53
Q

Concerns regarding supine exercise:

A
  • 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
54
Q

Very little information regarding ____ exercise.

A

supine

55
Q

Some evidence of ______ ____ ____ during and following acute supine exercise.

A

non-reactive fetal HR

56
Q

Avoid PA in excessive _____, especially with high _____.

A
  • heat

- humidity

57
Q

Avoid activities which involve ____ ____ or danger of _____.

A
  • physical contact

- falling

58
Q

Avoid ____ ____.

A

scuba diving

59
Q

Lowlander women (ie living below 2500m) should avoid PA at ____ _____.

A

high altitude (>2500m)

60
Q

Those considering athletic _____ or exercising significantly above the recommended guidelines should seek _____.

A
  • competition

- supervision

61
Q

Maintain adequate ____ and _____. Drink _____ before, during, and after PA.

A
  • nutrition
  • hydration
  • water
62
Q

Know the reasons to ____ PA and consult a qualified ___ immediately if they occur.

A
  • stop

- HCP

63
Q

Removed ___ _____ restriction: global caution re: exercise in excessive _____.

A
  • first trimester

- heat

64
Q

Pregnant women appear to be able to ____ heat in warm environments.

A

dissipate

65
Q

With heat, _____ and _____ is a real concern.

A
  • dehydration

- fainting

66
Q

Reasons to stop PA and consult a HCP:

A
  • 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
67
Q

4 traditional concerns about prenatal exercise:

A
  • increase early pregnancy loss
  • premature delivery
  • increased core body temperature leading to congenital anomalies
  • fetal growth restriction
68
Q

____ increased risk for miscarriage, possible ____ effect.

A
  • no

- protective

69
Q

Premature:

A

< 37 weeks

70
Q

1 in ___ babies born premature worldwide.

A

10

71
Q

Short term prematurity:

A
  • underdeveloped lungs

- NICU

72
Q

Long term prematurity:

A
  • cognitive impairments
  • developmental delay
  • chronic health issues
73
Q

____ increased risk of premature delivery.

A

no

74
Q

Hot tub use during ______ early in pregnancy increases ____ ____ defects.

A
  • embryogenesis

- neural tube

75
Q

Maternal core temperature ____ degrees during embryogenesis.

A

+2.0

76
Q

Non-RCT evidence did not support an increased risk of _____ anomalies for exercising throughout pregnancy.

A

congenital

77
Q

Why do we care about having a small baby?

A
  • redistribute oxygen and nutrients away from baby

- barker demonstrated SGA (small for gestational age) was a risk for CV disease later in life

78
Q

Exercise was ____ associated with increased risk of a small baby.

A

not

79
Q

Macrosomia:

A

birthweight > 4000g

80
Q

Exercise reduces the risk of macrosomia by ____%.

A

39%

81
Q

Other exercise benefits to the fetus:

A
  • healthier CV system
  • decreased adiposity at birth
  • lower risk of childhood obesity and diabetes
  • higher cognition
82
Q

Screening for pre-exercise for pregnant women:

A
  • PARmed-X for pregnancy
  • 4 pages
  • includes contraindications, exercise prescription, precautions
  • update in 2019
83
Q

What to do if you were physically active prior to pregnancy:

A
  • 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
84
Q

What to do if you were not physically active prior to pregnancy:

A
  • medical screening by HCP
  • start in 2nd trimester (or after discomfort of 1st trimester has subsided)
  • progress gradually
  • additional benefits for GDM
85
Q

PARmed-X for pregnancy is a _____ tool.

A

pre-screening

86
Q

PARmedX is writtenfor maternity _____ to increase communication between ____ and _____.

A
  • HCP
  • patient
  • clinician
87
Q

If doing an assessment, need ____ from the woman but remember you are dealing with…

A
  • consent

- 2 (or 3/4 +) individuals not 1

88
Q

Need to understand the impact of what you are doing to the _____, not just the ____.

A
  • baby

- woman

89
Q

When pre-screening, pregnant woman have higher ____ but may have lower ____.

A
  • HR (+15%)

- BP

90
Q

With PARmedX, we should discuss _____ and _____ contraindications to exercise.

A
  • relative

- absolute

91
Q

Aerobic exercise assessment:

A
  • modified balke
  • use Borg scale
  • eat 1 hour prior to test
  • measure blood sugars and BP before and after test
92
Q

Why use the modified balke assessment?

A
  • longer warm up/cool down and stages to reduce injury

- pregnant women have increased dyspnea

93
Q

____ blood sugars following aerobic assessment is common.

A

low

94
Q

Why check BP before doing an aerobic assessment?

A

pregnant women are typically low (increased risk of fainting)

95
Q

There are currently no guidelines for _____ assessment.

A

musculoskeletal

96
Q

How can we err on the side of caution when training a pregnant woman for musculoskeletal health?

A
  • 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
97
Q

Purpose of upper and lower back muscular strengthening:

A

promotion of good posture

98
Q

Exercises for upper back:

A
  • shoulder shrugs

- shoulder blade pinch

99
Q

Exercises for lower back:

A

modified standing opposite leg and arm lifts

100
Q

Purpose of abdominal muscular strengthening:

A
  • promotion of good posture
  • prevent low back pain
  • prevent diastasis recti
  • strengthen muscles of labour
101
Q

Exercises for abdomen:

A
  • abdominal tightening
  • abdominal curl ups
  • head raises lying on side or standing position
102
Q

Purpose of PF (kegels) strengthening:

A
  • promotion of good bladder control

- prevention of UI

103
Q

PF (Kegels) exercises:

A
  • wave

- elevator

104
Q

Purpose of upper body strengthening:

A

improve muscular support for breasts

105
Q

Exercises for upper body:

A
  • shoulder rotations

- modified push ups against a wall

106
Q

Purpose of buttocks, lower limb strengthening:

A
  • facilitation of weight bearing

- prevention of varicose veins

107
Q

Exercises for buttocks, lower limbs:

A
  • buttocks squeeze
  • standing leg lefts
  • heel raises
108
Q

Precautions for muscular conditioning during pregnancy:

A
  • body position
  • joint laxity
  • abdominal muscles
  • posture
109
Q

Ligaments become relaxed due to ….

A

increasing hormone levels

110
Q

Precautions for resistance exercise:

A
  • 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
111
Q

_____ of _____ tissue while doing abdominal exercises. Not recommended when ____ ____ develops.

A
  • bulging
  • connective
  • diastasis recti
112
Q

How is posture a precaution?

A
  • 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
113
Q

When can exercise be resumed in postpartum period?

A
  • 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
114
Q

_____ exercises can be initiated in the immediate postpartum period.

A

PF

115
Q

Postpartum: when starting to exercise….

A
  • take it slow

- listen to your body

116
Q

Postpartum: moderate intensity exercise does not alter ….

A

breast milk taste or supply

117
Q

Postpartum: in order to minimize discomfort, recommend _____ prior to exercise.

A

breastfeeding

118
Q

Postpartum depression affects up to ____% of women.

A

22%

119
Q

Depressive symptoms affect up to ___% of all postpartum women.

A

50%

120
Q

____ exercise is best for reducing depressive symptoms but even ____ ____ on your own is beneficial for mild to moderate depressive symptoms.

A
  • supervised/group

- daily walking

121
Q

Pregnant athletes are highly _____ population.

A

understudied

KIN 311 (19 decks)

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