GUest Lecture on Preg Flashcards
Influences 2 possibly three generations
Hypertensive disorders of pregnancy is about 3 times risk of chronic hypertension
gestational diabetes have about a 7 times risk of type 2 diabetes and hypertensive disorders of preg and gestational diabetes incresed risk of CVD nd type 2 diabtets in the child
PA have about a 40 percent reduction in diabetes and hypertension in preg and a 67 percent reduction in depression also imporves long term cardiovascula and metabolic health o f the child
History
prior 85 no guidelines 85 not above 140 bpm 94 took away 03 first canadian guidelines
current guidelines
150 mins moderate intensity aerobic and resistence training
benefits in preg pa
40% reduction in pregancy complications 24% refduction in instrumental devlity
What is the min requirement to deal with preg
CCEP CPt but there is a specialization for pregancy specific considerations you have to get
Pregency
Period of rapid and profound change where virtually every physiological system in the body is affected impact PA during pregancy first tri is 1-13 second is 14- 27 third is 28-40 baby is considered done at 37
Adaptations during a normal pregnancy 3 sections
Metabolic - incresed insulin resistence (too much leads to gastrointestional diabetes) lowered glucose availibility for mom and incresed resting VO@
Cardiovascular - incresed HR incresed blood vol incresed strok vol incresed cardiac output decresed vascular resistence if this does not occur BP will go up equal or lower bp
REspiratory - incresed resting ventilation decresed artial co2 torr
decresed bicarbonate incresed chemoreflext sensitivity HCVR HVR
Not all preg progress smoothly
85% of females get preg 20 % will dveleop complicatoins that will negatively impact current and future health
Pre screeening for exercise preg
GAQ pg 1 - contraindications absolute and relative
Absolute contraindications GAQ def and 9 things
Moderate to vig exercise shoul dbe avoided however ADLs may be continued as directed by the health care prof
Ruptured membrane or prematreure labour
unexplained persistent vaginal bleeding
placenta prawvia more than 28 weeks
preclampsia incresed bp
incompetend cervic or cervical insufficieny - less likley to keep in baby
intrauterine growth restriction smol baby
high order mulitples truiplets or larger
unocntrolled type 1 diabetes hypertension or thyroid disease other serioud cardiovascular respiriratory or systemic disorders
Relative contraindications to exercise def and 9 things
Speak with health care professional to discuss pros and cons of exercise is approriate consider scaled back intensity duration and volume
Recurrent loss in a row and very common on ein four
history of spontanoues preterm birth less then 37 weeks
gestational hypertension
symptonatic anaemia
malnutrition
eating disorders
twin preg after 28 weeks
mild moderate cardiovascualr or respiratory disease
other significant consitions
GAQ for preg page.2
assesment of current PA levels general aduce for PA during preg declaration if answer no to all questions on pg 1 continnue if they answer yes to one or more consult helath care prac if prac says no do not continue do not have the scope of practise to go over the head
Referrals
Communuication tool between prg qualified exercise professiona and health care provider identify potential concerns opportunity for health care providers to suggest modications to PA document is updtaed when there is a change in health
Resting HR preg
peaks in 3rd tri by 15-20 bpm 29% of women with over 30 bmi in theird tri go into sinus tachycardia
Rasied cut off to 120 bpm which also lowers the barrier to PA in preg
Resting bp
no preg speicific pre exercise bp cut offs but over 140 over 90 is criteria for hypertensive disorder for preg
Hypertensive disorders
over 140 over 90 after 20 weeks of gestation be very carefule women unaware need to be reffered for futher medical assessment
affects 8 percent of pregnancies and may be associated with reduced iteroplacental blood flow 180% increse in developing cardiovascular disease 25% chance of developing into preclampia which is an absoluete contraindication to prenatal exercise with high rates of pre term birth and perinatal mortality
Glucose control
exercise promotes glucose reuptake into the skeletal muscle
low glucose can casue numerous symptoms including loss ofconsciousness confusion and clumsiness
prior to exercise preg individual shoul dhave atleast 4mmol/l to avoid hypogluycemia which is less then 3.3mmol/l eat one hour pripor keep fast digesting carbs like juice on hand
is working w t1d t2d or gestational diabetes monitor glucose levels closely for atleast 24 hours following activity
FITT prinicble for Preg
F - min 3 days a week to see 25% reduction in odds of preg complication I- below 29 YOA mild is 102-124 moderate is 125- 146 vig is 147-169 after 30 it is 101- 120 mod is 121-141 and vig i 142- 162
T- atleast 150 mins per week
T - aerobic and resistences as well as some yoga may be useful
Type ( modality considerations 3 types and the olympic listing recommendations
physical discormforts need wider base of support
shift in center of gravity through preg
resistence trainng dumbeels vs machine barbell vs kettlebells how it affects form
the olumpic lifting recommendations says as gestation pregressies teh risk of causing traima to growing belly increses as the barbell needs to move away from the body to avoid trauma to the fetus this results in a loss of technique and promotes bas form fo rswitch to kettlebells
MInotoring client what method should you use
Use 2 of the 3 methods
Borg method (RPE)
talk test modertae can speak cant sing and vig cant say more than a few words third one is HR zones as stated before
Other considerations in terms of exercise for preg
Supine exercise - light headedness nausea or feel unwell when they exercise flat on back should modify
compression of inferior vena cava when supine decreses in venous return and cardiac output which cna result in symtomatic hypotension
some evidence of nonreative fetal heart rate during and following acute supine exercise
Hormone
Relaxin -produced by overy and placenta allows ligament to soften and relax to allow delivery but has an affect on all joints caution with activities that are jarring or have quick turns ie soccer appear more flexible soc aution not to overstretch adequate warm up and cool down relaxin is not associated with pain
Pelvic floor muscle trianing
may be performed on a daily basis to reduce risk or urinary incontineince ie kegal exercises urinary incontinence is teh involunatry leakage of urine 75% of women expeirnce UI peristint into the postpartum period
