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Clinical Exercise Prescription > pregnancy > Flashcards

pregnancy Flashcards

1
Q

how much does Q increase by

A

30-50%

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2
Q

how much does HR increase by

A

25%
5-10 beats first
total of 15 by 3rd trimester

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3
Q

why does HR increase

A

increased oestrogen and human chronic gondotropin stimulates HR increase
sympathetic NS actiavation secondary to maintining BP
- oestrogen and progestrogen reduce peripheral vascular resistance by 20% thus HR must increase to maintain BP

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4
Q

how much does SV increase by

A

25%

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5
Q

why does SV increase

A

increased blood volume

increased left ventricle

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6
Q

why does blood volume increase

A

progestrone increases production of renin by kidneys

  • Na2+ reabsorption -> kidneys reabsorbs fluid to expand plasma volume
  • increased EDV
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7
Q

why does LV size increase

A

due to maternal hormones

  • oestrogen stimulated myocardial hypertrophy and increased contractility
  • increased blood volume stimulates some myocardial hypertrophy
  • growth is eccentric rather than concentric
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8
Q

how much does blood volume increase by

A

35-50%

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9
Q

how is the increased blood volume offset

A

increase in venous capcitance

increased vasodilation at the skin - increase heat loss to help prevent hyperthermia during exercise

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10
Q

why can anemia occur

A

mismatch of increase in blood volume compared to increase in RBC
results from a relative greater increase in plasma volume than red cell mass

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11
Q

why is there a tendancy to develop varicose veins

A

relaxationation of the blood vessel walls with hormonal changes and from the pressure of the uterus on the inferior vena cava

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12
Q

effect of exercise on varicose viens

A

assists blood flow which helps prevent clots and skeletal muscle venous return to help minimize or prevent

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13
Q

how much can reserve volume be reduced by

A

25%

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14
Q

what pulmonary adapations occur

A

elevation of diaphragm - pushed up by enlarged uterus

rib cage flares outwrads - reducing fillinf effectivness

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15
Q

effect of exercise on endurance

A

may improve 12-15 weeks before increase in body weight and uterus size
results from increased blood volume and RBC mass

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16
Q

how much does resting oxygen consumption increase by

A

15-30%

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17
Q

why does resting oxygen consumption increase

A

due to enlarging uterus and growing fetus

increased work of breathing

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18
Q

why does CHO usage increase

A

foetal demand for glucose is large

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19
Q

why does maternal insulin production increase

A

increase oestrogen casues b-cell hyperplasia
increase insulin production -> hyperinsulinemia
stuimulates lipogenesis by the mother increasing fat deposition

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20
Q

how many women get gestational diabetes

A

2-3%

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21
Q

why does gestaniional diabetes occur

A

high levels of intramuscular fat, reduces GLUT 4 activity reducing cho uptake

22
Q

% of mums who become diabetic 4 years after delievry

A

60%

23
Q

effect of gestational diabetes

A

increased birth weigth
- inceased CHO availiabilty to foetus
- disporportate growth of head and shoulders
baby increases insulin production to counter mother high blood glucose
- insulin is a growth promoter

24
Q

what is pre-eclampsia associated with

A 
hypertriglyceridemia 
insulin resistance 
SNS overactivity 
atherosclerosis lesoins in placenta 
increased leptin 
increased risk of becoming hypertenive
25
Q

how does exercise help pre-ecpampsia

A

Reduced levels of C-reactive protein
- C reactive protein stops endothelium producing NO, thus less vasodilation
Increased nitric oxide production by endothelium = vasodilation
Decreased Leptin

26
Q

effect of decreased leptin

A

Leptin may contribute to hypertension because of its role in stimulating the body to burn fat. Leptin stimulates SNS activity to burn fat – but this increases blood pressure and lead to hypertension

27
Q

gastrointestinal changes

A

Increased plasma progesterone (a smooth muscle relaxant) + increased uterine size
constipation
slowing of gastrointestinal motility
relaxation of the lower oesophageal sphincter, which leads to increased gastric reflux ie: heartburn

28
Q

muscoskeletal changes during pregenacy

A

Anterior displacement of the enlarging uterus changes the woman’s
- centre of gravity
- exaggerates normal lumbar lordosis
↑ in hormone levels (especially progesterone, but also relaxin)
- promotes ligament and joint laxity
- Pelvic area susceptible
The enlarging breasts
- centre of gravity moves inferiorly and anteriorly
- increased weight can contribute to upper back and shoulder pain

29
Q

body mass changes

A 
Average weight gain ≅ 12 kg 
• fetus 3.5kg 
• Uterus 1.0 kg 
• Placenta 0.6kg 
• Amniotic fluid 0.8kg 
• Breast enlargement 1.5kg 
• Maternal fluid gain 2.0kg 
• Maternal fat 2.5kg
30
Q

effect on foetus during acute exercise

A

changes to placenta blood flow
foetal tachycardia
foetal bradycardia
foetal hyperthemia

31
Q

why does placenta blood flow change during actue exercise

A

changes in uteroplacental blood flow
the flow of blood through the placenta remains unchanged, but the flow of blood to the pregnant uterus is reduced, as it is for any organ during exercise.
Foetal oxygen supply not compromised or slightly reduced
- Compensatory increased placental a-vo2 difference (Baby extracts more)
Return to normal (or even higher temporarily) after 20 minutes of stopping

32
Q

why can foetal tachycardia occur during exercise

A 
>160bpm
Foetal HR + 10-30 beats during exercise 
Reduced blood flow? 
Response to circulating maternal catecholamines during exercise
Increased maternal core temperature
33
Q

why can foetal braycardia occur during exercise

A

<120bmp
Response to hypoxia, to reduce foetal O2 demands
Is seen mostly in long-duration exercise and / or post-exercise

34
Q

why can hyperthermia occur during acute exercise

A

Foetal temp is about 5 °(F) higher than maternal temp – thus baby loses heat via this gradient
Could increased maternal temp during exercise reduce heat gradient, plus reduced uterine blood flow meaning less blood is available to remove heat, cause foetal hyperthermia and damage?
No evidence for this as increased sweating, enhanced peripheral vasodilation helps to cool mother’s core temp.

35
Q

effect of chronic exercise on birth weight

A

Findings have been inconsistent
Feotoplacental growth higher in active mothers
Feotoplacental growth lower in active mothers
Birth weight appears unaffected in women who maintain adequate energy balance (diet = exercise)
Mothers who continue to perform a high volume of exercise in mid to late pregnancy, have thinner + lighter babies (200-400g less)

36
Q

effect of chronic exercise on gestational length

A

The concern is that increased norepinephrine and prostaglandin output during exercise could stimulate uterine activity and premature labour.
No real supportive evidence to confirm this

37
Q

contridiction to exercise
prior to starting
absolute

A

Haemodynamically significant heart disease
Restrictive lung disease
Incompetent cervix
Known risk of premature labour
Persistent 2nd or 3rd Trimester bleeding
Placenta previa after 26 weeks
Premature labour during current pregnancy
Ruptured membranes
Preeclampsia
Severe anaemia

38
Q

contridiction to exercise

relative

A 
Severe anaemia 
Unevaluated maternal cardiac dysrhythmias 
Chronic bronchitis 
Poorly control type 1 diabetes 
Extreme morbid obesity 
Extreme underweight (BMI <12) 
History of extremely sedentary lifestyle 
Intrauterine growth restriction 
Poorly controlled hypertension 
Orthopaedic limitations 
Poorly controlled seizures 
Poorly controlled hyperthyroidism 
Heavy smoker
39
Q

reasons to stop exercise

A 
Excessive shortness of breath 
Chest pain or palpitations 
Presyncope or dizziness 
Painful uterine contractions or preterm labour 
Leakage of amniotic fluid 
Vaginal bleeding 
Excessive fatigue 
Abdominal pain, particularly in back or pubic area
Pelvic girdle pain 
Reduced foetal movement 
Dyspnoea before exertion 
Headache 
Muscle weakness 
Calf pain or swelling
40
Q

things to be aware of during first trimester and exercise

A 
preventing hyperthermia 
- adequate hydration 
- wear appropriate clothing 
- environment not to hot or cold 
temp should not excedd 37.8
41
Q

what exercise can be done

A

low risk pregnancy - moderate exercise 30-30 mins on most days
aim towards 150 MVPA
participation in team sports for first 15 weeks

42
Q

submax exercise reponse

A

weigth supported - O2 cost is the same
weight bearing - increase in VO2, cost proportional to weigth
higher HR, SV, VE and Q compared to non preg

43
Q

why is cho delivery to mucsle reduced during submax

A

reduced liver glycogen stores
reduced sympathoadrenal activation reduces catecholamin production reducing delivery of CHO to muscles
foetal dmenad for CHO takes priority

44
Q

what aerobic exercise can be done

A 
3+ days a week 
low impact - cycling, walking 
20-30 minute sessions 
Hr 120-160, 40-60-90% HRmax 
RPE 13-14
45
Q

what resistance training can be done

A

for women already doing, can continue
light to mod loads, 12-15 reps
avoid exercise using valsalvas manoeuvre in 3rd trimester
abdominal conditionimg in 1st and 2nd

46
Q

what flexibilty can be done

A

stretches - not to max ROM
nothing that requires great balance due to chnage in CoG
low impact
get up slowly - BP

47
Q

how many extra calories are required in each trimester

A

1st - 100
2nd - 300
3rd -450

48
Q

does it help being fit during labour

A

mininmal research evidence

hypothetically - higher VO2 should allow female to cope better with O2 demand of labour

49
Q

when can you start exercise post partum if no compliactions

A

walking, plevic floor exercises and stretching may begin immediately

50
Q

when can you start exercise psot partum if compliactions

A

caesarean - medical caregiver consulted first, usually at 6-8 week check up

51
Q

why exercsie post partum

A

may help reverse weight gained during pregnancy
most weight loss occurs in 1st 3 months
no increased weight loss be exercising and breastfeeding due to increase EI

52
Q

effect of training after giving birth

A

peak VO2 increased by 10-25%
BMD naturally declines in lactating women
improved insulin sensivivity
improves body image, psychological well being

Clinical Exercise Prescription (12 decks)

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