ACTIVE LIVING DURING PREGNANCY & POST

PARTUM

Dr. Michelle F. Mottola, Ph.D. FACSM

Director,

R. Samuel McLaughlin Foundation-

Exercise and Pregnancy Laboratory

University of Western Ontario

London, Ont. Canada N6A 3K7

Email: mmottola@uwo.ca

Wolfe et al. Sports Med 1989;8:273-301

MATERNAL AND FETAL WELL-BEING

Optimal zone for maternalexercise prescription

• chronic fatigue

fetal death

• musculo- skeletal injury

• prematurity• fetal growth restriction

• altered fetal development

BASELINE

Threshold for maternalphysical conditioning effects

QUANTITY AND QUALITY OF MATERNAL EXERCISE

decrease

increase

•metabolic and cardiopulmonary reserve• promotion of normal glucose tolerance• psychological benefits

Maternal dose-response curveFetal dose-response curve

• fetal and placentaladaptations

IMPORTANCE OF MEDICAL PRESCREENING

THRESHOLD FOR PROBLEMS??

Prior to 1985 Exercise Guidelines for Pregnant Women did not exist – REST!!

1985 – ACOG suggested heart rate should not go above 140 beats per minute

1994 – ACOG Ignored heart rate; Replaced with common sense guidelines

HISTORICALLY:

2002 – ACOG Ignored heart rate; Replaced with exercise on all days of week!!

Canadian guidelines for active living during pregnancy**Joint SOGC/CSEP Clinical Practice Guideline 2003**CSEP & Health Canada (1996 Revised 2002)

PARmed-X for Pregnancy(Physical activity readiness, medicalprescreening & exercise prescription)- written for physician/midwife or health care

professionalAuthors: L.A. Wolfe, Queens & M.F. Mottola, Western

CSEP & Health Canada (1999)Active Living During Pregnancy

Physical activity guidelines for mother & baby.Author: Angela Kochan-Vintinner (Eds. Wolfe & Mottola)

www.csep.ca

- 4 page document- current history of pregnant women & occupation- list of contraindications to exercise

- absolute, relative- Aerobic conditioning guidelines

F. (frequency) 3- 4 times /weekI. (intensity) target HR zonesT. (time) 15 up to 30 minutesT. (type)

- Muscle conditioning guidelines & precautions- Safety considerations & reasons to consult

physician/midwife

PARmed-X for Pregnancy

• Occupational activity did not impact on birth weight• Structured exercise frequency during late pregnancy appears to be a determinant of birth weight• Too much vs too little vs just right!!

***** 3 – 4 times per week ******

Campbell & Mottola 2001. Amer. J. Obstet. Gynecol. 184:403.

Mottola et al. 2006 – Med. Sci. Sports Exerc. – new zonesVO2peak Prediction and Exercise Prescription for PregnantWomen. 38(8):1389-1395.

Target Heart Rate Zones:20-29 yearsFit – 145 – 160 beats/minuteUnfit – 129 - 144 beats/minute

30-39 yearsFit – 140 – 156 beats/minuteUnfit – 128 – 144 beats/minute

Summary of Canadian GuidelinesSummary of Canadian Guidelines

1. Previously sedentary women with healthy pregnancies can safely start an exercise program in the second trimester

2. Women with low risk pregnancies can continue mild to moderate activity throughout

3. Mild to moderate aerobic activity within the Canadian guidelines (PARmed-X for Pregnancy) is considered safe

4. Muscle conditioning activity with necessary precautions is also considered safe

Adapted from Wolfe et al., 1989

MATERNAL AND FETAL WELL-BEING

Optimal zone for maternalexercise prescription

BASELINE

QUANTITY AND QUALITY OF MATERNAL EXERCISE

• metabolic & cardiopulmonary reserve• promotion of normal glucose tolerance• psychological benefits

Maternal dose-response curveFetal dose-response curve

Threshold for maternalphysical conditioning effects

Fetal & Placental

Adaptations

•Altered Fetal Development

Altered Maternal

Pregnancy Adaptation

?

?

Sedentary lifestyle

*

PRESCRIPTION FOR AEROBIC ACTIVITY DURING PREGNANCY

FREQUENCY

TWO OR LESS TIMES PER WEEK

TOO LITTLE!!?

Campbell & Mottola 2001. Amer. J. Obstet. Gynecol. 184:403.

Cover page of The Economist, December 13-19th, 2003.

Among women of childbearing age, one potential pathway for obesity development is excessive pregnancy weight gain and post partum weight retention

Siega-Riz et al. 2004. Nut Rev 62:S105-11

Pregnancy link to Obesity?????

Impact of maternal & child health on current obesity epidemic?

Intervention times/promoting physical activity? • before conception• during pregnancy• post partum• early years of child’s life by mom’s influence & family life

Prevention vs treatment??

• Pregnancy is time when many women change to a healthier lifestyle

• improve eating habits• quit smoking• stop alcohol use• moderate caffeine consumption• think about active living

Promotion of Active Living During Pregnancy

Stages of Change (Intentional health behaviour change – 5 stages):

• precontemplation (no intention)• contemplation (considering a change)• preparation (making small changes)• action (actively engaging in change)• maintenance (sustaining change over time)

Bull et al. 2001. Med Sci Sports Exerc. 33:1147-56.

• Health care providers promote active living throughout the life span including pregnancy• Many women are interested in maintaining or improving pre pregnancy fitness levels as they become pregnant• Traditional view has been replaced with active living and healthy lifestyle habits before, during and after pregnancy.

Thus it is important that:

What do pregnant women want?

Walking most popular activity

Barriers to physical activity?

Having childrenLack of time

Mottola & Campbell 2003. CJAP 28(4):642-653.

Effective promotion of active living during pregnancy depends on the extent and type of physical activity performed before conception, while taking into account the needs and wants of pregnant women throughout the three trimesters of pregnancy.

How do we promote physical activity during pregnancy??

Education Programs that include:

• benefits of being active during pregnancy• guidelines available for exercise during pregnancy (www.csep.ca)• identified barriers to being active and ways to overcome them• assistance in social support (health care providers, family involvement, transportation, safety issues, facilities, subsidized community programs)

Perhaps community programs which facilitate and encourage walking ,

• such as mall walking (combined with elderly),

• which would also overcome barriers to exercise,

• include child care,• family walks including children

May be successful in promoting active living and physical activity during pregnancy and postpartum!!

(Active Living During Pregnancy, CSEP, 1999)(Active Living During Pregnancy, CSEP, 1999)

Rediscovering the “M” in “MCH”: Rediscovering the “M” in “MCH”: maternal health promotion after childbirthmaternal health promotion after childbirth

– The science and practice of health promotion after childbirth is less well developed except for breast feeding and family planning

– Why should we promote health in the postpartum? Improve women’s health and well-being in the immediate

postpartum period, Reduce the risk of developing heart disease, obesity and

other lifestyle-related diseases.

– Better understanding of women’s health promotion in the 1st postpartum year is an essential step in addressing this neglect in maternal health

Walker LO, Wilging S. JOGNN 2000;29:229-236

Active Living Post-partum

Post-natal Exercise Muscle ConditioningPost-natal Exercise Muscle Conditioning(Active Living During Pregnancy, CSEP, 1999)(Active Living During Pregnancy, CSEP, 1999)

Using baby for post-natal activities

Using baby as resistance tool (carefully!!)

Have fun interacting with baby when doing push-ups

Influence on early post-natal life

• Infants who were fed breast milk or who were breast fed longer had lower risk of overweight in adolescence• Parental feeding patterns• Parental activity patterns• Obese mother – obese child• Maternal influence as care-giver

If maternal-child interaction is a significant initiating factor in the obesity epidemic, will the prevention of excessive weight gain in mother during pregnancy and subsequently less weight retention post-partum lead to lower rates of obesity in successive generations?

Active living during pregnancy & Active living during pregnancy & post-partum??post-partum??