Exercise During Pregnancy KOMPLET

8/3/2019 Exercise During Pregnancy KOMPLET

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Exercise During Pregnancy

RNDr. Ale Jakubec Ph.D

Students : Tijana Radia

Balaban Ljiljana


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Pregnacy and exercise

Exercise has become avital part of manywomen's lives

the physiologic changesassociated with pregnancyas well as thehemodynamic response to

exercise, someprecautions should beobserved


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If women do not have medicalcomplications and can maintainregular exercise duration ofpregnancy but....

women should avoid exercise thatinvolves the risk of abdominal

trauma, falls or excessive jointstress, as in contact sports andvigorous racquet sports

Adequate hydration and proper

ventilation are important toprevent possible effects ofoverheating


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Physiological changes during

pregnancy Musculoskeletal

One of the most obviouschanges in pregnancy is the

alteration of the woman'sbody. Mechanical changesrelated to the weight ofgrowing breasts, uterus andfetus, as well as an increase in

lumbar lordosis, result in ashift in the woman's center ofgravity, which may causeproblems with balance.


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Thermoregulatory adaptations: Feotalhyperthermia, leading to abnormal foetaldevelopment, is a concern if the motherscore temperature is elevated followingexercise. In addressing this concern themothers resting body temperature isreduced and her ability to get rid of the heat

the skin is improved.


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Hemodynamic

Exercise acts in concert with pregnancy to increaseheart rate, stroke volume and cardiac output.However, during exercise, blood is diverted from

abdominal viscera, including the uterus, to supplyexercising muscle.

Measurements of the effect of exercise on fetalheart rate demonstrate either no significant change

or short-term increases of five to 15 beats perminute.


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Oxygen Demands

With mild exercise, pregnant womenhave a greater increase in respiratoryfrequency and oxygen consumption

to meet their greater oxygen demand.As exercise increases to moderate andmaximal levels, however, pregnant

women demonstrate decreasedrespiratory frequency, lower tidal

volume and maximal oxygenconsumption


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Energy Demands

Both exercise and pregnancy areassociated with a high demand for energy.In the first two trimesters, an increasedintake of 150 calories per day is

recommended; an increase of 300 caloriesper day is required in the thirdtrimester.Caloric demands with exerciseare even higher, although no studies havefocused on exact requirements. The

competing energy demands of theexercising mother and the growing fetusraise the theoretic concern that excessiveexercise might adversely affect fetaldevelopment.


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Hormonal adaptations:

Oestrogen: stimulates the growth of the uterus and breasts,and high level of oestrogen can result in excess waterretention, nausea (specially in the first trimester) and jointlooseness.

Progestrone: Thickens and develops the walls of the uterus,controlling and relaxing to stop contracting excessively.Relaxin: Softens ligaments, cartilage and the cervix,allowing these tissues to spread during deliver. This is amajor area you should be careful whilst doing stretching

exercises.Insulin: resistance increases during pregnancy, this makethe pregnant womens pattern of energy utilization similarto that of a mild diabetic. In mid and late pregnancy insulinresistance serves to utilize more fat for maternal energy and

rest during exercise.


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Impact of Pregnancy onExercise Performance

In the third trimester women go through majorchanges, and have to be careful with exercises

Of the sixth month of pregnancy intensityexercise are decreases

exercises such as cycling or swimming are veryhelpful

Rresearch has shown that moderate exercise inlate pregnancy does not influence on prematurebirth, shooting membranes or damage to fetuses


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Recommended

exercise


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Walking

One of the best

cardiovascular exercises forpregnant women, walkingkeeps you fit without jarring

your knees and ankles. It is

safe throughout the ninemonths of pregnancy andcan be built into your day-to-day schedule.


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Jogging - Running

Going for a jog is thequickest and most efficient

way to work your heart andyour body. You can tailor itto your schedule -- running15 minutes one day whenthat's all you can fit in and30 the next when you havethe time.


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Swimming

Healthcare providers and fitness experts hail swimming as thebest and safest exercise for pregnant women. Swimming is idealbecause it exercises both large muscle groups (arms and legs),provides good cardiovascular benefits, and allows pregnant

women to feel weightless despite the extra weight of pregnancy.


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Aquanatal classes

Many women find aquanatal

classes enjoyable duringpregnancy. Exercising whilestanding in water is gentle on

joints and can help lessenswelling in legs, which is a

common symptom in latepregnancy.


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Yoga and stretching

Yoga and stretching can helpmaintain muscle tone and keep

you flexible with little if anyimpact on your joints. However,

you may have to augment a yogaregime by walking a few times a

week to give your heart aworkout. Be careful not tooverdo the stretching. You willbe more supple as a result of the

effects of relaxin, which causesyour ligaments to be morepliable. Don't hold the stretchesfor too long or try to develop

your flexibility too much.


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Pilates

Pilates is a form of exercise which combines flexibility andstrength training with body awareness, breathing and relaxation.The exercises are based on certain movement patterns performed

with your tummy and pelvic floor muscules -- known in Pilatesas the "stable core" or base. These muscles are also known asdeep stabilizing muscles. Because Pilates targets the tummy andpelvic floor muscles and these muscles can weaken duringpregnancy, Pilates exercises can be useful.


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Low-impact aerobics

One good thing about anaerobics class is that it's aconsistent time slot when you

know you'll get some exercise. Ifyou sign up for a classspecifically designed forpregnant women, you'll get toenjoy the camaraderie of others

just like you, and can feelreassured that each movementhas been deemed safe for youand the baby.


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Contraindications to Exercise

women withmedicalcomplicationsshould beencouraged toavoid vigorousphysicalactivity

Contraindications

Pregnancy-inducedhypertension

Preterm rupture of membranes

Preterm labor during the prior or

current pregnancy

Incompetent cervix or cerclage

placement

Persistent second- or third-

trimester bleeding

Placenta previa

Intrauterine growth retardation

Relative contraindications

Chronic hypertension

Thyroid function abnormality

Cardiac disease

Vascular disease


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Recommendations

Studies have not documented a significant rise in core temperaturewith exercise, but thermal stressors present a theoretic risk ofcongenital anomalies in early pregnancy

Women can minimize thermal stress by performing exercise in theearly morning or late evening to improve heat dissipation when it is hotoutside

May be used during stationary cycling or other indoor exercise, andswimming may be an option to improve conductive heat loss

The intensity, duration and frequency of exercise should start at a levelthat does not result in pain, shortness of breath or excessive fatigue

Physical conditioning and well-being, including hydration, caloricintake, and quality of rest

Exercises performed in the supine position are inadvisable after thefirst trimester, as are prolonged periods of motionless standing


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FinalComment

The physiologic interactions between pregnancy andexercise are not fully understood. Although sometheoretic concerns remain about exercise inpregnancy, the data thus far have been reassuring

It should be kept in mind, however, that there aremajor deficits in our knowledge

Some studies have shown positive effects of exerciseand some do not because they are not included in all

social economic categories of womenWhether exercise is harmful or whether it improves

the course and outcome of pregnancy is largelyunknown


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Therefore, no definitiverecommendation can be

made to promote exerciseduring pregnancy

Nevertheless, there appears tobe no reason that most

women cannot continue withexercise during pregnancyand reap the possible benefitsof improvement in well-

being.


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TheAuthors

THOMAS W. WANG, M.D.,is director of the Primary Care Sports Medicine Fellowship atthe Department of Family Practice at MacNeal Hospital,Berwyn, Ill. Dr. Wang graduated from the Medical College ofOhio, Toledo, and served his residency in family practice atthe University of Michigan, Ann Arbor, Medical School.

BARBARA S. APGAR, M.D.,is a clinical associate professor in the Department of FamilyPractice at the University of Michigan Medical School. She isa graduate of Texas Tech University School of Medicine,Lubbock, where she served a family practice residency. Dr.Apgar also completed a master's program at the University

of Michigan and a faculty development fellowship atMichigan State University, East Lansing.

Address correspondence to Thomas W. Wang, M.D., MacNealFamily Practice, 3231 S. Euclid Avenue, Berwyn, IL 60402.Reprints are not available from the authors.


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REFERENCES

American College of Obstetricians and Gynecologists.Exercise during pregnancy and the postpartum period.ACOG Technical Bulletin 189. Washington, D.C.:American College of Obstetricians and Gynecologists,

1994. Calguneri M, Bird HA, Wright V. Changes in joint

laxity occurring during pregnancy. Ann Rheum Dis1982;41:126-8.

Clapp JF 3d. Exercise in pregnancy: a brief clinicalreview


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