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EXERCISE FOR GIRLS & WOMEN
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Transcript of EXERCISE FOR GIRLS & WOMEN
EXERCISE FOR
GIRLS &
WOMEN
EXERCISE FOR
GIRLS &
WOMEN
1875: Hutchingson:
• Women have a sum total of nervous force equivalent to man
• Women have more organs
• Nervous force is weakened in each organ
• Resistance to disease is weakened
• Women are more sensitive and more liable to derangement
1875: Hutchingson:
• Women have a sum total of nervous force equivalent to man
• Women have more organs
• Nervous force is weakened in each organ
• Resistance to disease is weakened
• Women are more sensitive and more liable to derangement
Historical Attitudes Towards Women
Historical Attitudes Towards Women
1875 Dr. King, Obstetrics & Gynecology1875 Dr. King, Obstetrics & GynecologyWomen menstruate because of a failure to conceiveWomen menstruate because of a failure to conceiveMenstruate occurs because the organ was not used for it’s intended purposeMenstruate occurs because the organ was not used for it’s intended purpose
When an organ is not used = atrophy & diseaseWhen an organ is not used = atrophy & disease
Therefore, once reaching puberty a woman should be encouraged to marry and immediately impregnated
Therefore, once reaching puberty a woman should be encouraged to marry and immediately impregnatedContinuously impregnated as not to menstruateContinuously impregnated as not to menstruate
Beigel, Physician:Beigel, Physician:
10-14 days of Bed Rest
for Each Menstrual Cycle
10-14 days of Bed Rest
for Each Menstrual Cycle
International Olympic Committee: Circa 1900 International Olympic Committee: Circa 1900
Women should not engage in any activity which they cannot wear a long dress
Women should not engage in any activity which they cannot wear a long dress
0
20
40
60
80
100
120
Heart
Rate
(/m
in)
Seargent
Heart Rate Response to Running 540 Yard Run
Wit
hout
Wit
hout
Weari
ng
C
ors
ets
Weari
ng
C
ors
ets
Fashion allowed more
exercise
Fashion allowed more
exercise
1928 Modern Olympics1928 Modern Olympics
11 women
First 800 m Race
11 women
First 800 m Race
• 5 collapsed during the Run
• 5 collapsed at the Finish
• Winner collapsed in the Dressing Room
• 5 collapsed during the Run
• 5 collapsed at the Finish
• Winner collapsed in the Dressing Room
EXERCISE & GYNECOLOGYEXERCISE & GYNECOLOGY
5
10
15
Normal Level Type
AGE OF MENARCHEAGE OF MENARCHE
Hig
h S
chool
Hig
h S
chool
Colle
ge
Colle
ge
Sport
Sport
Balle
tB
alle
t
Oly
mpic
Oly
mpic
MATURATION AND SPORTMATURATION AND SPORT
Does sport delay maturation?
Does sport delay maturation?
Is maturation unsuccessful for
sport?
Is maturation unsuccessful for
sport?
6
8
10
12
14
16
18
Normal Level Type6
8
10
12
14
16
18
Normal Level Type
AGE OF MENARCHEAGE OF MENARCHE
Hig
h S
chool
Hig
h S
chool
Colle
ge
Colle
ge
Sport
Balle
tB
alle
t
Oly
mpic
Oly
mpic
LATER AGE OF MENARCHELATER AGE OF MENARCHE
FEWER COMPAINTS IN MENOPAUSEFEWER COMPAINTS IN MENOPAUSE
Jazman, Frontiers of Hormone Research 2:22, 1973.Jazman, Frontiers of Hormone Research 2:22, 1973.
….AS A
YOUNG WOMAN…
….AS A
YOUNG WOMAN…
AMENORRHEAAMENORRHEA
EATING D
ISORD
ERS
EATING D
ISORD
ERSOST
EOPO
ROSI
S
OST
EOPO
ROSI
S
FEMALE ATHLETE TRIADFEMALE ATHLETE TRIAD
0
10
20
30
40
50
60
70
0
10
20
30
40
50
60
70
Perc
en
t of
Ath
lete
sPerc
en
t of
Ath
lete
s
HSHSC
olle
ge
Colle
ge
Speci
fic
Sp
ort
sS
peci
fic
Sp
ort
s
INCIDENCE OF ANOREXIA & BULIMAINCIDENCE OF ANOREXIA & BULIMA
0
10
20
30
40
50
60
70
Perc
en
t of
Popu
lati
on
(%
)Perc
en
t of
Popu
lati
on
(%
)
General
AthletesAthletes
AMENORRHEAAMENORRHEA
0
5
10
15
20
25
30
35
Marcus eat al, Ann Int Med 102:158-163, 1985
ControlControl
Active Regular Cycling
Active Regular Cycling A
ctiv
e
Am
en
orr
hi
cAct
ive
Am
en
orr
hi
c
OSTEOPOROSISOSTEOPOROSISIn
cid
en
ce o
f B
on
e F
ract
ure
s (%
)In
cid
en
ce o
f B
one F
ract
ure
s (%
)
ACSM RECOMMENDATIONS1. Serious Syndrome
2. Unrealistic pressures to lose weight in athletics.
3. Sports Medicine Professionals need more education
4. Screening programs should be developed.
5. Develop prevention strategies
6. Educate parents to have reasonable goals for children.
7. Educate the girls
8. More research.
1. Serious Syndrome
2. Unrealistic pressures to lose weight in athletics.
3. Sports Medicine Professionals need more education
4. Screening programs should be developed.
5. Develop prevention strategies
6. Educate parents to have reasonable goals for children.
7. Educate the girls
8. More research.
EXERCISE IN PREGNANCYEXERCISE IN PREGNANCY
PREGNANCYPREGNANCYEXERCISE
• SKELETAL
• METABOLISM
• RESPIRATORY
• CARDIOVASCULAR
• ENDOCRINE
• THERMOREGULATION
• SKELETAL
• METABOLISM
• RESPIRATORY
• CARDIOVASCULAR
• ENDOCRINE
• THERMOREGULATION
1. Safe for mother?
2. Safe for fetus
3. Affect on pregnancy outcome?
1. Safe for mother?
2. Safe for fetus
3. Affect on pregnancy outcome?
EXERCISE IN PREGNANCY
0
2
4
6
8
10
12
14
0 13 27 40
Weig
ht
(kg)
Weig
ht
(kg
)
Weeks of Gestation (wks)Weeks of Gestation (wks)
WEIGHT GAIN DURING PREGANACY
SKELETAL SYSTEM
Lumbar LordosisLumbar Lordosis
Forward displacement of the center
of gravity
Forward displacement of the center
of gravity
Increased anterior flexion of cervical spine
Increased anterior flexion of cervical spine
Forward rotation of
Pelvis & Femur
Forward rotation of
Pelvis & Femur
PREGNANCYPREGNANCY EXERCISE
1. Lumbar Lordosis
2. Cervical Spine
3. Pelvis & Femur
4. Center of Gravity
1. Lumbar Lordosis
2. Cervical Spine
3. Pelvis & Femur
4. Center of Gravity
1. Lumbrosacral Pain2. Compression Syndromes
1. Carpal Tunnel2. Ulnar Nerve3. Posterior Tibial4. Perennial
1. Lumbrosacral Pain2. Compression Syndromes
1. Carpal Tunnel2. Ulnar Nerve3. Posterior Tibial4. Perennial
SKELETAL SYSTEMSKELETAL SYSTEM
5. Increased joint mobility5. Increased joint mobility 5. Overextension Injury5. Overextension Injury
META
BO
LISM
META
BO
LISM
PREGNANCYPREGNANCY EXERCISEEXERCISE
1. Increased Resting Metabolism
1. 80,000 cal
2. 300 cal/day
1. Increased Resting Metabolism
1. 80,000 cal
2. 300 cal/day
1. Increased metabolism at submaximal work
1. Increased metabolism at submaximal work
METABOLISMMETABOLISM
2. Glucose = primary fuel2. Glucose = primary fuel
2. Hypoglycemia2. Hypoglycemia
RESPIRATORY
SYSTEM
RESPIRATORY
SYSTEM
1. Chest cavity increases transverse diameter
2. Raised diaphragm
1. Chest cavity increases transverse diameter
2. Raised diaphragm
PULMONARY FUNCTIONS
- 2000
- 1000
0
1000
2000
3000
4000
NonPregnant Pregnant
RV
Tidal Vol.
Exp Res
Insp Res
Volu
me (
ml)
Volu
me (
ml)
PREGNANCYPREGNANCY EXERCISEEXERCISE
1. Pulmonary Functions
1. Pulmonary Functions
1. Increased tidal volume
2. Decreased Residual Vol
1. Increased tidal volume
2. Decreased Residual Vol
RESPIRATORY SYSTEMRESPIRATORY SYSTEM
2. Metabolism & Pulmonary Functions
2. Metabolism & Pulmonary Functions
3. 40% increase in Resting Minute Ventilation (VE)
3. 40% increase in Resting Minute Ventilation (VE)
RESTING HEART RATE
60
65
70
75
80
85
90
0 8 12 16 20 24 28 32 36 40 Post
Heart
Rate
(/m
in)
Heart
Rate
(/m
in)
Gestation (wks)Gestation (wks)Wilson et al., Am J Med 68:97, 1980.
CARDIOVASCULAR SYSTEM
0
10
20
30
40
50
60
0 12 20 28 36
Gestation (wks)Gestation (wks)
Perc
en
t In
crease
(%
)Perc
en
t In
crease
(%
)
Blood Volume
Cardiac Output
PREGNANCYPREGNANCY EXERCISEEXERCISE
1. Cardiac Output
1. Heart Rate
2. Stroke Volume
1. Cardiac Output
1. Heart Rate
2. Stroke Volume
1. Decreased Physical Work Capacity
2. Increased Sub-maximal work1. Heart Rate2. Stroke
Volume3. Cardiac
Output
1. Decreased Physical Work Capacity
2. Increased Sub-maximal work1. Heart Rate2. Stroke
Volume3. Cardiac
Output
CARDIOVASCULAR SYSTEMCARDIOVASCULAR SYSTEM
CARDIOVASCULAR SYSTEM
100
110
120
130
140
150 250 300
Non
<19 wks
20- 28 wks
29- 35 wks
36- 40 wk
Heart
Rate
(/m
in)
Heart
Rate
(/m
in)
Workrate (kpm/min)Workrate (kpm/min)
40
50
60
70
80
90
150 250 300
Non
<19 wks
20- 28 wks
29- 35 wks
36- 40 wk
Workrate (kpm/min)Workrate (kpm/min)
CARDIOVASCULAR SYSTEMS
troke
Volu
me (
cc)
Str
oke
Volu
me (
cc)
2
4
6
8
10
12
150 250 300
Non
<19 wks
20- 28 wks
29- 35 wks
36- 40 wk
2
4
6
8
10
12
150 250 300
Non
<19 wks
20- 28 wks
29- 35 wks
36- 40 wk
Workrate (kpm/min)Workrate (kpm/min)
CARDIOVASCULAR SYSTEMC
ard
iac
Ou
tput
(L/m
in)
Card
iac
Ou
tput
(L/m
in)
60
80
100
120
150 250 300
Non
<19 wks
20- 28 wks
29- 35 wks
36- 40 wk
60
80
100
120
150 250 300
Non
<19 wks
20- 28 wks
29- 35 wks
36- 40 wk
Workrate (kpm/min)Workrate (kpm/min)
CARDIOVASCULAR SYSTEMC
(a-v
)O2 (
ml/L)
C(a
-v)O
2 (
ml/L)
PHYSICAL WORK CAPACITY
• Lowest PWC in First Trimester
• Highest PWC in Second Trimester
• Decreases as Body Weight Increases in Third Trimester
• Lowest PWC in First Trimester
• Highest PWC in Second Trimester
• Decreases as Body Weight Increases in Third Trimester
ENDOCRINE SYSTEM
Gestation (days)Gestation (days)
HCG
0
5
10
15
20
25
30
35
40
0 70 140 210 280
Estriol
HSC
Pregnanediol
Con
cen
trati
on (
iu/1
00
0m
l u
rin
e)
Con
cen
trati
on (
iu/1
00
0m
l u
rine)
PREGNANCYPREGNANCY EXERCISEEXERCISE
1. Hormone Changes
1. Hormone Changes
1. Physical Work Capacity
2. Joint Injury3. Gestational
Diabetes
1. Physical Work Capacity
2. Joint Injury3. Gestational
Diabetes
ENDOCRINE SYSTEMENDOCRINE SYSTEM
PREGNANCYPREGNANCY EXERCISEEXERCISE
1. Increased Sweat Gland Activity
2. Shunt blood to Periphery
3. Fetus >1oC
1. Increased Sweat Gland Activity
2. Shunt blood to Periphery
3. Fetus >1oC
1. Dehydration2. Heat Related
Injury3. Spinal Cord
Growth Retardation (1st trimester)
1. Dehydration2. Heat Related
Injury3. Spinal Cord
Growth Retardation (1st trimester)
THERMOREGULATIONTHERMOREGULATION
1. Safe for mother?
2. Safe for fetus
3. Affect on pregnancy outcome?
1. Safe for mother?
2. Safe for fetus
3. Affect on pregnancy outcome?
EXERCISE IN PREGNANCYEXERCISE IN PREGNANCY
FOR THE MOTHER?FOR THE MOTHER?Exercise Training during PregnancyExercise Training during Pregnancy
1. Physical Work Capacity1. Increases during pregnancy
2. Not above Pre-Pregnant Values
2. Lower Exercise Heart Rates*1. At same workrate
3. Increased Heart Volume*
1. Physical Work Capacity1. Increases during pregnancy
2. Not above Pre-Pregnant Values
2. Lower Exercise Heart Rates*1. At same workrate
3. Increased Heart Volume** Not all studies agree
FOR THE MOTHER?FOR THE MOTHER?1. Skinfold thickness
2. Maternal Weight Gain
3. Resting Heart Rate
4. Maximal Heart Rate
5. Exercising Heart Rates*
6. Cardiac Output at Submax
7. Stroke Volume at Submax
8. Resting & Orthostatic Blood Pressures
9. VO2 at submax
10.Resting Metabolism
11.VEmax
12.VEsubmax
1. Skinfold thickness
2. Maternal Weight Gain
3. Resting Heart Rate
4. Maximal Heart Rate
5. Exercising Heart Rates*
6. Cardiac Output at Submax
7. Stroke Volume at Submax
8. Resting & Orthostatic Blood Pressures
9. VO2 at submax
10.Resting Metabolism
11.VEmax
12.VEsubmax
FOR THE FETUS?
FETAL HEART RATESFETAL HEART RATES
Deceleration >15 /min Normal response to mild or transient
hypoxia
Moderate 100-120/min Initial response to
Bradycardia hypoxia
Profound <100/min Normal response to
Bradycardia prolonged hypoxia
Tachycardia >160/min Compensatory adaptation
during hypoxic recovery
Deceleration >15 /min Normal response to mild or transient
hypoxia
Moderate 100-120/min Initial response to
Bradycardia hypoxia
Profound <100/min Normal response to
Bradycardia prolonged hypoxia
Tachycardia >160/min Compensatory adaptation
during hypoxic recovery
FETAL HEART RATESFETAL HEART RATES
1. During Exercise1. Slight Increase
2. Slight Decrease
3. No change
2. Recovery from Exercise
1. Slight Increase
2. Slight Decrease
3. No change
1. During Exercise1. Slight Increase
2. Slight Decrease
3. No change
2. Recovery from Exercise
1. Slight Increase
2. Slight Decrease
3. No change
FETAL HEART RATESFETAL HEART RATES
Hon & Wohlgemuth, Am J Obstet Gynecol 81:361-371, 1961.
6/40 Exercise Studies• Bradycardia• Irregularity• Tachycardia
6/40 Exercise Studies• Bradycardia• Irregularity• Tachycardia
• Cord tightly wrapped around neck (3x)
• Loop of umbilical cord prolapsed by head
• Flattened umbilical cord (4”)
• Fetal distress at birth
• Cord tightly wrapped around neck (3x)
• Loop of umbilical cord prolapsed by head
• Flattened umbilical cord (4”)
• Fetal distress at birth
UTERINE BLOOD FLOWUTERINE BLOOD FLOW
0
2
4
6
8
10
Normal Pre- Eclaptic
Rest
Exercise
Recovery
0
2
4
6
8
10
Normal Pre- Eclaptic
Rest
Exercise
Recovery
Cle
ara
nce
Tim
es
(min
)C
leara
nce
Tim
es
(min
)
Morris, et al., Lancet 8 Sept 1956; pg 481-484
• Human
•26 normal
•29 Pre-Ec
• Supine Ex
• Radioactive Na+
• Human
•26 normal
•29 Pre-Ec
• Supine Ex
• Radioactive Na+
UTERINE BLOOD FLOW
Orr, et al., Am J Obstet Gynecol 114:213-217, 1972Orr, et al., Am J Obstet Gynecol 114:213-217, 1972
0
10
20
30
40
50
60
70
80
Rest 2 3 Max
Pregnant
Non- PregnantPerc
en
t C
han
ge f
rom
Rest
(%
)Perc
en
t C
han
ge f
rom
Rest
(%
)• 6 Pregnant
• 2 Non-Pregnant
• Flow of Uterine Artery
• 6 Pregnant
• 2 Non-Pregnant
• Flow of Uterine Artery
0
20
40
60
80
100
Endometrium Placenta
Pre
Post
Perc
en
t of
Ute
rin
e B
lood
Flo
w (
%)
Perc
en
t of
Ute
rin
e B
lood
Flo
w (
%)
Curet, et al., J Appl Physiol 40:725-728, 1976Curet, et al., J Appl Physiol 40:725-728, 1976
• 3 mph 10%
• Exhaustion
• n=10
• Cath
• 3 mph 10%
• Exhaustion
• n=10
• Cath
UTERINE BLOOD FLOW
UTERINE BLOOD FLOW
0
10
20
30
40
50
60
70
80
90
Maternal Fetal
Rest
Exercise
Recovery
0
10
20
30
40
50
60
70
80
90
Maternal Fetal
Rest
Exercise
Recovery
PO
2 (m
mH
g)
PO
2 (m
mH
g)
Emmanouilides et al. Am J Obstet Gynecol 122:130-137, 1972Emmanouilides et al. Am J Obstet Gynecol 122:130-137, 1972
UTERINE BLOOD FLOW
0
5
10
15
20
25
30
35
40
45
50
Maternal Fetal
Rest
Exercise
RecoveryPC
O2
(mm
Hg
)P
CO
2 (m
mH
g)
Emmanouilides et al. Am J Obstet Gynecol 122:130-137, 1972Emmanouilides et al. Am J Obstet Gynecol 122:130-137, 1972
UTERINE BLOOD FLOW
7
7.2
7.4
7.6
7.8
8
Maternal Fetal
Rest
Exercise
Recovery
7
7.2
7.4
7.6
7.8
8
Maternal Fetal
Rest
Exercise
Recovery
pH
pH
Emmanouilides et al. Am J Obstet Gynecol 122:130-137, 1972Emmanouilides et al. Am J Obstet Gynecol 122:130-137, 1972
FETAL GLUCOSE
10
15
20
25
30
35
40
0 15 30 45 60 Rec
NonPregnantPregnant
Soultanakis, et al., Seminars in Perinatology. 20(4):315-27, 1996
Glu
cose
(m
g/d
l)
Time (min)
FETAL TEMPERATURES
35
36
37
38
39
40
0 15 30 45 60 Rec
NonPregnantPregnant
Soultanakis, et al., Seminars in Perinatology. 20(4):315-27, 1996
Co
re T
emp
erat
ure
(C
o)
Time (min)
PREGNANCY OUTCOME
1. Stages of Labor
2. Complications of Labor & Delivery
3. Health of Infant
1. Stages of Labor
2. Complications of Labor & Delivery
3. Health of Infant
PREGNANCY OUTCOMEPREGNANCY OUTCOME
STAGES OF LABORSTAGES OF LABOR
1. Progressive Cervical Dilation 8 to 24 hrs (same as head)
2. Head moves into birth canal 1 – 30 min to birth
3. Passing of the Placenta
1. Progressive Cervical Dilation 8 to 24 hrs (same as head)
2. Head moves into birth canal 1 – 30 min to birth
3. Passing of the Placenta
PREGNANCY OUTCOMEPREGNANCY OUTCOME
STAGES OF LABORSTAGES OF LABOR
1. Duration of Labor
1. Primi- or Multi-parous
2. Mode of Delivery
3. Work of Labor & Delivery
1. Duration of Labor
1. Primi- or Multi-parous
2. Mode of Delivery
3. Work of Labor & Delivery
Complications of Labor & DeliveryComplications of Labor & Delivery
1. Pre-Mature
2. Caesarean Section
3. Rupture
4. Perineotomy
5. Episiotomy
6. Forceps Delivery
1. Pre-Mature
2. Caesarean Section
3. Rupture
4. Perineotomy
5. Episiotomy
6. Forceps Delivery
PREGNANCY OUTCOMEPREGNANCY OUTCOME
Health of InfantHealth of Infant
1. Apgar Scores
2. Neonatal Complications
3. Infant Birth Weight
4. Infant Head Circumference
1. Apgar Scores
2. Neonatal Complications
3. Infant Birth Weight
4. Infant Head Circumference
APGAR SCORESAPGAR SCORES0 1 2
Heart Rate Absent <100 >100
Respiratory Absent Weak Strong Cry Effort
Muscle Tone Limp Some Fl Flex
Extremities
Reflex (feet) Absent Some Cry Irritability Motion
Color Blue Body PinkCompletely Limbs blue Pink
0 1 2
Heart Rate Absent <100 >100
Respiratory Absent Weak Strong Cry Effort
Muscle Tone Limp Some Fl Flex
Extremities
Reflex (feet) Absent Some Cry Irritability Motion
Color Blue Body PinkCompletely Limbs blue Pink
Perfect
10
Perfect
10
Neonatal ComplicationsNeonatal Complications
1. Asphyxiated Infants
2. Neonatal Morbidity
1. Asphyxiated Infants
2. Neonatal Morbidity
PREGNANCY OUTCOMEPREGNANCY OUTCOME
0
500
1000
1500
First Total
Control Exercise
0
500
1000
1500
First Total
Control Exercise
Lamasze
• 276 Exercise
• 281 Control
Lamasze
• 276 Exercise
• 281 Control
0
20
40
60
80
100
Second Third
0
20
40
60
80
100
Second Third
Min
ute
sM
inu
tes
Rodway et al. J Obstet Gynec Brt Comm 54:77-85, 1947.
Rodway et al. J Obstet Gynec Brt Comm 54:77-85, 1947.
BIRTH WEIGHT
3000
3200
3400
3600
3800
<20
wks
20-2
8 wk
s
29-3
0 wk
s
34-3
8 wk
s
>38
wks
Sitting Work
Standing Work
Other Children
3000
3200
3400
3600
3800
<20
wks
20-2
8 wk
s
29-3
0 wk
s
34-3
8 wk
s
>38
wks
Sitting Work
Standing Work
Other Children
Naeye & Peters, Pediatrics 69:724-727, 1982.Naeye & Peters, Pediatrics 69:724-727, 1982.
Infa
nt
Bir
th W
eig
ht
(gm
s)In
fan
t B
irth
Weig
ht
(gm
s)
ATHLETIC TRAINING
• 729 athletes• General
population
ATHLETIC TRAINING
Perc
en
t of
Sam
ple
(%
)
n=64 n=59 n=27
• Disturbances with Pregnancy
• Competing during Pregnancy
• Good Pregnancy Outcome
• Improved Performance after
EXERCISE IN PREGNANCYEXERCISE IN PREGNANCY
• Not Unsafe for Mother or Fetus
• In moderation
• No Athletic Competition or Sport
• Not Unsafe for Mother or Fetus
• In moderation
• No Athletic Competition or Sport
1. Physical conditioning during pregnancy results in no detrimental effect on pregnancy outcome.
2. Physical conditioning during pregnancy does not appear to result in the same physiological changes as physical conditioning in the non-pregnant state.
3. Continued athletic training during pregnancy may result in obstetric complications.
4. Athletic training, if discontinued during pregnancy results in no detrimental effects on pregnancy.
5. Pregnancy may improve athletic performance following pregnancy. 1. Continued occupational activity during the last weeks of pregnancy
can result in lower infant birth weight which in some cases, is related to poorer infant health.
ABSOLUTE CONTRAINDICATIONS FOR EXERICSE IN PREGNANCY
ABSOLUTE CONTRAINDICATIONS FOR EXERICSE IN PREGNANCY
• Heart Disease• Restrictive lung disease•Pregnancy induced hypertension•Incompetent Cervix•Multiple Gestation•Hx: Placenta Previa• Hx: Breech Presentation• Hx: Ruptured Membranes•Hx: Premature Labor
• Heart Disease• Restrictive lung disease•Pregnancy induced hypertension•Incompetent Cervix•Multiple Gestation•Hx: Placenta Previa• Hx: Breech Presentation• Hx: Ruptured Membranes•Hx: Premature Labor
RELA
TIV
E
CO
NTR
AIN
DIC
ATIO
NS F
OR
EX
ER
ICSE IN
PR
EG
NA
NC
Y
RELA
TIV
E
CO
NTR
AIN
DIC
ATIO
NS F
OR
EX
ER
ICSE IN
PR
EG
NA
NC
Y • Anemia• Maternal cardiac arrhythmia• Chronic bronchitis• Extreme Morbid Obesity• Extreme Underweight (BMI <12)
• Orthopedic limitations• Heavy Smoker• Poorly controlled
• Thyroid Disease• Type 1 diabetes• Hypertension/pre eclampsia• Seizure disorder
• Anemia• Maternal cardiac arrhythmia• Chronic bronchitis• Extreme Morbid Obesity• Extreme Underweight (BMI <12)
• Orthopedic limitations• Heavy Smoker• Poorly controlled
• Thyroid Disease• Type 1 diabetes• Hypertension/pre eclampsia• Seizure disorder
MODE CV; non-wt bearing as weight increases
Discontinue Athletic Training
Flexibility for Muscle Soreness
Muscle Endurance is OK
FREQUENCY 3-4/wk (resistance 2/wk)
DURATION 20-30 min up to 60 min
INTENSITY Moderate 50-85% (< Ventilatory threshold)
Not guided by Heart Rates
MODE CV; non-wt bearing as weight increases
Discontinue Athletic Training
Flexibility for Muscle Soreness
Muscle Endurance is OK
FREQUENCY 3-4/wk (resistance 2/wk)
DURATION 20-30 min up to 60 min
INTENSITY Moderate 50-85% (< Ventilatory threshold)
Not guided by Heart Rates
EXRX: PregnancyEXRX: Pregnancy
EXRX: PregnancyEXRX: PregnancyPRECAUTIONS
1.Thermoregulation
2. Injury
3. Supine Exercise (>4 months)
4. As pregnancy progresses
1. Move to non-weight bearing
2. Decrease intensity increase frequency
PRECAUTIONS
1.Thermoregulation
2. Injury
3. Supine Exercise (>4 months)
4. As pregnancy progresses
1. Move to non-weight bearing
2. Decrease intensity increase frequency
EXRX: PregnancyEXRX: Pregnancy
DISCONTINUE:1. Pain or Bleeding
2. Dizziness or Faintness
3. Pubic Pain
4. Palpitations
5. Back Pain
6. Shortness of Breath
7. Difficulty Walking
DISCONTINUE:1. Pain or Bleeding
2. Dizziness or Faintness
3. Pubic Pain
4. Palpitations
5. Back Pain
6. Shortness of Breath
7. Difficulty Walking
EXERCISE IN POST-PARTUMEXERCISE IN POST-PARTUM
• Beginning In 1974
• Infants Refused to Nurse following Maternal Exercise
• 7%
• Beginning In 1974
• Infants Refused to Nurse following Maternal Exercise
• 7%
0
2
4
6
8
Rest 10 min Post 30 min Post
Blood
Milk
Wallace & Rabin, Int J Sports Med 12:328-331, 1991Wallace & Rabin, Int J Sports Med 12:328-331, 1991
Lact
ic A
cid
(m
M/L
)La
ctic
Aci
d (
mM
/L)
Concentrations of Lactic Acid in Blood and Milk following Maximal Exercise
Concentrations of Lactic Acid in Blood and Milk following Maximal Exercise
0
0.5
1
1.5
2
2.5
3
Workout Aerobics Walk/ J og Maximal
Pre
Post
Wallace et al, J Women’s Health 3:91-96, 1994 Wallace et al, J Women’s Health 3:91-96, 1994
Lact
ic A
cid
(m
M/L
)La
ctic
Aci
d (
mM
/L)
Concentrations of Lactic Acid in Milk following a Normal Workout & Maximal
Exercise
SOUR MILK?SOUR MILK?
0
2
4
6
8
10
1 2 3 4 5
PE
RC
EP
TIO
N O
F T
AS
TE
PE
RC
EP
TIO
N O
F T
AS
TE AcceptAccept
RejectReject
Lactic Acid ConcentrationLactic Acid Concentration
THE RELATIOSHIP BETWEEN TASTE AND LACTIC ACID CONENTRATIONS IN MOTHER’S MILK
THE RELATIOSHIP BETWEEN TASTE AND LACTIC ACID CONENTRATIONS IN MOTHER’S MILK
Detect Recognize
EXERCISE GUIDELINES FOR LACTATION
EXERCISE GUIDELINES FOR LACTATION
Only for Women who have ProblemsOnly for Women who have Problems
1. Nurse before Exercise
2. Collect Milk before Exercise
3. Discard first 30-60 min post exercise milk production
4. Exercise below Ventilatory Threshold
1. Nurse before Exercise
2. Collect Milk before Exercise
3. Discard first 30-60 min post exercise milk production
4. Exercise below Ventilatory Threshold
IN MENOPAUSEIN MENOPAUSE
• Increased Risk of Disease• Heart Disease• Hypertension• Hyperlipidemia• Breast Cancer
• Symptoms of Menopause
• Hot Flash• Insomnia• Fatigue• Nervousness/Depression
• Increased Risk of Disease• Heart Disease• Hypertension• Hyperlipidemia• Breast Cancer
• Symptoms of Menopause
• Hot Flash• Insomnia• Fatigue• Nervousness/Depression
STUDIES ON MENOPAUSAL SYMPTOMSSTUDIES ON MENOPAUSAL SYMPTOMS
• Subjects• 11 Pre• 7 Peri-• 11 Post
• Exercise• Walk/Jog• Swim• Dance• Aerobic Games• 4/wk for 6 wks• Moderate
• Subjects• 11 Pre• 7 Peri-• 11 Post
• Exercise• Walk/Jog• Swim• Dance• Aerobic Games• 4/wk for 6 wks• Moderate
• Subjects• 9 Post• 4 Control
• Exercise• Walk/Jog• 3/wk for 12 wks• Moderate
• Subjects• 9 Post• 4 Control
• Exercise• Walk/Jog• 3/wk for 12 wks• Moderate
•Subjects• 10 Post• 10 Control
• Exercise• Walk/Jog• 3/wk for 12 wks• Moderate
•Subjects• 10 Post• 10 Control
• Exercise• Walk/Jog• 3/wk for 12 wks• Moderate
PENN STATEPENN STATE SAN DIEGO STATESAN DIEGO STATE IUIU
-80
-60
-40
-20
0
20
40
60
Penn State San Diego I U
Exercise
Control
-80
-60
-40
-20
0
20
40
60
Penn State San Diego I U
Exercise
Control
Ch
an
ges
wit
h T
rain
ing
(%
)C
han
ges
wit
h T
rain
ing
(%
)
CHANGES IN POSTMENOPAUSAL SYMPTOMS WITH TRAIING
CHANGES IN POSTMENOPAUSAL SYMPTOMS WITH TRAIING
IN OLD AGE
IMMERSION EXERCISEIMMERSION EXERCISE
McMurray, R.G., et al. American Journal of Obstetrics & Gynecology. 158(3 Pt 1):481-6, 1988
• 12 pregnant women• 15, 25, 35 weeks• 8-10 wks postpartum
• 20 min of immersion
• 30oC
• 20 min of exercise @ 60% VO2max (bike)
• 20 min supine recovery
• 12 pregnant women• 15, 25, 35 weeks• 8-10 wks postpartum
• 20 min of immersion
• 30oC
• 20 min of exercise @ 60% VO2max (bike)
• 20 min supine recovery
IMMERSION EXERCISEIMMERSION EXERCISE
McMurray, R.G., et al., International Journal of Sports Medicine. 9(6):443-7, 1988
• HRwater <HRland
• Qwater>Qpostpartum
• PVRwater<PVRpostpartum
Pregnancy has increased demand, yet water reduces those demands