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CAQ REVIEW

Exercise During Pregnancy


Elizabeth Albright, DO, PGY-2

Physiologic Changes (1): Maternal Benefits (1,4):


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& Musculoskeletal: & Improvement/maintenance of fitness


) Weight gain & Decreased overall pregnancy weight gain
) Shifted center of gravity: due to increased lumbar & Decreased incidence of gestational diabetes mellitus
(GDM)
lordosis caused by anterior pelvic rotation
) Increased ligamentous laxity: from increased pro- ) Improved blood glucose control in patients with GDM
gesterone and relaxin
) Most sports-related injuries are secondary to joint & Reduced risk of preeclampsia
laxity and lower extremity edema & Decreased intrapartum interventions including pito-
cin augmentation and operative vaginal or cesarean
& Cardiac: deliveries
) Increased blood volume: up to 50% at term & Decreased labor time
) Increased heart rate: resting HR can increase 10 to ) Twice as likely to progress from 4 to 10 cm in G4 h
15 bpm ) Decreased length of the second stage of labor from
) Increased stroke volume and cardiac output an average of 60 to 36 min
) Decreased systemic vascular resistance and blood
pressure & Decreased postpartum recovery time
& Respiratory:
) Increased tidal volume and minute ventilation: up Recommendations for Exercise Program (1,2):
to 50% & The goal of exercise during pregnancy is to improve
) Physiologic decrease of pulmonary reserve maternal fitness without increased risk to the mother
or baby.
h Increased work load with decreased oxygen
availability & Motivational interviewing is key. Studies show that
patients are more likely to start/continue an exercise
h Physiologic respiratory alkalosis: not always
program and healthy diet if recommended by a physician.
enough to compensate for metabolic acidosis of
strenuous exercise ) Pregnancy is the ideal time to discuss; most patients
are highly motivated to do what is best for the baby.
& Temperature regulation:
) Dependent on hydration status and environment & Patient categories:
) Previously sedentary: recommend gradual progres-
Fetal Response (1): sion of exercise beginning with walking program
& Increased fetal heart rate (FHR) 10 to 30 bpm over ) Previously active: no safe upper level of intensity es-
baseline during/immediately after exercise tablished. The consensus is to continue previous fit-
& No clinically significant difference in birth weight ness routine if the patient regularly exercises before
& Cohort study assessed umbilical artery blood flow, pregnancy and has an uncomplicated pregnancy.
FHR, and biophysical profile before/after exercise:
30 min of exercise was well tolerated by fetus. & General guidelines:
& Improved fetal tolerance of labor process ) Up to 40 min of moderate exercise is well tol-
erated by low-risk pregnant women (3)
Address for correspondence: Elizabeth Albright, DO, PGY-2, Eglin Family
Medicine Residency Program, 307 Boatner Road, Suite 114, Eglin AFB, FL h Beyond 40 min, maternal glucose levels decrease
32542; E-mail: ebethalbrite12@gmail.com.
Column Editor: John R. Hatzenbuehler, MD; E-mail: jhatz@intermed.com.
and effects are unstudied
) Ensure adequate hydration
1537-890X/1504/226Y227
Current Sports Medicine Reports ) Walking, strength training, and water exercises are
Copyright * 2016 by the American College of Sports Medicine safe for almost all women

226 Volume 15 & Number 4 & July/August 2016 CAQ Review

Copyright © 2016 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
h Biking is safe during the first trimester but ad- h Chest pain
vised against as pregnancy progresses because of h Muscle weakness affecting balance
balance changes and fall risk. h Calf pain or swelling

) Avoid activities with: & Contraindications to exercise


h High risk of fall/impact ) Hemodynamically significant heart disease
h High heat/humidity ) Restrictive lung disease
h Static and supine poses ) Incompetent cervix/cerclage
) Multiple gestation
& Patients may do yoga or Pilates but should ) Second/third trimester bleeding
modify certain poses. ) Placenta previa after 26 wk of gestation
& Supine poses are specifically not recommended ) Premature rupture of membranes or labor
during the second and third trimesters because ) Preeclampsia
these cause decreased venous return. ) Severe anemia
h Exertion at altitudes 96000 ft
h Scuba diving: fetal pulmonary circulation is not References
1. Committee Opinion No. 650 Summary: physical activity and exercise during
mature enough to filter bubble formation, high pregnancy and the postpartum period. Obstet. Gynecol. 2015; 126:e135Y42.
risk of decompression sickness in the fetus 2. Herring SA, Bergfeld JA, Boyajian-O’Neill LA, et al. Female athlete issues
for the team physician: a consensus statement. Med. Sci. Sports Exerc. 2003;
) Stop exercise if any of the following occur: 35:1785Y93.
3. Mottola MF, Inglis S, Brun CR, Hammond J. Physiological and metabo-
h Vaginal bleeding or leaking fluid lic responses of late pregnant women to 40 min of steady-state exercise
h Regular contractions followed by an oral glucose tolerance perturbation. J. Appl. Physiol. 2013;
115:597Y604.
h Dyspnea before exercise
4. Price BB, Amini SB, Kappeler K. Exercise in pregnancy: effect on fitness and
h Dizziness
obstetric outcomesVa randomized trial. Med. Sci. Sports Exerc. 2012; 44:
h Headache 2263Y9.

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