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 Pregnacy and exercise
• Exercise has become a
vital part of many
women's lives
• the physiologic changes
associated with pregnancy
as well as the
hemodynamic response to
exercise, some precautions
should be observed
If women do not have medical
complications and can maintain
regular exercise duration of
pregnancy but....
women should avoid exercise thatff*)
involves the risk of abdominal
trauma, falls or excessive joint
stress, as in contact sports
and vigorous racquet sports
Adequate hydration and
proper ventilation are
important to prevent possible
effects of
overheating
pregnancy
• Musculoskeletal
One of the most obvious
changes in pregnancy is the
alteration of the woman's body.
Mechanical changes related to
the weight of growing breasts,
uterus and fetus, as well as an
increase in lumbar lordosis,
result in a shift in the woman's
center of gravity, which may
cause problems with balance.
Thermoregulatory adaptations: Feotal
hyperthermia, leading to abnormal foetal
development, is a concern if the mothers
core temperature is elevated following
exercise. In addressing this concern the
mother’s resting body temperature is
reduced and her ability to get rid of the
heat the skin is improved.
Hemodynamic
Exercise acts in concert with pregnancy to increase
heart rate, stroke volume and cardiac output. However,
during exercise, blood is diverted from abdominal
viscera, including the uterus, to supply exercising
muscle.
Measurements of the effect of exercise on fetal heart
rate demonstrate either no significant change or short-
term increases of five to 15 beats per minute.
Oxygen Demands

With mild exercise, pregnant women

have a greater increase in respiratory
frequency and oxygen consumption
to meet their greater oxygen
demand. As exercise increases to
moderate and maximal levels,
however, pregnant women
demonstrate decreased respiratory
frequency, lower tidal volume and
maximal oxygen consumption
Energy Demands
Both exercise and pregnancy are
associated with a high demand for
energy. In the first two trimesters, an
increased intake of 150 calories per day is
recommended; an increase of 300
calories per day is required in the third
trimester.Caloric demands with exercise
are even higher, although no studies
have focused on exact requirements. The
competing energy demands of the
exercising mother and the growing fetus
raise the theoretic concern that
excessive exercise might adversely affect
fetal development.
Hormonal adaptations:

Oestrogen: stimulates the growth of the uterus and breasts,

and high level of oestrogen can result in excess water
retention, nausea (specially in the first trimester) and joint
looseness.
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 a
major area you should be careful whilst doing stretching
exercises.
Insulin: resistance increases during pregnancy, this make
the pregnant women's pattern of energy utilization similar
to that of a mild diabetic. In mid and late pregnancy insulin
resistance serves to utilize more fat for maternal energy
and rest during exercise.
 Exercise Performance
In the third trimester women go through major
changes, and have to be careful with exercises
Of the sixth month of pregnancy intensity
exercise are decreases
exercises such as cycling or swimming are very
helpful
Rresearch has shown that moderate exercise in
late pregnancy does not influence on premature
birth, shooting membranes or damage to fetuses
Recommended
exercise
Walking

One of the best '

cardiovascular exercises for
pregnant women, walking
keeps you fit without
jarrinj your knees and
ankles. It is
safe throughout the nine
months of pregnancy and
can be built into your day
to-day schedule.
Jogging - Running

• Going for a jog is the

quickest and most
efficient way to work your
heart and your body. You
can tailor it to your
schedule -running 15
minutes one day when
that's all you can fit in and
30 the next when you have
the time.
Swimming

Healthcare providers and fitness experts hail swimming as the

best and safest exercise for pregnant women. Swimming is ideal
because 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.
Aquanatal classes

Many women find aquanatal

classes enjoyable during
pregnancy. Exercising while
standing in water is gentle on
joints and can help lessen
swelling in legs, which is a
common symptom in late
pregnancy.
Yoga and stretching
Yoga and stretching can help
maintain muscle tone and keep
you flexible with little if any
impact on your joints. However,
you may have to augment a
yoga regime by walking a few
times a week to give your heart
a workout. Be careful not to
overdo the stretching. You will
be more supple as a result of the
effects of relaxin, which causes
your ligaments to be more
pliable. Don't hold the stretches
for too long or try to develop
your flexibility too much.
Pilates
Pilates is a form of exercise which combines flexibility and
strength 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 Pilates as the "stable core" or base. These muscles
are also known as deep stabilizing muscles. Because Pilates
targets the tummy and pelvic floor muscles and these muscles
can weaken during pregnancy, Pilates exercises can be useful.
Low-impact aerobics

• One good thing about an

aerobics class is that it's a
consistent time slot when you
know you'll get some exercise.
If you sign up for a class
specifically designed for
pregnant women, you'll get to
enjoy the camaraderie of
others just like you, and can
feel reassured that each
movement has been deemed
safe for you and the baby.
 puimuudi y uisease

Contraindications
• women with Pregnancy-induced
medical hypertension
complications Preterm rupture of membranes
Preterm labor during the prior or
should be current pregnancy Incompetent
encouraged to cervix or cerclage
placement
avoid vigorous Persistent second- or third-
physical trimester bleeding Placenta
previa Intrauterine growth
activity
retardation Relative
contraindications Chronic
hypertension Thyroid function
abnormality Cardiac disease
Vascular disease
Studies have not documented a significant rise in core temperature
with exercise, but thermal stressors present a theoretic risk of
congenital anomalies in early pregnancy
Women can minimize thermal stress by performing exercise in the
early morning or late evening to improve heat dissipation when it is
hot outside
May be used during stationary cycling or other indoor exercise, and
swimming may be an option to improve conductive heat loss
The intensity, duration and frequency of exercise should start at a
level that does not result in pain, shortness of breath or excessive
fatigue
Physical conditioning and well-being, including hydration, caloric
intake, and quality of rest
Exercises performed in the supine position are inadvisable after the
first trimester, as are prolonged periods of motionless standing
The physiologic interactions between pregnancy and
exercise are not fully understood. Although some
theoretic concerns remain about exercise in pregnancy,
the data thus far have been reassuring
It should be kept in mind, however, that there are
major deficits in our knowledge
Some studies have shown positive effects of exercise and
some do not because they are not included in all social
economic categories of women
Whether exercise is harmful or whether it improves the
course and outcome of pregnancy is largely
unknown
• Therefore, no definitive
recommendation can be made
to promote exercise
during pregnancy
• Nevertheless, there appears to
be no reason that most women
cannot continue with exercise
during pregnancy and reap the
possible benefits of
improvement in wellbeing.
THOMAS W. WANG, M.D.,
is director of the Primary Care Sports Medicine Fellowship at
the Department of Family Practice at MacNeal Hospital,
Berwyn, Ill. Dr. Wang graduated from the Medical College of
Ohio, Toledo, and served his residency in family practice at the
University of Michigan, Ann Arbor, Medical School.
BARBARA S. APGAR, M.D.,
is a clinical associate professor in the Department of Family
Practice at the University of Michigan Medical School. She is a
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 at Michigan State
University, East Lansing.
Address correspondence to Thomas W. Wang, M.D.,
MacNeal Family Practice, 3231 S. Euclid Avenue, Berwyn, IL
60402. Reprints are not available from the authors.
 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 Dis
1982;41:126-8.
Clapp JF 3d. Exercise in pregnancy: a brief clinical
review