Exercise During PregnancyAlbright, Elizabeth DO, PGY-2Current Sports Medicine Reports: July/August 2016 - Volume 15 - Issue 4 - p 226–227 doi: 10.1249/JSR.0000000000000277 CAQ Review Free Author InformationAuthors Article OutlineOutline Article MetricsMetrics Address for correspondence: Elizabeth Albright, DO, PGY-2, Eglin Family Medicine Residency Program, 307 Boatner Road, Suite 114, Eglin AFB, FL 32542; E-mail: firstname.lastname@example.org. Column Editor: John R. Hatzenbuehler, MD; E-mail: email@example.com. Physiologic Changes (1): Fetal Response (1): Maternal Benefits (1,4): Recommendations for Exercise Program (1,2): References Back to Top | Article Outline Physiologic Changes (1): Musculoskeletal: ○ Weight gain ○ Shifted center of gravity: due to increased lumbar lordosis caused by anterior pelvic rotation ○ Increased ligamentous laxity: from increased progesterone and relaxin ○ Most sports-related injuries are secondary to joint laxity and lower extremity edema Cardiac: ○ Increased blood volume: up to 50% at term ○ Increased heart rate: resting HR can increase 10 to 15 bpm ○ Increased stroke volume and cardiac output ○ Decreased systemic vascular resistance and blood pressure Respiratory: ○ Increased tidal volume and minute ventilation: up to 50% ○ Physiologic decrease of pulmonary reserve ▪ Increased work load with decreased oxygen availability ▪ Physiologic respiratory alkalosis: not always enough to compensate for metabolic acidosis of strenuous exercise Temperature regulation: ○ Dependent on hydration status and environment Back to Top | Article Outline Fetal Response (1): Increased fetal heart rate (FHR) 10 to 30 bpm over baseline during/immediately after exercise No clinically significant difference in birth weight Cohort study assessed umbilical artery blood flow, FHR, and biophysical profile before/after exercise: 30 min of exercise was well tolerated by fetus. Improved fetal tolerance of labor process Back to Top | Article Outline Maternal Benefits (1,4): Improvement/maintenance of fitness Decreased overall pregnancy weight gain Decreased incidence of gestational diabetes mellitus (GDM) ○ Improved blood glucose control in patients with GDM Reduced risk of preeclampsia Decreased intrapartum interventions including pitocin augmentation and operative vaginal or cesarean deliveries Decreased labor time ○ Twice as likely to progress from 4 to 10 cm in <4 h ○ Decreased length of the second stage of labor from an average of 60 to 36 min Decreased postpartum recovery time Back to Top | Article Outline Recommendations for Exercise Program (1,2): The goal of exercise during pregnancy is to improve maternal fitness without increased risk to the mother or baby. Motivational interviewing is key. Studies show that patients are more likely to start/continue an exercise program and healthy diet if recommended by a physician. ○ Pregnancy is the ideal time to discuss; most patients are highly motivated to do what is best for the baby. Patient categories: ○ Previously sedentary: recommend gradual progression of exercise beginning with walking program ○ Previously active: no safe upper level of intensity established. The consensus is to continue previous fitness routine if the patient regularly exercises before pregnancy and has an uncomplicated pregnancy. General guidelines: ○ Up to 40 min of moderate exercise is well tolerated by low-risk pregnant women (3) ▪ Beyond 40 min, maternal glucose levels decrease and effects are unstudied ○ Ensure adequate hydration ○ Walking, strength training, and water exercises are safe for almost all women ▪ Biking is safe during the first trimester but advised against as pregnancy progresses because of balance changes and fall risk. ○ Avoid activities with: ▪ High risk of fall/impact ▪ High heat/humidity ▪ Static and supine poses • Patients may do yoga or Pilates but should modify certain poses. • Supine poses are specifically not recommended during the second and third trimesters because these cause decreased venous return. ▪ Exertion at altitudes >6000 ft ▪ Scuba diving: fetal pulmonary circulation is not mature enough to filter bubble formation, high risk of decompression sickness in the fetus ○ Stop exercise if any of the following occur: ▪ Vaginal bleeding or leaking fluid ▪ Regular contractions ▪ Dyspnea before exercise ▪ Dizziness ▪ Headache ▪ Chest pain ▪ Muscle weakness affecting balance ▪ Calf pain or swelling Contraindications to exercise ○ Hemodynamically significant heart disease ○ Restrictive lung disease ○ Incompetent cervix/cerclage ○ Multiple gestation ○ Second/third trimester bleeding ○ Placenta previa after 26 wk of gestation ○ Premature rupture of membranes or labor ○ Preeclampsia ○ Severe anemia Back to Top | Article Outline References Committee Opinion No. 650 Summary: physical activity and exercise during pregnancy and the postpartum period. Obstet. Gynecol. 2015; 126:e135–42. 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; 35:1785–93. PubMed Mottola MF, Inglis S, Brun CR, Hammond J. Physiological and metabolic responses of late pregnant women to 40 min of steady-state exercise followed by an oral glucose tolerance perturbation. J. Appl. Physiol. 2013; 115:597–604. PubMed | CrossRef Price BB, Amini SB, Kappeler K. Exercise in pregnancy: effect on fitness and obstetric outcomes—a randomized trial. Med. Sci. Sports Exerc. 2012; 44:2263–9. View Full Text | PubMed | CrossRef Copyright © 2016 by the American College of Sports Medicine.