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Santos Rocha - Coggle Diagram
Santos Rocha
Health-enhancing exercise during pregnancy
What is it?
PA vs exercise
PA
categorized by different contexts = leisure time, exercise, sports, occupational, household, transport
categorized by intensity
any movement produced by muscle contraction -> increase in caloric requirements
PA during pregnancy/postpartum = impact in depression
exercise
subcategory of PA
physical fitness = attributes/characteristics that we have or achieve -> regarding ability to perform PA
type of PA -> planned, structured, repetitive -> improve/maintain components of physical fitness
prenatal/postnatal exercise = impact on anxiety & depressive symptoms
metabolic vs mechanical intensity
metabolic intensity
= MET = multiple of resting metabolic rate
biomechanical intensity
-> ground reaction force (GRF) -> regular exposure to high magnitude force is good but can be overloaded
guidelines with recommendations
What do we know about it?
health benefits for: pregnant woman, course of pregnancy, fetal development & health, labor & delivery, postpartum recovery, baby, mother & child, ...
preventive role
well-being, sleep, enhanced quality of life
regular &
specific
PA program
prevent hypertensive disorders
promote food posture
decrease low back & pelvic girdle pain
weight control & prevent diabetes
decrease urinary incontinence
increase functional capacity
promote mental health & sleep
general fitness benefits
postpartum recovery
regular &
general
PA program
mental health, anxiety, depressive symptoms
fitness & functional parameters
bone health
cardiorespiratory health & fitness
increased energy expenditure
prevention in musculoskeletal disorders
gestional diabetes & diabetes type 2
dyslipemia
fertility, fetus development, birth & baby health
hypertension & pre-eclampsia
Implications for professional practice
support women
be familiar with benefits, recommendations, guidelines, health conditions, symptoms & body adaptations
existing recommendations
health & PA promotion
more likely to be active later & also children
window of opportunity -> stay active lifelong
physical ecercise part of active lifestyle -> knowledge gap (often pregnant women not active)
Exercise Testing and Prescription during Pregnancy & Postpartum
What is it?
better supervised, tailored, effective, sustained, safe exercise programs -> improved adherence & effectiveness -> responsibility of professionals
testing + prescription = designed for goals & motivations of the woman
professionals should be familiar with sources of information
communication with health professionals
body adaptations & pregnancy-related symptoms
recommendations
exercise testing & prescription guidelines
interpretation of studies
address health-related fitness components & pregnancy-specific conditions -> health & exercise assessments -> consider body adaptations + symptoms
What do we know about it?
Key guidelines
at least 150 min/wk moderate aerobic PA
if habitually vigorous -> continue
health care provider
2019 Canadian guideline
if previously inactive = strong recommendation
with gestational diabetes = weak recommendation
if overweight/obese = strong recommendation
3 days/week = strong recommendation
aerobic & strength training & yoga/stretching = strong recom.
pelvic floor muscle training (PFMT) -> proper technique = weak r.
if headedness, nausea, unwell -> modify position or avoid supine = weak recommendation
ACOG 2020
3-4 x/week or daily
thermoneutral
moderate intensity = 12-14 Borg
if possible supervised
30-60 min/session
Safety precautions
avoid excessive heat & humidity
avoid physical contact or danger of falling
lowlanders avoid high altitude (>2500m)
athletes -> with obstetric supervision
adequate nutrition & hydration
know reasons to stop PA if needed & consult healthcare provider
severe chest pain
regular painful uterine contractions
vaginal bleeding
persistent loss of fluid from vagina (rupture of membranes)
persistent excessive shortness of breath
persistent dizziness or faintness
Exercise testing & prescription
health screening
1st/2nd/3rd trimester, immediate/early/late postpartum
doctor & PAR-Q
contraindications
absolute
ölacenta praevia after 28 wks gestation
pre-exlampsia
persistent vaginal bleeding
incompetent cervix
intrauterine growth restriction
high-order multiple pregnancy (e.g. triplets)
uncontrolled diabetes/hypertension/thyroid disease
rupture membranes
cardiovascular/respiratory/systemic disorder
relative
spontaneous preterm birth
gestational hypertension
malnutrition
twin pregnancy after 28th week
symptomatic anaemia
eating disorder
recurrent pregnancy loss
mild/moderate cardiovascular/respiratory disease
other medical conditions
physical & physiologic adaptations
anatomical & physiological changes
circulatory system
locomotion system
endocrine system & hormonal changes
weight gain
body biomechanical & musculoskeletal adaptations
curvature of spine
altered ROM
centre of gravity
locomotion system
pelvic organs & floor muscles
psychological changes
anxiety
depression
stress
pre-exercise assessment
PA questionnaires & trackers
objectives & motivations
sedentary/active/very active/athlete
fitness/exercise testing
research purposes
anatomical & musculoskeletal changes
reliability/validation
client's purposes
availability/cost
expertise
cardiorespiratory
resistance/postural
flexibility
balance
exercise prescription
aerobic
moderate = RPE 12-13, vigorous = RPE 14-17
30 min/d, 150 min/wk or 75 min/wk intense
3 d/wk
large muscle groups, weight & non-weight-bearing
progress after 1st semester, caution in jumping, avoid risk fall/trauma
resistance/postural
40-60% 1RM, submaximal (8-10 or 12/15 reps)
1 set for beginners, then 2-3 sets, major muscle groups (8-10 ex)
2-3 nonconsecutive d/wk
machines, free weights, body weight
supine position after 16 wk, limit heavy RT & isometric
flexibility
to the point of tightness or slight discomfort
10-30s 2-4 reps
at least 2-3 to 7 d/wk
active/passive static/dynamic for each muscle-tendon unit
avoid excessive joint stress
balance & coordination (neuromotor)
20-30 to 60 min/day
at least 2-3 up to 7 d/wk
included in daily activities, safety considerations, proper technique, avoid uncomfortable positions
motor skill, proprioceptive training, multifaceted activities
pelvic floor muscles training
10-30 min/day
1-7 d/wk
anywhere, anytime
contraction + relaxation, e.g. with devices
F(requency) I(ntensity) T(time) T(ype of exercise) V(olume) P(rogression)
postpartum exercise
breastfeeding -> exercise afterwards -> mild/moderate intensity
RT is ok but NO trunk flexion (crunches) -> plank instead
pilates -> deep ab muscles & pelvic floor
progress gradually
group exercises / online programs
vaginal (4 wks) / cesarean (6 wks) delivery
limit sedentarity
exercise adaptions -> effective & safe
supervision -> proper technique, confidence, progression
regular feedback, positive reinforcement, enhance adherence
exercise professional -> provide safest training & testing environment, be familiar with safety & emergency procedures
Implications for professional practice
knowledge about effectiveness & safety -> more favorable attitudes
key elements in selecting & using appropriate pre-exercise & assessment tools
be familiar with benefits, recommendations, guidelines, health conditions, symtoms & body adaptations, modify if needed
implementing effective & safe exercise programs
