Exercise During Pregnancy RND r . Ale š Jakubec Ph.D Student s : Tijana Radiša Balaban Ljiljana

1. Exercise During Pregnancy RNDr. Aleš Jakubec Ph.D Students : Tijana Radiša Balaban Ljiljana

2. 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

3. If women do not have medical complications and can maintain regular exercise duration of pregnancy but.... • women should avoid exercise that 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

4. Physiological changes during 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.

5. 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.

6. 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.

7. 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

8. 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.

9. 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.

10. Impact of Pregnancy on 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

11. Recommendedexercise

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

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. 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.

19. Pulmonary disease Contraindications to Exercise • women with medical complications should be encouraged to avoid vigorous physical activity

20. Recommendations • 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

21. FinalComment • 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

22. 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 well-being.

23. TheAuthors • 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.

24. 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

25. Thank you for your attention