Perinatal Maternal Exercise

1. Perinatal Maternal Exercise By Mohammad Ahmed Emam (MD)Prof OB &GYN Mansoura Faculty of Medicine Egypt 2004

2. Increased awareness of the benefits of regular exercise generally. Exercise has become a vital part of daily life for many women. Rationale

3. Pregnancy is a state of health, not of illness so, a well-conditioned body will perform better during the stress of advanced pregnancy, and delivery. Objective data regarding the impact of exercise on the mother, the fetus and the course of pregnancy are limited. Rationale

4. Various guidelines regarding exercise during pregnancy are available: Conservative or restrictive ( 1985 ). Reviving and revising permissive ( 2003). The dilemma of intractions between the physiologic changes in pregnancy + hemodynamic response to exercise. Rationale

5. Recently ((SOGC), (CSEP), (ACOG). 2003) , not only are moving towards actively encouraging exercise but also have suggested that failure to exercise during pregnancy may be associated with some risks. Rationale

6. To explain the impact of exercise on maternal,fetal, and neonatal conditions. To pinpoint the guidelines for exercise during pregnancy. Objective

7. Medline search from 1966 to 2003 for English langauge articles related to exercise during pregnancy. Discussing the guidelines suggested by(SOGC), (CSEP) &(ACOG) 2003. Methods

8. 1) For exercising women: to reduce the habitual levels of exercise during pregnancy . 2) For non-exercising women: to refrain from initiating exercise . Conservative Recommendations (ACOG 1985)

9. Rationale For Conservative Rcommendations 1)Exercise could affect early and late pregnancy outcomes by: Increasing core body temperature during embryogenesis Increasing the risk of congenital anomalies. Shifting oxygenated blood and energy to maternal skeletal muscle away from the developing fetus disturbances in growth.

10. 2) Risk of maternal musculoskeletal injury due to: Changes in posture and centre of gravity. 3) Fetoplacental injury due to blunt trauma or stress from sudden motions. Rationale For Traditional Rcommendations

11. Recent Investigations (ACOG) .& (SOGC)& ( CSEP_) (EBM) 2003  1) Both aerobic and strength-conditioning exercise in pregnancy, not lead to increase in: Early pregnancy loss Late pregnancy complications Abnormal fetal growth Adverse neonatal outcomes.

12. Recent Investigations cont…. 2) Risks of non practicing exercise during pregnancy: loss of muscular and cardiovascular fitness. Excessive maternal weight gain Gestational diabetes pregnancy-induced hypertension Development of varicose veins Deep vein thrombosis.

13. 2) Risks of non practicing exercise during pregnancy: cont… Higher incidence of physical complaints:- Dyspnea Low back pain, Poor psychological adjustment to the physical changes of pregnancy.

14. Recent Investigations cont…. 3) Benefits Of Exercise During Pregnancy: Minimize minor discomfort associated with the pregnancy. Improve posture. Make the body more supple, Enhance circulation.

15. 3) Benefits Of Exercise During Pregnancy cont…. Assist expulsion of fetus during delivery Provide a feeling of general well-being. Strengthen the muscles stressed by pregnancy—(abdominal, low back and Pelvic floor).

17. Permissive Guidelines ( ACOG , SOGC & CSEP ) 2003 Guidelines are evidence-based. Shift from restriction to permission: 1) For exercising women: continue an exercise program before pregnancy. 2) For non-exercising women: begin an exercise program

18. Consider your pre-pregnancy fitness and activity level. Do not try to exceed pre-pregnancy levels.

19. What Are The permissive Guidelines (ACOG& SOGC& CSEP , 2003) All pregnant women without contraindications should participate in aerobic and strength-conditioning exercises. The goals should be: To maintain a good fitness level throughout pregnancy. No trial to reach peak fitness. No training for competition.

20. ACOG& SOGC& CSEP Guidelines cont….. 3. Exercise with the least risk should be choosen. 4. Adverse maternal or foetal outcome are not increased with exercise.

21. ACOG& SOGC& CSEP Guidelines cont….. Pelvic floor exercises should be initiated immediately postpartum to reduce the risk of future urinary incontinence. 6. Moderate exercise during lactation does not adversely affect breast milk.

22. How To Attain These Guidelines ?  Medical consultations before beginning an exercise program ( exclude contraindications).

23. Absolute Contraindications PIH Preterm rupture of membranes Threatened preterm labor . Incompetent cervix .

24. Absolute Contraindications Persistent second- trimester bleeding Placenta previa. Intrauterine growth restriction.

25. Relative contraindications Chronic hypertension Thyroid dysfunction Cardiac disease Vascular disease Pulmonary disease Multiple pregnancy

26. STOP exercising and consult obstetrician if any of the following symptoms : Bleeding Cramping Faintness elevated blood pressure dizziness severe joint pain

27. How To Attain These Guidelines ?  Listen to your body (individual tolerance). Exercise regularly, rather than occasionally. Exercise should not be painful.

28. The Best Exercises During Pregnancy Stationary cycling

29. The Best Exercises During Pregnancy Aerobics Swimming Walking. Yoga Praying.

30. Exercises To Be Discouraged Contact sports Hockey Boxing Football Horseback riding Skiing (snow and water) Weight lifting Diving

32. Exercise in hot, humid weather. Exercise during illness with fever. Exercise increasing lordosis Exercise causing compression of the uterus. Exercise while lying on the back After 20 weeks.

33. Deep flexion and extension of the joints Activities that require jumping or rapid changes in direction. breathless space competitive events. Avoidance

34. Exercises that use the Valsalva maneuver ; for example, lifting weights while holding breath. increase in BP &PROM. Avoidance

35. Drink plenty of fluids, especially water, before and after exercise to avoid becoming dehydrated. Drink even if you are not thirsty, as thirst lags behind the body's need for fluids

36. Rise gradually from the floor to avoid a sudden, rapid decrease in BP momentary blackout. Continue walking after rising to assist return blood flow to the heart.

37. Exercise at a comfortable intensity (the talk test):

38. Measure your heart rate 2-3 times during peak activity to make sure you are exercising at the proper intensity.

39. Do not become overheated. If you feel you are becoming too hot, decrease your exercise intensity.

40. Follow your exercise with a 5-15 minute cool-down consisting of slow biking or walking. Cool down until your heart rate is less than 100 beats per minute (16 beats in 10 seconds).

41. Conclusions Exercise during Pregnancy are growing more liberal , shifted from restricion to permission . the final guidelines give physically fit patients more freedom to maintain exercise during pregnancy.

42. Conclusions Also the guidelines encourage previously inactive women to start an exercise. ( Provided no contraindications).

43. Conclusions Because of the interactions between the physiologic changes associated with pregnancy, and the hemodynamic response to exercise obstetrician should be aware to pick up any contraindications.

44. Recommendations Maternal perinatal exercise should not be forgotten, and the obstetricians should be aware of the different guidelines and recommendations regarding this issue.

45. Any exercise regimen should be individually structured to the patient; taking in consideration the general health.