ACTIVE LIVING DURING PREGNANCY & POST PARTUMDr. Michelle F. Mottola, Ph.D. FACSM Director,R. Samuel McLaughlin Foundation-Exercise and Pregnancy LaboratoryUniversity of Western OntarioLondon, Ont. Canada N6A 3K7Email: email@example.com
Wolfe et al. Sports Med 1989;8:273-301MATERNAL AND FETAL WELL-BEINGOptimal zone for maternalexercise prescription chronic fatiguefetal death musculo- skeletal injury prematurity fetal growth restriction altered fetal developmentBASELINEThreshold for maternalphysical conditioning effectsQUANTITY AND QUALITY OF MATERNAL EXERCISEdecreaseincreasemetabolic and cardiopulmonary reserve promotion of normal glucose tolerance psychological benefitsMaternal dose-response curveFetal dose-response curve fetal and placentaladaptations
IMPORTANCE OF MEDICAL PRESCREENING
THRESHOLD FOR PROBLEMS??
Prior to 1985 Exercise Guidelines for Pregnant Women did not exist REST!!1985 ACOG suggested heart rate should not go above 140 beats per minute1994 ACOG Ignored heart rate; Replaced with common sense guidelines HISTORICALLY:2002 ACOG Ignored heart rate; Replaced with exercise on all days of week!!
Canadian guidelines for active living during pregnancy**Joint SOGC/CSEP Clinical Practice Guideline 2003**CSEP & Health Canada (1996 Revised 2002)PARmed-X for Pregnancy(Physical activity readiness, medicalprescreening & exercise prescription)- written for physician/midwife or health care professionalAuthors: L.A. Wolfe, Queens & M.F. Mottola, Western
CSEP & Health Canada (1999)Active Living During PregnancyPhysical activity guidelines for mother & baby.Author: Angela Kochan-Vintinner (Eds. Wolfe & Mottola)www.csep.ca
- 4 page document- current history of pregnant women & occupation- list of contraindications to exercise- absolute, relative- Aerobic conditioning guidelinesF. (frequency) 3- 4 times /weekI. (intensity) target HR zonesT. (time) 15 up to 30 minutesT. (type) - Muscle conditioning guidelines & precautions- Safety considerations & reasons to consult physician/midwife
PARmed-X for Pregnancy
Occupational activity did not impact on birth weight Structured exercise frequency during late pregnancy appears to be a determinant of birth weight Too much vs too little vs just right!!***** 3 4 times per week ******Campbell & Mottola 2001. Amer. J. Obstet. Gynecol. 184:403.
Mottola et al. 2006 Med. Sci. Sports Exerc. new zonesVO2peak Prediction and Exercise Prescription for PregnantWomen. 38(8):1389-1395. Target Heart Rate Zones:20-29 yearsFit 145 160 beats/minuteUnfit 129 - 144 beats/minute
30-39 yearsFit 140 156 beats/minuteUnfit 128 144 beats/minute
Summary of Canadian Guidelines Previously sedentary women with healthy pregnancies can safely start an exercise program in the second trimester Women with low risk pregnancies can continue mild to moderate activity throughoutMild to moderate aerobic activity within the Canadian guidelines (PARmed-X for Pregnancy) is considered safe Muscle conditioning activity with necessary precautions is also considered safe
Adapted from Wolfe et al., 1989MATERNAL AND FETAL WELL-BEINGOptimal zone for maternalexercise prescriptionBASELINEQUANTITY AND QUALITY OF MATERNAL EXERCISE metabolic & cardiopulmonary reserve promotion of normal glucose tolerance psychological benefits
Maternal dose-response curveFetal dose-response curve Fetal & Placental AdaptationsAltered Fetal DevelopmentAltered Maternal Pregnancy Adaptation??Sedentary lifestyle*
PRESCRIPTION FOR AEROBIC ACTIVITY DURING PREGNANCYFREQUENCYTWO OR LESS TIMES PER WEEKTOO LITTLE!!?Campbell & Mottola 2001. Amer. J. Obstet. Gynecol. 184:403.
Cover page of The Economist, December 13-19th, 2003.
Among women of childbearing age, one potential pathway for obesity development is excessive pregnancy weight gain and post partum weight retentionSiega-Riz et al. 2004. Nut Rev 62:S105-11Pregnancy link to Obesity?????
Impact of maternal & child health on current obesity epidemic?Intervention times/promoting physical activity? before conception during pregnancy post partum early years of childs life by moms influence & family lifePrevention vs treatment??
Pregnancy is time when many women change to a healthier lifestyle improve eating habits quit smoking stop alcohol use moderate caffeine consumption think about active livingPromotion of Active Living During Pregnancy
Stages of Change (Intentional health behaviour change 5 stages): precontemplation (no intention) contemplation (considering a change) preparation (making small changes) action (actively engaging in change) maintenance (sustaining change over time)Bull et al. 2001. Med Sci Sports Exerc. 33:1147-56.
Health care providers promote active living throughout the life span including pregnancy Many women are interested in maintaining or improving pre pregnancy fitness levels as they become pregnant Traditional view has been replaced with active living and healthy lifestyle habits before, during and after pregnancy.Thus it is important that:
What do pregnant women want?Walking most popular activityBarriers to physical activity?Having childrenLack of timeMottola & Campbell 2003. CJAP 28(4):642-653.
Effective promotion of active living during pregnancy depends on the extent and type of physical activity performed before conception, while taking into account the needs and wants of pregnant women throughout the three trimesters of pregnancy.How do we promote physical activity during pregnancy??
Education Programs that include:
benefits of being active during pregnancy guidelines available for exercise during pregnancy (www.csep.ca) identified barriers to being active and ways to overcome them assistance in social support (health care providers, family involvement, transportation, safety issues, facilities, subsidized community programs)
Perhaps community programs which facilitate and encourage walking , such as mall walking (combined with elderly), which would also overcome barriers to exercise, include child care, family walks including children May be successful in promoting active living and physical activity during pregnancy and postpartum!!(Active Living During Pregnancy, CSEP, 1999)
Rediscovering the M in MCH: maternal health promotion after childbirthThe science and practice of health promotion after childbirth is less well developed except for breast feeding and family planningWhy should we promote health in the postpartum? Improve womens health and well-being in the immediate postpartum period, Reduce the risk of developing heart disease, obesity and other lifestyle-related diseases.Better understanding of womens health promotion in the 1st postpartum year is an essential step in addressing this neglect in maternal healthWalker LO, Wilging S. JOGNN 2000;29:229-236 Active Living Post-partum
Post-natal Exercise Muscle Conditioning(Active Living During Pregnancy, CSEP, 1999)Using baby for post-natal activitiesUsing baby as resistance tool (carefully!!) Have fun interacting with baby when doing push-ups
Influence on early post-natal life Infants who were fed breast milk or who were breast fed longer had lower risk of overweight in adolescence Parental feeding patterns Parental activity patterns Obese mother obese child Maternal influence as care-giver
If maternal-child interaction is a significant initiating factor in the obesity epidemic, will the prevention of excessive weight gain in mother during pregnancy and subsequently less weight retention post-partum lead to lower rates of obesity in successive generations?Active living during pregnancy & post-partum??