1. Exercising Through Your Pregnancy Book by James F. Clapp, III, M.D. & Catherine Cram, M.S. Report by Shayla Bentley December 2 nd, 2013 HLTH 2430

2. Meet the Authors James F. Clapp, III, M.D.Catherine Cram, M.S. Professor emeritus of reproductive biology at Case Western Reserve University and a research professor of obstetrics and gynecology at the University of Vermont College of Medicine Studies in the book are his own Exercise physiologist specializing in prenatal and postpartum fitness whose consulting company, Comprehensive Fitness Consulting, LLC, provides maternal-fitness certificate- training courses for health and fitness professionals

3. Exercise + Pregnancy? Myth or Fact: Never get your heart rate over 130 while exercising during pregnancy. Myth or Fact: It's not safe to do abdominal work during pregnancy. Myth or Fact: If I exercise too much during pregnancy, I will pull nutrients from my baby so he/she won't grow properly. Myth or Fact: If I never exercised before pregnancy, now is not the time to start. Myth or Fact: Any sign of trouble -- like spotting or pain -- means I should stop exercising and not do it any more during my pregnancy.

4. Heart/Circulatory Adaptations Regular, Vigorous Exercise Normal Pregnant Increases in: ◦ Blood volume ◦ Size of the heart chambers ◦ Volume of blood pumped with each beat ◦ Maximum cardiac output ◦ Density and growth of blood vessels ◦ Number of elements within muscle cells that generate energy ◦ Ability to dissipate heat Increases in: ◦ Volume of blood in circulation ◦ Skin blood flow response ◦ Size of the heart chambers ◦ Volume of blood pumped each beat ◦ Delivery of oxygen to the tissues

5. Exercise + Pregnancy = AWESOME Superimposed cardiovascular adaptations on preexisting adaptations to training 10 – 15% increase in plasma, red cell, and total blood volumes More circulatory reserve = improvements in ability to deal with anticipated and unanticipated circulatory stress Enhancement in left ventricular volumes = 30 – 50% increase

6. Exercise Considerations Heart rate sky rockets during early pregnancy (easy, free pregnancy test) By late pregnancy heart rate comes down Heart rate monitor? Not a good tool Better tool? Borg Rating of Perceived Exertion (RPE)

7. Lung and Placental Gas Transport At rest air breathed increase 40 – 50%+ Training + pregnancy = improvement in maximal aerobic capacity 5 – 10% ◦ Training effect (VO2 max) ◦ Blood doping Induces an increase in alveolar ventilation Improves gas transfer at tissue level Maintains peak ventilation Maintains absolute maximal aerobic capacity

8. The Placenta New organ: placenta ◦ Fetal lung Faster growth Better functionality More nutrients and oxygen to baby

9. Summary Functional changes from exercise compensate for or complement the functional changes of pregnancy Blood volume and vascular reactivity maintain blood flow to placenta Ventilations and placental development combine with metabolism changes to improve the availability of oxygen and energy-producing sugar for the baby’s growth without compromising maternal function Improved ability to dissipate heat protects against thermal injury Musculoskeletal and ligamentous effects protect the mother from significant symptomatology or injury

10. Benefits of Maternal Exercise Gain less weight Deposit and retain less fat Feel better Have shorter, less complicated labors Recover more rapidly than women who either stop or don’t exercise No ill effects from exercise during pregnancy or early resumption after birth

11. Contraindications Conception and Exercise ◦ Excess stress = hypothalamus causes cessation in release of eggs and hormones ◦ Overtraining + fatigue = libido killer  “Remember, it takes more than a lonesome egg in the fallopian tube to become pregnant!”

12. Exercise: Doing it Right When to NOT ExerciseFinding the Right Program Absent or infrequent menstrual periods Injury Acute illness Vaginal bleeding with or without cramping in early pregnancy Intractably nausea and vomiting Sudden onset of new pain, especially in the abdomen or pelvis Start the day with exercise Exercise with a friend or group Build rewards into the prescription Keep an exercise log and diary to encourage a feeling or accomplishment Keep in mind that ultimately the exerciser should always make the final decision to alter the exercise regimen

13. Exercise Instruction Observe the 1 st, 5 th, and 10 th exercise sessions Aim for a minimum of 20 to 30 minute sessions, 3x a week, at a moderate level Ask questions ◦ How does she feel in terms of well-being? (once a week) ◦ How much weight has she gained? (2x/month) ◦ Is she depositing fat over her hips, thighs, and abdomen? (2x a month) Increase some aspect of performance every 6 – 10 sessions ◦ Workload (cadence, range of motion, or speed) ◦ Duration (5 min at a time) ◦ Frequency Progress should be slow but steady – assess by subjective changes in capacity, endurance, and satisfaction

14. Dos and Don’ts Pay attention to environmental conditions, especially thermal ones. Rest one hour for each hour of exercise. Pay attention to hydration and salt intake. Pay attention to eating patterns. Avoid excessive fatigue. Confirm pregnancy as soon as possible after probable conception. Stop and evaluate.

15. Recreational Athletes Skill, speed, and distance are only occasionally important Demonstrable improved fitness Improved sense of well-being ◦ Focus on endurance, strength, flexibility, appearance, etc. Include a monitoring component that will demonstrate progress Program should be diverse

16. Safety Considerations Limit increasing time spent in endurance workouts to a total of an additional 30 minutes/week Focus on improving upper-body strength ◦ Regular exercisers: do not increase weight loads, repetitions, or sets until 10 – 12 weeks ◦ Beginners: light free weights; aerobics with light weights (3 – 4 lbs) – introduce heavier weights (if ready) before 28 th week of pregnancy

17. Competitive Athletes Must gain trust and respect Stress education, planning, and monitoring Create a detailed and in-depth program before conception Something has to give – more attention to adequate diet and hydration, getting enough nonphysical leisure activity, committing time for monitoring and assessments All-out effort and serious competition = TOO RISKY

18. Type of Exercise Endurance regimens – overdistance and interval Keep endurance training constant Continue with regular strength-training program No program? Start with machines, initially emphasizing upper body and extremities Increase strength rather than muscle mass Continue with usual skills training that doesn’t interfere with oxygenation, nutrition, hydration, or body temperature.

19. Dos and Don’ts Pay attention to envrionmental conditions; specifically, avoid hot, humid environments and poor ventilation. Stay well hydrated and by drinking water regularly all day long as well as while exerchising. Eat frequently and well. Stay away from fad diets and supervitamins. Follow the rest-activity cycle plan. Don’t train at altitudes higher than 7,500 feet. Don’t ignore symptoms that may indicate a significant problem. Don’t lead an erratic lifestyle.

20. Absolute Contraindications Recurrent, light vaginal bleeding that originates inside the womb. Rupture of the membranes that surround the baby before the onset of labor. Evidence that the woman has either started or may soon start labor well ahead of schedule (before the last month of pregnancy). Evidence that the uterus or womb is not structurally normal. Acute illness or a problem with the pregnancy that the doctor feels should be treated by restricting activity.

21. Relative Contraindications Twin pregnancy ◦ Early labor onset, growth demands much greater (happens with or without activity) History of early labor Multiple-birth pregnancy = no exercise

22. First 6 Weeks After Birth Exercise 3+ times a week Exercise should feel good and enhance feelings of well-being No exercise-associated pain or heavy bleeding Personal well-being should be self-assessed every two or three days Fluid intake should be high Adequate rest is a must. Infant weight gain should be normal.

23. Things to Watch For Dos and Don’tsContraindications to Exercise Do be sure that the amount of exercise is enough but not too much. Do be sure that exercise feels good. Do pay attention to the little things. Don’t chart performance progress. Absolute ◦ Heavy bleeding. ◦ Pain. ◦ Breast Infection or abscess. Relative ◦ Cesarean birth or traumatic vaginal birth. ◦ Breast discomfort. ◦ Heavy urine leakage or pelvic pressure during exercise.

24. From 6 Weeks On Three main goals ◦ A return to pre-pregnancy weight ◦ A rapid improvement in abdominal tone ◦ An improved body image Schedule time for exercise Monitor assessing progress in performance Do monitor the growth of the baby as long as regular exercise and breast- feeding are combined.

25. Six Guidelines Begin slowly and increase gradually Avoid excessive fatigue and dehydration Support and compress the abdomen and breasts If it hurts, stop and evaluate If it feels good, it probably is Bright red vaginal bleeding that is heavier than a normal menstrual period should not occur

26. Developing the Program Intensity ◦ Maintained at moderate to somewhat hard; use self- assessment (13 – 14 on Borg scale) Duration ◦ At least 30 minutes of cardio; increase as long as pregnancy continues normally Type ◦ Make it enjoyable and convenient Frequency ◦ 3 days minimum for benefits and gain improvements; reduce if overtraining Incorporate pelvic floor exercises Supine exercises should be modified after 1 st trimester

27. Conclusion “Exercise during and after pregnancy is an important component in a healthy pregnancy. …exercise can provide tremendous benefits to both mom and baby. Exercising to stay fit during your pregnancy can positively impact your baby’s health and your body’s ability to meet the demands of pregnancy, as well as shorten your postpartum recovery.”