EXERCISE DURING PREGNANCY: A Clinical Update

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The goal of this article is to update the information provided in an article initially written for Clinics in Sports Medicine 5 years ago.10 It begins with a brief summary of that information followed by a presentation of new data that continue to support its main conclusion—that beginning or continuing a regular program of recreational exercise during pregnancy is safe and beneficial for healthy women and their offspring. The reader is referred to the initial article for the older references. Additional new information includes sections addressing the effect of different training volumes, diet, and additional types of exercise on pregnancy outcome, the short- and long-term maternal cardiovascular benefits of continuing regular exercise during and after pregnancy, and other long-term benefits for mothers and their offspring.

Section snippets

SUMMARY OF EARLIER ARTICLE

Exercise programs involving strenuous, prolonged physical activity such as aerobics, circuit training, stair climbing, and running remain a way of life for almost one quarter of women planning a pregnancy. Most continue their exercise regimen during pregnancy and many of the regimens exceed the current sanctioned guidelines.1 In addition, a recent national survey reports that 42% of women reported exercising during pregnancy and half of those exercised beyond the sixth month.46 The unanswered

EFFECT OF EXERCISE TYPE, TRAINING VOLUME, AND DIET ON OUTCOME

Because the reported effects of maternal exercise on pregnancy outcome have been so variable, the author and others have begun a series of prospective protocols designed to assess the effects of specific exercise regimens on pregnancy outcome. For purposes of clarity, he has divided them into those that have studied a specific type of exercise, those that have examined training volume, and one study of the interaction between exercise and diet.

Cardiovascular Adaptations to Pregnancy

Exercise and pregnancy increase plasma volume. When the two are combined, the effect is additive so that women who exercise have blood volumes which are about 20% greater than their sedentary controls.41 Pregnancy and exercise increase cardiac output.13 The fact that running throughout pregnancy increases maximal aerobic capacity by 8% postpartum suggests that exercise also may augment the pregnancy-associated increase in cardiac output and that the effect may persist postpartum.17 The author

OTHER LONG-TERM MATERNAL BENEFITS

The author currently is examining the affect on other parameters of continuing exercise throughout pregnancy and the first year postpartum, using examination and questionnaire approaches throughout the first year after the index pregnancy. To date, follow-up data have been obtained in approximately 150 women that address the areas of mental well-being, fitness, weight and fat retention, bone density, abdominal muscle tone, musculoskeletal injury, and bladder function.13

Women who continue to

BENEFITS FOR THE OFFSPRING BEFORE AND AFTER BIRTH

The fetal benefits of exercise seem to be caused by the stimulatory effects of an intermittent reduction in uterine blood flow on placental growth, placental function, and fetal behavior coupled with a small but significant decrease in fetal nutrient availability.11, 21, 30, 32 The physiologic result is that these fetuses are lean at birth and seem to have an increased tolerance for the physiologic stresses of late pregnancy, labor, and delivery.12, 13, 19 In the first few days after birth,

SUMMARY

Research dealing with exercise during pregnancy continues to demonstrate marked benefits for mother and fetus. The type, intensity, frequency, and duration of the exercise seem to be important determinants of its beneficial effects. Maternal benefits include improved cardiovascular function, limited weight gain and fat retention, improved attitude and mental state, easier and less complicated labor, quick recovery, and improved fitness. Fetal benefits may include decreased growth of the fat

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  • Cited by (161)

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      Citation Excerpt :

      Lewis and Lynch (1993) found that medical professional training can increase the amount of advice given regarding PA in a primary healthcare setting. Similarly, Clapp (2000) reported that healthcare providers can have a positive effect on their patients’ attitudes towards exercise and it is therefore possible that gaining knowledge of the benefits of PA during pregnancy may motivate women to become more active (Prather et al., 2012). Therefore, CPD needs to be more accessible.

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    Address reprint requests to James F. Clapp III, MD, Department of Obstetrics and Gynecology, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109

    This work was supported by National Institutes of Health grants #HD21268, #HD21109, #RR00080, funds from MetroHealth Medical Center, and The Robert Schwartz MD Center for Metabolism and Nutrition at Case Western Reserve University.

    *

    Department of Reproductive Biology, Case Western Reserve University School of Medicine; and the Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio

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