Exercise and Physical Activity During Pregnancy and Postpartum: Evidence-Based Guidelines

489 Pages·2022·28.613 MB·English

by  Rita Santos-Rocha

Exercise and Physical
Activity During Pregnancy
and Postpartum
Evidence-Based Guidelines
Rita Santos-Rocha
Editor
Second Edition
123
Exercise and Physical Activity During
Pregnancy and Postpartum
Rita Santos-Rocha
Editor
Exercise and Physical
Activity During Pregnancy
and Postpartum
Evidence-Based Guidelines
Second Edition
Editor
Rita Santos-Rocha
Sport Sciences School of Rio Maior - ESDRM
Polytechnic Institute of Santarém
Rio Maior, Portugal
ISBN 978-3-031-06136-3 ISBN 978-3-031-06137-0 (eBook)
https://doi.org/10.1007/978-3-031-06137-0
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Previous editions published with Springer International Publishing
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Foreword
Exercise and a healthy lifestyle during pregnancy are key to preventing chronic
disease risk in both mother and her developing fetus [1]. Maternal benefits of exer-
cise include improved fitness [2], prevention of excessive pregnancy weight gain
[3], weight retention and potential obesity [4], gestational diabetes [5], hypertension
[6], maternal depression [7], and reduction in cesarean section rates [8]. Maternal
exercise has also been linked to appropriate birth weight [9] and prevention of
chronic disease development in the offspring [1]. When these benefits are consid-
ered, it is surprising that many healthcare providers do not advocate a healthy life-
style for pregnant individuals. The second edition of this well-rounded book
provides updated information in each chapter plus the inclusion of the insights into
the early postpartum period. The first two chapters present information regarding
education of healthcare providers and fitness professionals of the importance of
health promotion during pregnancy (Chap. 1) and the importance of psychological
and behavioral support necessary for women to be successful in beginning or main-
taining physical activity during pregnancy (Chap. 2). Lack of information and social
support are two reasons why pregnant women may not be engaged in physical activ-
ity. Knowledge of benefits of prenatal exercise may lead to a more favorable attitude
towards exercise among participants, healthcare providers, and exercise profession-
als from an international perspective as Chap. 7 presents evidence-based guidelines
for exercising during pregnancy that are practice-oriented. Guidelines for exercise
testing and prescription for pregnant individuals are presented in Chap. 8, followed
by suggestions for programming exercise classes that includes steps for planning
and conducting classes, and monitoring pregnant individuals and providing exercise
adaptations during pregnancy for safe physical activity (Chap. 9).
Pregnancy affects every system of the body, and it is important to understand the
physiological changes (Chap. 3), body composition alterations (Chap. 4), and the
biomechanical adaptations (Chap. 5) to pregnancy and the implications for physical
activity. In addition, pregnancy alterations to the musculoskeletal system (including
the pelvic floor, pelvic girdle, and lower back) may increase risk factors for muscu-
loskeletal disorders (such as diastasis recti), impairments (such as urinary inconti-
nence), and pain in the lower back and pelvic girdle (Chap. 6). Recommendations
for treatment and guidance for recovery of functional capacity related to potential
impairment and disorders of the musculoskeletal system are also important features
of Chap. 6. Prenatal exercise can also be used as a therapy for musculoskeletal
v
vi Foreword
health of the pregnant exerciser and athlete to improve and restore physical function
(Chap. 12).
Nutritional and energy requirements of the pregnant individual who exercises
including the athlete are outlined in Chap. 13 with the dietary recommendations for
these individuals bridging the gap between science and practice with a summary of
main dietary recommendations found in Chap. 14. Dietary intake before, during,
and after maternal exercise is important to monitor to maintain adequate energy
availability while avoiding unhealthy behaviors such as alcohol or drug use. New to
this edition is Chap. 10 with a focus on exercise prescription and adaptations in the
early postpartum, considered the “fourth trimester” with emphasis on planning,
conducting, and monitoring exercise classes to assist in transitioning back to exer-
cise and physical activity after giving birth, followed by Chap. 11 which discusses
strengthening the competences of future healthcare professionals in promoting
physical activity during pregnancy and the postpartum period using educational
strategies and digital health.
The second edition provides chapters written by experts in their respective fields
with a summary of revised and up-to-date evidence-based literature and presented
in a comprehensive format that can be used by healthcare providers and fitness pro-
fessionals to assist and engage individuals who wish to be physically active and
follow a healthy lifestyle throughout pregnancy and into the “fourth trimester.”
References
1. Nagpal TS, Mottola MF. Physical activity throughout pregnancy is key to preventing chronic
disease. Reproduction. 2020;160:R111–8.
2. Ruchat SM, Davenport MH, Giroux I, Hillier M, Batada A, Hammond JA, Sopper MM, Mottola
MF. Walking program of low or vigorous intensity during pregnancy confers an aerobic benefit.
Int J Sports Med. 2012;33:661–6.
3. Ruchat SM, Mottola MF, Skow RJ, Nagpal TS, Meah VL, James M, Riske L, Sobierajski
F, Kathol AJ, Marchand AA, Nuspl M, Weeks A, Gray CE, Poitras VJ, Jaramillo Garcia A,
Barrowman N, Slater LG, Adamo KB, Davies GA, Barakat R, Davenport MH. Effectiveness
of exercise interventions in the prevention of excessive gestational weight gain and postpartum
weight retention: a systematic review and meta-analysis. Br J Sports Med. 2018;52(21):1347–56.
4. Mottola MF. Pregnancy, physical activity and weight control to prevent obesity and future
chronic disease risk in both mother and child. Curr Women’s Health Rev. 2015;11(1):31–40.
5. Davenport MH, Ruchat SM, Poitras VJ, Jaramillo Garcia A, Gray CE, Barrowman N, Skow
RJ, Meah VL, Riske L, Sobierajski F, James M, Kathol AJ, Nuspl M, Marchand AA, Nagpal
TS, Slater LG, Weeks A, Adamo KB, Davies GA, Barakat R, Mottola MF. Prenatal exercise
for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a
systematic review and meta-analysis. Br J Sports Med. 2018;52(21):1367–75.
6. Barakat R, Pelaez M, Cordero Y, Perales M, Lopez C, Mottola MF. Exercise initiated in early
pregnancy protects against hypertension, excessive weight gain and macrosomia: randomized
control trial. Am J Obstet Gynecol. 2016;214(5):649.e1–8.
7. Vargas-Terrones M, Nagpal TS, Perales M, Prapavessis P, Mottola MF, Barakat R. Physical
activity and prenatal depression: going beyond statistical significance by assessing the impact
of reliable and clinical significant change. Psychol Med. 2021;51(4):688–93.
Foreword vii
8. Shojaei B, Loripoor M, Sheikhfathollahi M, Aminzadeh F. The effect of walking during late
pregnancy on the outcomes of labor and delivery: a randomized clinical trial. J Educ Health
Promot. 2021;10:277–85.
9. Wiebe HW, Boule N, Chari R, Davenport MH. The effect of supervised prenatal exercise on
fetal growth. A meta-analysis. Obstet Gynecol. 2015;125:1185–94.
R. Samuel McLaughlin Foundation— Michelle F. Mottola
Exercise and Pregnancy Laboratory,
School of Kinesiology, Faculty of
Health Sciences, Department of
Anatomy and Cell Biology, Schulich
School of Medicine and Dentistry,
Children’s Health Research Institute
[email protected] https://www.uwo.
ca/fhs/EPL/
The University of Western Ontario
London, ON, Canada
Preface
For several years I had the opportunity to work as exercise professional in the health
and fitness context with populations of all ages, including pregnant and postpartum
women. I do believe in exercise, and I have always been enthusiastic about working
with pregnant women in the roles of exercise professional, and later, also as a mother
(of Guilherme, Sofia, and Leonor). As a professor and researcher, I have devoted my
efforts to the field of exercise and sporting activity during pregnancy and the post-
partum period, by means of lectures, workshops, conferences, thesis supervision,
and publications.
The current evidence leaves no room for doubt that physical activity and exercise
should be part of a healthy lifestyle during pregnancy and the postpartum period.
Moreover, physical activity and exercise are beneficial for the health and fitness of
both mother and fetus. However, too many pregnant and postpartum women give up
or limit their exercise due to undue fear of losing a child or complications during
pregnancy and childbirth. On the other hand, sometimes neither the women nor the
professionals know what types of exercises are the best, the safest, and the most
effective.
Sport, exercise, and physical activity during pregnancy and postpartum is a quite
demanding field of knowledge and practice. Exercise professionals must be aware
of the many physiological, biomechanical, and psychosocial adaptations caused by
pregnancy, as well as the pregnancy-related health conditions, symptoms, and dis-
comforts, bearing in mind the proper pre-exercise and basic fitness evaluations,
individualized exercise prescription, exercise selection, adaptation, and safety,
while conducting pre- and postnatal exercise programs. Healthcare professionals
must develop appropriate health screening, ongoing medical monitoring, and spe-
cific treatment as necessary, as well as monitor potential contraindications for exer-
cise, having in mind the quite prevalent health conditions (such as excessive weight
gain, gestational diabetes, low back and pelvic girdle pain, urinary incontinence,
and diastasis recti). They must also be active agents in the health promotion process
by providing counseling on the benefits of physical activity, recreational exercise,
sports, and therapeutic exercise, and other aspects of health, such as nutrition, sleep,
and behaviors to be avoided. Thus, a multidisciplinary team approach is of particu-
lar importance, and communication between exercising or sporting women, medical
doctors (obstetricians, gynecologists, general practitioners, or other), midwives,
ix
x Preface
exercise professionals (exercise specialists, coaches, and exercise physiologists),
physical therapists, nutritionists, psychologists, among others, is fundamental.
My personal goals were to gather international researchers and practitioners
focused on the field of physical activity, exercise, and sports during pregnancy and
postpartum, to provide practical and evidence-based knowledge on the topic. This
book is intended to fill the gap between evidence-based knowledge on the benefits
of physical activity in pregnancy and postpartum, and practice in the implementa-
tion of exercise programs, bridging the gap between science and practice, between
researchers, health, and exercise professionals, and between women and exercise.
The ultimate goal is to help both exercise professionals and healthcare professionals
to provide better care to pregnant and postpartum women by means of physical
activity, exercise, and sports.
I want to thank from the bottom of my heart all the authors that shared their
knowledge and devoted some of their busy schedules to the first and the second edi-
tions of the present publication, as well as to all models and photographers.
These authors have different academic and practice backgrounds in gynecology,
physiotherapy, nursing, nutrition, psychology, and sports and exercise sciences, and
come from countries such as Argentina, Australia, Canada, England, Germany,
Lithuania, Norway, Poland, Portugal, Spain, Switzerland, and the Netherlands. The
first edition of this book was the first time that authors from different countries have
decided to present a collective release of their scientific or practical experience in
this topic. The second edition represents an update and reinforcement of this inter-
national cooperation.
The second edition is a comprehensive and multidisciplinary volume structured
in 14 chapters. The book combines research and exercise/clinical applications and
provides a real standard reference in this specific field for medical, health, sports,
and exercise professionals, as well as students and researchers.
Chapter 1 will give an overview regarding the concepts of physical activity and
exercise and health promotion aspects for the pregnant exerciser. Chapter 2 addresses
the current evidence surrounding the psychosocial aspects of an active pregnancy
and provides recommendations for providing psychological and behavioral support
to women to become or remain active throughout their pregnancy. Chapters 3, 4,
and 5 address, respectively, the physiological, body composition, and biomechani-
cal changes during pregnancy, the main forms of assessing these parameters, and
their implications for physical activity and exercise. Chapter 6 addresses the most
prevalent musculoskeletal impairments during pregnancy and postpartum, such as
urinary incontinence, diastasis recti abdominis, pregnancy-related low back pain
and/or pelvic girdle pain, and provides recommendations on how to recover func-
tional capacity. Chapter 7 updates the review of the current evidence-based and
practice-oriented guidelines for exercising during pregnancy in different countries,
regarding the contents related to prenatal exercise programs. Chapter 8 focuses on
the components of pre-exercise evaluation, exercise testing, and exercise prescrip-
tion for pregnant exercisers. Chapter 9 is practice-oriented regarding exercise selec-
tion and adaptations during pregnancy. Chapter 10 focuses on the components of
pre-exercise evaluation and exercise prescription and is practice-oriented regarding
Preface xi
the selection of exercises during the early postpartum period. Chapter 11 focuses on
educational strategies and digital health to empower future healthcare professionals
in the promotion of physical activity during the perinatal period. Chapter 12 is also
practice-oriented to the therapeutic exercise regarding the musculoskeletal health of
the pregnant exerciser. Chapter 13 addresses the nutritional requirements for the
pregnant exerciser and athlete, and the unhealthy habits to avoid. Finally, Chap. 14
aims to fill the gap between evidence-based knowledge on the impact of dietary
habits during pregnancy and particularly the pregnant exerciser and athlete and pro-
vides diet recommendations.
The following features of the book should be highlighted:
1. Multidisciplinary volume
2. Combines research and exercise/clinical applications
3. Practice-oriented with increased number of figures and links to videos
4. Updated and extended second edition of the first international collective,
evidence- based book on exercise in pregnancy and postpartum.
Hopefully, this book will attract health professionals, exercise and sports profes-
sionals, researchers, and students and will increase the recognition of the impor-
tance, effectiveness, and safety of the broad area of physical activity, exercise, and
sport during pregnancy and postpartum.
This book is dedicated to the memory of Elisa Geranio, editor at Springer, whom
I had the pleasure to meet in Vienna, in July 2016, during the Congress of the
European College of Sport Science. Elisa Geranio challenged me to this editorial
project and provided support until the first edition was submitted.
Rio Maior, Portugal Rita Santos-Rocha