Exercise and Sporting Activity During Pregnancy: Evidence-Based Guidelines

355 Pages·2019·11.68 MB·English

by  Rita Santos-Rocha

Exercise and Sporting
Activity During
Pregnancy
Evidence-Based Guidelines
Rita Santos-Rocha
Editor
123
Exercise and Sporting Activity During
Pregnancy
Rita Santos-Rocha
Editor
Exercise and Sporting
Activity During Pregnancy
Evidence-Based Guidelines
Editor
Rita Santos-Rocha
Sport Sciences School of Rio Maior
Polytechnic Institute of Santarém
Rio Maior
Portugal
Laboratory of Biomechanics and Functional Morphology
Interdisciplinary Centre for the Study of Human Performance
Faculty of Human Kinetics
University of Lisbon
Cruz Quebrada-Dafundo
Portugal
ISBN 978-3-319-91031-4 ISBN 978-3-319-91032-1 (eBook)
https://doi.org/10.1007/978-3-319-91032-1
Library of Congress Control Number: 2018958985
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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 [1]. Maternal
exercise has also been linked to appropriate birth weight [8] and prevention of
chronic disease development in the offspring [4]. When these benefits are consid-
ered, it is surprising that many healthcare providers do not advocate a healthy life-
style for pregnant women. 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
toward exercise among women, healthcare providers, and exercise professionals
from an international perspective (Chap. 7).
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
health in order to improve and restore physical function (Chap. 10).
Medical screening is an important component to ensure that pregnant women
have a low-risk pregnancy before engaging in exercise. Guidelines for exercise test-
ing and prescription for pregnant and postpartum women are presented in Chap. 8,
followed by suggestions for programming exercise classes that includes steps for
planning and conducting classes, and monitoring pregnant women for safe physical
activity (Chap. 9). Lastly, a healthy lifestyle would not be complete without nutri-
tion requirements for pregnant women who exercise. Dietary intake before, during,
v
vi Foreword
and after maternal exercise is important to monitor in order to maintain adequate
energy availability while avoiding unhealthy behaviors such as alcohol or drug use
(Chap. 11).
Each of these chapters are written by experts in their respective fields with a sum-
mary of up-to-date evidence-based literature and presented in a well-rounded for-
mat that can be used by healthcare providers and fitness professionals to assist and
engage women who wish to be physically active and follow a healthy lifestyle
throughout pregnancy.
Michelle F. Mottola
R. Samuel McLaughlin Foundation – Exercise
and Pregnancy Laboratory,
Department of Anatomy and Cell Biology,
Faculty of Health Sciences, School of Kinesiology,
Schulich School of Medicine and Dentistry,
Children’s Health Research Institute,
The University of Western Ontario,
London, ON, Canada
References
1. Hinman SK, Smith K, Quillen DM, Smith MS. Exercise in pregnancy: a clinical
review. Sports Health. 2015;7:527–31.
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;33:661–66.
3. Muktabhant B, Lawrie TA, Lumbiganan P, Laopaiboon M. Diet or exercise, or
both, for preventing excessive weight gain in pregnancy. Cochrane Database Syst
Rev. 2015;6:CD007145.
4. Ruchat SM, Mottola MF. Preventing long-term risk of obesity for two genera-
tions: prenatal physical activity is part of the puzzle. J Preg. 2012;470247.
5. Cordero Y, Mottola MF, Vargas J, Blanco M, Barakat R. Exercise is associated
with a reduction in gestational diabetes mellitus. Med Sci Sports Exerc.
2015;47:1328–33.
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–e8.
7. Vargas-Terrones M, Barakat R, Santacruz B, Fernandez-Buhigas I, Mottola
MF. Physical exercise programme during pregnancy decreases perinatal depression
risk: a randomized controlled trial. Br J Sports Med. 2018. pii: bjsports-2017-098926.
[Epub ahead of print].
8. 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.
Preface
For many years I had the opportunity to work as an exercise professional in the
health and fitness context with populations of all ages, including pregnant and post-
partum women. I believe in exercise, and I have always been enthusiastic about
working with pregnant women, both as an exercise professional and later as a
mother. As a professor and researcher, I have devoted my efforts to the field of exer-
cise and sporting activity during pregnancy and the postpartum 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. Moreover, physical activity
and exercise are beneficial for the health and fitness of both mother and fetus.
However, too many pregnant women still 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 exer-
cises are the best, the safest, and the most effective.
Sport and exercise during pregnancy is a quite demanding field of knowledge
and practice. Exercise professionals must be aware of the many physiological, bio-
mechanical, and psychosocial adaptations caused by pregnancy, as well as the
pregnancy- related health conditions, symptoms, and discomforts, bearing in mind
the proper pre-exercise and basic fitness evaluations, individualized exercise pre-
scription, exercise selection, adaptation, and safety, while conducting prenatal exer-
cise programs. Healthcare professionals must develop appropriate health screening,
ongoing medical monitoring, and specific treatment as necessary, as well as monitor
potential contraindications for exercise, 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 and behaviors to be avoided. Thus, a team
approach is of particular importance, and the communication between the exercis-
ing or sporting women, the medical doctors (obstetricians, gynecologists, general
practitioners, or other), the midwives, the exercise professionals (exercise special-
ists and exercise physiologists), the physical therapists, the nutritionists, the psy-
chologists, among others, is fundamental.
vii
viii Preface
My personal goals were to gather international researchers and practitioners
focused on the field of sports and exercise during pregnancy, 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 preg-
nancy and practice in the implementation of exercise in pregnant women, bridging
the gap between science and practice, between researchers and 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 preg-
nant women by means of sport and exercise.
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 present publication, as
well as to all models.
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, Lithuania,
Norway, Poland, Portugal, Spain, and The Netherlands. Thus, for the first time,
authors from different countries have decided to present a collective release of their
scientific or practical experience in this topic.
This is a comprehensive and multidisciplinary volume structured in eleven chap-
ters. 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 and the
pregnant athlete. Chapter 2 addresses the current evidence surrounding the psy-
chosocial 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 biomechanical changes during pregnancy,
the main forms of assessing these parameters, and their implications for physi-
cal activity and exercise. Chapter 6 addresses the most prevalent musculoskel-
etal impairments during pregnancy, such as urinary incontinence, diastasis recti
abdominis, pregnancy-related low back pain, and/or pelvic girdle pain, and pro-
vides recommendations on how to recover functional capacity. Chapter 7
reviews the current evidence-based and practice- oriented guidelines for exercis-
ing during pregnancy in different countries, regarding the contents related to
prenatal exercise programs. Chapter 8 is focused on the components of pre-
exercise evaluation, exercise testing, and exercise prescription for pregnant
exercisers and athletes. Chapter 9 is practice-oriented regarding the exercise
selection and adaptations during pregnancy. Chapter 10 is practice-oriented to
therapeutic exercise for the musculoskeletal health of the pregnant exerciser.
Finally, Chap. 11 addresses the nutritional requirements for the pregnant exer-
ciser and athlete.
Preface ix
The following features of the book should be highlighted:
1. Multidisciplinary volume
2. Combines research and exercise/clinical applications
3. Practice-oriented
4. It is the first international collective, evidence-based book on exercise in
pregnancy
Hopefully, this book will attract health professionals, exercise and sports profes-
sionals, researchers, and students and will increase the recognition of the need for
further research on the broad area of sport and exercise during pregnancy.
This book is dedicated to the memory of Elisa Geranio, Editor at Springer, that 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 it was submitted.
Lisbon, Portugal Rita Santos-Rocha
Contents
1 Physical Activity, Exercise, and Health Promotion for the Pregnant
Exerciser and the Pregnant Athlete . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Mireille van Poppel, Katrine Mari Owe, Rita Santos-Rocha, and
Hélia Dias
2 Psychological, Social and Behaviour Changes During Pregnancy:
Implications for Physical Activity and Exercise . . . . . . . . . . . . . . . . . . 19
Lou Atkinson and Megan Teychenne
3 Physiological Changes During Pregnancy: Main Adaptations,
Discomforts, and Implications for Physical Activity and Exercise . . . 45
María Perales, Taniya Singh Nagpal, and Ruben Barakat
4 Body Composition Changes During Pregnancy and Effects
of Physical Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Nuno M. Pimenta and Mireille van Poppel
5 Biomechanical Adaptations of Gait in Pregnancy: Implications
for Physical Activity and Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Rita Santos-Rocha, Marco Branco, Liliana Aguiar, Filomena Vieira,
and António Prieto Veloso
6 Specific Musculoskeletal Adaptations in Pregnancy: Pelvic Floor,
Pelvic Girdle, and Low Back Pain: Implications for Physical
Activity and Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Kari Bø, Britt Stuge, and Gunvor Hilde
7 Evidence-Based and Practice-Oriented Guidelines for
Exercising During Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Anna Szumilewicz, Aneta Worska, Rita Santos-Rocha, and Miguel
Ángel Oviedo-Caro
8 Exercise Testing and Prescription for Pregnant Women . . . . . . . . . . . 183
Rita Santos-Rocha, Isabel Corrales Gutiérrez, Anna Szumilewicz,
and Simona Pajaujiene
xi