Our time can be confidently characterized as the time of the craze for sports. And if once sports were, for the most part, the lot of men, now there is clear gender equality in this.
Both men and women have an equal healthy fanaticism about exercise, nutrition, and lifestyle in general. However, there is a circumstance that can only prevent a woman from realizing her sports ambitions.
This is pregnancy. Public opinion has a negative attitude towards the coexistence of the period of pregnancy and active sports, believing that it is better to postpone sports during pregnancy until the postpartum period.
However, the medical community thinks quite differently. Sports not only should not be excluded, on the contrary, but it must also be added, adhering to certain restrictions.
As an illustrative example, we can cite the recommendations on physical activity and exercise during pregnancy and the postpartum period, developed by the American College of Obstetricians and Gynecologists, adopted by other countries of the world (German Obstetric Practice Committee, Conclusion No. 804). These recommendations are designed for medical professionals so that they can be based on this, prescribe specific measures related to physical activity, based on the individual characteristics of the particular patient they are observing. Individualization is indispensable. And pregnancy can proceed in different ways and the load can differ significantly (professional and amateur sports are a big difference). Therefore, this article does not contain specific numbers, how many approaches you should do, repetitions, with what intensity, how much. Although certain guidelines are given.
- Physical activity and exercise during pregnancy is associated with minimal risks and has been shown to benefit most women, although some exercise modification may be necessary due to the normal anatomical and physiological changes and needs of the fetus.
- Before recommending an exercise program, careful clinical evaluation should be done to ensure that there is no medical reason for the patient to avoid exercise.
- Women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength exercise before, during, and after pregnancy. (Women who routinely did a vigorous aerobic activity or who were physically active before pregnancy may continue this activity during pregnancy and the postpartum period. Observational studies of women who exercise during pregnancy have shown benefits such as reducing the risk of gestational sugar diabetes, cesarean section and operative vaginal delivery, and postpartum recovery time. Physical activity can also be a significant factor in the prevention of depressive disorders in postpartum women.)
- Obstetricians and other obstetric care providers should carefully evaluate women with medical or obstetric complications before making recommendations for engaging in physical activity during pregnancy. Restriction of activity should not be prescribed regularly as a treatment to reduce preterm labor.
- More research is needed to examine the effects of exercise on pregnancy-specific conditions and outcomes, and to clarify further effective behavioral counseling methods and the optimal type, frequency, and intensity of exercise. Similar studies are needed to create a better evidence base on the effects of occupational physical activity on maternal and fetal health.
Anatomical and physiological aspects of physical activity during pregnancy
Pregnancy leads to anatomical and physiological changes that should be considered when prescribing exercise. The most pronounced changes during pregnancy are weight gain and a shift in the point of gravity, leading to progressive lordosis. These changes lead to increased efforts in the joints and spine during strength training. As a result, over 60% of all pregnant women experience lower back pain.
Strengthening your abdominal and back muscles can minimize this risk. Blood volume, heart rate, stroke volume, and cardiac output normally increase during pregnancy, and systemic vascular resistance decreases. These hemodynamic changes establish the circulatory reserve needed to keep the pregnant woman and the fetus at rest and during exercise.
During pregnancy, profound respiratory changes also occur. Minute ventilation is increased by up to 50%, primarily as a result of an increase in tidal volume. Due to the physiological decrease in lung reserve, the ability to anaerobic exercise is impaired, and the availability of oxygen for aerobic exercise and increased workload is constantly falling behind.
Physiological respiratory alkalosis of pregnancy may not be sufficient to compensate for the developing metabolic acidosis during strenuous physical activity.
Reduced subjective workload and maximum physical performance in pregnant women, especially those who are overweight or obese, limit their ability to engage in more strenuous physical activity.
Aerobic exercise during pregnancy has been shown to increase aerobic capacity in normal and overweight pregnant women.
Fetal response to maternal exercise
Most of the research on fetal response to maternal exercise has focused on changes in fetal heart rate and birth weight. Studies have shown a minimal to moderate increase in fetal heart rate of 10-30 beats per minute compared to baseline during or after exercise. Three meta-analyses concluded that differences in birth weight were minimal or absent in women who exercised during pregnancy compared to controls. However, women who continued to exercise vigorously during the third trimester were more likely to have babies weighing 200-400 g less than comparable control groups, although there was no increased risk of fetal growth restriction. A cohort study, which assessed umbilical artery blood flow, fetal heart rate, and biophysical profiles before and after strenuous exercise in the second trimester showed that 30 minutes of strenuous exercise was well tolerated by women and the fetus is active and inactive pregnant women.
For pregnant athletes, individual exercise protocols can be justified to establish whether there is a threshold (an absolute level of intensity or duration, or both) beyond which fetal well-being may be compromised.
Appointment of an individual exercise program
The principles of prescribing exercise for pregnant women are the same as those for prescribing exercise for the general population. Before recommending an exercise program, careful clinical evaluation should be done to ensure that there is no medical reason for the patient to avoid exercise. An exercise program that leads to the ultimate goal of moderate-intensity exercise for at least 20-30 minutes per day on most or all days of the week should be developed with the patient and adjusted according to the medical indication. Pregnant women who were sedentary before pregnancy should follow a more gradual progression of exercise.
Although an upper level of safe exercise intensity has not been established, women who regularly exercise before pregnancy and who have an uncomplicated, healthy pregnancy should be able to participate in high-intensity exercise programs such as jogging and aerobics without any side effects. effects. High-intensity or prolonged physical activity over 45 minutes can lead to hypoglycemia; thus, adequate caloric intake before exercise or limiting the intensity or duration of an exercise session is essential to minimize this risk.
Long-term exercise should be performed in a thermoneutral or controlled environment (air-conditioned room), and pregnant women should avoid prolonged exposure to heat and pay close attention to proper drinking and caloric intake.
In studies of pregnant women engaged in physical exercise, in which physical activity was self-sustaining under controlled temperature conditions, the body temperature rose by less than 1.5 ° C within 30 minutes and remained within safe limits.
Although physical activity and dehydration during pregnancy were associated with a modest increase in uterine contractions, a systematic review and meta-analysis of normal weight pregnant women with singleton uncomplicated pregnancies found that exercising 35-90 minutes 3-4 times per week was not associated with an increased risk of preterm birth or with a reduction in mean gestational age at the time of delivery.
Women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength exercise before, during, and after pregnancy. Contact activities with a high risk of abdominal injury or imbalance should be avoided.
Scuba diving should be avoided during pregnancy due to the inability of fetal pulmonary circulation to filter blister formation.
Women living at sea level were able to endure physical activity up to 6,000 feet, suggesting that this altitude is safe during pregnancy.
Women living at high altitudes can exercise safely at altitudes over 6,000 feet.
In cases where women experience lower back pain, water exercise is a good alternative. There may be additional benefits of aquatic exercise. A randomized controlled trial of an aquatic exercise program during pregnancy, consisting of three 60-minute exercises, demonstrated a higher incidence of intact perineum after childbirth.
For obese persons
Obese pregnant women should be encouraged to make changes to a healthy lifestyle during pregnancy that includes exercise and sensible diets.
Women should start with low intensity, short duration of exercise, and gradually increase the duration or intensity of exercise as much as they can.
In recent studies looking at the effects of exercise on obese pregnant women, women assigned to exercise showed moderate reductions in weight gain and no adverse outcomes.
Intense exercise in the third trimester appears to be safe for most healthy pregnancies. Further research is needed to investigate the effects of intense exercise in the first and second trimesters and exercise intensity above 90% of maximum heart rate.
Competitive athletes require frequent and close monitoring because they tend to maintain a more strenuous exercise schedule throughout their pregnancy and resume high-intensity exercise sooner after childbirth than other women. These athletes should pay particular attention to avoiding hyperthermia and maintaining adequate hydration and caloric intake to prevent weight loss that can adversely affect fetal growth.
An elite athlete can be generally defined as an athlete with several years of experience in a particular sport who has successfully competed with other high-level competitors and trained year-round at the peak of his ability; an elite athlete typically trains at least 5 days a week, averaging about 2 hours a day throughout the year.
In addition to aerobic training, elite athletes in most sports also practice resistance training (weights, machines, bodyweight, rubber buffers) to increase muscle strength and endurance, however, this training was not considered a safe activity in early training guidelines during pregnancy due to potential injury and possible slowing of fetal cardiac activity as a result of Valsalva maneuvers. Hence, there is scanty literature on this topic. For elite athletes who wish to continue strenuous activities during pregnancy, it is advisable to have a clear understanding of the risks, get approval from their healthcare providers, and consider reducing resistance stress versus prepregnant conditions. Activities with an increased risk of blunt trauma (martial arts) should be avoided, and a pregnant elite athlete must avoid overheating when participating in intense training or competition.
Several reviews have found that there is no reliable evidence for the use of bed rest during pregnancy to prevent premature birth and should not be recommended regularly.
Patients who are prescribed prolonged bed rest or limited physical activity are at risk of venous thromboembolism, bone demineralization, and deconditioning.
There are no studies to support improved outcomes for women at risk of preterm birth who are prescribed activity restriction, including bed rest, and numerous studies are supporting the adverse effects of restricting voluntary activity on mother and family, including negative psychosocial effects.
Activity limitation should not be given arbitrarily as a treatment to reduce preterm labor. Also, there is no evidence that bed rest reduces the risk of preeclampsia and should not be recommended for the primary prevention of preeclampsia and its complications.