ACTIVE LIVING DURING
PREGNANCY & POST
PARTUM
Dr. Michelle F. Mottola, Ph.D. FACSM
Director,
R. Samuel McLaughlin FoundationExercise and Pregnancy Laboratory
University of Western Ontario
London, Ont. Canada N6A 3K7
Email: mmottola@uwo.ca
MATERNAL AND FETAL WELL-BEING
Optimal zone for maternal
exercise prescription
Threshold for maternal
physical conditioning effects
increase
BASELINE
decrease
•metabolic and
cardiopulmonary reserve
• promotion of normal
glucose tolerance
• psychological benefits
• fetal and placental
adaptations
• chronic
fatigue
• musculo• prematurity
skeletal
• fetal growth
injury
restriction
• altered fetal
development
fetal death
QUANTITY AND QUALITY OF MATERNAL EXERCISE
Maternal dose-response curve
Fetal dose-response curve
Wolfe et al. Sports Med 1989;8:273-301
IMPORTANCE OF MEDICAL
PRESCREENING
THRESHOLD FOR PROBLEMS??
HISTORICALLY:
Prior to 1985 Exercise Guidelines for
Pregnant Women did not exist – REST!!
1985 – ACOG suggested heart rate should
not go above 140 beats per minute
1994 – ACOG Ignored heart rate;
Replaced with common sense guidelines
2002 – ACOG Ignored heart rate;
Replaced with exercise on all days of week!!
www.csep.ca
Canadian guidelines for active living during pregnancy
**Joint SOGC/CSEP Clinical Practice Guideline 2003**
CSEP & Health Canada (1996 Revised 2002)
PARmed-X for Pregnancy
(Physical activity readiness, medical
prescreening & exercise prescription)
- written for physician/midwife or health care
professional
Authors: L.A. Wolfe, Queens & M.F. Mottola, Western
CSEP & Health Canada (1999)
Active Living During Pregnancy
Physical activity guidelines for mother & baby.
Author: Angela Kochan-Vintinner (Eds. Wolfe & Mottola)
PARmed-X for Pregnancy
- 4 page document
- current history of pregnant women & occupation
- list of contraindications to exercise
- absolute, relative
- Aerobic conditioning guidelines
F. (frequency) 3- 4 times /week
I. (intensity) target HR zones
T. (time) 15 up to 30 minutes
T. (type)
- Muscle conditioning guidelines & precautions
- Safety considerations & reasons to consult
physician/midwife
Campbell & Mottola 2001. Amer. J. Obstet. Gynecol. 184:403.
• Occupational activity did not impact
on birth weight
• Structured exercise frequency during
late pregnancy appears to be a
determinant of birth weight
• Too much vs too little vs just right!!
***** 3 – 4 times per week ******
Mottola et al. 2006 – Med. Sci. Sports Exerc. – new zones
VO2peak Prediction and Exercise Prescription for Pregnant
Women. 38(8):1389-1395.
Target Heart Rate Zones:
20-29 years
Fit – 145 – 160 beats/minute
Unfit – 129 - 144 beats/minute
30-39 years
Fit – 140 – 156 beats/minute
Unfit – 128 – 144 beats/minute
Summary of Canadian Guidelines
1. Previously sedentary women with healthy
pregnancies can safely start an exercise program
in the second trimester
2. Women with low risk pregnancies can continue
mild to moderate activity throughout
3. Mild to moderate aerobic activity within the
Canadian guidelines (PARmed-X for Pregnancy)
is considered safe
4. Muscle conditioning activity with necessary
precautions is also considered safe
MATERNAL AND FETAL WELL-BEING
Threshold for maternal
physical conditioning effects
Optimal zone for maternal
exercise prescription
Sedentary lifestyle
*
Fetal & Placental
BASELINE
Altered ?
Maternal
Pregnancy
Adaptation
• metabolic &
cardiopulmonary reserve
• promotion of normal
glucose tolerance
• psychological benefits
Adaptations
?
•Altered Fetal Development
QUANTITY AND QUALITY OF MATERNAL EXERCISE
Maternal dose-response curve
Fetal dose-response curve
Adapted from Wolfe et al., 1989
PRESCRIPTION FOR AEROBIC
ACTIVITY DURING PREGNANCY
FREQUENCY
TWO OR LESS TIMES PER WEEK
TOO LITTLE!!?
Campbell & Mottola 2001. Amer. J. Obstet. Gynecol. 184:403.
Cover page of The Economist, December 13-19th, 2003.
Pregnancy link to Obesity?????
Among women of childbearing
age, one potential pathway for
obesity development is
excessive pregnancy weight
gain and post partum weight
retention
Siega-Riz et al. 2004. Nut Rev 62:S105-11
Impact of maternal & child health
on current obesity epidemic?
Prevention vs treatment??
Intervention times/promoting
physical activity?
• before conception
• during pregnancy
• post partum
• early years of child’s life by mom’s
influence & family life
Promotion of Active Living During Pregnancy
• Pregnancy is time when many
women change to a healthier
lifestyle
• improve eating habits
• quit smoking
• stop alcohol use
• moderate caffeine
consumption
• think about active living
Stages of Change (Intentional health
behaviour change – 5 stages):
• precontemplation (no intention)
• contemplation (considering a change)
• preparation (making small changes)
• action (actively engaging in change)
• maintenance (sustaining change over time)
Bull et al. 2001. Med Sci Sports Exerc. 33:1147-56.
Thus it is important that:
• Health care providers promote active
living throughout the life span including
pregnancy
• Many women are interested in
maintaining or improving pre pregnancy
fitness levels as they become pregnant
• Traditional view has been replaced with
active living and healthy lifestyle habits
before, during and after pregnancy.
What do pregnant women want?
Walking most popular activity
Barriers to physical activity?
Having children
Lack of time
Mottola & Campbell 2003. CJAP 28(4):642-653.
How do we promote physical
activity during pregnancy??
Effective promotion of active living
during pregnancy depends on the
extent and type of physical activity
performed before conception, while
taking into account the needs and
wants of pregnant women
throughout the three trimesters of
pregnancy.
Education Programs that include:
• benefits of being active during pregnancy
• guidelines available for exercise during
pregnancy (www.csep.ca)
• identified barriers to being active and
ways to overcome them
• assistance in social support (health care
providers, family involvement,
transportation, safety issues, facilities,
subsidized community programs)
Perhaps community programs
which facilitate and encourage
walking ,
• such as mall walking
(combined with elderly),
• which would also overcome
barriers to exercise,
• include child care,
• family walks including
children
May be successful in promoting
active living and physical
activity during pregnancy and
postpartum!!
(Active Living During Pregnancy, CSEP, 1999)
Active Living Post-partum
Rediscovering the “M” in “MCH”:
maternal health promotion after childbirth
– The science and practice of health promotion after
childbirth is less well developed except for breast
feeding and family planning
– Why should we promote health in the postpartum?


Improve women’s health and well-being in the immediate
postpartum period,
Reduce the risk of developing heart disease, obesity and
other lifestyle-related diseases.
– Better understanding of women’s health promotion in
the 1st postpartum year is an essential step in
addressing this neglect in maternal health
Walker LO, Wilging S. JOGNN 2000;29:229-236
Post-natal Exercise Muscle Conditioning
(Active Living During Pregnancy, CSEP, 1999)

Using baby for post-natal
activities
 Using baby as resistance
tool (carefully!!)
 Have fun interacting with
baby when doing pushups
Influence on early post-natal life
• Infants who were fed breast milk or
who were breast fed longer had lower
risk of overweight in adolescence
• Parental feeding patterns
• Parental activity patterns
• Obese mother – obese child
• Maternal influence as care-giver
If maternal-child interaction is a
significant initiating factor in the
obesity epidemic, will the prevention
of excessive weight gain in mother
during pregnancy and subsequently
less weight retention post-partum
lead to lower rates of obesity in
successive generations?
Active living during pregnancy &
post-partum??