HHP 312
Exercise Prescription
Clinical Case Study: Pregnancy and Exercise
Amber Topil and Kelsey Timmerman
4/26/13
Source: Hanne, H. (2011). Sports and leisure time physical activity during pregnancy in
nulliparous women. Maternal & Child Health Journal, 15(6), 806-813.
Our clinical case study looks at the impact of physical activity during pregnancy. We
looked at the article Sport and Leisure Time Activity During Pregnancy in Nulliparous Women.
Nulliparous refers to a woman who has never given birth before. We chose this population so
that it would be easier to see where each woman is coming from activity wise, without the
variable as to whether or not they’ve been given birth before (assuming that the pregnancy
experience has impacted the activity levels of any specific woman.) Since we chose pregnancy,
obviously the population would include currently pregnant women who are having a normal,
singleton, and spontaneous vaginal delivery. The article looked at “4,718 nulliparous women, 4%
participated in competitive sports, 25% in moderate-to- heavy exercise, 66% in light exercise,
and 5% in sedentary activities in the year before pregnancy.” It’s important to know where the
women are coming from in their previous activity lifestyle, because that can play a role as to how
active they are during pregnancy. The women ranged from ages 18 to 34. The majority of them
were in the 25 to 29 range (2,217.) The majority of the women were in a healthy BMI before
pregnancy with 3,214 in the 18.5-24.99 BMI range. Only 352 have received infertility treatment,
and 1,162 had a smoking status before pregnancy.
The hypothesis or purpose of the study was to “describe patterns of leisure time physical
activity during pregnancy in relation to pre-pregnancy leisure time physical activity, sociodemographic characteristics, fertility history, and lifestyle factors.” To test this hypothesis, nine
obstetric departments asked women to fill out a questionnaire that was self-administered. A total
of 4,718 out of 5,282 women filled returned it. The questionnaire provided information on sociodemographic characteristics, chronic disease, infertility treatment, and life style factors,
including questions related to leisure time physical activity before and during pregnancy. There
weren’t any invasive procedures that required further “Ethics Committee Approval.”
Overall many associations and links were found in this study regarding pre-pregnancy
exercise habits and exercise habits during pregnancy. Some of the more obvious links are the fact
that women who had we obese or had a pre pregnancy BMI of 30 or over tended to be less active
during pregnancy than other women. Women who were more active during pregnancy tended to
be involved in competitive sports or moderate to heavy physical activity before they became
pregnant and had a lower incident rate of chronic disease. Overall there was a general decrease in
the amount of women participating in competitive or moderate activity as they went from first to
third trimester. This is probably due to the fact that as pregnancy progresses it becomes more
uncomfortable to do some activities and some women report being worried about fetal health and
development. Most women that were active before continued to be active into their pregnancy
but most decreased the intensity of their exercise. In the case of women with light activities pre
pregnancy there was a 1% increase from light to moderate activity. Of the women that were
sedentary pre pregnancy about 27% increased their activity level, 25% to light and 2% to
moderate activity.
A prescription for pregnant women has many variables and is more involved than
prescriptions for the general population. One big factor someone must look at when putting
together a workout program is how active the woman was before pregnancy. The pre-pregnancy
workout habits of the mother determine her workouts while being pregnant. Other big things to
keep in mind when creating workouts is that the woman should not perform exercises in the
supine position after the first trimester, and pregnant women should always workout in thermo
neutral environments to avoid heat stress.
Our program is set up based on the trimester. The first trimester can be just as intense as
pre-pregnancy workouts but after that there are modifications that need to be made. Even women
who were very active in resistance workouts before pregnancy must still be careful and need to
modify the lifts and weights they use. Our prescription is pretty basic since most of the
population within the article was moderately active. We included squats and lunges at either
lighter weight or body weight, seated shoulder press (to prevent laying in supine position), then
curls, triceps extensions, and shoulder raises. All lifts and activities should be as tolerated and at
lighter weights than pre-pregnancy. We would also stress that lighter weights should be used to
prevent the tendency to use the Valsalva maneuver. Care needs to also be taken when choosing a
mode of aerobic training, women further on in their pregnancy should avoid things like biking so
as to avoid the danger of falling.
Prescription
First Trimester:
Frequency: at least 3 days but preferably all days of the week
Intensity: Moderate 40-60% VO2 reserve, may be good idea to use RPE instead due to
varying HR during pregnancy
Time: at least 15 min/day or total of 150min/week
Type: dynamic or rhythmic activities like walking or stationary biking
Second Trimester:
Frequency: at least 3-5 (may drop off some as pregnancy become more uncomfortable)
Intensity: Moderate about 40% VO2 reserve
Time: 100-150 min/week
Type: Walking (probably avoid biking at this point to reduce risk of falling)
Third Trimester:
Frequency: as much as tolerated, may need to cut back as pregnancy progresses
Intensity: low 25-30% VO2 reserve
Time 50-100 min/week (shorter bouts are probably more comfortable at this point)
Type: whatever is most comfortable, such as swimming
Resistance:
2-3 sets of 12-15 reps or till fatigue
1.
2.
3.
4.
5.
6.
7.
Squats – light or body weight
Lunges – light or body weight
Seated shoulder press – light
Bicep curls
Tricep Extensions
Lateral Shoulder raises
Frontal Shoulder raises
In conclusion, it has been proven through numerous studies that exercise during
pregnancy can have a big positive impact on both fetal and maternal health. Although many
precautions must be observed, exercising while pregnant is safe and healthy. Our article
researched women’s activity level before and during pregnancy and found that most that were
active before, stayed active during pregnancy. The study also showed that some women became
active once they were pregnant. Although this is not a bad thing, they must be extra careful and
try not to train at too high a level. The general rule is to base your intensity and training on where
you were pre-pregnancy.