Exercise during
Pregnancy
CASM/ OMA Cutting Edge Sport Medicine 2010
E. Laura Cruz, MD
SportCARE, Women’s College Hospital
drlaura@pivotsmo.com
The presenter declares no conflict of interest.
What’s new since 2002?
► ACOG
Guidelines 2002
► SOGC Guidelines (2003)
► CASM Position Paper (2008)
► Exercise in the Active Pregnant Woman
► Evidence based recommendations (2010)
► Available resources
What are the issues?
► Exercise
during pregnancy previously
restricted
► Now encouraged for all healthy pregnant
women
► What are the benefits of exercise seen in
pregnant patients?
► Is there a safety threshold? What can
athletes do?
► Heart
rate changes
► Hyperthermia
► Trauma to uterus
► Hyper/ hypobaric exercise
► Hypotension
► MSK changes
SOGC Guidelines 2003
► Evaluated
research of the time
► In conjunction with CSEP
► Used by SportCARE for its North America
wide “Exercise and Pregnancy Helpline”
► Ideal for low risk pregnancy in inactive or
recreationally exercising women
Purpose of Guidelines
► Standardize
care
► Accessible to health care providers
► Protect maternal and fetal health and wellbeing
► Evidence based
SOGC Recommendations 2003
1. All women without contraindications should
be encouraged to participate in aerobic and
strength-conditioning exercises as part of a
healthy lifestyle during their pregnancy.
(II-1,2B)
SOGC Recommendations 2003
2. Reasonable goals of aerobic conditioning in
pregnancy should be to maintain a good
fitness level throughout pregnancy without
trying to reach peak fitness or train for an
athletic competition. (II-1,2C)
SOGC Recommendations 2003
3. Women should choose activities that will
minimize the risk of loss of balance and
fetal trauma. (III-C)
Table 3
Exercise in Pregnancy
Olson, David; Sikka, Robby S.; Hayman,
Jacob; Novak, Melissa; Stavig, Christina
Current Sports Medicine Reports.
8(3):147-153, May/June 2009.
doi: 10.1249/JSR.0b013e3181a61d51
TABLE 3. Sports recommendations.
Copyright © 2010 Current Sports Medicine Reports. Published by Lippincott Williams & Wilkins.
14
SOGC Recommendations 2003
4. Women should be advised that adverse
pregnancy or neonatal outcomes are not
increased for exercising women. (II-1,2B)
SOGC Recommendations 2003
5.Initiation of pelvic floor exercises in the
immediate postpartum period may reduce
the risk of future urinary incontinence. (II1C)
SOGC Recommendations 2003
6.Women should be advised that moderate
exercise during lactation does not affect the
quantity or composition of breast milk or
impact infant growth. (I-A)
Cochrane Systematic Reviews
► Aerobic
Exercise in
Pregnancy
► Prevention of
Gestational Diabetes
► Decrease risk of PreEclampsia
Aerobic exercise for women during pregnancy
Michael S Kramer1, Sheila W McDonald2
1Faculty of Medicine, McGill University, Montreal, Canada. 2Department of Epidemiology and Biostatistics, McGill University,
Montreal, Canada
Citation: Kramer MS, McDonald SW. Aerobic exercise for women during pregnancy. Cochrane Database of Systematic
Reviews 2006, Issue 3
(reviewed and published in 2009)
►
►
Authors' conclusions
Regular aerobic exercise during pregnancy appears to improve (or maintain)
physical fitness. Available data are insufficient to infer important risks or
benefits for the mother or infant. Larger and better trials are needed before
confident recommendations can be made about the benefits and risk of
aerobic exercise in pregnancy.
[Note: The 21 citations from 18 separate trials in the awaiting classification
section of the review may alter the conclusions of the review once assessed.]
Exercise for Diabetic Pregnant Women
Ceysens G, Rouiller D, Boulvain M.
Cochrane Database of Systematic Reviews 2006, Issue 3.
►
Authors' conclusions
►
There is insufficient evidence to recommend, or advise against,
diabetic pregnant women to enrol in exercise programs. Further trials,
with larger sample size, involving women with gestational diabetes,
and possibly type 1 and 2 diabetes, are needed to evaluate this
intervention.
►
[Note: The six citations in the awaiting classification section of the review may
alter the conclusions of the review once assessed.]
Exercise or other physical activity for preventing preeclampsia and its complications.
Meher S, Duley L. Cochrane Database of Systematic Reviews 2006, Issue 2.
MAIN RESULTS:
Two small, good quality trials (45 women) were included. Both
compared moderate intensity regular aerobic exercise with
maintenance of normal physical activity during pregnancy. The
confidence intervals were wide and crossed the line of no effect for all
reported outcomes including pre-eclampsia (relative risk 0.31, 95%
confidence interval 0.01 to 7.09).
►
►
AUTHORS' CONCLUSIONS:
There is insufficient evidence for reliable conclusions about the effects
of exercise on prevention of pre-eclampsia and its complications
.
CASM Position Paper 2008
► Previously
active women may continue in T1
► Mild core temp changes are tolerated
► No affect birth weight
► No known threshold for maternal exercise, and
fetal stress: ongoing research needed
► Psychological benefits can be achieved by
moderate exercise
► Post Partum exercise is supported as intervention
for healthy lifestyle without adverse effects
Exercise in the Active Pregnant
Woman
Evidence- based Recommendations
for Active Women in 2010
► Paucity
of new research about pregnant
elite athletes
► Many anecdotes (AKA case reports?)
► Some advances in role of exercise and GDM
► Little if any data on elite pregnant athletes
► One comprehensive review (level III)
Strenuous Exercise During Pregnancy: Is It Safe for
Fit, Healthy Women?
Wolfe, L A. FACSM; Mottola, M F.
MSSE 2002; 34 (5): S46 B5 Mini-Symposium
► In
summary, information presented in this
mini-symposium supports the hypothesis
that healthy, fit pregnant women are welladapted to perform acute bouts of highintensity, short duration as well as
prolonged exercise at moderate intensities
Effects of intense training during and after pregnancy
in top-level athletes
Kristin Reimers Kardel
Scand J Med Sci Sports 2005: 15: 79–86
►
“The overall aim of the study was to define a safe training regime for the
maintenance of fitness in top-level female athletes during pregnancy”
Cohort study with 41 pregnant elite athletes (from 17 wk GA)
► High intensity exercise (n=20) and medium intensity exercise (n-21)
►
 Strength training- 1 hr 12 min 2X wkly
 Interval training-10 or 15 min sprints (mean HR 170-180 bpm) 2X wkly
 Endurance training-1.5 or 2.5 hr (mean HR 120- 140 bpm) 2X wkly
Measured parameters demonstrated maintenance of fitness levels
► Interval and endurance training exceeded guidelines-no effect on fetal health
►
Pregnancy in endurance athletes.
Penttinen J, Erkkola R.
Scand J Med Sci Sports 1997: 7: 226228
►
►
►
►
►
►
Retrospective questionnaire and review of pregnancy diaries in 30 elite
Finnish endurance athletes
Compared to 30 control women
No information about training regimen
23 athletes continued to train (GA 7-39 wk)
18 continued to compete (GA 0-25 wk)
Results:
 No significant differences in fetal well being, labour, complications
►
Authors concluded endurance training was safe and effect of
pregnancy on performance was individual
Exercise in Pregnancy
Olson, David; Sikka, Robby S.; Hayman, Jacob; Novak, Melissa; Stavig, Christina
Current Sports Medicine Reports:
May/June 2009 - Volume 8 - Issue 3 - pp 147-153
The 2006 “Cochrane review highlights the need for more studies examining the
impact of exercise upon pregnancy (35).
► However, recent research suggests that positive effects include
►





potential risk reduction for development of gestational diabetes
pregnancy-induced hypertension,
decrease in postpartum depression symptoms, and
a decreased incidence of urinary incontinence and preeclampsia, and
no increased risk of preterm birth (1,8,13,28,29,31,36).”
“Despite methodological pitfalls in the studies published, the evidence
does suggest a benefit of exercise in pregnancy”
“In the absence of
contraindications, the
authors believe that
physicians should help
to develop a
reasonable exercise
protocol for women
based upon their
previous activity
levels.”
Olson et al, Exercise and Pregnancy 2009
Curr Sports Med Rep ; 8(3): 147-153
Available Resources
► PARmed-
X for
Pregnancy
► Cochrane Reviews?
► SportCARE Exercise
and Pregnancy
Helpline
► SportCARE Active
Pregnancy Clinic
PARmed-X for Pregnancy
SportCARE Resources
► Exercise
and Pregnancy Helpline
 1-866-937-7678
► Active
Pregnancy Clinic
 416-323-6479
 MSK; pelvic floor; metabolic conditions of
pregnancy (e.g. uncomplicated GDM; obese
patients)
 Pregnant athletes
Thank you!