|
Exercise and pregnancy |
||
| The importance
of maintaining adequate hydration should be emphasized. Drinking up to
500 mL of liquid before exercising and 250 mL of liquid every 30 minutes
during exercise should be sufficient to maintain adequate hydration.
Even if the patient is not thirsty after exercise, she should drink
enough liquid to replenish lost fluids. It is common to lose 1 to 2
litres of fluid per hour in sweat (1,15,16). Exercises performed in the supine position are inadvisable after the first trimester, as are prolonged periods of motionless standing. Both of these body positions have been associated with decreased cardiac output. Prolonged Valsalva maneuvers with isometric exercise such as weight lifting should be avoided because they may result in decreases in splanchnic blood flow and uterine perfusion (1,15,16). At each respective appointment, fundal height, hydration status, urine dipstick for ketones, sugar, and protein, blood pressure, adequate caloric intake between 150 to 300 kcal per day, and maternal weight should be routinely followed. The patient should show a normal weight gain throughout the pregnancy, independent of exercise. Some experts have recommended a baseline ultrasound examination at 16 to 18 weeks. Subsequent ultrasound evaluation would be indicated only if a size/date discrepancy were noted (1,15,19,20). Some women may experience a subjective increase in contractions during exercise in the late trimester, but these will generally resolve spontaneously without adverse sequelae. If contractions are still felt 30 minutes after exercise, the physician should be notified. Cervical checks or monitoring for contractions should be based on the patient's history and physical examination (21,22). Activities that require exceptional balance or extreme range of motion should be avoided in late pregnancy. The patient should also be discouraged from performing exercises that involve sudden changes in body position, chances of abdominal trauma, and increased potential of falls. A summary of recommendations regarding sports activities is provided in the table following (1). |
Activities to encourage Walking Stationary cycling Low-impact aerobics Swimming Activities to discourage Contact sports (increased risk of abdominal trauma) Hockey (field and ice) Football Soccer High-risk sports (increased potential for falls/trauma) Gymnastics Skating Skiing (snow and water) Vigorous racquet sports Weight lifting Scuba diving Conclusion The multifactorial physiological changes in pregnancy and exercise are still largely misunderstood. There is a long list of theoretical concerns. Given the appropriate guidelines and some helpful advice, there appears to be no reason that most women cannot continue with exercise during pregnancy and reap the possible benefits of improvement in well-being. References 1. American College of Obstetricians and Gynecologists. Exercise during pregnancy and the postpartum period. ACOG Technical Bulletin 189. Washington, D.C.: American College of Obstetricians and Gynecologists, 1994. 2. Pivarnik JM, Lee W, Clark SL, Cotton DB, Spillman HT, Miller JF. Cardiac output responses of primigravid women during exercise determined by the direct Fick technique. Obstet Gynecol 1990;75:954-9. |
|