2.13.08 Pregnancy

The minute a woman comes to you pregnant it is an automatic doctor's approval.

See all class notes in the packet.

1985
1994
2002
Statements

Must go w/Dr.'s restrictions even if they are from the 1985 statement which is the most restrictive.

Test Question definitions:
Morphology (according to dictionary.com)- 6. the study of the form or structure of anything. (basically meaning the size, form and shape of the pregnant woman)

Postpartum: (according to dictionary.com)- of or noting the period of time following childbirth; after delivery.

Changes start at conception and do not reverse until about 6 weeks postpartum. This is only if she isn't breastfeeding and there were not complications.

How does pregnancy change the ability to exercise?

1. Blood flow- must share O2 and blood with fetus (extra blood flow to uterus)

2. Cardiac Output (Q)- Increases 20-23% at rest (amount of blood pumped by the heart per min.)

Pregnancy is like a low level exercise just at rest. Increased HR by 15-20 bpm.
increased SV to support Q (stroke volume=the amount of blood pumped by the Left ventricle per beat)

Use RPE instead of HR. DO NOT USE HR to rate intensity of exercise.

Increased VO2 by 15-30%
1. For baby
2. support extra weight

Usually same BP
but Increase in Left ventricle thickness (good) -see this in resistance trained athletes.

see pkt. Blood vessels get bigger, return vessels become larger in diameter (ie varicose veins).

Blood pooling- in lower extremities- swelling, cannot return blood to heart efficiently.

As the uterus grows (to 6000x its original size), it puts pressure on the inferior vena cava- minimizing blood flow return. Avoid prolonged standing in one position, elevate legs (recumbant bike is good)

Be aware of postural hypotension- minimize sudden position changes (up to down and back up again).

Emphasis cool down to facilitate blood flow return to heart.

Increased plasma V by 45% (like in sports amemia -good)-increased water in blood

Increased red blood cell count by 30%

Joints relax-hormone relaxin -for the pelvis it is good for birthing, but not great for exercise. The hormone is not site specific-it relaxes ALL ligaments.

DO NOT be aggressive with flexibility and be very careful if doing any at all.
Be careful about pelvic dislocation.

Postural Changes (major)
Spinal changes

change in center of gravity-decreases balance significantly.

NO BALANCE work all together.

No fall risk/No abdominal trauma risk

Good- standing pelvic tilt (NOT supine)
cat back stretch (on all fours)

Increased frequency of urination (exercise incontinence)

Fetal Response

FHR increases 1 bpm for mother's 10. 80% of HRmax does not produce abnormal FHR.

Jarring is not detrimental, may actually be soothing, fluid acts as a shock absorption.

Difficulty because of weight gain, increased risk of injury.

Sheep studies- reproductive system is almost identical, even closer to us than monkeys.
Increased core Temp of 104 has been shown to be detrimental to fetus.

See ex. effects on Pregnancy pkt. (APGAR is a score given to newborns to quantify vitality moment to moment)



Women who exercise 3d/w before conception can increase their VO2max by 18% while pregnant, ie they are still trainable.

Just by being physically active you can improve glucose tolerance-need very little exercise.

General Recommendations 2002
Not a time to begin aggressive exercise (gradually increase)

For already trained women, 1st 3-4 monts-do not restrict exercise- women will naturally decrease Intensity/Duration with increased length of pregnancy.

Do not train to exhaustion

All suggestions extend 4-6 weeks postpartum.

Relative to mother's fitness level SEE PKT. LISTS!!
Know absolute contraindications
Know relative contraindications.