What you should know about physical activity during pregnancy?

Nowadays we know about advantages of physical activity during pregnancy. Some of them can decrease risk of excessive gestational weight gain, gestational diabetes, preeclampsia, preterm birth, varicose veins, and deep vein thrombosis. Physical activity during pregnancy can reduce length of labour and delivery complications too.

Despite physical benefits of regular exercise, there are also psychological benefits, such as reduced fatigue, stress, anxiety, and depression, as well as improved well-being.  The evidence shows that  women who are active during pregnancy are more likely to continue physical activity during postpartum.

Moreover, it is worth to know how your body responds to changes throughout your pregnancy if you decide to take regular physical activity. There are greater changes happening (heart rate, cardiac output, ventilation, and energy expenditure) in this particular stage of your life compare to prepregnancy.  

As we can see, there are many information available out there regarding physical activity during pregnancy. However personally I would look for recommendations from professional and refer to varies medical articles including guidelines. This is due to that every pregnancy is individual and what can work for me might not work for you. Due to above, you can be guided how long, how far, how often, and at what intensity of exercises is appropriate for you.

For example, the World Health Organization (WHO) recommends that adults age 18 to 64 years should engage in at least 150 minutes of moderate intensity aerobic activity throughout the week, or at least 75 minutes of vigorous intensity aerobic activity, or an equivalent combination of the two. You might not be able to meet those recommendation at least initially. Or strengthening exercises should be done two or more days per week, but again for you it might be too much if you were not active before pregnancy. Finally, hormonal changes increase joint laxity that may place a woman at increased risk for injury too. So again it is very important to take precaution and you should seek medical advice before you decide to start taking regular exercises during your pregnancy.

References:

1. Pivarnik JM, Chambliss H, Clapp J, III, et al. Impact of physical activity during pregnancy and postpartum on chronic disease risk. Med Sci Sports Exerc. 2006;38(5):989–1006. https://www.ncbi.nlm.nih.gov/pubmed/16672855

2. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. ODPHP Publication No. U0036. Washington, D.C: [Accessed November 1, 2012]. 2008. at http://www.health.gov/paguidelines/

3. Davies G, Wolfe L, Mottola M, MacKinnon C. Joint SOGC/CSEP clinical practice guideline: Exercise in pregnancy and the postpartum period. Can J Appl Physiol. 2003;28(3):330–341. https://www.ncbi.nlm.nih.gov/pubmed/12955862

4. Royal College of Obstetricians and Gynaecologists. Exercise in pregnancy. [Accessed September 1, 2012];RCOG Statement No. 4 - January 2006. 2006 at http://www.rcog.org.uk/files/rcog-corp/uploaded-files/RCOGStatement4ExercisePregnancy2006.pdf.

5. Mottola M. Chapter 12: Performance in the pregnant woman: maternal and fetal considerations. In: Taylor N, Groeller H, editors. Physiological Bases of Human Performance During Work and Exercise. Elsevier; USA: 2008. pp. 225–237.

 

6. O’Toole ML. Physiologic aspects of exercise in pregnancy. Clin Obstet Gynecol. 2003;46(2):379–389. https://www.ncbi.nlm.nih.gov/pubmed/12808388

 

7. Vladutiu C, Evenson K, Marshall S. Physical activity and injuries during pregnancy. J Physical Activity Health. 2010;7:761–769. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3319730/

 

8. World Health Organization. Global Recommendations on Physical Activity for Health. Geneva, Switzerland: [Accessed September 28, 2012]. 2010. at http://apps.who.int/iris/bitstream/10665/44399/1/9789241599979_eng.pdf

Modifiable stroke risk factors

Ten potentially modifiable risk factors are collectively associated with about 90% of the PAR of stroke in each major region of the world, among ethnic groups, in men and women, and in all ages. 

Previous history of hypertension or blood pressure of 140/90 mm Hg  (99%)

Regular physical activity (35·8%)

Apolipoprotein  (26·8%)

Diet (23·2%) 

Waist-to-hip ratio (18·6%)

Psychosocial factors (17·4%)

Current smoking (12·4%)

Alcohol consumption (5·8%) 

Diabetes mellitus ( 3·9%)

Cardiac causes (9.1%)

Collectively, these risk factors accounted for 90·7% of the PAR for all stroke worldwide (91·5% for ischaemic stroke, 87·1% for intracerebral haemorrhage), and were consistent across regions (ranging from 82·7% in Africa to 97·4% in southeast Asia), sex (90·6% in men and in women), and age groups (92·2% in patients aged ≤55 years, 90·0% in patients aged >55 years).

Hypertension was more associated with intracerebral haemorrhage than with ischaemic stroke, whereas current smoking, diabetes, apolipoproteins, and cardiac causes were more associated with ischaemic stroke.

Improvement of lifestyle related risk factors 

Resources:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30506-2/fulltext

https://www.ncbi.nlm.nih.gov/pubmed/27431356

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30679-1/fulltext

http://circres.ahajournals.org/content/120/3/472/tab-figures-data

Global Recommendations on Physical Activity for Health 65 years and above ( WHO 2017)

There is strong scientific evidence that regular physical activity produces major and extensive health benefits in both adults aged 18–64 and in older adults aged 65 and above. In some cases the evidence of health benefits is strongest in older adults because the outcomes related to inactivity are more common in older adults. This results in an increased ability of observational studies to detect the protective effect of physical activity in this age group. Overall, conclusive evidence shows that both moderate-intensity and vigorous-intensity activity provide similar health benefits in both adult age groups.

The overall evidence for adults aged 65 years and above demonstrates that, compared to less active individuals, men and women who are more active have lower rates of all-cause mortality, coronary heart disease, high blood pressure, stroke, type 2 diabetes, colon cancer, breast cancer, a higher level of cardiorespiratory and muscular fitness, healthier body mass and composition, and a biomarker profile that is more favourable for the prevention of cardiovascular disease, type 2 diabetes and the enhancement of bone health.

These benefits are observed in adults in the older age range, with or without existing noncommunicable diseases (NCDs). Hence inactive adults of the 65 years and above age group, including those with NCDs, are likely to gain health benefits by increasing their level of physical activity. If they cannot increase activity to levels required to meet guidelines, they should be active to the level their abilities and health conditions allow. Older adults who currently do not meet the recommendations for physical activity should aim to increase physical activity gradually, starting with increasing duration and frequency of moderate-intensity activity before considering increasing the intensity to vigorous-intensity activity. In addition, strong evidence indicates that being physically active is associated with higher levels of functional health, a lower risk of falling, and better cognitive function. [...] 

In older adults with poor mobility, there is consistent evidence that regular physical activity is safe and reduces risk of falls by nearly 30%. For prevention of falls, most evidence supports a physical activity pattern of balance training and moderate-intensity muscle-strengthening activities three times per week. There is no evidence that planned physical activity reduces falls in adults and older adults who are not at risk of falls. Evidence specific for this age group related to the maintenance or improvement of balance for those at risk of falling was reviewed from the systematic reviews by Paterson (2007) and Patterson and Warburton (2009).

WHO. Global recommendations on physical activity for health. Age group; 65 years old and above 2017: 30-33. 

WHO global recommendations on physical activity for health in older adults

Recommendations in short

Phenomenon of Nordic Walking

A physical outdoor activity discovered in Finland has been recognised and accepted as an important step in maintaining good health among people in every age and around the globe.

Mark Kantaneva, father of modern NW, said “Nordic Walking is more extensive walking, where arms are used as the propulsion.” Marko Kantaneva agrees with health professionals that there are numerous benefits of NW. No one  denies its positive value  for health, including its rehabilitation aspect – which can be a sound addition to contemporary physiotherapy treatments.

As a Physiotherapist, I can see the value of active walking in rehabilitation. Firstly, the muscles of the upper body are activated significantly. Secondly, the lower limbs are not excessively exploited as happens during regular walking.  When you use the walking poles properly, they help your arms to carry some of your body weight.  In normal walk that force is applied on weight bearing joints causing overloading, mainly on knee joints, often very vulnerable to injuries.

This Finnish sport can be a remedy for a large number of individuals with a chronic condition.  However, the “four-on-the-floor” approach to walking give an opportunity to those with co-ordination and balance issues.  The base of support is increased by using of walking poles. Moreover, normal gait pattern and coordination is improved. According to Physiotherapist Hilary Jebson: “The poles facilitate a normal gait pattern with a heel strike and toe push-off, and pressing down on the base of the handle causes the core muscles to contract and encourages spinal extension.” Patients with multiple sclerosis, after spinal cord surgery and even those in the early stages of  Parkinson’s disease can definitely benefit from NW.

Most people with sedentary work suffer from neck and upper limbs pain, but regular training with NW reduces pain around neck and upper limbs. It also improves the flexibility of the cervical spinal cord and circulation in the chest. During NW, muscle activity is most intense in the biceps, triceps, posterior aspect of deltoideus, pectoralis major and latissimus dorsii (Mark Kantaneva).

Also worth mentioning is the effectiveness of NW in providing cardiovascular exercise. The upper body, in order to work harder, requires more respiratory and cardiac capacity. At the 20th Annual Meeting of  the Canadian Association of Cardiac Rehabilitation in Montreal (October 2010) it was shown that patients with moderate to severe heart failure (14%) improved functional status when assigned to Nordic pole walking versus more usual cardiac rehabilitation care. Finally, the European Society of Cardiology’s Heart Failure Congress in Belgrade (May 2012), presented that Nordic Walking enables a safe increase in exercise intensity and may be a more effective training method than walking without poles in patients with Heart Failure.

While  Nordic Walking is undoubtedly becoming a more and more popular recreational activity, it has a great potential as a leading form of  therapy in contemporary and complex rehabilitation.

Iwona Obroslak

Published on  Pangea Magazine