Physical activity and pregnancy: Cardiovascular adaptations, recommendations and pregnancy outcomes

Sports Medicine

Volumn 40, Issue 6, 2010, Pages 493-507

  Melzer, Katarina ^a,b   Schutz, Yves ^c   Boulvain, Michel ^b   Kayser, Bengt ^a  

^a UNIVERSITY OF GENEVA   (Switzerland)

^b GENEVA UNIVERSITY HOSPITALS   (Switzerland)

^c UNIVERSITY OF LAUSANNE   (Switzerland)

Author keywords

Exercise; Pregnancy

Indexed keywords

CARDIOVASCULAR FUNCTION; DELIVERY; EXERCISE; FEMALE; FETUS DEVELOPMENT; HUMAN; LABOR; OXYGEN CONSUMPTION; PHYSIOLOGY; PRACTICE GUIDELINE; PREGNANCY; PREGNANCY OUTCOME; REVIEW;

CARDIOVASCULAR PHYSIOLOGICAL PHENOMENA; DELIVERY, OBSTETRIC; EXERCISE; FEMALE; FETAL DEVELOPMENT; GUIDELINES AS TOPIC; HUMANS; LABOR, OBSTETRIC; OXYGEN CONSUMPTION; PREGNANCY; PREGNANCY OUTCOME;

EID: 77953190436     PISSN: 01121642     EISSN: 11792035     Source Type: Journal    
DOI: 10.2165/11532290-000000000-00000     Document Type: Review

References (115)

1. Melzer K, Kayser B, Pichard C. Physical activity: the health benefits outweigh the risks. Curr Opin Clin Nutr Metab Care 2004; 7: 641-647
2. American College of Sports Medicine. ACSM's guidelines for exercise testing and prescription. Philadelphia (PA): Lippincott Williams & Wilkins, 2006
3. Wolfe LA, Weissgerber TL. Clinical physiology of exercise in pregnancy: a literature review. J Obstet Gynaecol Can 2003; 25: 473-483
4. Zhang J, Savitz DA. Exercise during pregnancy among US women. Ann Epidemiol 1996; 6: 53-59
5. Pivarnik JM, Chambliss HO, Clapp JF, et al. Special communications, roundtable consensus statement: impact of physical activity during pregnancy and postpartum on chronic disease risk. Med Sci Sports Exerc 2006; 38: 989-1006
6. Jones AM, Carter H. The effect of endurance training on parameters of aerobic fitness. Sports Med 2000; 29: 373-386
7. Fujimoto T, Kemppainen J, Kalliokoski KK, et al. Skeletal muscle glucose uptake response to exercise in trained and untrained men. Med Sci Sports Exerc 2003; 35: 777-783 (Pubitemid 36547380)
8. McArdle W, Katch F, Katch V. Essentials of exercise physiology. Philadelphia (PA): Lippincott Williams & Wilkins, 2000
9. Wibom R, Hultman E, Johansson M, et al. Adaptation of mitochondrial ATP production in human skeletal muscle to endurance training and detraining. J Appl Physiol 1992; 73: 2004-2010
10. Blair SN. Physical inactivity: the biggest public health problem of the 21st century. Br J Sports Med 2009; 43: 1-2
11. Mujika I, Padilla S. Cardiorespiratory and metabolic characteristics of detraining in humans. Med Sci Sports Exerc 2001; 33: 413-421
12. Hunter S, Robson SC. Adaptation of the maternal heart in pregnancy. Br Heart J 1992; 68: 540-543
13. Clapp III JF. Maternal heart rate in pregnancy. Am J Ob-stet Gynecol 1985; 152: 659-660
14. Ueland K, Novy MJ, Peterson EN, et al. Maternal cardiovascular dynamics, IV: the influence of gestational age on the maternal cardiovascular response to posture and exercise. Am J Obstet Gynecol 1969; 104: 856-864
15. Wolfe LA, Mottola MF. Aerobic exercise in pregnancy: an update. Can J Appl Physiol 1993; 18: 119-147
16. Pritchard JA. Changes in the blood volume during preg-nancy and delivery. Anesthesiology 1965; 26: 393-399
17. Cunningham FG, Gant NF, Leveno KJ, et al. Williams obstetrics. New York: McGraw-Hill, 2005
18. Yeomans ER, Gilstrap III LC. Physiologic changes in pregnancy and their impact on critical care. Crit Care Med 2005; 33: S256-8
19. Wadlington J, Natale M, Crowley M. Anesthesia for ob-stetrics and gynecology. In: Hurford WE, et al., editors. Clinical anesthesia procedures of the Massachusetts General Hospital. Philadelphia (PA): Lippincott Williams & Wilkins, 1998: 523-545
20. Capeless EL, Clapp JF. Cardiovascular changes in early phase of pregnancy. Am J Obstet Gynecol 1989; 161: 1449-1453
21. Fujitani S, Baldisseri MR. Hemodynamic assessment in a pregnant and peripartum patient. Crit Care Med 2005; 33: S354-61
22. Ezmerli NM. Exercise in pregnancy. Prim Care Update Ob Gyns 2000; 7: 260-265
23. Hemmings GT, Whalley DG, O'Connor PJ, et al. Invasive monitoring and anaesthetic management of a parturient with mitral stenosis. Can J Anaesth 1987; 34: 182-185
24. Ueland K, Hansen JM. Maternal cardiovascular dynamics, 3: labor and delivery under local and caudal analgesia. Am J Obstet Gynecol 1969; 103: 8-18
25. Katz M, Kroll D, Shapiro Y, et al. Energy expenditure in normal labor. Isr J Med Sci 1990; 26: 254-257
26. Shnider SM, Abboud TK, Artal R, et al. Maternal ca-techolamines decrease during labor after lumbar epidural anesthesia. Am J Obstet Gynecol 1983; 147: 13-15
27. Hagerdal M, Morgan CW, Sumner AE, et al. Minute ventilation and oxygen consumption during labor with epidural analgesia. Anesthesiology 1983; 59: 425-427
28. Sangoul F, Fox GS, Houle GL. Effect of regional analgesia on maternal oxygen consumption during the first stage of labor. Am J Obstet Gynecol 1975; 121: 1080-1083
29. Kreiser D, Katorza E, Seidman DS, et al. The effect of ephedrine on intrapartum fetal heart rate after epidural analgesia. Obstet Gynecol 2004; 104: 1277-1281
30. Cascio M, Pygon B, Bernett C, et al. Labour analgesia with intrathecal fentanyl decreases maternal stress. Can J An-aesth 1997; 44: 605-609
31. Hammond RR, Webster AC. Haemodynamic effects of induction of epidural analgesia in labour. Can J Anaesth 1988; 35: 41-46
32. Manninen T, Aantaa R, Salonen M, et al. A comparison of the hemodynamic effects of paracervical block and epi-dural anesthesia for labor analgesia. Acta Anaesthesiol Scand 2000; 44: 441-445
33. Danilenko-Dixon DR, Tefft L, Cohen RA, et al. Positional effects on maternal cardiac output during labor with epi-dural analgesia. Am J Obstet Gynecol 1996; 175: 867-872
34. Robson SC, Dunlop W, Boys RJ, et al. Cardiac output during labour. Br Med J (Clin Res Ed) 1987; 295: 1169-1172
35. O'Toole ML. Physiologic aspects of exercise in pregnancy. Clin Obstet Gynecol 2003; 46: 379-389
36. Pivarnik JM, Ayres NA, Mauer MB, et al. Effects of maternal aerobic fitness on cardiorespiratory responses to exercise. Med Sci Sports Exerc 1993; 25: 993-998
37. Carpenter MW, Sady SP, Sady MA, et al. Effect of maternal weight gain during pregnancy on exercise performance. J Appl Physiol 1990; 68: 1173-1176
38. Knuttgen HG, Emerson Jr K. Physiological response to pregnancy at rest and during exercise. J Appl Physiol 1974; 36: 549-553
39. Artal R. Exercise and pregnancy. Clin Sports Med 1992; 11: 363-377
40. Pivarnik JM, Lee W, Miller JF. Physiological and percep-tual responses to cycle and treadmill exercise during pregnancy. Med Sci Sports Exerc 1991; 23: 470-475
41. Artal R, Wiswell R, Romem Y, et al. Pulmonary responses to exercise in pregnancy. Am J Obstet Gynecol 1986; 154: 378-383
42. Pernoll ML, Metcalfe J, Schlenker TL, et al. Oxygen con-sumption at rest and during exercise in pregnancy. Respir Physiol 1975; 25: 285-293
43. Bonen A, Campagna P, Gilchrist L, et al. Substrate and endocrine responses during exercise at selected stages of pregnancy. J Appl Physiol 1992; 73: 134-142
44. Heenan AP, Wolfe LA, Davies GA. Maximal exercise testing in late gestation: maternal responses. Obstet Gynecol 2001; 97: 127-134
45. 2max during cycle exercise in pregnant women. J Appl Physiol 1988; 65: 657-661
46. Sady SP, Carpenter MW, Thompson PD, et al. Cardio-vascular response to cycle exercise during and after pregnancy. J Appl Physiol 1989; 66: 336-341
47. Spinnewijn WE, Wallenburg HC, Struijk PC, et al. Peak ventilatory responses during cycling and swimming in pregnant and nonpregnant women. J Appl Physiol 1996; 81: 738-742
48. Spaaij CJ, van Raaij JM, de Groot LC, et al. No changes during pregnancy in the net cost of cycling exercise. Eur J Clin Nutr 1994; 48: 513-521
49. Clapp III JF. Oxygen consumption during treadmill ex-ercise before, during, and after pregnancy. Am J Obstet Gynecol 1989; 161: 1458-1464
50. Lotgering FK, van Doorn MB, Struijk PC, et al. Maximal aerobic exercise in pregnant women: heart rate, O2 consumption, CO2 production, and ventilation. J Appl Phy-siol 1991; 70: 1016-1023
51. Lotgering FK, Struijk PC, van Doorn MB, et al. Errors in predicting maximal oxygen consumption in pregnant women. J Appl Physiol 1992; 72: 562-567
52. McMurray RG, Hackney AC, Katz VL, et al. Pregnancy-induced changes in the maximal physiological responses during swimming. J Appl Physiol 1991; 71: 1454-1459
53. Kardel KR. Effects of intense training during and after pregnancy in top-level athletes. Scand J Med Sci Sports 2005; 15: 79-86
54. 2max of recreational ath-letes before and after pregnancy. Med Sci Sports Exerc 1991; 23: 1128-1133
55. Pivarnik JM, Stein AD, Rivera JM. Effect of pregnancy on heart rate/oxygen consumption calibration curves. Med Sci Sports Exerc 2002; 34: 750-755
56. McMurray RG, Mottola MF, Wolfe LA, et al. Recent advances in understanding maternal and fetal responses to exercise. Med Sci Sports Exerc 1993; 25: 1305-1321
57. Artal R, O'Toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med 2003; 37: 6-12
58. Davies GA, Wolfe LA, Mottola MF, et al. Joint SOGC/CSEP clinical practice guideline: exercise in pregnancy and the postpartum period. J Obstet Gynaecol Can 2003; 25: 516-529
59. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health: a recommendation from the centers for disease control and prevention and the American College of Sports Medicine. JAMA 1995; 273: 402-407
60. Arena B, Maffulli N. Exercise in pregnancy: how safe is it? Sports Med Arthroscop Rev 2002; 10: 15-22
61. Wolfe LA, Davies GA. Canadian guidelines for exercise in pregnancy. Clin Obstet Gynecol 2003; 46: 488-495
62. Huch R. Physical activity at altitude in pregnancy. Semin Perinatol 1996; 20: 303-314
63. Soultanakis HN, Artal R, Wiswell RA. Prolonged exercise in pregnancy: glucose homeostasis, ventilatory and cardiovascular responses. Semin Perinatol 1996; 20: 315-327
64. Lokey EA, Tran ZV, Wells CL, et al. Effects of physical exercise on pregnancy outcomes: a meta-analytic review. Med Sci Sports Exerc 1991; 23: 1234-1239
65. McMurray RG, Hackney AC, Guion WK, etal. Metabolic and hormonal responses to low-impact aerobic dance during pregnancy. Med Sci Sports Exerc 1996; 28: 41-46
66. Milunsky A, Ulcickas M, Rothman KJ, et al. Maternal heat exposure and neural tube defects. JAMA 1992; 268: 882-885
67. Jones RL, Botti JJ, Anderson WM, et al. Thermoregula-tion during aerobic exercise in pregnancy. Obstet Gynecol 1985; 65: 340-345
68. McMurray RG, Katz VL. Thermoregulation in pregnancy: implications for exercise. Sports Med 1990; 10: 146-158
69. Borg G. Borg's perceived exertion and pain scales. Cham-paign (IL): Human Kinetics, 1998
70. Butte NF, Wong WW, Treuth MS, et al. Energy require-ments during pregnancy based on total energy expenditure and energy deposition. Am J Clin Nutr 2004; 79: 1078-1087
71. Clarke PE, Rousham EK, Gross H, et al. Activity patterns and time allocation during pregnancy: a longitudinal study of British women. Ann Hum Biol 2005; 32: 247-258
72. Lawrence M, Whitehead RG. Physical activity and total energy expenditure of child-bearing Gambian village women. Eur J Clin Nutr 1988; 42: 145-160
73. Lof M, Forsum E. Activity pattern and energy expenditure due to physical activity before and during pregnancy in healthy Swedish women. Br J Nutr 2006; 95: 296-302
74. Rousham EK, Clarke PE, Gross H. Significant changes in physical activity among pregnant women in the UK as assessed by accelerometry and self-reported activity. Eur J Clin Nutr 2006; 60: 393-400
75. Haakstad LA, Voldner N, Henriksen T, et al. Physical activity level and weight gain in a cohort of pregnant Norwegian women. Acta Obstet Gynecol Scand 2007; 86: 559-564
76. Forsum E, Kabir N, Sadurskis A, et al. Total energy ex-penditure of healthy Swedish women during pregnancy and lactation. Am J Clin Nutr 1992; 56: 334-342
77. Heini A, Schutz Y, Diaz E, et al. Free-living energy expen-diture measured by two independent techniques in pregnant and nonpregnant Gambian women. Am J Physiol 1991; 261: E9-17
78. Lawrence M, Singh J, Lawrence F, et al. The energy cost of common daily activities in African women: increased expenditure in pregnancy? Am J Clin Nutr 1985; 42: 753-763
79. Singh J, Prentice AM, Diaz E, et al. Energy expenditure of Gambian women during peak agricultural activity measured by the doubly-labelled water method. Br J Nutr 1989; 62: 315-329
80. Borodulin KM, Evenson KR, Wen F, et al. Physical ac-tivity patterns during pregnancy. Med Sci Sports Exerc 2008; 40: 1901-1908
81. Gawade P, Pekow P, Markenson G, et al. Physical activity before and during pregnancy and duration of second stage of labor among Hispanic women. J Reprod Med 2009; 54: 429-435
82. van Raaij JM, Schonk CM, Vermaat-Miedema SH, et al. Body fat mass and basal metabolic rate in Dutch women before, during, and after pregnancy: a reappraisal of energy cost of pregnancy. Am J Clin Nutr 1989; 49: 765-772
83. Poudevigne MS, O'Connor PJ. A review of physical ac-tivity patterns in pregnant women and their relationship to psychological health. Sports Med 2006; 36: 19-38
84. DiNallo JM, Le Masurier GC, Williams NI, et al. Walking for health in pregnancy: assessment by indirect calorimetry and accelerometry. Res Q Exerc Sport 2008; 79: 28-35
85. Nagy LE, King JC. Energy expenditure of pregnant women at rest or walking self-paced. Am J Clin Nutr 1983; 38: 369-376
86. Chasan-Taber L, Schmidt MD, Pekow P, et al. Correlates of physical activity in pregnancy among Latina women. Matern Child Health J 2007; 11: 353-363
87. Pereira MA, Rifas-Shiman SL, Kleinman KP, et al. Pre-dictors of change in physical activity during and after pregnancy: Project Viva. Am J Prev Med 2007; 32: 312-319
88. Jarrett JC, Spellacy WN. Jogging during pregnancy: an improved outcome? Obstet Gynecol 1983; 61: 705-709
89. Dufour DL, Reina JC, Spurr G. Energy intake and ex-penditure of free-living, pregnant Colombian women in an urban setting. Am J Clin Nutr 1999; 70: 269-276
90. Melzer K, Schutz Y, Boulvain M, et al. Pregnancy-related changes in activity energy expenditure and resting metabolic rate in Switzerland. Eur J Clin Nutr 2009; 63: 1185-1191
91. Petersen AM, Leet TL, Brownson RC. Correlates of phy-sical activity among pregnant women in the United States. Med Sci Sports Exerc 2005; 37: 1748-1753
92. Melzer K, Schutz Y, Soehnchen N, et al. Effects of re-commended levels of physical activity on pregnancy outcomes. Am J Obstet Gynecol 2010; 202 (3): 266.e1-6
93. Gavard JA, Artal R. Effect of exercise on pregnancy out-come. Clin Obstet Gynecol 2008; 51: 467-480
94. Mottola MF. Exercise prescription for overweight and obese women: pregnancy and postpartum. Obstet Gyne-col Clin North Am 2009; 36: 301-316 viii
95. Poudevigne MS, O'Connor PJ. Physical activity and mood during pregnancy. Med Sci Sports Exerc 2005; 37: 1374-1380
96. Artal R. Exercise: the alternative therapeutic intervention for gestational diabetes. Clin Obstet Gynecol 2003; 46: 479-487
97. Clapp III JF, Lopez B, Harcar-Sevcik R. Neonatal beha-vioral profile of the offspring of women who continued to exercise regularly throughout pregnancy. Am J Obstet Gynecol 1999; 180: 91-94
98. Clapp III JF. Exercise and fetal health. J Dev Physiol 1991; 15: 9-14
99. Wolfe LA, Charlesworth SA, Glenn NM, et al. Effects of pregnancy on maternal work tolerance. Can J Appl Phy-siol 2005; 30: 212-232
100. Clapp III JF. The course of labor after endurance ex-ercise during pregnancy. Am J Obstet Gynecol 1990; 163: 1799-1805
101. Erdelyi GJ. Gynecological survey of female athletes. J Sports Med Phys Fitness 1962; 2: 174-179
102. Beckmann CR, Beckmann CA. Effect of a structured antepartum exercise program on pregnancy and labor outcome in primiparas. J Reprod Med 1990; 35: 704-709
103. Hall DC, Kaufmann DA. Effects of aerobic and strength conditioning on pregnancy outcomes. Am J Obstet Gynecol 1987; 157: 1199-1203
104. Wong SC, McKenzie DC. Cardiorespiratory fitness during pregnancy and its effect on outcome. Int J Sports Med 1987; 8: 79-83
105. Kardel KR, Johansen B, Voldner N, et al. Association be-tween aerobic fitness in late pregnancy and duration of labor in nulliparous women. Acta Obstet Gynecol Scand 2009; 88: 948-952
106. Penttinen J, Erkkola R. Pregnancy in endurance athletes. Scand J Med Sci Sports 1997; 7: 226-228
107. Collings CA, Curet LB, Mullin JP. Maternal and fetal re-sponses to a maternal aerobic exercise program. Am J Obstet Gynecol 1983; 145: 702-707
108. Rice PL, Fort IL. The relationship of maternal exercise on labor, delivery and health of the newborn. J Sports Med Phys Fitness 1991; 31: 95-99
109. Erkkola R. The physical work capacity of the expectant mother and its effect on pregnancy, labor and the newborn. Int J Gynaecol Obstet 1976; 14: 153-159
110. Hatch MC, Shu XO, McLean DE, et al. Maternal exercise during pregnancy, physical fitness, and fetal growth. Am J Epidemiol 1993; 137: 1105-1114
111. Magann EF, Evans SF, Weitz B, et al. Antepartum, in-trapartum, and neonatal significance of exercise on healthy low-risk pregnant working women. Obstet Gynecol 2002; 99: 466-472
112. Kardel KR, Kase T. Training in pregnant women: effects on fetal development and birth. Am J Obstet Gynecol 1998; 178: 280-286
113. Clapp III JF, Kim H, Burciu B, et al. Beginning regular exercise in early pregnancy: effect on fetoplacental growth. Am J Obstet Gynecol 2000; 183: 1484-1488
114. Clapp III JF, Kim H, Burciu B, et al. Continuing regular exercise during pregnancy: effect of exercise volume on fetoplacental growth. Am J Obstet Gynecol 2002; 186: 142-147
115. Clapp III JF, Capeless EL. Neonatal morphometrics after endurance exercise during pregnancy. Am J Obstet Gynecol 1990; 163: 1805-1811