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Jaques LA, Stermer PRR, de Oliveira AKB, Marães VRFDS, Jácomo RH, Alves AT, Cunha KDC, da Silva ML. Autonomic modulation of heart rate during physical activity in pregnant women: A systematic review of literature. Pacing Clin Electrophysiol 2024; 47:802-814. [PMID: 38577940 DOI: 10.1111/pace.14976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/05/2024] [Accepted: 03/16/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND There are important physiological changes in the heart rate autonomic modulation in pregnant women and these changes may affect the way their bodies respond to exercise stimulus. The objective of this review is to verify the physical exercise influence on autonomic modulation of heart rate in pregnant women. METHODS This study is a Systematic Review. The electronic databases used to search for the studies were Cochrane Library, MEDLINE via PUBMED, Regional Health Portal and EMBASE. Experimental studies that evaluated heart-rate variability in pregnant women practicing physical exercises were included. And articles that addressed only fetal heart-rate variability, case reports, congress abstracts, clinical trial protocols without results, preprints, and gray literature were excluded. There were no language or publication year restrictions. The descriptors used in the Search were Cardiac Chronotropism, Sympathetic Nervous System, Pregnancy, and Physical Exercise. For statistical analysis, the fixed effect model was used. RESULTS A total of 3106 articles were found, and 12 studies were included, which 5 were nonrandomized clinical trials, 4 were randomized clinical trials, and 3 were cross-sectional studies. Three hundred and four pregnant women were included in the studies. The application of physical exercise was varied, but in general they used aerobic exercises and with increased variability of the heart rate and reflex on the autonomic modulation of heart rate. CONCLUSION Most studies demonstrate benefits heart rate in pregnant women, but limited research makes it hard to compare specific types of exercise and larger studies are needed to identify the best exercise.
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Affiliation(s)
- Lucas Alves Jaques
- Center of Biological and Health Sciences, State University of Pará, Marabá, Pará State, Brazil
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2
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Wowdzia JB, Hazell TJ, Davenport MH. Glycemic response to acute high-intensity interval versus moderate-intensity continuous exercise during pregnancy. Physiol Rep 2022; 10:e15454. [PMID: 36117457 PMCID: PMC9483614 DOI: 10.14814/phy2.15454] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/12/2022] [Accepted: 08/20/2022] [Indexed: 05/30/2023] Open
Abstract
The present study investigated the glycemic response to an acute high-intensity interval training (HIIT) session (10 one-minute intervals ≥90% HRmax interspersed with one-minute of active recovery) versus a moderate-intensity continuous training (MICT) session (30 min at 64%-76% HRmax ) during pregnancy. Twenty-four normoglycemic females with a singleton pregnancy (27.8 ± 4.7 weeks of gestation, 31.5 ± 4.1 years of age, body mass index: 25.2 ± 11.3) participated in a randomized crossover design study. A flash glucose monitor and accelerometer were worn continuously for 7 days recording glycemic response, physical activity, and sleep. Nutritional intake and enjoyment of the exercise were self-reported. Average heart rate during exercise was higher for HIIT (82 ± 4% HRmax ) compared with MICT (74 ± 4% HRmax ; p < 0.001) and participants achieved a peak heart rate of 92 ± 3% during HIIT (range 85%-97% HRmax ) compared with 81 ± 4% during MICT (p < 0.001). The change in glucose values from pre-to-postexercise were not different between conditions (HIIT: -0.62 ± 1.00 mmol/L; MICT: -0.81 ± 1.05 mmol/L; p = 0.300) with the exception that fewer individuals experienced postexercise hypoglycemia immediately following HIIT compared with MICT (8% versus 33% respectively; p = 0.041). Other glucose variables was not different between exercise protocols. Physical activity (p = 0.07) and caloric intake did not differ (p = 0.10). The majority of participants preferred HIIT (87.5%) and had greater perceived enjoyment compared to MICT (HIIT: 7.8 ± 1.5; MICT: 6.6 ± 2.0; p = 0.015). Sleep duration was 52 ± 73 min longer after participating in HIIT compared with the night prior (main effect for time p = 0.017); no significant changes for MICT. Overall, an acute session of HIIT appears to be well tolerated and demonstrates no adverse effects on maternal glycemic response.
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Affiliation(s)
- Jenna B. Wowdzia
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sports and Recreation, Women and Children's Health Research Institute, Alberta Diabetes InstituteUniversity of AlbertaEdmontonAlbertaCanada
| | - Tom J. Hazell
- Department of Kinesiology and Physical Education, Faculty of ScienceWilfrid Laurier UniversityWaterlooOntarioCanada
| | - Margie H. Davenport
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sports and Recreation, Women and Children's Health Research Institute, Alberta Diabetes InstituteUniversity of AlbertaEdmontonAlbertaCanada
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Association between Cardiorespiratory Fitness and Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11154364. [PMID: 35955988 PMCID: PMC9369055 DOI: 10.3390/jcm11154364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 02/01/2023] Open
Abstract
Hypertensive disorders of pregnancy (HDP) are associated with future cardiovascular disease (CVD), which may be mediated by diminished cardiorespiratory fitness (CRF). In this systematic review and meta-analysis, we summarize evidence linking CRF with HDP before, during, and after pregnancy. We searched relevant databases to identify observational or randomized studies that measured CRF (VO2 max or peak, VO2 at anaerobic threshold, or work rate at peak VO2) in women with and without HDP. We pooled results using random effects models. Fourteen studies (n = 2406 women) reporting on CRF before, during, and after pregnancy were included. Before pregnancy, women who developed HDP had lower CRF (e.g., VO2max < 37 vs. ≥37 mL O2/min) than those without HDP (two studies, 811 women). VO2max at 14−18 weeks of pregnancy was marginally lower among women who developed preeclampsia vs. normotensive women (three studies, 275 women; mean difference 0.43 mL/kg/min [95% CI 0.97, 0.10]). Postpartum, there was a trend towards lower VO2peak in women with previous preeclampsia (three studies, 208 women; 0.26 mL/kg/min [−0.54, 0.02]). While exploratory, our findings raise the possibility that CRF can identify women at risk for HDP, and furthermore, that HDP confers a hit to a woman’s cardiorespiratory reserve.
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Active Pregnancy: A Physical Exercise Program Promoting Fitness and Health during Pregnancy-Development and Validation of a Complex Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084902. [PMID: 35457769 PMCID: PMC9028999 DOI: 10.3390/ijerph19084902] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 12/13/2022]
Abstract
Physical activity during pregnancy is a public health issue. In the view of reproducibility and the successful implementation of exercise interventions, reporting the quality of such study design must be ensured. The objective of this study was to develop and validate a physical exercise program promoting fitness and health during pregnancy. A qualitative methodological study was carried out. For the description of the exercise program, the Consensus on Exercise Reporting Template (CERT) was used. For the validation of the program, the revised guideline of the Criteria for Reporting the Development and Evaluation of Complex Interventions in Health Care (CReDECI2) was followed and went through three stages of development, piloting, and evaluation. The customizable exercise program was designed and validated by exercise and health specialists based on evidence-based, international recommendations and supported by different educational tools to be implemented by qualified exercise professionals in health and fitness settings. A 12-week testing intervention addressing a group of 29 pregnant women was carried out. The program's feasibility was subsequently evaluated by all the pregnant women. The CReDECI2 process guides practitioners and researchers in developing and evaluating complex educational interventions. The presented intervention may assist exercise specialists, health professionals, and researchers in planning, promoting, and implementing a prenatal exercise program.
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Ljubojević V, Bojanić V, Nožica-Radulović T, Draganović D, Skočić-Smoljanović S. The research of correlation between blood pressure and nailfold capillary parameters in exercising and non-exercising pregnant women. SCRIPTA MEDICA 2022. [DOI: 10.5937/scriptamed53-38104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background/Aim: With an increase in cardiac output, blood pressure values in pregnancy increase. The aim of the study was to examine the effect of prenatal exercises on the circulatory parameters and the correlation between blood pressure and nailfold capillary parameters in healthy pregnant women. Methods: The blood pressure shape and length of nailfold capillary were assessed in 35 non-exercising pregnant women and 35 pregnant women who exercised, at the beginning of the study (between 20 and 32 gestational week) and the end of the study (28 - 40 gestational week). Results: The elevation in blood pressure was significantly lower in pregnant women who exercised in relation to non-exercising pregnant women. After eight weeks, the length of the capillary loops was increased by 30 µm and the number of pregnant women with pronounced shape changes of capillary loops increased, with no difference between the groups. Non-exercisers had a correlation between the change in diastolic pressure and the increase in capillary length (r = 0.53, p = 0.001). In the experimental group, the correlation between the change in blood pressure and the increase in the length of capillary loops was not determined. Conclusion: Prenatal physical activity had a beneficial impact on the circulation of pregnant women. In pregnant women in the third trimester, after eight weeks of follow-up, the length of the nailfold capillary loops and the presence of pronounced shape changes of capillary loops were increased, without difference between exercisers and non-exercisers. In non-exercising pregnant women, the capillary length was increased with the elevation of diastolic blood pressure, while the correlation was not found in pregnant women who exercised.
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6
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Carmichael RD. Considerations for the Pregnant Endurance Athlete. Strength Cond J 2021. [DOI: 10.1519/ssc.0000000000000655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
For apparently healthy pregnant women, regular physical activity is recommended. The American College of Obstetricians and Gynecologists (ACOG) created recommendations for physical activity and exercise during pregnancy in 1985. At that time, pregnant women were advised to not exceed a heart rate of 140 beats per minute with physical activity. The heart rate recommendation was subsequently removed with the recommendations published in 1994, 2002, and 2015. In 2020, the ACOG updated its recommendations on physical activity for pregnant and postpartum women. The recommendation included exercising at a "fairly light to somewhat hard" perceived intensity and at less than 60-80% of age-predicted maximum heart rate, usually not exceeding a heart rate of 140 beats per minute. Women often seek advice from healthcare providers on physical activity during pregnancy, yet providers report concern about giving appropriate physical activity guidance. This paper summarizes the key scientific literature on monitoring absolute and relative exercise intensity in relation to the current ACOG recommendations, providing background on intensity-related concepts used in the recommendation. This paper also provides practical guidance to assist healthcare providers in relaying this information to pregnant women.
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Affiliation(s)
- Kelly R. Evenson
- Kelly R. Evenson, Department of
Epidemiology, University of NC, Gillings School of Global Public Health, 123 W
Franklin Street, Building C, Suite 410, Chapel Hill, NC, USA; e-mail:
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Brislane Á, Steinback CD, Davenport MH. The Nine Month Stress Test: Pregnancy and Exercise - Similarities and Interactions. Can J Cardiol 2021; 37:2014-2025. [PMID: 34534622 DOI: 10.1016/j.cjca.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/18/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022] Open
Abstract
Of all physiological systems, the cardiovascular system takes on the most profound adaptation in pregnancy to support fetal growth and development. The adaptations that arise are systemic and involve structural and functional changes that can be observed at the cerebral, central, peripheral, and microvascular beds. This includes, although is not limited to increased heart rate, stroke volume and cardiac output with negligible change to blood pressure, reductions in vascular resistance and cerebral blood flow velocity, systemic artery enlargement, enhanced endothelial function. All of this takes place to accommodate blood volume expansion and ensure adequate fetal and maternal oxygen delivery. In some instances, the demand placed on the vasculature can manifest as cardiovascular maladaptation and thus, cardiovascular complications can arise. Exercise is recommended in pregnancy because of its powerful ability to reduce the incidence and severity of cardiovascular complications in pregnancy. However, the mechanism by which it acts is poorly understood. The first aim of this review is to describe the systemic adaptations that take place in pregnancy. Secondly, this review aims to describe the influence of exercise on these systemic adaptations. It is anticipated that this review can comprehensively capture the extent of knowledge in this area while identifying areas that warrant further investigation.
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Affiliation(s)
- Áine Brislane
- Program for Pregnancy & Postpartum Health, Neurovascular Health Lab, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Alberta, Canada
| | - Craig D Steinback
- Program for Pregnancy & Postpartum Health, Neurovascular Health Lab, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Alberta, Canada
| | - Margie H Davenport
- Program for Pregnancy & Postpartum Health, Neurovascular Health Lab, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Alberta, Canada.
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9
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Integrative Review of Exercise at Altitude during Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179272. [PMID: 34501869 PMCID: PMC8430622 DOI: 10.3390/ijerph18179272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/19/2021] [Accepted: 08/29/2021] [Indexed: 11/17/2022]
Abstract
Many competitive and elite athletes continue to train throughout their pregnancies and many visit or live at altitude. The purpose of this integrative review is to synthesize, analyze and critique published studies regarding the safety of serious recreational or elite athletes exercising at altitude while pregnant. Seven databases were searched, and 157 documents were located, which were screened for appropriateness and reduced to seven articles that met the criteria. The studies were analyzed based on maternal and fetal outcomes. Current recommendations for exercising at altitude were based on sedentary individuals who frequently did not have the expected physiological responses based on research on pregnancy and altitude. It is unknown whether competitive and elite athletes would have similar responses to exercise at altitude. More research on exercise at altitude on individuals with a variety of fitness levels is needed.
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10
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Skow RJ, Steinback CD, Davenport MH. Prenatal Exercise and Cardiovascular Health (PEACH) Study: Impact on the Vascular System. Med Sci Sports Exerc 2021; 53:2605-2617. [PMID: 34225321 DOI: 10.1249/mss.0000000000002736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Healthy pregnancy is typically associated with favorable vascular adaptations to both structure and function of the peripheral arteries. Exercise is independently associated with improvements in peripheral vascular health; however, the impact of exercise on prenatal adaptations is unclear. Therefore, we hypothesized that a structured aerobic exercise intervention between the second and third trimester (TM2 and TM3, respectively) of pregnancy would augment the already-positive changes in vascular outcomes. METHODS We recruited 59 inactive pregnant women (<20 weeks gestation) and randomized them into control (standard care; n = 28) or exercise (moderate intensity aerobic exercise, 3-4 days/week, 25-40 minutes, 14 ± 1 weeks; n = 31) conditions. Before and after the intervention all women completed comprehensive peripheral vascular assessment, which included blood markers of vascular health, carotid distensibility metrics, measures of arterial stiffness (pulse wave velocity; PWV), and [superficial] femoral artery reactivity during cold pressor test (CPT). RESULTS Carotid artery diameter increased from 6.5 mm to 6.9 mm (p < 0.001) strain (%)decreased from 9.9% to 8.4% (p < 0.001). Carotid artery blood flow, compliance and distensibility coefficients, stiffness (β), distensibility (1/β), and Elastic modulus were not different across gestation. PWV was not different across gestation. Superficial femoral artery diameter was increased from 5.4 mm to 5.6 mm (p = 0.004) while blood flow, conductance, and resistance at rest and during CPT were not different across gestation. None of our measures of vascular health were impacted by exercise. CONCLUSION We did not observe an impact of aerobic exercise on altering the changes across pregnancy in blood vessel health. However, the present study was conducted in women who were overall at low risk for developing gestational hypertension and should be interpreted with caution. Future work in high-risk women is needed.
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Affiliation(s)
- Rachel J Skow
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
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Lee R, Thain S, Tan LK, Teo T, Tan KH. Asia-Pacific consensus on physical activity and exercise in pregnancy and the postpartum period. BMJ Open Sport Exerc Med 2021; 7:e000967. [PMID: 34055384 PMCID: PMC8130752 DOI: 10.1136/bmjsem-2020-000967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/25/2022] Open
Abstract
Physical activity and exercise in pregnancy are generally beneficial and enhance the physical and mental health of women. These benefits also prevent excessive weight gain and reduce risks of obesity in pregnancy, such as gestational diabetes, hypertensive disorders, higher rates of caesarean delivery, macrosomia and stillbirth. Thus, there is a need to optimise perinatal exercise and physical activity globally. There is currently no consensus recommendation on the role of physical activity and exercise in pregnancy and the postpartum period in the Asia-Pacific region. In this paper, we present seven key consensus recommendations on physical activity and exercise in pregnancy and the postpartum period by 18 key members representing 10 countries in Asia-Pacific regions during an international workshop of the Asia Diabetes in Pregnancy Conference in Singapore on 11–12 January 2020. Through these consensus recommendations, we hope to improve the metabolic health of pregnant women living in Asia-Pacific regions by educating the public and guiding healthcare professionals on the safety and importance of physical exercise and activity to benefit pregnant women and after childbirth.
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Affiliation(s)
- Ryan Lee
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Serene Thain
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Lay Kok Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Terry Teo
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
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12
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Archiza B, Leahy MG, Kipp S, Sheel AW. An integrative approach to the pulmonary physiology of exercise: when does biological sex matter? Eur J Appl Physiol 2021; 121:2377-2391. [PMID: 33903937 DOI: 10.1007/s00421-021-04690-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
Historically, many studies investigating the pulmonary physiology of exercise (and biomedical research in general) were performed exclusively or predominantly with male research participants. This has led to an incomplete understanding of the pulmonary response to exercise. More recently, important sex-based differences with respect to the human respiratory system have been identified. The purpose of this review is to summarize current findings related to sex-based differences in the pulmonary physiology of exercise. To that end, we will discuss how morphological sex-based differences of the respiratory system affect the respiratory response to exercise. Moreover, we will discuss sex-based differences of the physiological integrative responses to exercise, and how all these differences can influence the regulation of breathing. We end with a brief discussion of pregnancy and menopause and the accompanying ventilatory changes observed during exercise.
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Affiliation(s)
- Bruno Archiza
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada.
| | - Michael G Leahy
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada
| | - Shalaya Kipp
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada
| | - A William Sheel
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada
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13
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Dobson KL, da Silva DF, Dervis S, Mohammad S, Nagpal TS, Adamo KB. Physical activity and gestational weight gain predict physiological and perceptual responses to exercise during pregnancy. Birth Defects Res 2020; 113:276-286. [PMID: 32969175 DOI: 10.1002/bdr2.1808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/25/2020] [Accepted: 09/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Exercise is known to improve the health of the pregnant woman and her child. Studies that have evaluated physiological parameters during prenatal exercise have conflicting results. Better understanding of these physiological responses can modify exercise prescriptions, safety, and monitoring strategies. We examined the association between age, prepregnancy body mass index (BMI), gestational weight gain (GWG), and physical activity (PA) levels, factors that may influence a change in physiological (HR, VO2 responses) and perceptual (RPE) responses to acute exercise throughout pregnancy. METHODS Twenty-two healthy pregnant women (31.4 ± 3.7 years) performed a Submaximal incremental Walking Exercise Test (SWET). Early- (13-18 weeks), mid- (24-28 weeks), and late-pregnancy (34-37 weeks) were compared. VO2 (L/min; ml/kg/min), HR (bpm), and RPE were collected at the end of each test stage. PA was determined by accelerometry. We associated PA levels, GWG, prepregnancy BMI, and age with HR, RPE, and VO2 responses. RESULTS HR, RPE, and absolute VO2 were higher in late-pregnancy compared to earlier time points (p < .05; η2 = 0.299-0.525). Regression models were built for HR (all time points), RPE (early- and late-pregnancy), and VO2 (L/min; late-pregnancy). HR (late-pregnancy) was predicted by time in vigorous PA, GWG, age, and prepregnancy BMI (r2 = 0.645; SEE = 5.84). RPE (late-pregnancy) was predicted by sedentary time, GWG, prepregnancy BMI, and age (r2 = 0.662; SEE = 1.21). CONCLUSION Physiological/perceptual responses were higher in late-pregnancy compared to other time points and associated with combined PA, GWG, prepregnancy BMI, and age. These findings can be used to modify exercise prescriptions and designs for future PA interventions in pregnant women.
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Affiliation(s)
- Kayla L Dobson
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Danilo F da Silva
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Sheila Dervis
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Shuhiba Mohammad
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Taniya S Nagpal
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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14
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Nagpal TS, Bhattacharjee J, da Silva DF, Souza SCS, Mohammad S, Puranda JL, Abu-Dieh A, Cook J, Adamo KB. Physical activity may be an adjuvant treatment option for substance use disorders during pregnancy: A scoping review. Birth Defects Res 2020; 113:265-275. [PMID: 32940021 DOI: 10.1002/bdr2.1803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Substance abuse in pregnancy increases the chance of physical and neurobehavioral disabilities as well as many other undesirable fetal outcomes. In nonpregnant populations, physical exercise has shown to be an effective adjunctive therapy option for substance use disorders. Given the known positive maternal and fetal physiological and mental health benefits associated with prenatal exercise, perhaps exercise during pregnancy may also be a viable adjuvant therapy option for women with substance use disorders. The purpose of this scoping review was to summarize the available literature that has assessed the relationship between prenatal exercise and substance use disorders. METHODS A search strategy was developed combining the terms pregnancy, exercise/physical activity, and substance use. A systematic search was completed in the following databases: Medline/PubMed, SPORTDiscus, and ProQuest. Substances eligible for inclusion included illicit drugs, alcohol, and cannabis. Retrieved data were categorized as animal or human model studies, and were summarized narratively. RESULTS Eight studies were included in this review (five human studies, three animal model studies). Studies in humans suggest that pregnant women with substance use disorders are interested in engaging in physical activity interventions; however, known acute metabolic and physiological responses to prenatal exercise may be impaired in this population. Rodent models show preliminary evidence for improved mental health outcomes following prenatal exercise for substance use disorders. CONCLUSION The findings from this review may inform the development of future clinical trials to test the effect of structured exercise programs as an adjunctive treatment option for pregnant women with substance use disorders.
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Affiliation(s)
- Taniya S Nagpal
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, Canada
| | | | | | - Sara C S Souza
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Shuhiba Mohammad
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | | | - Anas Abu-Dieh
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Jocelynn Cook
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
| | - Kristi B Adamo
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
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15
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Dieberger AM, Desoye G, Stolz E, Hill DJ, Corcoy R, Simmons D, Harreiter J, Kautzky-Willer A, Dunne F, Devlieger R, Wender-Ozegowska E, Zawiejska A, Lapolla A, Dalfra MG, Bertolotto A, Galjaard S, Adelantado JM, Jensen DM, Andersen LL, Tanvig M, Damm P, Mathiesen ER, Snoek FJ, Jelsma JGM, van Poppel MNM. Less sedentary time is associated with a more favourable glucose-insulin axis in obese pregnant women-a secondary analysis of the DALI study. Int J Obes (Lond) 2020; 45:296-307. [PMID: 32661292 PMCID: PMC7840500 DOI: 10.1038/s41366-020-0639-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/03/2020] [Indexed: 12/29/2022]
Abstract
Background/objectives Obese pregnant women are at high risk of developing gestational diabetes mellitus (GDM), which might be reduced by sufficient physical activity (PA) and reduced sedentary time (ST). We assessed whether PA and ST are longitudinally associated with the glucose-insulin axis in obese pregnant women. Subjects/methods In this secondary analysis of the DALI (vitamin D And Lifestyle Intervention for gestational diabetes mellitus prevention) study, pregnant women, <20 weeks gestation, with a pre-pregnancy body mass index (BMI) ≥ 29 kg/m2, without GDM on entry were included. Time spent in moderate-to-vigorous PA (MVPA) and ST were measured objectively with accelerometers at <20 weeks, 24–28 weeks and 35–37 weeks of gestation. Fasting glucose (mmol/l) and insulin (mU/l), insulin resistance (HOMA-IR) and first-phase and second-phase insulin release (Stumvoll first and second phase) were assessed at the same time. Linear mixed regression models were used to calculate between-participant differences and within-participant changes over time. Analyses were adjusted for gestational age, randomisation, pre-pregnancy BMI, education and age. MVPA, Insulin, HOMA-IR and Stumvoll first and second phase were log-transformed for analyses due to skewness. Results 232 women were included in the analysis. Concerning differences between participants, more ST was associated with higher fasting glucose (Estimate: 0.008; 95% CI: 0.002, 0.014), fasting insulin (0.011; 0.002, 0.019), HOMA-IR (0.012; 0.004, 0.021) and Stumvoll first and second phase (0.008; 0.001, 0.014 and 0.007; 0.001, 0.014). Participants with more MVPA had lower Stumvoll first and second phase (−0.137; −0.210, −0.064 and −0.133; −0.202, −0.063). Concerning changes over time, an increase in ST during gestation was associated with elevated Stumvoll first and second phase (0.006; 0.000, 0.011). Conclusions As the glucose-insulin axis is more strongly associated with ST than MVPA in our obese population, pregnant women could be advised to reduce ST in addition to increasing MVPA. Moreover, our findings suggest that behaviour change interventions aiming at GDM risk reduction should start in early or pre-pregnancy.
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Affiliation(s)
- Anna M Dieberger
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria.
| | - Gernot Desoye
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - David J Hill
- Recherche en Santé Lawson SA, Bronschhofen, Switzerland.,Lawson Health Research Institute, London, ON, N6C 2R5, Canada
| | - Rosa Corcoy
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.,CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Madrid, Spain
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, Australia
| | - Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Fidelma Dunne
- Galway Diabetes Research Centre and College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - Roland Devlieger
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | | | - Agnieszka Zawiejska
- Division of Reproduction, Poznan University of Medical Sciences, Poznan, Poland
| | | | | | | | - Sander Galjaard
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Juan M Adelantado
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lise-Lotte Andersen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mette Tanvig
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth Reinhardt Mathiesen
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Frank J Snoek
- Department of Medical Psychology, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Judith G M Jelsma
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Tinius R, Nagpal TS, Edens K, Duchette C, Blankenship M. Exploring Beliefs About Exercise Among Pregnant Women in Rural Communities. J Midwifery Womens Health 2020; 65:538-545. [PMID: 32277590 DOI: 10.1111/jmwh.13080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Women who are pregnant in rural communities are disproportionally impacted by obesity and sedentary behavior, and this could be related to having negative beliefs about exercise during pregnancy, leading to inactivity. The purpose of this study was to identify self-reported beliefs about exercise among pregnant women in a rural community. METHODS Pregnant participants (N = 70) between 8 and 16 weeks' gestation were recruited from an obstetric clinic serving a rural population. An open-ended questionnaire addressing beliefs about exercise and based on the constructs of the theory of planned behavior was administered. Descriptive survey results were analyzed by calculating means and frequencies. Open-ended responses were assessed by inductive content analysis. RESULTS Commonly reported advantages of exercise during pregnancy included improved perinatal health outcomes and weight management. Commonly reported disadvantages included an increase in fatigue and concerns for maternal and fetal safety. Common facilitators of exercise included access to resources, free time or a decrease in demands from work, and support systems including family and friends. Common barriers to exercise included a lack of time, physical changes including feelings of nausea and fatigue, and lack of access to resources. DISCUSSION This study was the first to report beliefs about exercise during pregnancy in a rural setting. Responses in the current study suggest potential gaps in knowledge of evidence-based information regarding physical activity during pregnancy. Beliefs as well as reported barriers and facilitators of physical activity during pregnancy were similar those reported in other populations. In addition, access to resources (or lack of) appears to be an important facilitator (or barrier) among women in rural settings; thus, developing strategies designed to overcome this barrier, specifically in rural areas, is critically important. Future intervention strategies need to be tailored specifically to the needs of women living in rural areas.
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Affiliation(s)
- Rachel Tinius
- Exercise Science Program, School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, Kentucky
| | - Taniya Singh Nagpal
- School of Kinesiology, Faculty of Health Science, University of Western Ontario, London, Canada
| | - Kolbi Edens
- Exercise Science Program, School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, Kentucky
| | - Cathryn Duchette
- Exercise Science Program, School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, Kentucky
| | - Maire Blankenship
- School of Nursing and Allied Health, Western Kentucky University, Bowling Green, Kentucky
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da Silva DF, Mohammad S, Hutchinson KA, Adamo KB. Determination of minimal recording period to assess resting heart rate variability during pregnancy. Appl Physiol Nutr Metab 2020; 45:431-436. [DOI: 10.1139/apnm-2019-0351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Traditionally, resting heart rate variability (rHRV) is measured for 10 min using the last 5 min for analyses (e.g., criterion period). It is unknown whether the measurement period can be shortened in pregnant women as there are currently no established standards. We aimed to compare shorter time segments (e.g., from the 1st to 10th minutes) of the parasympathetic index natural logarithm transformation of root mean square of successive R–R differences (Ln rMSSD) with the criterion period in pregnant and nonpregnant women. Twelve pregnant (age: 30.8 ± 3.4 years; gestational age: 20.1 ± 5.0 weeks) and 15 nonpregnant women (age: 29.8 ± 4.0 years) were included. rHRV was measured using a portable heart rate monitor for 10 min while sitting. Ln rMSSD difference/agreement between shorter time segments and criterion period was analyzed. The result observed between the 4th–5th minutes was the shortest time segment not different from/highly agreed with the criterion period in pregnant women (difference [95% confidence interval (CI)]: −0.10 [−0.22 to 0.02]/bias ± 1.96 × SD: −0.06 [−0.38 to 0.25]). In nonpregnant women, the 2nd–3rd-minute segment was the shortest with similar results (difference [95% CI]: −0.04 [−0.15 to 0.07]/bias ± 1.96 × SD: −0.03 [−0.39 to 0.32]). The Ln rMSSD was found to be stable from the 5th–10th minutes and the 3rd–10th minutes in pregnant and nonpregnant women, respectively. A shortened rHRV assessment can increase its applicability in clinical/exercise-training settings. Novelty Ln rMSSD can be measured for 5 min in pregnant women, with the last 1-min segment analyzed. The last 1-min segment from 3 min can be used for rHRV measurement in nonpregnant women. The shortened rHRV assessment can facilitate its applicability in clinical/exercise-training settings.
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Affiliation(s)
- Danilo Fernandes da Silva
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1L 6N5, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1L 6N5, Canada
| | - Shuhiba Mohammad
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1L 6N5, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1L 6N5, Canada
| | - Kelly Ann Hutchinson
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1L 6N5, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1L 6N5, Canada
| | - Kristi Bree Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1L 6N5, Canada
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18
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REYES LAURAM, FAROOQ SAULEHAM, SKOW RACHELJ, BUSCH STEPHENA, PYKE KYRAE, KHURANA RSHMI, CHARI RADHAS, STICKLAND MICHAELK, DEVOLIN MAUREEN, DAVIDGE SANDRAT, SOBIERAJSKI FRANCES, LUGG ANNA, STEINBACK CRAIGD, DAVENPORT MARGIEH. Physical Activity in Pregnancy Is Associated with Increased Flow-mediated Dilation. Med Sci Sports Exerc 2019; 52:801-809. [DOI: 10.1249/mss.0000000000002201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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19
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Davenport MH, Sobierajski F, Mottola MF, Skow RJ, Meah VL, Poitras VJ, Gray CE, Jaramillo Garcia A, Barrowman N, Riske L, James M, Nagpal TS, Marchand AA, Slater LG, Adamo KB, Davies GA, Barakat R, Ruchat SM. Glucose responses to acute and chronic exercise during pregnancy: a systematic review and meta-analysis. Br J Sports Med 2018; 52:1357-1366. [DOI: 10.1136/bjsports-2018-099829] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2018] [Indexed: 11/03/2022]
Abstract
ObjectiveTo perform a systematic review and meta-analysis to explore the relationship between prenatal exercise and glycaemic control.DesignSystematic review with random-effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were included (except case studies and reviews) if they were published in English, Spanish or French, and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of acute or chronic exercise, alone (‘exercise-only’) or in combination with other intervention components (eg, dietary; ‘exercise+cointervention’) at any stage of pregnancy), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and outcome (glycaemic control).ResultsA total of 58 studies (n=8699) were included. There was ‘very low’ quality evidence showing that an acute bout of exercise was associated with a decrease in maternal blood glucose from before to during exercise (6 studies, n=123; mean difference (MD) −0.94 mmol/L, 95% CI −1.18 to −0.70, I2=41%) and following exercise (n=333; MD −0.57 mmol/L, 95% CI −0.72 to −0.41, I2=72%). Subgroup analysis showed that there were larger decreases in blood glucose following acute exercise in women with diabetes (n=26; MD −1.42, 95% CI −1.69 to −1.16, I2=8%) compared with those without diabetes (n=285; MD −0.46, 95% CI −0.60 to −0.32, I2=62%). Finally, chronic exercise-only interventions reduced fasting blood glucose compared with no exercise postintervention in women with diabetes (2 studies, n=70; MD −2.76, 95% CI −3.18 to −2.34, I2=52%; ‘low’ quality of evidence), but not in those without diabetes (9 studies, n=2174; MD −0.05, 95% CI −0.16 to 0.05, I2=79%).ConclusionAcute and chronic prenatal exercise reduced maternal circulating blood glucose concentrations, with a larger effect in women with diabetes.
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20
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Purdy GM, James MA, Wakefield PK, Skow RJ, Van Diepen S, May LE, Davenport MH, Steinback CD. Maternal cardioautonomic responses during and following exercise throughout pregnancy. Appl Physiol Nutr Metab 2018; 44:263-270. [PMID: 30138571 DOI: 10.1139/apnm-2018-0397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Blood pressure regulation during pregnancy is poorly understood. Cardiovagal baroreflex gain (BRG) is an important contributor to blood pressure regulation through its influence on heart rate. Heart rate fluctuations occur in response to various physiological stimuli and can be measured using heart rate variability (HRV). It is unclear how these mechanisms operate during pregnancy, particularly with regard to exercise. We examined BRG and HRV prior to, during, and following prenatal exercise. Forty-three pregnant (n = 10 first trimester (TM1), n = 17 second trimester (TM2), n = 16 third trimester (TM3)) and 20 nonpregnant (NP) women underwent an incremental peak exercise test. Beat-by-beat blood pressure (photoplethysmography) and heart rate (lead II electrocardiogram) were measured throughout. BRG (the slope of the relationship between fluctuations in systolic blood pressure and the R-R interval) and HRV (root mean square of the successive differences; RMSSD) were assessed at rest, during steady-state exercise (EX), and during active recovery. BRG decreased with gestation and was lower in the TM3 group than in the NP group (17.9 ± 6.9 ms/mm Hg vs 24.8 ± 7.4 ms/mm Hg, p = 0.017). BRG was reduced during EX in all groups. Resting HRV (RMSSD) also decreased with gestation and was lower in the TM3 group than in the NP group (29 ± 17 ms vs 48 ± 20 ms, p < 0.001). RMSSD was blunted during EX in all groups compared with rest. During active recovery, RMSSD was further blunted compared with EX in the NP group but not during pregnancy (TM1, TM2, and TM3). Compared with the nonpregnant controls, the pregnant women had lower BRG and HRV at rest, but comparable cardioautonomic control during both exercise and active recovery following peak exercise.
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Affiliation(s)
- Graeme M Purdy
- a Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.,b Women and Children's Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Marina A James
- a Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.,b Women and Children's Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Paige K Wakefield
- a Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.,b Women and Children's Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada.,c Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Rachel J Skow
- a Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.,b Women and Children's Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada.,c Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Sean Van Diepen
- d Faculty of Medicine and Dentistry, Department of Critical Care and Division of Cardiology, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - Linda E May
- e Division of Foundational Sciences and Research, East Carolina University, Greenville, NC 27858, USA
| | - Margie H Davenport
- a Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.,b Women and Children's Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada.,c Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Craig D Steinback
- a Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.,b Women and Children's Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada.,c Alberta Diabetes Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
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21
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Davenport MH, Steinback CD, Borle KJ, Matenchuk BA, Vanden Berg ER, de Freitas EM, Linares AM, O'Halloran KD, Sherpa MT, Day TA. Extreme pregnancy: maternal physical activity at Everest Base Camp. J Appl Physiol (1985) 2018; 125:580-585. [PMID: 29745793 DOI: 10.1152/japplphysiol.00146.2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
High-altitude natives employ numerous physiological strategies to survive and reproduce. However, the concomitant influence of altitude and physical activity during pregnancy has not been studied above 3,700 m. We report a case of physical activity, sleep behavior, and physiological measurements on a 28-yr-old third-trimester pregnant native highlander (Sherpa) during ascent from 3,440 m to Everest Base Camp (~5,300 m) over 8 days in the Nepal Himalaya and again ~10 mo postpartum during a similar ascent profile. The participant engaged in 250-300 min of moderate to vigorous physical activity per day during ascent to altitude while pregnant, with similar volumes of moderate to vigorous physical activity while postpartum. There were no apparent maternal, fetal, or neonatal complications related to the superimposition of the large volumes of physical activity at altitude. This report demonstrates a rare description of physical activity and ascent to high altitude during pregnancy and points to novel questions regarding the superimposition of pregnancy, altitude, and physical activity in high-altitude natives.
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Affiliation(s)
- Margie H Davenport
- Program for Pregnancy and Postpartum Health, Neurovascular Health Lab, Faculty of Kinesiology, Sport, and Recreation, University of Alberta , Edmonton, Alberta , Canada
| | - Craig D Steinback
- Program for Pregnancy and Postpartum Health, Neurovascular Health Lab, Faculty of Kinesiology, Sport, and Recreation, University of Alberta , Edmonton, Alberta , Canada
| | - Kennedy J Borle
- Faculty of Science and Technology, Department of Biology, Mount Royal University , Calgary, Alberta , Canada.,University of British Columbia , Vancouver, British Columbia , Canada
| | - Brittany A Matenchuk
- Program for Pregnancy and Postpartum Health, Neurovascular Health Lab, Faculty of Kinesiology, Sport, and Recreation, University of Alberta , Edmonton, Alberta , Canada
| | - Emily R Vanden Berg
- Faculty of Science and Technology, Department of Biology, Mount Royal University , Calgary, Alberta , Canada.,Department of Biology, University of Victoria , Victoria, British Columbia , Canada
| | - Emily M de Freitas
- Faculty of Science and Technology, Department of Biology, Mount Royal University , Calgary, Alberta , Canada
| | - Andrea M Linares
- Faculty of Science and Technology, Department of Biology, Mount Royal University , Calgary, Alberta , Canada.,University of Ontario Institute of Technology , Oshawa, Ontario , Canada
| | - Ken D O'Halloran
- Department of Physiology, University College Cork , Cork , Ireland
| | | | - Trevor A Day
- Faculty of Science and Technology, Department of Biology, Mount Royal University , Calgary, Alberta , Canada
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22
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Reyes LM, Davenport MH. Exercise as a therapeutic intervention to optimize fetal weight. Pharmacol Res 2018; 132:160-167. [PMID: 29684673 DOI: 10.1016/j.phrs.2018.04.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/16/2018] [Accepted: 04/18/2018] [Indexed: 12/29/2022]
Abstract
The Developmental Origins of Health and Disease suggest the in utero environment programs offspring obesity and cardiovascular disease. Therefore, there is a need to implement safe therapeutic interventions that do not involve the intake of medications or biological products during pregnancy that can improve maternal and fetal health. Prenatal exercise is established to promote maternal and fetal health. It is generally recommended that women accumulate at least 150 min per week of moderate-intensity exercise. It has been demonstrated that prenatal exercise maintains healthy weight gain and improves maternal glucose control, maternal cardiac autonomic control, placental efficiency (increases angiogenesis, downregulates genes involved in fatty acid transport and insulin transport across the placenta, and upregulates genes involved in amino acid transport across the placenta), and oxidative stress. These adaptations following exercise improve maternal metabolism and provide adequate uteroplacental perfusion. In this review, we will focus on exercise as a therapeutic intervention to optimize fetal weight. It has been established that prenatal exercise does not increase the risk of having a small for gestational age baby. To the contrary, prenatal exercise has been associated with the prevention of excessive fat accumulation in the newborn and the maintenance of fetal muscle mass.
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Affiliation(s)
- Laura M Reyes
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport and Recreation, 1-052 Li Ka Shing Centre for Health Research Innovation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, T6G 2E1, Alberta, Canada.
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport and Recreation, 1-052 Li Ka Shing Centre for Health Research Innovation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, T6G 2E1, Alberta, Canada.
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23
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Sobierajski FM, Purdy GM, Usselman CW, Skow RJ, James MA, Chari RS, Khurana R, Stickland MK, Davidge ST, Devolin M, Steinback CD, Davenport MH. Maternal Physical Activity Is Associated With Improved Blood Pressure Regulation During Late Pregnancy. Can J Cardiol 2018; 34:485-491. [DOI: 10.1016/j.cjca.2018.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 12/16/2022] Open
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Meah VL, Backx K, Davenport MH. Functional hemodynamic testing in pregnancy: recommendations of the International Working Group on Maternal Hemodynamics. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:331-340. [PMID: 28857365 DOI: 10.1002/uog.18890] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 06/07/2023]
Abstract
In the general population, functional hemodynamic testing, such as that during submaximal aerobic exercise and isometric handgrip, and the cold pressor test, has long been utilized to unmask abnormalities in cardiovascular function. During pregnancy, functional hemodynamic testing places additional demands on an already stressed maternal cardiovascular system. Dysfunctional responses to such tests in early pregnancy may predict the development of hypertensive disorders that develop later in gestation. For each of the above functional hemodynamic tests, these recommendations provide a description of the test, test protocol and equipment required, and an overview of the current understanding of clinical application during pregnancy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- V L Meah
- Centre for Exercise and Health, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - K Backx
- Centre for Exercise and Health, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - M H Davenport
- Program for Pregnancy & Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Physical Education & Recreation, Alberta Diabetes Institute, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
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25
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The influence of prenatal exercise and pre-eclampsia on maternal vascular function. Clin Sci (Lond) 2017; 131:2223-2240. [PMID: 28798074 DOI: 10.1042/cs20171036] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/03/2017] [Accepted: 07/06/2017] [Indexed: 01/10/2023]
Abstract
During healthy pregnancy, the cardiovascular system undergoes diverse adaptations to support adequate transfer of oxygen and nutrients from mother to fetus. In order to accommodate the large expansion of blood volume and associated cardiac output, the structure, mechanics, and function of the arteries are altered. Specifically, in healthy pregnancy there is a remodeling of arteries (increased angiogenesis and vasodilation), a generalized reduction in arterial stiffness (increased compliance), and an enhanced endothelial function. The development of pregnancy complications, specifically pre-eclampsia, is associated with poor placentation (decreased angiogenesis), increased arterial stiffness, and vascular dysfunction (reduced endothelial function). Many of the positive adaptations that occur in healthy pregnancy are enhanced in response to chronic exercise. Specifically, placental angiogenesis and endothelial function have been shown to improve to a greater extent in women who are active during their pregnancy compared with those who are not. Prenatal exercise may be important in helping to reduce the risk of vascular dysfunction in pregnancy. However, our knowledge of the vascular adaptations resulting from maternal exercise is limited. This review highlights maternal vascular adaptations occurring during healthy pregnancy, and contrasts the vascular maladaptation associated with pre-eclampsia. Finally, we discuss the role of prenatal exercise on vascular function in the potential prevention of vascular complications associated with pre-eclampsia.
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Charkoudian N, Usselman CW, Skow RJ, Staab JS, Julian CG, Stickland MK, Chari RS, Khurana R, Davidge ST, Davenport MH, Steinback CD. Muscle sympathetic nerve activity and volume-regulating factors in healthy pregnant and nonpregnant women. Am J Physiol Heart Circ Physiol 2017; 313:H782-H787. [PMID: 28733450 DOI: 10.1152/ajpheart.00312.2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/18/2017] [Accepted: 07/18/2017] [Indexed: 11/22/2022]
Abstract
Healthy, normotensive human pregnancies are associated with striking increases in both plasma volume and vascular sympathetic nerve activity (SNA). In nonpregnant humans, volume-regulatory factors including plasma osmolality, vasopressin, and the renin-angiotensin-aldosterone system have important modulatory effects on control of sympathetic outflow. We hypothesized that pregnancy would be associated with changes in the relationships between SNA (measured as muscle SNA) and volume-regulating factors, including plasma osmolality, plasma renin activity, and arginine vasopressin (AVP). We studied 46 healthy, normotensive young women (23 pregnant and 23 nonpregnant). We measured SNA, arterial pressure, plasma osmolality, plasma renin activity, AVP, and other volume-regulatory factors in resting, semirecumbent posture. Pregnant women had significantly higher resting SNA (38 ± 12 vs. 23 ± 6 bursts/min in nonpregnant women), lower osmolality, and higher plasma renin activity and aldosterone (all P < 0.05). Group mean values for AVP were not different between groups [4.64 ± 2.57 (nonpregnant) vs. 5.17 ± 2.03 (pregnant), P > 0.05]. However, regression analysis detected a significant relationship between individual values for SNA and AVP in pregnant (r = 0.71, P < 0.05) but not nonpregnant women (r = 0.04). No relationships were found for other variables. These data suggest that the link between AVP release and resting SNA becomes stronger in pregnancy, which may contribute importantly to blood pressure regulation in healthy women during pregnancy.NEW & NOTEWORTHY Sympathetic nerve activity and blood volume are both elevated during pregnancy, but blood pressure is usually normal. Here, we identified a relationship between vasopressin and sympathetic nerve activity in pregnant but not nonpregnant women. This may provide mechanistic insights into blood pressure regulation in normal pregnancy and in pregnancy-related hypertension.
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Affiliation(s)
- Nisha Charkoudian
- United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Charlotte W Usselman
- Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Physical Education and Recreation, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Rachel J Skow
- Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Physical Education and Recreation, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffery S Staab
- United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Colleen G Julian
- Department of Medicine, University of Colorado Denver School of Medicine, Denver, Colorado; and
| | - Michael K Stickland
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Radha S Chari
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Rshmi Khurana
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.,Department of Medicine, University of Colorado Denver School of Medicine, Denver, Colorado; and
| | - Sandra T Davidge
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.,Department of Medicine, University of Colorado Denver School of Medicine, Denver, Colorado; and
| | - Margie H Davenport
- Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Physical Education and Recreation, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Craig D Steinback
- Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Faculty of Physical Education and Recreation, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada; .,Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
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Dubé C, Aguer C, Adamo K, Bainbridge S. A role for maternally derived myokines to optimize placental function and fetal growth across gestation. Appl Physiol Nutr Metab 2017; 42:459-469. [DOI: 10.1139/apnm-2016-0446] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Exercise during pregnancy is associated with improved health outcomes for both mother and baby, including a reduced risk of future obesity and susceptibility to chronic diseases. Overwhelming evidence demonstrates a protective effect of maternal exercise against fetal birth weight extremes, reducing the rates of both large- and small-for-gestational-age infants. It is speculated that this protective effect is mediated in part through exercise-induced regulation of maternal physiology and placental development and function. However, the specific mechanisms through which maternal exercise regulates these changes remain to be discovered. We hypothesize that myokines, a collection of peptides and cytokines secreted from contracting skeletal muscles during exercise, may be an important missing link in the story. Myokines are known to reduce inflammation, improve metabolism and enhance macronutrient transporter expression and activity in various tissues of nonpregnant individuals. Little research to date has focused on the specific roles of the myokine secretome in the context of pregnancy; however, it is likely that myokines secreted from exercising skeletal muscles may modulate the maternal milieu and directly impact the vital organ of pregnancy—the placenta. In the current review, data in strong support of this potential role of myokines will be presented, suggesting myokine secretion as a key mechanism through which maternal exercise optimizes fetal growth trajectories. It is clear that further research is warranted in this area, as knowledge of the biological roles of myokines in the context of pregnancy would better inform clinical recommendations for exercise during pregnancy and contribute to the development of important therapeutic interventions.
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Affiliation(s)
- Chantal Dubé
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Céline Aguer
- Institut de recherche de l’Hôpital Montfort, Ottawa, ON K1K 0T1, Canada
- Biochemistry, Microbiology and Immunology department, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Kristi Adamo
- School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 1A2, Canada
- Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Shannon Bainbridge
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
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