Exercise and Physical Activity During Pregnancy and Postpartum: Evidence-Based Guidelines

Description

This is the second edition of a well-received, practice oriented, multidisciplinary book filling the gap between evidence-based knowledge on the benefits of physical activity and exercise during pregnancy and postpartum and the implementation of exercise programs and related health promotion measures in pregnant women. Readers will find up-to-date evidence on the psychological, social, physiological, body composition, musculoskeletal, and biomechanical changes that occur during pregnancy and their implications for physical activity and exercise. Further, the authors equip the reader with the latest guidelines and detailed description of exercise testing, prescription, selection and adaptation for pregnant and postpartum women, including those with clinical conditions. This new edition has been thoroughly updated, and includes additional chapters focused on the pedagogical intervention in pre and postnatal exercise programs, exercise prescription and adaptation during postpartum and diet recommendations for the pregnant exerciser and athlete.  Written by recognized experts in the field, the book aims to allay undue fears regarding the consequences of exercising during pregnancy. Moreover, it provides medical, sports, and fitness professionals both with the knowledge and the practical expertise needed to offer an optimal guidance on exercising to pregnant exercisers and athletes.  Foreword References Preface Contents Editors and Contributors About the Editor Contributors 1: Physical Activity, Exercise, and Health Promotion for the Pregnant Exerciser 1.1 Introduction 1.2 Education for Health and Lifestyle During Pregnancy 1.2.1 Pregnancy as an Opportunity to Promote Health 1.2.2 Preparing for Childbirth and Parenting 1.2.3 Health and Lifestyle Promotion 1.3 Public Health and Physical Activity During Pregnancy 1.3.1 Impact of Maternal Physical Activity on Chronic Disease Risk 1.3.2 Impact of Maternal Physical Activity on Offspring Health 1.4 Correlates of Physical Activity Among Pregnant Women 1.4.1 Identifying Physically Active Pregnant Women 1.4.2 Identifying Physically Inactive Women 1.5 Physical Activity Patterns Among Pregnant Women 1.6 Measuring Physical Activity, Sedentary Behavior, and Sleep Pattern 1.7 Further Research References 2: Psychological, Social and Behavioural Changes During Pregnancy: Implications for Physical Activity and Exercise 2.1 Psychological and Social Changes During Pregnancy 2.1.1 Identity 2.1.2 Loss of Control 2.1.3 Cognitive Function 2.1.4 Behavioural Changes 2.2 The Influence of Physical Activity and Exercise on Psychological Well-Being During Pregnancy 2.2.1 Depressive Symptoms 2.2.2 Anxiety Symptoms 2.2.3 Sleep 2.2.4 Summary 2.3 Psychosocial Barriers and Facilitators to Being Active During Pregnancy 2.3.1 Individual Factors 2.3.2 Physical Symptoms 2.3.2.1 Fatigue 2.3.2.2 Nausea 2.3.2.3 Discomfort, Physical Limitations and High-Risk Pregnancies 2.3.2.4 Lack of Time 2.3.2.5 Motivation 2.3.2.6 Attitudes and Beliefs 2.3.3 Social Factors 2.3.3.1 Social Norms 2.3.3.2 Healthcare Professional Advice 2.3.3.3 Social Support 2.3.4 Physical Environmental Factors 2.3.4.1 Transport 2.3.4.2 Access to Facilities 2.3.5 Summary 2.4 Behaviour Change Strategies 2.4.1 Systematic Reviews 2.4.2 Walking Interventions 2.4.3 Supervised Individual or Group Exercise 2.4.4 Information and Behavioural Counselling 2.4.5 Combined Interventions 2.4.6 Summary 2.5 Using Theory to Support Physical Activity in Pregnancy 2.5.1 The COM-B Model 2.6 Conclusion References 3: Physiological Changes During Pregnancy: Main Adaptations, Discomforts, and Implications for Physical Activity and Exercise 3.1 Cardiovascular Changes 3.1.1 Implications of Exercise During Pregnancy on the Maternal Heart 3.1.1.1 Maternal Cardiovascular Response to Exercise 3.1.1.2 Maternal Cardiovascular Adaptations to Exercise 3.2 Hematological Changes 3.3 Respiratory Changes 3.4 Metabolic Changes 3.5 Locomotor Changes 3.6 Microbiome Changes During Pregnancy References 4: Body Composition Changes During Pregnancy and Effects of Physical Exercise 4.1 Introduction 4.2 Body Composition Overview 4.2.1 Body Composition Levels 4.2.2 Fat and Adipose Tissue 4.2.3 Fat Depots and Adipose Tissue location 4.3 Body Composition During Pregnancy 4.3.1 Pregnancy and Obesity 4.3.2 Pregnancy and Weight Gain 4.3.3 Pregnancy and Body Components 4.4 Body Composition Assessment in Pregnancy 4.4.1 Instruments and Methods 4.4.1.1 Laboratory Body Composition Assessment Four-Compartment Model Three-Compartment Model Two-Compartment Model Non-molecular Model Body Composition Assessment 4.4.1.2 Clinical Markers of Body Composition/Obesity in Pregnancy Body Mass Index Bioelectric Impedance Skinfold Thickness Body Circumferences 4.5 Effect of Exercise on Body Composition in Pregnancy and Postpartum 4.5.1 Effect of Exercise on Gestational Weight Gain and Body Composition 4.5.2 Recommendations of Physical Activity and Exercise During Pregnancy and Postpartum 4.6 Conclusion 4.7 Further Research References 5: Biomechanical Adaptations of Gait in Pregnancy: Implications for Physical Activity and Exercise 5.1 Introduction 5.2 Understanding the Biomechanical Variables 5.2.1 Why Gait Analysis? 5.2.2 Spatiotemporal and Kinematic Analysis 5.2.3 Kinetic Analysis and Biomechanical Loading 5.2.3.1 Ground Reaction Forces 5.2.3.2 Biomechanical Loading 5.2.3.3 Plantar Pressure 5.3 Biomechanical Gait and Balance Adaptations During Pregnancy 5.3.1 General Characteristics of the Biomechanical Studies with Pregnant and Postpartum Women 5.3.2 Spatiotemporal and Kinematic Adaptations During Pregnancy and Postpartum 5.3.2.1 Centre of Gravity and Balance 5.3.2.2 Spatial and Temporal Parameters During Gait 5.3.2.3 Gait and Joint Kinematics 5.3.3 Biomechanical Loading During Pregnancy and Postpartum 5.3.3.1 Ground Reaction Forces 5.3.3.2 Plantar Pressure 5.3.3.3 Joint Reaction Forces 5.4 Other Biomechanical Adaptations During Pregnancy 5.4.1 Balance and Fall Risk 5.4.2 Trunk Motion and Load Transportation 5.5 Implications for Exercise Prescription and Intervention 5.6 Further Research 5.7 Conclusion References 6: Specific Musculoskeletal Adaptations in Pregnancy: Pelvic Floor, Abdominal Muscles, Pelvic Girdle, and Lower Back—Implications for Physical Activity and Exercise 6.1 Introduction 6.2 The Pelvic Floor 6.2.1 Pelvic Floor Dysfunction and Risk Factors 6.2.2 Urinary Incontinence 6.2.2.1 Prevalence 6.2.2.2 Prevalence During Pregnancy 6.2.2.3 Prevalence After Childbirth 6.2.3 Etiology and Pathophysiology of Urinary Incontinence 6.2.3.1 Pregnancy 6.2.3.2 Childbirth 6.2.3.3 Bladder Neck and Urethral Hypermobility 6.2.3.4 Neural Denervation 6.2.3.5 Weakening of the Pelvic Floor Muscles 6.2.4 Levator Ani Muscle Defects 6.2.5 Muscle Injury Regeneration 6.2.5.1 Treatment Principles for Skeletal Muscle Injuries 6.3 Diastasis Recti Abdominis 6.3.1 Consequences of Diastasis Recti Abdominis 6.4 Pregnancy-Related Low Back Pain and Pelvic Girdle Pain References Further Reading 7: Evidence-Based and Practice-Oriented Guidelines for Exercising During Pregnancy 7.1 Introduction 7.2 General Features of the Guidelines on Physical Activity in Pregnancy 7.3 Exercise Prescription Considering Pre-pregnancy Habits Related to Physical Activity and the Course of Pregnancy 7.3.1 Previously Inactive Pregnant Women 7.3.2 Previously Active Pregnant Women 7.3.3 Elite or Competitive Athletes 7.3.4 Pregnant Women with Obesity 7.3.5 Exercising in Complicated Pregnancy 7.3.6 Recommendations to Reduce Time Spent in Sedentary Behavior 7.4 Recommended Types of Exercise and Forms of Sports Activities for Pregnant women 7.5 Targeted Exercise Classes for Pregnant Women 7.5.1 Aerobic, Resistance, and Stretching Exercises 7.5.2 Specific Exercises for Pregnancy and in Selected Pregnancy Complaints 7.5.3 Exercise Positions, Structure of the Exercise Class, and Other Organizational Recommendations 7.6 Exercise Professionals and Obstetrics Care Providers 7.7 Limitations 7.8 Conclusions References 8: Exercise Testing and Prescription in Pregnancy 8.1 Introduction 8.1.1 Previous Considerations Before Start Exercising 8.1.2 Contraindications for Exercising While Pregnant 8.2 Guidelines on Exercise During Pregnancy and Useful Sources of Information 8.3 Health Screening of Pregnant Women Before Starting Exercise 8.4 Pre-exercise Evaluation with Pregnant Exercisers and Athletes 8.5 Exercise Testing with Pregnant Women 8.6 Exercise Prescription for Pregnant Women 8.6.1 Type and Mode of Exercise 8.6.2 Exercise Duration, Frequency, and Intensity 8.6.3 Exercise Volume 8.6.4 Other Forms of Physical Activity 8.6.5 Exercise Progression and Adaptation 8.6.6 Session Organization 8.7 Exercise Prescription in Special Conditions 8.7.1 Gestational Diabetes 8.7.2 Excess Weight and Obesity 8.7.3 Hypertension and Preeclampsia 8.7.4 Low Back Pain 8.7.5 Depression and Mental Disorders 8.8 Specific Considerations and Safety Issues Regarding Exercise During Pregnancy 8.8.1 Weight Gain and Caloric Intake 8.8.2 Hydration and Urinary Incontinence 8.8.3 Falls and Injury 8.8.4 Nausea and Dizziness 8.8.5 Heat, Humidity, and Environment 8.8.6 Sportswear and Shoes 8.9 Exercise Supervision and Multidisciplinary Teams 8.10 Further Research 8.11 Conclusions References 9: Exercise Selection and Adaptations During Pregnancy 9.1 Introduction 9.2 Planning, Conducting, and Monitoring of the Prenatal Exercise Sessions 9.3 The Structure of the Exercise Session for Pregnant Women 9.3.1 Warm-Up 9.3.2 Aerobic Exercise 9.3.2.1 Aerobics 9.3.2.2 Step Aerobics 9.3.2.3 Indoor and Outdoor Cycling 9.3.2.4 Walking, Jogging, or Running 9.3.2.5 Water Exercise and Swimming 9.3.3 High-Intensity Interval Training (HIIT) 9.3.4 Resistance, Postural, and Neuromotor Exercises 9.3.4.1 Resistance Exercises 9.3.4.2 Pilates Mat 9.3.4.3 Abdominals Exercises 9.3.4.4 Postural Exercises 9.3.4.5 Neuromotor Exercise 9.3.5 Flexibility Exercises 9.3.6 Pelvic Floor Muscle Exercises 9.3.7 Cool-Down 9.3.7.1 Birth Positions 9.3.7.2 Breathing Exercises 9.3.7.3 Visualization of Pregnancy and Birth 9.4 Further Research 9.5 Conclusion Appendix 1: Exercise Positions for Pregnant Women Standing Position (Fig. 9.9) Sitting Positions (Figs. 9.10 and 9.11) Vertical Kneeling Position (Fig. 9.12a) Kneeling Sit-Down Position (Fig. 9.12b) Supported Kneeling Position (So-Called On All Fours) On Forearms or Hands (Fig. 9.12c) Frontal Plank Position (Fig. 9.13) Supine Position (Fig. 9.14) Lying on the Side (Fig. 9.16) Prone Position (Lying on the Front) Appendix 2: Examples of Aerobics Movements for Pregnant Women Appendix 3: Examples of Basic Step Aerobics Exercises for Pregnant Women Appendix 4: Examples of Resistance Exercises for Pregnant Women Appendix 5: Examples of Abdominal Exercises for Pregnant Women Previously Inactive Suggestions for Exercises in the Presence of Diastasis Recti Abdominis Appendix 6: Examples of Posture Exercises for Pregnant Women Appendix 7: Examples of Balance Exercises for Pregnant Women Appendix 8: Examples of Flexibility Exercises for Pregnant Women Appendix 9: Examples of Exercises for Proper Pelvic Floor Muscle Contraction Appendix 10: Examples of Birth Position Exercises Appendix 11: Examples of Breathing Exercises for Pregnant Women References 10: Exercise Prescription and Adaptations in Early Postpartum 10.1 Introduction 10.2 Physical Activity and Health in the Early Postpartum, the “Fourth Trimester” 10.3 Physical Activity Guidelines in the Early Postpartum 10.4 Pre-Exercise Assessment in the Early Postpartum 10.5 Exercise Prescription in the Early Postpartum 10.6 Exercise Selection and Adaptation in the Early Postpartum 10.6.1 Exercises to Be Implemented in the Early Postpartum 10.6.2 Exercises to Be Implemented in the Early Postpartum, After Full Recovery of Pelvic Organs and Musculoskeletal Structures 10.6.3 Other Forms of Increasing the Volume of Physicochemical Activity or Exercise 10.7 Further Research References 11: Strengthening Competencies of Future Healthcare Professionals to Promote Physical Activity During Pregnancy 11.1 Introduction 11.2 Going Beyond Knowledge Acquisition 11.3 Trends and Examples of Existing Programs in Healthcare Education to Promote Physical Activity in Perinatal Care 11.3.1 Interprofessional and Community-Based Education: Bringing Future Healthcare Professionals and Pregnant Women Together 11.3.1.1 “Move Your Baby” as an Example for Interprofessional and Community-Based Education 11.4 Training in Behavioral Change Theory and Interventions for Pregnant Women 11.4.1 Continuation of Health Education Activities into Postpartum 11.4.2 Emphasis on Lifelong Learning and Consequences for Students’ Evaluation 11.5 Education in Digital Health to Encourage Physical Activity During Pregnancy 11.6 Future Research 11.7 Conclusion References 12: Therapeutic Exercise Regarding Musculoskeletal Health of the Pregnant Exerciser and Athlete 12.1 Introduction 12.2 Pelvic Floor Muscle Training 12.2.1 Pre-Contraction 12.2.2 Strength Training 12.2.3 Evidence for Pelvic Floor Muscle Training to Prevent and Treat Urinary Incontinence during Pregnancy 12.2.4 Can Pelvic Floor Muscle Training Compromise Vaginal Birth? 12.3 Diastasis Recti Abdominis 12.3.1 Prevention and Treatment 12.4 Low Back and Pelvic Girdle Pain 12.4.1 Therapeutic Exercise for Pregnancy-Related Low Back and Pelvic Girdle Pain 12.5 Further Research 12.6 Conclusions References 13: Nutritional and Energy Requirements of the Pregnant Exerciser and Athlete 13.1 Introduction 13.2 Nutritional and Clinical Issues During Pregnancy 13.3 Special Groups of Pregnant Exercisers and Pregnant Athletes 13.3.1 Pregnant Athletes Practicing Aesthetic Sports, Weight Competing Sports, and Sports of Long Duration 13.3.2 Pregnant Exerciser Women Who Restrict or Prohibit Certain Dietary Practices or the Consumption of Important Sources of Energy and Nutrients 13.3.3 Adolescents Pregnant Exercisers 13.3.4 Pregnant Exerciser Women in High-Risk Categories 13.4 Nutritional Status of the Pregnant Exerciser and Athlete 13.4.1 Energy and Nutritional Requirements for the Pregnant Exerciser and Athlete 13.5 Diet and Physical Exercise 13.5.1 Daily Requirements by Activity 13.5.1.1 Carbohydrates 13.5.1.2 Proteins 13.5.1.3 Fat 13.5.2 Dietary Intake Before Physical Exercise 13.5.3 Dietary Intake During Physical Exercise 13.5.4 Dietary Intake After Physical Exercise 13.6 Unhealthy Habits to Avoid 13.6.1 Alcohol, Smoking, and Other Stimulant Substances 13.6.2 Lack of Sleep 13.7 Conclusion References 14: Diet Recommendations for the Pregnant Exerciser and Athlete 14.1 Introduction 14.2 Diet Quality During Pregnancy 14.2.1 Determinants of Dietary Quality 14.2.2 Dietary Sources of Nutrients 14.2.2.1 Protein Dietary Sources 14.2.2.2 Carbohydrates and Fiber Dietary Sources 14.2.2.3 Fat and Omega 3 Dietary Sources 14.2.2.4 Folate Dietary Sources 14.2.2.5 Vitamin C Dietary Sources 14.2.2.6 Vitamin D Dietary Sources 14.2.2.7 Calcium Dietary Sources 14.2.2.8 Iron Dietary Sources 14.2.2.9 Magnesium Dietary Sources 14.2.2.10 Iodine Dietary Sources 14.2.2.11 Zinc Dietary Sources 14.2.2.12 Selenium Dietary Sources 14.2.3 Dietary Patterns 14.2.3.1 Mediterranean Diet 14.2.3.2 Vegetarian Diets 14.2.4 Other Relevant Dietary Aspects 14.2.4.1 Hydration 14.2.4.2 Caffeine 14.2.4.3 Low- and Non-Calorie Sweeteners 14.3 Impact of Maternal Diet on Offspring Health 14.4 Food Safety for Pregnant Women 14.4.1 Food-Borne Infections 14.4.2 Dietary Contaminants Exposure 14.4.3 Food Supplements 14.5 Diet in Special Conditions 14.5.1 Excessive Weight Gain During Pregnancy 14.5.2 Gestational Diabetes 14.6 Practice-Oriented Dietary Guide for an Active Pregnancy 14.6.1 General Dietary Advice 14.6.2 Food Safety Advice References