Alterations in maternal physiology during pregnancy affect the physiological response to aerobic exercise. Maternal resting oxygen consumption (V̇O2) and cardiac output (Q̇) increase during pregnancy. Heart rate (HR) becomes progressively elevated throughout gestation, whereas stroke volume (SV) increases until the third trimester and then declines until term, probably because of diminished venous return. Plasma volume increases earlier and to a greater magnitude than red cell volume, resulting in the ‘haemodilutional anaemia’ of pregnancy and a decline in the oxygen-carrying capacity. Ventilation is greater during pregnancy because of elevated tidal volume and unchanged rate of breathing. The acute and chronic (training) responses to aerobic exercise during pregnancy have not been thoroughly investigated. Specifically, the effect of gestational age, maternal activity status, and type, duration and intensity of exercise on maternal cardiovascular response have only recently begun to be explored. During pregnancy cardiac output during submaximal exertion increases above values in non-pregnant women, except perhaps late in gestation. Both heart rate and stroke volume contribute to the elevated cardiac output. Changes in submaximal exercise V̇O2 during pregnancy are dependent on the mode of exercise. At the same workload, V̇O2 increases during weight-bearing exercise, but usually does not differ from postpartum values during weight-supported exercise. One study found no change in V̇02max during pregnancy compared to postpartum values. Some recent evidence indicates that the cardiac output vs V̇O2 relationship for pregnant women is within the range of average values reported for non-pregnant individuals. Exercise arterial-venous oxygen difference is lower during pregnancy, suggesting that the higher cardiac output is distributed to non-exercising vascular beds. The data are limited but suggest that the perfusion of exercising muscle is unchanged during pregnancy and that the major haemodynamic change is an augmented cardiac output so that blood flow to the uterus and fetus is not compromised. Only one study has measured blood flow during exercise in pregnant women. The reported 25% decrease in uterine blood flow during supine cycle exercise in women late in gestation must be interpreted cautiously because the uterus may obstruct the vena cava in the supine position. Studies of exercising pregnant animals usually indicate a decreased uterine blood flow but an enhanced oxygen extraction; the lower blood flow may be limited to non-placental areas. The applicability of these results to humans is unknown. Fetal heart rate has been reported to increase, decrease or remain unchanged during and after maternal exercise. Some of the discrepancies among studies may be because the measurement techniques do not account for artifact related to maternal movement. Fetal bradycardia is not uncommon following maximal maternal exertion. The few training studies of pregnant women are limited in value by the inclusion of several exercise modes, inadequately defined intensity and duration of exercise, or omission of important cardiovascular variables. Nevertheless, these studies generally indicate increased performance or physiological fitness with training during pregnancy. The literature suggests normal or improved parturition and fetal outcome for women who exercise during pregnancy, although large well-designed prospective studies are lacking. Recommendations for exercising during pregnancy are provided.
ASJC Scopus subject areas
- Orthopedics and Sports Medicine
- Physical Therapy, Sports Therapy and Rehabilitation
- Public Health, Environmental and Occupational Health