Exercise Prescription for Overweight and Obese Women: Pregnancy and Postpartum
Section snippets
The maternal-fetal-child link to obesity
Obesity begets obesity.18, 19 With childhood obesity on the rise worldwide, the recent release of the agenda for obesity research suggests that priority should be given to investigating critical periods throughout life. Three of these time points include early life: the fetal and neonatal periods, and pregnancy.20
Mothers of obese preschoolers have a higher prepregnancy BMI,21 children of obese mothers are twice as likely to be large for gestational age (greater than the 95%ile) at birth, and
Aerobic exercise interventions for overweight or obese pregnant women
Although the healthy lifestyle approach is intuitive,33 to date only eight studies have examined the effectiveness of a combined nutrition and exercise intervention designed to prevent excessive weight gain during pregnancy, and not all exclusively examined overweight or obese women. As shown in Table 1, 63%34, 35, 36, 37, 38 were not successful in preventing excessive pregnancy weight gain in overweight and obese women. Studies using education alone as an intervention34, 35, 36, 37 were not
Aerobic exercise prescription for overweight and obese pregnant women
A recent study in which 20 medically prescreened obese and 20 normal-weight pregnant women participated in a graded-treadmill exercise test to volitional fatigue, examined the impact of obesity on the ventilatory response to weight-bearing exercise during pregnancy.45 The investigators concluded that exercise ventilatory response is increased during pregnancy but is not affected further by obesity during graded-treadmill exercise. This is important in that there is no apparent ventilatory
Rate of progression
The best time to progress is during the second trimester, when the risks and discomforts of pregnancy are lowest. Aerobic exercise should be increased gradually from a minimum of 15 minutes per session, three times per week at the appropriate target heart rate or RPE to a maximum of 30 minutes per session, four times per week (at the appropriate target heart rate or RPE), preceded by the warm-up and followed by the cool down.46
Muscle conditioning and strength training
Muscular strength and conditioning involves specific muscle groups that are stretched or moved through a specific range of motion, with or without added resistance to that muscle group.46 The effects of muscle strength and conditioning exercise performed during pregnancy have rarely been examined, especially in the overweight or obese population. Muscle conditioning exercises in combination with aerobic activities provide a well-rounded fitness program for pregnant women who have no
Postpartum
Maternal obesity has a negative association with the initiation of, and continuation of, breastfeeding, which may be attributed to excessive gestational weight gain, complications of pregnancy and delivery, or condition of the infant at birth.68 Excessive fat may hinder mammary gland development and lactogenesis in obese women.69 The greater the BMI of the mother before pregnancy, the less likely breastfeeding will be initiated70 and the more likely she will terminate breastfeeding early.71
Postpartum exercise interventions for overweight or obese women
Two recent reviews suggest that dieting and exercise together is more effective than dieting alone in reducing weight retention after childbirth,75 and that more interventions are necessary that focus primarily on weight management from a multi-level approach that includes the health care provider.76 Problems exist in postpartum care, as education on the increased risk for development of type-2 diabetes mellitus and cardiovascular disease, the benefits of breastfeeding, and the importance of
Exercise guidelines for overweight and obese postpartum women
Exercise guidelines for postpartum women are virtually nonexistent81 and certainly do not exist for overweight and obese women. Common sense, as indicated with recommendations for exercise during pregnancy, would suggest that postpartum women seek approval from their health care providers before beginning a moderate, structured exercise program. PAGA recommends at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity per week, with this activity spread throughout the
General guidelines for breastfeeding and exercise
Common-sense guidelines are available for postpartum women who wish to exercise. These include exercising after the baby has been fed or the breasts are empty to reduce discomfort. It is recommended that a good support bra be worn and that a sports bra be avoided because of breast compression.81 Adequate nutrition and hydration should be maintained to support the energy demands of breastfeeding and exercise.81 If there were no complications from delivery, a mild exercise program consisting of
Guidelines for aerobic exercise for overweight and obese postpartum women
Every structured aerobic-exercise program should be based on the FITT principle. Once medical approval has been obtained, frequency of a moderate program should begin slowly at three times per week, and depending on the mother's fitness level, can be increased to four or five times per week.81 Intensity can be monitored by the “talk test” and the RPE scale, where intensity should be of a moderate level (somewhat hard). If this is difficult for the overweight or obese woman, using an appropriate
Summary
To break the spiraling cycle of generations of unhealthy body weights and obesity-related health problems in adulthood, it is imperative to prevent excessive weight gain and to promote a healthy lifestyle during prenatal life and the postpartum period, especially for those women who are overweight and obese. The link between maternal lifestyle and the fetal environment reinforces the idea that the best solution for obesity prevention may begin with the promotion of a healthy lifestyle during
References (83)
- et al.
Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study
Lancet
(2006) - et al.
Trends in diabetes prevalence, incidence, and mortality in Ontario, Canada 1995–2005: a population-based study
Lancet
(2007) - et al.
Population-based trends and correlates of maternal overweight and obesity, Utah 1991–2001
Am J Obstet Gynecol
(2005) - et al.
Adolescent body mass index and infertility caused by ovulatory disorder
Am J Obstet Gynecol
(1994) - et al.
Prepregnancy weight and adverse perinatal outcomes in an ethnically diverse population
Obstet Gynecol
(2003) - et al.
Excess pregnancy weight gain and long-term obesity: one decade later
Obstet Gynecol
(2002) - et al.
Recreational exercise and occupational activity during pregnancy and birth weight: a case-control study
Am J Obstet Gynecol
(2001) - et al.
Effects of aerobic and strength conditioning on pregnancy outcomes
Am J Obstet Gynecol
(1987) - et al.
Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single blind randomized controlled trial
Obstet Gynecol
(2003) - et al.
Arterial pressure response to maximal isometric exercise in pregnant women
Obstet Gynecol
(1992)
Comparative evaluation of uterine response to exercise on five aerobic machines
Am J Obstet Gynecol
The fetal heart rate response to static antenatal exercises in the supine position
Aust J Physiother
The influence of maternal exercise on the pulsatility index of the umbilical artery blood velocity waveform
Eur J Obstet Gynecol Reprod Biol
Resistance exercise decreases the need for insulin in overweight women with gestational diabetes mellitus
Am J Obstet Gynecol
The association of maternal overweight and obesity with breastfeeding duration
J Pediatr
High prepregnant body mass index is associated with early termination of full and any breastfeeding in Danish women
Am J Clin Nutr
Birth weight; postnatal, infant, and childhood growth; and obesity in young adulthood: evidence from the Barry Caerphilly Growth Study
Am J Clin Nutr
Parent-child relationships in nutrient intake: the Framingham Children's Study
Am J Clin Nutr
Interventions for weight management in postpartum women
J Obstet Gynecol Neonatal Nurs
Impact of perinatal weight change on long-term obesity and obesity-related illnesses
Obstet Gynecol
The prevalence and impact of overweight and obesity in an Australian obstetric population
Med J Aust
Trends in pre-pregnancy obesity in nine states, 1993–2003
Obes
Effect of prepregnancy body mass index categories on obstetrical and neonatal outcomes
Arch Gynecol Obstet
Timing of weight gain during pregnancy: promoting fetal growth and minimizing maternal weight retention
Int J Obes Relat Metab Disord
Maternal outcomes associated with weight change between pregnancies
Can J Public Health
Glucose tolerance and insulin secretion in pregnancy
Diabetes Nutr Metab
Recurrence of gestational diabetes
Aust NZ J Obst Gyn
Relationship of clomiphene dose and patient weight to successful treatment
Humanit Rep
Fat and female fecundity: prospective study of effect of body fat distribution on conception rates
BMJ
Weight excess before pregnancy: complications and cost
Int J Obes Relat Metab Disord
Maternal morbid obesity and the risk of adverse pregnancy outcome
Obstet Gynecol
The short- and long-term implications of maternal obesity on the mother and her offspring
BJOG
Editorial: obesity and pregnancy-the propagation of a viscous cycle?
J Clin Endocrinol Metab
The agenda for obesity research in Canada
CMAJ
Prevalence of and risk factors for childhood overweight and obesity
CMAJ
Maternal obesity at conception programs obesity in the offspring
Am J Physiol Regul Integr Comp Physiol
Fetal origins of obesity
Obes Res
Metabolic programming: fetal origins of obesity and metabolic syndrome in the adult
Am J Physiol Endocrinol Metab
Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia
Diabetes Care
A maternal “junk food” diet in pregnancy and lactation promotes an exacerbated taste for “junk food” and a greater propensity for obesity in rat offspring
Br J Nutr
Early nutrition and later health. Early developmental pathways of obesity and diabetes risk
Proc Nutr Soc
Cited by (53)
A cross sectional study investigating weight management motivations, methods and perceived healthy eating and physical activity influences in women up to five years following childbirth
2017, MidwiferyCitation Excerpt :Despite reporting a number of health concerns after childbirth, which may impact on achievement of healthy lifestyle behaviours (e.g. maternal depression), women often do not seek support from health professionals (Brown and Lumley, 1998; Woolhouse et al., 2015). Therefore, to achieve a healthy weight following childbirth, women are encouraged to engage in a healthy lifestyle including regular physical activity and healthy eating (Institute of Medicine (US), 2009; Mottola, 2009; Evenson et al., 2014). Despite this, many women following childbirth do not achieve recommended physical activity and dietary targets (Hure et al., 2009; Blumfield et al., 2011; Durham et al., 2011).
Fetal and maternal cardiac responses to physical activity and exercise during pregnancy
2016, Early Human DevelopmentCitation Excerpt :Based on current empirical evidence, the safe and recommended exercise guidelines will be summarized for pregnancy. Acute cardiovascular response to aerobic exercise during pregnancy is similar to that observed in the general population: increased heart rate (HR), stroke volume, and cardiac output, with little to no change in blood pressure [12]. Similarly, participating in regular aerobic exercise during pregnancy provides improvements in overall cardiovascular function [13–15].
Certified Nurse-Midwives’ Experiences with Gestational Weight Management
2016, Nursing for Women's HealthCitation Excerpt :It has been recommended that women monitor their exercise intensity via the “patient talk test” (i.e., a woman determines if she can carry on a conversation while exercising) and their perceived self-exertion; self–heart-rate monitoring is no longer recommended because of lack of scientific data (Mottola, 2009). Mottola (2009) also advocates clinicians providing patients with proper instruction on initiating an exercise program that is appropriate and specific to their individual needs. Buschur and Kim (2012) found that diet and physical exercise in pregnant women who were obese decreased gestational weight gain more than diet alone.
Prenatal Physical Activity and Gestational Weight Gain
2015, Handbook of Fertility: Nutrition, Diet, Lifestyle and Reproductive HealthExercise in pregnancies complicated by obesity: Achieving benefits and overcoming barriers
2015, American Journal of Obstetrics and Gynecology
This work is supported by the Canadian Institute of Health Research, The Lawson Foundation, and the Molly Towell Perinatal Research Foundation.