Exercise Prescription for Overweight and Obese Women: Pregnancy and Postpartum

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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

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    This work is supported by the Canadian Institute of Health Research, The Lawson Foundation, and the Molly Towell Perinatal Research Foundation.

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