EXERCISE FOR GIRLS & WOMEN

EXERCISE FOR

GIRLS &

WOMEN

EXERCISE FOR

GIRLS &

WOMEN

1875: Hutchingson:

• Women have a sum total of nervous force equivalent to man

• Women have more organs

• Nervous force is weakened in each organ

• Resistance to disease is weakened

• Women are more sensitive and more liable to derangement

1875: Hutchingson:

• Women have a sum total of nervous force equivalent to man

• Women have more organs

• Nervous force is weakened in each organ

• Resistance to disease is weakened

• Women are more sensitive and more liable to derangement

Historical Attitudes Towards Women

Historical Attitudes Towards Women

1875 Dr. King, Obstetrics & Gynecology1875 Dr. King, Obstetrics & GynecologyWomen menstruate because of a failure to conceiveWomen menstruate because of a failure to conceiveMenstruate occurs because the organ was not used for it’s intended purposeMenstruate occurs because the organ was not used for it’s intended purpose

When an organ is not used = atrophy & diseaseWhen an organ is not used = atrophy & disease

Therefore, once reaching puberty a woman should be encouraged to marry and immediately impregnated

Therefore, once reaching puberty a woman should be encouraged to marry and immediately impregnatedContinuously impregnated as not to menstruateContinuously impregnated as not to menstruate

Beigel, Physician:Beigel, Physician:

10-14 days of Bed Rest

for Each Menstrual Cycle

10-14 days of Bed Rest

for Each Menstrual Cycle

International Olympic Committee: Circa 1900 International Olympic Committee: Circa 1900

Women should not engage in any activity which they cannot wear a long dress

Women should not engage in any activity which they cannot wear a long dress

0

20

40

60

80

100

120

Heart

Rate

(/m

in)

Seargent

Heart Rate Response to Running 540 Yard Run

Wit

hout

Wit

hout

Weari

ng

C

ors

ets

Weari

ng

C

ors

ets

Fashion allowed more

exercise

Fashion allowed more

exercise

1928 Modern Olympics1928 Modern Olympics

11 women

First 800 m Race

11 women

First 800 m Race

• 5 collapsed during the Run

• 5 collapsed at the Finish

• Winner collapsed in the Dressing Room

• 5 collapsed during the Run

• 5 collapsed at the Finish

• Winner collapsed in the Dressing Room

EXERCISE & GYNECOLOGYEXERCISE & GYNECOLOGY

5

10

15

Normal Level Type

AGE OF MENARCHEAGE OF MENARCHE

Hig

h S

chool

Hig

h S

chool

Colle

ge

Colle

ge

Sport

Sport

Balle

tB

alle

t

Oly

mpic

Oly

mpic

MATURATION AND SPORTMATURATION AND SPORT

Does sport delay maturation?

Does sport delay maturation?

Is maturation unsuccessful for

sport?

Is maturation unsuccessful for

sport?

6

8

10

12

14

16

18

Normal Level Type6

8

10

12

14

16

18

Normal Level Type

AGE OF MENARCHEAGE OF MENARCHE

Hig

h S

chool

Hig

h S

chool

Colle

ge

Colle

ge

Sport

Balle

tB

alle

t

Oly

mpic

Oly

mpic

LATER AGE OF MENARCHELATER AGE OF MENARCHE

FEWER COMPAINTS IN MENOPAUSEFEWER COMPAINTS IN MENOPAUSE

Jazman, Frontiers of Hormone Research 2:22, 1973.Jazman, Frontiers of Hormone Research 2:22, 1973.

….AS A

YOUNG WOMAN…

….AS A

YOUNG WOMAN…

AMENORRHEAAMENORRHEA

EATING D

ISORD

ERS

EATING D

ISORD

ERSOST

EOPO

ROSI

S

OST

EOPO

ROSI

S

FEMALE ATHLETE TRIADFEMALE ATHLETE TRIAD

0

10

20

30

40

50

60

70

0

10

20

30

40

50

60

70

Perc

en

t of

Ath

lete

sPerc

en

t of

Ath

lete

s

HSHSC

olle

ge

Colle

ge

Speci

fic

Sp

ort

sS

peci

fic

Sp

ort

s

INCIDENCE OF ANOREXIA & BULIMAINCIDENCE OF ANOREXIA & BULIMA

0

10

20

30

40

50

60

70

Perc

en

t of

Popu

lati

on

(%

)Perc

en

t of

Popu

lati

on

(%

)

General

AthletesAthletes

AMENORRHEAAMENORRHEA

0

5

10

15

20

25

30

35

Marcus eat al, Ann Int Med 102:158-163, 1985

ControlControl

Active Regular Cycling

Active Regular Cycling A

ctiv

e

Am

en

orr

hi

cAct

ive

Am

en

orr

hi

c

OSTEOPOROSISOSTEOPOROSISIn

cid

en

ce o

f B

on

e F

ract

ure

s (%

)In

cid

en

ce o

f B

one F

ract

ure

s (%

)

ACSM RECOMMENDATIONS1. Serious Syndrome

2. Unrealistic pressures to lose weight in athletics.

3. Sports Medicine Professionals need more education

4. Screening programs should be developed.

5. Develop prevention strategies

6. Educate parents to have reasonable goals for children.

7. Educate the girls

8. More research.

1. Serious Syndrome

2. Unrealistic pressures to lose weight in athletics.

3. Sports Medicine Professionals need more education

4. Screening programs should be developed.

5. Develop prevention strategies

6. Educate parents to have reasonable goals for children.

7. Educate the girls

8. More research.

EXERCISE IN PREGNANCYEXERCISE IN PREGNANCY

PREGNANCYPREGNANCYEXERCISE

• SKELETAL

• METABOLISM

• RESPIRATORY

• CARDIOVASCULAR

• ENDOCRINE

• THERMOREGULATION

• SKELETAL

• METABOLISM

• RESPIRATORY

• CARDIOVASCULAR

• ENDOCRINE

• THERMOREGULATION

1. Safe for mother?

2. Safe for fetus

3. Affect on pregnancy outcome?

1. Safe for mother?

2. Safe for fetus


EXERCISE IN PREGNANCY

0

2

4

6

8

10

12

14

0 13 27 40

Weig

ht

(kg)

Weig

ht

(kg

)

Weeks of Gestation (wks)Weeks of Gestation (wks)

WEIGHT GAIN DURING PREGANACY

SKELETAL SYSTEM

Lumbar LordosisLumbar Lordosis

Forward displacement of the center

of gravity

Forward displacement of the center

of gravity

Increased anterior flexion of cervical spine

Increased anterior flexion of cervical spine

Forward rotation of

Pelvis & Femur

Forward rotation of

Pelvis & Femur

PREGNANCYPREGNANCY EXERCISE

1. Lumbar Lordosis

2. Cervical Spine

3. Pelvis & Femur

4. Center of Gravity

1. Lumbar Lordosis

2. Cervical Spine

3. Pelvis & Femur

4. Center of Gravity

1. Lumbrosacral Pain2. Compression Syndromes

1. Carpal Tunnel2. Ulnar Nerve3. Posterior Tibial4. Perennial

1. Lumbrosacral Pain2. Compression Syndromes

1. Carpal Tunnel2. Ulnar Nerve3. Posterior Tibial4. Perennial

SKELETAL SYSTEMSKELETAL SYSTEM

5. Increased joint mobility5. Increased joint mobility 5. Overextension Injury5. Overextension Injury

META

BO

LISM

META

BO

LISM

PREGNANCYPREGNANCY EXERCISEEXERCISE

1. Increased Resting Metabolism

1. 80,000 cal

2. 300 cal/day

1. Increased Resting Metabolism

1. 80,000 cal

2. 300 cal/day

1. Increased metabolism at submaximal work

1. Increased metabolism at submaximal work

METABOLISMMETABOLISM

2. Glucose = primary fuel2. Glucose = primary fuel

2. Hypoglycemia2. Hypoglycemia

RESPIRATORY

SYSTEM

RESPIRATORY

SYSTEM

1. Chest cavity increases transverse diameter

2. Raised diaphragm

1. Chest cavity increases transverse diameter

2. Raised diaphragm

PULMONARY FUNCTIONS

- 2000

- 1000

0

1000

2000

3000

4000

NonPregnant Pregnant

RV

Tidal Vol.

Exp Res

Insp Res

Volu

me (

ml)

Volu

me (

ml)


1. Pulmonary Functions

1. Pulmonary Functions

1. Increased tidal volume

2. Decreased Residual Vol

1. Increased tidal volume

2. Decreased Residual Vol

RESPIRATORY SYSTEMRESPIRATORY SYSTEM

2. Metabolism & Pulmonary Functions

2. Metabolism & Pulmonary Functions

3. 40% increase in Resting Minute Ventilation (VE)

3. 40% increase in Resting Minute Ventilation (VE)

RESTING HEART RATE

60

65

70

75

80

85

90

0 8 12 16 20 24 28 32 36 40 Post

Heart

Rate

(/m

in)

Heart

Rate

(/m

in)

Gestation (wks)Gestation (wks)Wilson et al., Am J Med 68:97, 1980.

CARDIOVASCULAR SYSTEM

0

10

20

30

40

50

60

0 12 20 28 36

Gestation (wks)Gestation (wks)

Perc

en

t In

crease

(%

)Perc

en

t In

crease

(%

)

Blood Volume

Cardiac Output


1. Cardiac Output

1. Heart Rate

2. Stroke Volume

1. Cardiac Output

1. Heart Rate

2. Stroke Volume

1. Decreased Physical Work Capacity

2. Increased Sub-maximal work1. Heart Rate2. Stroke

Volume3. Cardiac

Output

1. Decreased Physical Work Capacity

2. Increased Sub-maximal work1. Heart Rate2. Stroke

Volume3. Cardiac

Output

CARDIOVASCULAR SYSTEMCARDIOVASCULAR SYSTEM

CARDIOVASCULAR SYSTEM

100

110

120

130

140

150 250 300

Non

<19 wks

20- 28 wks

29- 35 wks

36- 40 wk

Heart

Rate

(/m

in)

Heart

Rate

(/m

in)

Workrate (kpm/min)Workrate (kpm/min)

40

50

60

70

80

90

150 250 300

Non

<19 wks

20- 28 wks

29- 35 wks

36- 40 wk


CARDIOVASCULAR SYSTEMS

troke

Volu

me (

cc)

Str

oke

Volu

me (

cc)

2

4

6

8

10

12

150 250 300

Non

<19 wks

20- 28 wks

29- 35 wks

36- 40 wk

2

4

6

8

10

12

150 250 300

Non

<19 wks

20- 28 wks

29- 35 wks

36- 40 wk


CARDIOVASCULAR SYSTEMC

ard

iac

Ou

tput

(L/m

in)

Card

iac

Ou

tput

(L/m

in)

60

80

100

120

150 250 300

Non

<19 wks

20- 28 wks

29- 35 wks

36- 40 wk

60

80

100

120

150 250 300

Non

<19 wks

20- 28 wks

29- 35 wks

36- 40 wk


CARDIOVASCULAR SYSTEMC

(a-v

)O2 (

ml/L)

C(a

-v)O

2 (

ml/L)

PHYSICAL WORK CAPACITY

• Lowest PWC in First Trimester

• Highest PWC in Second Trimester

• Decreases as Body Weight Increases in Third Trimester

• Lowest PWC in First Trimester

• Highest PWC in Second Trimester

• Decreases as Body Weight Increases in Third Trimester

ENDOCRINE SYSTEM

Gestation (days)Gestation (days)

HCG

0

5

10

15

20

25

30

35

40

0 70 140 210 280

Estriol

HSC

Pregnanediol

Con

cen

trati

on (

iu/1

00

0m

l u

rin

e)

Con

cen

trati

on (

iu/1

00

0m

l u

rine)


1. Hormone Changes

1. Hormone Changes

1. Physical Work Capacity

2. Joint Injury3. Gestational

Diabetes

1. Physical Work Capacity

2. Joint Injury3. Gestational

Diabetes

ENDOCRINE SYSTEMENDOCRINE SYSTEM


1. Increased Sweat Gland Activity

2. Shunt blood to Periphery

3. Fetus >1oC

1. Increased Sweat Gland Activity

2. Shunt blood to Periphery

3. Fetus >1oC

1. Dehydration2. Heat Related

Injury3. Spinal Cord

Growth Retardation (1st trimester)

1. Dehydration2. Heat Related

Injury3. Spinal Cord

Growth Retardation (1st trimester)

THERMOREGULATIONTHERMOREGULATION

1. Safe for mother?

2. Safe for fetus


1. Safe for mother?

2. Safe for fetus



FOR THE MOTHER?FOR THE MOTHER?Exercise Training during PregnancyExercise Training during Pregnancy

1. Physical Work Capacity1. Increases during pregnancy

2. Not above Pre-Pregnant Values

2. Lower Exercise Heart Rates*1. At same workrate

3. Increased Heart Volume*

1. Physical Work Capacity1. Increases during pregnancy

2. Not above Pre-Pregnant Values

2. Lower Exercise Heart Rates*1. At same workrate

3. Increased Heart Volume** Not all studies agree

FOR THE MOTHER?FOR THE MOTHER?1. Skinfold thickness

2. Maternal Weight Gain

3. Resting Heart Rate

4. Maximal Heart Rate

5. Exercising Heart Rates*

6. Cardiac Output at Submax

7. Stroke Volume at Submax

8. Resting & Orthostatic Blood Pressures

9. VO2 at submax

10.Resting Metabolism

11.VEmax

12.VEsubmax

1. Skinfold thickness

2. Maternal Weight Gain

3. Resting Heart Rate

4. Maximal Heart Rate

5. Exercising Heart Rates*

6. Cardiac Output at Submax

7. Stroke Volume at Submax

8. Resting & Orthostatic Blood Pressures

9. VO2 at submax

10.Resting Metabolism

11.VEmax

12.VEsubmax

FOR THE FETUS?

FETAL HEART RATESFETAL HEART RATES

Deceleration >15 /min Normal response to mild or transient

hypoxia

Moderate 100-120/min Initial response to

Bradycardia hypoxia

Profound <100/min Normal response to

Bradycardia prolonged hypoxia

Tachycardia >160/min Compensatory adaptation

during hypoxic recovery

Deceleration >15 /min Normal response to mild or transient

hypoxia

Moderate 100-120/min Initial response to

Bradycardia hypoxia

Profound <100/min Normal response to

Bradycardia prolonged hypoxia

Tachycardia >160/min Compensatory adaptation

during hypoxic recovery


1. During Exercise1. Slight Increase

2. Slight Decrease

3. No change

2. Recovery from Exercise

1. Slight Increase

2. Slight Decrease

3. No change

1. During Exercise1. Slight Increase

2. Slight Decrease

3. No change

2. Recovery from Exercise

1. Slight Increase

2. Slight Decrease

3. No change


Hon & Wohlgemuth, Am J Obstet Gynecol 81:361-371, 1961.

6/40 Exercise Studies• Bradycardia• Irregularity• Tachycardia

6/40 Exercise Studies• Bradycardia• Irregularity• Tachycardia

• Cord tightly wrapped around neck (3x)

• Loop of umbilical cord prolapsed by head

• Flattened umbilical cord (4”)

• Fetal distress at birth

• Cord tightly wrapped around neck (3x)

• Loop of umbilical cord prolapsed by head

• Flattened umbilical cord (4”)

• Fetal distress at birth

UTERINE BLOOD FLOWUTERINE BLOOD FLOW

0

2

4

6

8

10

Normal Pre- Eclaptic

Rest

Exercise

Recovery

0

2

4

6

8

10

Normal Pre- Eclaptic

Rest

Exercise

Recovery

Cle

ara

nce

Tim

es

(min

)C

leara

nce

Tim

es

(min

)

Morris, et al., Lancet 8 Sept 1956; pg 481-484

• Human

•26 normal

•29 Pre-Ec

• Supine Ex

• Radioactive Na+

• Human

•26 normal

•29 Pre-Ec

• Supine Ex

• Radioactive Na+

UTERINE BLOOD FLOW

Orr, et al., Am J Obstet Gynecol 114:213-217, 1972Orr, et al., Am J Obstet Gynecol 114:213-217, 1972

0

10

20

30

40

50

60

70

80

Rest 2 3 Max

Pregnant

Non- PregnantPerc

en

t C

han

ge f

rom

Rest

(%

)Perc

en

t C

han

ge f

rom

Rest

(%

)• 6 Pregnant

• 2 Non-Pregnant

• Flow of Uterine Artery

• 6 Pregnant

• 2 Non-Pregnant

• Flow of Uterine Artery

0

20

40

60

80

100

Endometrium Placenta

Pre

Post

Perc

en

t of

Ute

rin

e B

lood

Flo

w (

%)

Perc

en

t of

Ute

rin

e B

lood

Flo

w (

%)

Curet, et al., J Appl Physiol 40:725-728, 1976Curet, et al., J Appl Physiol 40:725-728, 1976

• 3 mph 10%

• Exhaustion

• n=10

• Cath

• 3 mph 10%

• Exhaustion

• n=10

• Cath

UTERINE BLOOD FLOW

UTERINE BLOOD FLOW

0

10

20

30

40

50

60

70

80

90

Maternal Fetal

Rest

Exercise

Recovery

0

10

20

30

40

50

60

70

80

90

Maternal Fetal

Rest

Exercise

Recovery

PO

2 (m

mH

g)

PO

2 (m

mH

g)

Emmanouilides et al. Am J Obstet Gynecol 122:130-137, 1972Emmanouilides et al. Am J Obstet Gynecol 122:130-137, 1972

UTERINE BLOOD FLOW

0

5

10

15

20

25

30

35

40

45

50

Maternal Fetal

Rest

Exercise

RecoveryPC

O2

(mm

Hg

)P

CO

2 (m

mH

g)


UTERINE BLOOD FLOW

7

7.2

7.4

7.6

7.8

8

Maternal Fetal

Rest

Exercise

Recovery

7

7.2

7.4

7.6

7.8

8

Maternal Fetal

Rest

Exercise

Recovery

pH

pH


FETAL GLUCOSE

10

15

20

25

30

35

40

0 15 30 45 60 Rec

NonPregnantPregnant

Soultanakis, et al., Seminars in Perinatology. 20(4):315-27, 1996

Glu

cose

(m

g/d

l)

Time (min)

FETAL TEMPERATURES

35

36

37

38

39

40

0 15 30 45 60 Rec

NonPregnantPregnant

Soultanakis, et al., Seminars in Perinatology. 20(4):315-27, 1996

Co

re T

emp

erat

ure

(C

o)

Time (min)

PREGNANCY OUTCOME

1. Stages of Labor

2. Complications of Labor & Delivery

3. Health of Infant

1. Stages of Labor

2. Complications of Labor & Delivery

3. Health of Infant

PREGNANCY OUTCOMEPREGNANCY OUTCOME

STAGES OF LABORSTAGES OF LABOR

1. Progressive Cervical Dilation 8 to 24 hrs (same as head)

2. Head moves into birth canal 1 – 30 min to birth

3. Passing of the Placenta

1. Progressive Cervical Dilation 8 to 24 hrs (same as head)

2. Head moves into birth canal 1 – 30 min to birth

3. Passing of the Placenta


STAGES OF LABORSTAGES OF LABOR

1. Duration of Labor

1. Primi- or Multi-parous

2. Mode of Delivery

3. Work of Labor & Delivery

1. Duration of Labor

1. Primi- or Multi-parous

2. Mode of Delivery

3. Work of Labor & Delivery

Complications of Labor & DeliveryComplications of Labor & Delivery

1. Pre-Mature

2. Caesarean Section

3. Rupture

4. Perineotomy

5. Episiotomy

6. Forceps Delivery

1. Pre-Mature

2. Caesarean Section

3. Rupture

4. Perineotomy

5. Episiotomy

6. Forceps Delivery


Health of InfantHealth of Infant

1. Apgar Scores

2. Neonatal Complications

3. Infant Birth Weight

4. Infant Head Circumference

1. Apgar Scores

2. Neonatal Complications

3. Infant Birth Weight

4. Infant Head Circumference

APGAR SCORESAPGAR SCORES0 1 2

Heart Rate Absent <100 >100

Respiratory Absent Weak Strong Cry Effort

Muscle Tone Limp Some Fl Flex

Extremities

Reflex (feet) Absent Some Cry Irritability Motion

Color Blue Body PinkCompletely Limbs blue Pink

0 1 2

Heart Rate Absent <100 >100

Respiratory Absent Weak Strong Cry Effort

Muscle Tone Limp Some Fl Flex

Extremities

Reflex (feet) Absent Some Cry Irritability Motion

Color Blue Body PinkCompletely Limbs blue Pink

Perfect

10

Perfect

10

Neonatal ComplicationsNeonatal Complications

1. Asphyxiated Infants

2. Neonatal Morbidity

1. Asphyxiated Infants

2. Neonatal Morbidity


0

500

1000

1500

First Total

Control Exercise

0

500

1000

1500

First Total

Control Exercise

Lamasze

• 276 Exercise

• 281 Control

Lamasze

• 276 Exercise

• 281 Control

0

20

40

60

80

100

Second Third

0

20

40

60

80

100

Second Third

Min

ute

sM

inu

tes

Rodway et al. J Obstet Gynec Brt Comm 54:77-85, 1947.

Rodway et al. J Obstet Gynec Brt Comm 54:77-85, 1947.

BIRTH WEIGHT

3000

3200

3400

3600

3800

<20

wks

20-2

8 wk

s

29-3

0 wk

s

34-3

8 wk

s

>38

wks

Sitting Work

Standing Work

Other Children

3000

3200

3400

3600

3800

<20

wks

20-2

8 wk

s

29-3

0 wk

s

34-3

8 wk

s

>38

wks

Sitting Work

Standing Work

Other Children

Naeye & Peters, Pediatrics 69:724-727, 1982.Naeye & Peters, Pediatrics 69:724-727, 1982.

Infa

nt

Bir

th W

eig

ht

(gm

s)In

fan

t B

irth

Weig

ht

(gm

s)

ATHLETIC TRAINING

• 729 athletes• General

population

ATHLETIC TRAINING

Perc

en

t of

Sam

ple

(%

)

n=64 n=59 n=27

• Disturbances with Pregnancy

• Competing during Pregnancy

• Good Pregnancy Outcome

• Improved Performance after


• Not Unsafe for Mother or Fetus

• In moderation

• No Athletic Competition or Sport

• Not Unsafe for Mother or Fetus

• In moderation

• No Athletic Competition or Sport

1. Physical conditioning during pregnancy results in no detrimental effect on pregnancy outcome.

2. Physical conditioning during pregnancy does not appear to result in the same physiological changes as physical conditioning in the non-pregnant state.

3. Continued athletic training during pregnancy may result in obstetric complications.

4. Athletic training, if discontinued during pregnancy results in no detrimental effects on pregnancy.

5. Pregnancy may improve athletic performance following pregnancy. 1. Continued occupational activity during the last weeks of pregnancy

can result in lower infant birth weight which in some cases, is related to poorer infant health.

ABSOLUTE CONTRAINDICATIONS FOR EXERICSE IN PREGNANCY

ABSOLUTE CONTRAINDICATIONS FOR EXERICSE IN PREGNANCY

• Heart Disease• Restrictive lung disease•Pregnancy induced hypertension•Incompetent Cervix•Multiple Gestation•Hx: Placenta Previa• Hx: Breech Presentation• Hx: Ruptured Membranes•Hx: Premature Labor

• Heart Disease• Restrictive lung disease•Pregnancy induced hypertension•Incompetent Cervix•Multiple Gestation•Hx: Placenta Previa• Hx: Breech Presentation• Hx: Ruptured Membranes•Hx: Premature Labor

RELA

TIV

E

CO

NTR

AIN

DIC

ATIO

NS F

OR

EX

ER

ICSE IN

PR

EG

NA

NC

Y

RELA

TIV

E

CO

NTR

AIN

DIC

ATIO

NS F

OR

EX

ER

ICSE IN

PR

EG

NA

NC

Y • Anemia• Maternal cardiac arrhythmia• Chronic bronchitis• Extreme Morbid Obesity• Extreme Underweight (BMI <12)

• Orthopedic limitations• Heavy Smoker• Poorly controlled

• Thyroid Disease• Type 1 diabetes• Hypertension/pre eclampsia• Seizure disorder

• Anemia• Maternal cardiac arrhythmia• Chronic bronchitis• Extreme Morbid Obesity• Extreme Underweight (BMI <12)

• Orthopedic limitations• Heavy Smoker• Poorly controlled

• Thyroid Disease• Type 1 diabetes• Hypertension/pre eclampsia• Seizure disorder

MODE CV; non-wt bearing as weight increases

Discontinue Athletic Training

Flexibility for Muscle Soreness

Muscle Endurance is OK

FREQUENCY 3-4/wk (resistance 2/wk)

DURATION 20-30 min up to 60 min

INTENSITY Moderate 50-85% (< Ventilatory threshold)

Not guided by Heart Rates

MODE CV; non-wt bearing as weight increases

Discontinue Athletic Training

Flexibility for Muscle Soreness

Muscle Endurance is OK

FREQUENCY 3-4/wk (resistance 2/wk)

DURATION 20-30 min up to 60 min

INTENSITY Moderate 50-85% (< Ventilatory threshold)

Not guided by Heart Rates

EXRX: PregnancyEXRX: Pregnancy

EXRX: PregnancyEXRX: PregnancyPRECAUTIONS

1.Thermoregulation

2. Injury

3. Supine Exercise (>4 months)

4. As pregnancy progresses

1. Move to non-weight bearing

2. Decrease intensity increase frequency

PRECAUTIONS

1.Thermoregulation

2. Injury

3. Supine Exercise (>4 months)

4. As pregnancy progresses

1. Move to non-weight bearing

2. Decrease intensity increase frequency

EXRX: PregnancyEXRX: Pregnancy

DISCONTINUE:1. Pain or Bleeding

2. Dizziness or Faintness

3. Pubic Pain

4. Palpitations

5. Back Pain

6. Shortness of Breath

7. Difficulty Walking

DISCONTINUE:1. Pain or Bleeding

2. Dizziness or Faintness

3. Pubic Pain

4. Palpitations

5. Back Pain

6. Shortness of Breath

7. Difficulty Walking

EXERCISE IN POST-PARTUMEXERCISE IN POST-PARTUM

• Beginning In 1974

• Infants Refused to Nurse following Maternal Exercise

• 7%

• Beginning In 1974

• Infants Refused to Nurse following Maternal Exercise

• 7%

0

2

4

6

8

Rest 10 min Post 30 min Post

Blood

Milk

Wallace & Rabin, Int J Sports Med 12:328-331, 1991Wallace & Rabin, Int J Sports Med 12:328-331, 1991

Lact

ic A

cid

(m

M/L

)La

ctic

Aci

d (

mM

/L)

Concentrations of Lactic Acid in Blood and Milk following Maximal Exercise

Concentrations of Lactic Acid in Blood and Milk following Maximal Exercise

0

0.5

1

1.5

2

2.5

3

Workout Aerobics Walk/ J og Maximal

Pre

Post

Wallace et al, J Women’s Health 3:91-96, 1994 Wallace et al, J Women’s Health 3:91-96, 1994

Lact

ic A

cid

(m

M/L

)La

ctic

Aci

d (

mM

/L)

Concentrations of Lactic Acid in Milk following a Normal Workout & Maximal

Exercise

SOUR MILK?SOUR MILK?

0

2

4

6

8

10

1 2 3 4 5

PE

RC

EP

TIO

N O

F T

AS

TE

PE

RC

EP

TIO

N O

F T

AS

TE AcceptAccept

RejectReject

Lactic Acid ConcentrationLactic Acid Concentration

THE RELATIOSHIP BETWEEN TASTE AND LACTIC ACID CONENTRATIONS IN MOTHER’S MILK

THE RELATIOSHIP BETWEEN TASTE AND LACTIC ACID CONENTRATIONS IN MOTHER’S MILK

Detect Recognize

EXERCISE GUIDELINES FOR LACTATION

EXERCISE GUIDELINES FOR LACTATION

Only for Women who have ProblemsOnly for Women who have Problems

1. Nurse before Exercise

2. Collect Milk before Exercise

3. Discard first 30-60 min post exercise milk production

4. Exercise below Ventilatory Threshold

1. Nurse before Exercise

2. Collect Milk before Exercise

3. Discard first 30-60 min post exercise milk production

4. Exercise below Ventilatory Threshold

IN MENOPAUSEIN MENOPAUSE

• Increased Risk of Disease• Heart Disease• Hypertension• Hyperlipidemia• Breast Cancer

• Symptoms of Menopause

• Hot Flash• Insomnia• Fatigue• Nervousness/Depression

• Increased Risk of Disease• Heart Disease• Hypertension• Hyperlipidemia• Breast Cancer

• Symptoms of Menopause

• Hot Flash• Insomnia• Fatigue• Nervousness/Depression

STUDIES ON MENOPAUSAL SYMPTOMSSTUDIES ON MENOPAUSAL SYMPTOMS

• Subjects• 11 Pre• 7 Peri-• 11 Post

• Exercise• Walk/Jog• Swim• Dance• Aerobic Games• 4/wk for 6 wks• Moderate

• Subjects• 11 Pre• 7 Peri-• 11 Post

• Exercise• Walk/Jog• Swim• Dance• Aerobic Games• 4/wk for 6 wks• Moderate

• Subjects• 9 Post• 4 Control

• Exercise• Walk/Jog• 3/wk for 12 wks• Moderate

• Subjects• 9 Post• 4 Control


•Subjects• 10 Post• 10 Control


•Subjects• 10 Post• 10 Control


PENN STATEPENN STATE SAN DIEGO STATESAN DIEGO STATE IUIU

-80

-60

-40

-20

0

20

40

60

Penn State San Diego I U

Exercise

Control

-80

-60

-40

-20

0

20

40

60

Penn State San Diego I U

Exercise

Control

Ch

an

ges

wit

h T

rain

ing

(%

)C

han

ges

wit

h T

rain

ing

(%

)

CHANGES IN POSTMENOPAUSAL SYMPTOMS WITH TRAIING

CHANGES IN POSTMENOPAUSAL SYMPTOMS WITH TRAIING

IN OLD AGE

IMMERSION EXERCISEIMMERSION EXERCISE

McMurray, R.G., et al. American Journal of Obstetrics & Gynecology. 158(3 Pt 1):481-6, 1988

• 12 pregnant women• 15, 25, 35 weeks• 8-10 wks postpartum

• 20 min of immersion

• 30oC

• 20 min of exercise @ 60% VO2max (bike)

• 20 min supine recovery

• 12 pregnant women• 15, 25, 35 weeks• 8-10 wks postpartum

• 20 min of immersion

• 30oC

• 20 min of exercise @ 60% VO2max (bike)

• 20 min supine recovery

IMMERSION EXERCISEIMMERSION EXERCISE

McMurray, R.G., et al., International Journal of Sports Medicine. 9(6):443-7, 1988

• HRwater <HRland

• Qwater>Qpostpartum

• PVRwater<PVRpostpartum

Pregnancy has increased demand, yet water reduces those demands

EXERCISE FOR GIRLS & WOMEN

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