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Cardiorespiratory fitness during pregnancy and its relationship to outcome Wong, Susan Carol 1985

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CARDIORESPIRATORY  FITNESS  DURING  PREGNANCY  AND  ITS  RELATIONSHIP TO OUTCOME by SUSAN CAROL WONG B.H.E.  U n i v e r s i t y of B r i t i s h Columbia,  1976.  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER IN PHYSICAL EDUCATION  in THE FACULTY OF GRADUATE STUDIES P h y s i c a l Education and Recreation  We accept t h i s t h e s i s as conforming to the r e q u i r e d standard  THE UNIVERSITY OF BRITISH COLUMBIA ©  October  1985  Susan Carol Wong  In  presenting  degree freely  at  the  available  copying  of  department publication  this  of  in  partial  fulfilment  University  of  British  Columbia,  for  this or  thesis  reference  thesis by  this  for  his thesis  and  study.  scholarly  or for  her  of  Physiral  purposes  gain  Fducatlon  Date  DE-6(3/81)  the  shall  requirements  agree  that  agree  may  representatives.  financial  The University of British Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3  I  I further  permission.  Department  of  be  It not  is be  that  the  for  Library  an  advanced  shall  permission for  granted  by  understood allowed  the that  without  make  it  extensive  head  of  copying my  my or  written  ABSTRACT In  order  to  pregnancy studied  determine  and  the  the e f f e c t s  newborn  throughout  their  The  or  (UT=10) based  submaximal  subjects  cycle  C a s e room r e p o r t s d i f f e rence  were  were  between  testing  weeks)  pregnancy  (T=13.92;  of  labour  was  extended  1lhrs.18.Omin. mins.  f o r T.  nor  UT  had  Stage  length  as  also  trained  UT,  (T=10)  response  to  trimester. There  was  gestational  The  pre-  first  stage  13hrs.58.8min. stage  prolonged  ,  i n UT,  no  period  versus  UT=13.30 k g s ) . the  were  immediately  gained  a l o n g e r second  3 was  and  rate  of  on  subjects  delivery.  weight  in  fitness  done i n e a c h  after  i n the  (T=40.75;UT=40.75 measures  the heart  reviewed  groups  period  classified  on  ergometry  aerobic  primigravid  gestational  post-partum. untrained  20  of  vs  90.57 vs  70.0  15.17  7.43  vs j  mins.  In  both  equally. 3  of  Two  the  10  groups  of  were:  The  weights  the  UT  were 8  m a l e s and A l l  the  stage  fitness  the  The  9.20;  had  a n a e s t h e s i a was caesarean  mean a p g a r  2 females,  and  There  of  were  healthy  appears  fitness  t h e UT  on  t o be the  and no  newborn.  ii  larger T  than  newborns  without  The may  and  5 m a l e s and  positive  l a b o u r i n the T group  levels.  The  were  1  vs  respectively.  T b a b i e s were m a r g i n a l l y 3679.97 gms).  used  sections  scores at  UT=7.90, 9.33,  (3733.00 vs  of maternal  active  improved  of  and/or  females  group.  babies  abnormalities. effects  T  T=7.70,  newborns  females.  10  i n t h e UT  5 minutes birth  the  analgesia  or  5  apparent negative  reduction  reflect  in  their  TABLE OF CONTENTS  ii  Abstract List  of Tables  Acknowledgement I.  INTRODUCTION  1  II.  METHODS  7  I I I . RESULTS  9  IV.  DISCUSSION  13  V.  REFERENCES  19  APPENDIX A  -  REVIEW OF LITERATURE  26  Introduction  26  Animal S t u d i e s  27  Uterine Effect  Blood  Flow  28  on O f f s p r i n g  33  Human S t u d i e s Physiological Respiratory  Changes d u r i n g  Pregnancy  Changes  Cardiovascular Effects  46 47 47  Changes  o f E x e r c i s e and P r e g n a n c y  48 50  Repiratory  50  Cardiovascular  52  Temperature  57  Work T e s t s  57  Effects  66  on t h e f e t u s o f m a t e r n a l e x e r c i s e  Retrospective  studies  Conclusion  74 79  iii  APPENDIX  B - I N D I V I D U A L HEART R A T E DATA  82  A P P E N D I X C - P R E D I C T E D MAXIMUM  OXYGEN U P T A K E  84  A P P E N D I X D - A C T I V I T Y LOGBOOKS  SUMMARIZED  87  iv  L I S T OF  Mean M a t e r n a l  Data  Mean Newborn D a t a  TABLES  Acknowledgements  I  would  like  subjects follow Drs.  for  their Ken  friends never  their  Don  ,  thanks  and  appreciation  to  my  participation,  and  for allowing  me  to  family  A s p e c i a l thanks  P e t e r Grantham  McKenzie  throughout and  my  pregnancies.  Coutts  especially guidance  to express  the  ,  ,  for their study.  without  Not  t o my  Jack  whose s u p p o r t  be  t  -  and  support  and  forgotten  are  the p r o j e c t  have been p o s s i b l e , a v e r y s p e c i a l t h a n k  vi  Taunton  continual to  committee  you.  would  INTRODUCTION  Increased  participation,  programs  o f a l l v a r i e t i e s h a s been a c h a r a c t e r i s t i c  1980's.  Exercise  all  h a s been i n v o l v e d i n i n d u c i n g  physiological  s y s t e m s and i s r e s p o n s i b l e  changes i n l i f e s t y l e fitness,  modification.  perhaps e x e r c i s e during  lack of well-designed  exercising basing  during advice  in  humans  differences  rats  healthy on  or  as  flow  care  of  models.  professionals  The  anecdotal  physiological the d i r e c t  r e s u l t s t o humans.  f o r observing  pigs,  Exercise  testing  p r e g n a n t s h e e p on a t r e a d m i l l h a s had no i l l  effects  training  1976),  but levels  1980),  during  gestation.  fetuses  ( Orr et a l . ,  exercising  ewes  (Longo e t a l . ,  or with  fetuses with  (Emmanoulides e t a l . ,  responses  guinea  exercise  or  models  humans  to  sustained' Clapp,  and c o n t r o l l e d s t u d i e s  animal  an i d e a l  fetus.  o f a n i m a l s t u d i e s have used sheep,  t h e ewes o r t h e i r  al.,  t o promote h e a l t h ,  b e t w e e n humans a n d a n i m a l s p r e c l u d e s  majority  testing  in  for positive  t o e x e r c i s i n g p r e g n a n t women on  a p p l i c a t i o n o f animal study  and  changes  pregnancy might assure  pregnancy has h e a l t h  their  studies  The  of the  W i t h t h e new e m p h a s i s on  As e x e r c i s e i s p e r c e i v e d  g e s t a t i o n a l p e r i o d and a h e a l t h y The  fitness  e x e r c i s e p r o g r a m s h a v e been e x p a n d e d t o i n c l u d e t h e  p r e g n a n t woman. then  by men and women i n p h y s i c a l  1972)  1  at  1972; C u r e t  'moderate  1978), impaired  to  et  heavy  to exhaustion  (  u m b i l i c a l blood  produced  t r a n s i e n t decreases i n f e t a l  the e x e r c i s e t e s t i n g s e s s i o n s . flow  (UBF)  duration  al.,  i n p r e g n a n t sheep was of  delivery  maternal exercise  o f o x y g e n was  1 9 8 3 a ) , and  maintained  r e l a t e d to the  ,  maintained  but  to the  uterus  shunting  f e t a l and  p l a c e n t a l V02  a t , or s l i g h t l y  The  during  fetal  pO  exercise  constant  w i t h i n the  et  uterus  above,  (Lotgering  l e v e l s were w i t h i n  and  (Lotgering  preferrential  values  level  a relatively  the  pre-exercise 1983b).  responses during 2 decrease i n u t e r i n e blood  The  pO  et  the  al.,  normal  levels  2 because during  total  u t e r i n e oxygen  e x e r c i s e due  extraction.  with  guinea p i g s ,  controlled  physical activity  gestation.  Training  increased  the  time  decreased  the  mortality,  decreased  weight  increased  and/or rate,  maternal  Studies  on  increased  intensity  weight  of  gain,  weight  may  have been due  maternal  cannibalism,or  to the  low  the  i n v o l v e d c a r d i o v a s c u l a r and 1978., 1 9 7 9 ) , w h i l e  2  exercise  increased  fetal  lowered  testing  pregnant  newborn  trained  groups  pregnancy  used,  (Wilson of  lipid  have  groups'  protocol  offspring  others  found  period,  birthweight the  have during  exercising  The  changes ( P a r i k o v a  on  and  the  during  Gisolfi,1980). rats  effects  mice  gestation  gain,  and  mortality in  offspring  oxygen  pregnant guinea pigs  e x e r c i s i n g r a t s before  that  to conception  newborn m o r t a l i t y i n t h e  et a l . , 1980).  maintained  increased  r a t s , and  shortened the  fetal  (Gilbert  found  prior  studies with  the a b o r t i o n  and  was  t o h e m o c o n c e n t r a t i o n and  Studies  increasing  consumption  and  exercised metabolism  ( Mottola  et a l . ,  1983)  found  no  developmental  changes  with  mild  aerobic  exercise.  The  human s t u d i e s h a v e f o c u s e d  to exercise during pregnancy studies bed  on  on t h e p h y s i o l o g i c a l r e s p o n s e s  pregnancy or the e f f e c t of e x e r c i s e  t h e outcome o f p r e g n a n c y .  reported  reduced u t e r i n e blood  c y c l e ergometer ( M o r r i s e t a l . ,  UBF  may  supine inferior  vena  Physical  .  Fitness  insufficiency tested  cava  the enlarged  determined  from f e t a l  on a b i c y c l e e r g o m e t e r l a t e  to press  was and  heart  a  The r e d u c t i o n i n  uterus  (PFS)  first  protocol i n that  No c o r r e l a t i o n Scores  the  flow while cycling  1956).  h a v e been due t o t h e t e s t i n g p o s i t i o n allowed  One o f  during  the  on t h e  found  between  uteroplacental  r a t e ( F H R ) i n women  i n gestation  (Pommerance  e t a l . , 1974a) .  E a r l y work u s i n g of  P h y s i c a l Work C a p a c i t y ( P W C ) a s an i n d i c a t i o n  physical f i t n e s s during  1960)  found  decreased  a  constant  sharply  pregnancy value  variable  17.6%  with exercise t r a i n i n g ,  values Erkkola normal  increased  2 weeks p r i o r as  a  (1976b) PWC  found  values  labours, heavier  had  A  and r e t u r n e d  of  the  t h a t those  shorter .  which  series  a  of that  further  pre-pregnancy  t h e p r e g n a n t PWC  women w i t h  n e w b o r n s and p l a c e n t a s 3  to  non-pregnant  significantly  Ihrman,  1976b) f o u n d  1 0 % w i t h p r e g n a n c y and  to d e l i v e r y . Expressing  percentage  and  gestation  delivery.  ( E r k k o l a 1975, 1976a,  this  values  through  a few days a f t e r  s t u d i e s u s i n g PWC,  (Dahlstrom  PWC greater  value, than  spontaneous  Pommerance were  and c o - w o r k e r s ( 1 9 7 4 b ) s t u d i e d  classified  as " f i t "  cycle  ergometer  levels  of physical f i t n e s s  Astrand's  test  using  responses, based  multiparas  them  o f VO max f r o m 2  shorter  labour  They  who  weights, to the  on n o n - p r e g n a n t women  and Rodah.1,1970 ) .  had  women  pre-pregnancy  and compared  nomogram f o r c a l c u l a t i o n  measurements ( A s t r a n d "fit"  their  pregnant  using  submaximal  found  - stages  that the  were  not  specified.  Recent  studies  maintained (Sibley  through  et a l . ,  primiparas 12  have  found  regular aerobic  1981,  Collings  and m u l t i p a r a s  weeks d u r i n g  that  gestation.  reported  these  works  and  on e x e r c i s i n g d u r i n g  reported  be  pregnancy  1983).  Healthy  problem-  Two c a s e  studies  have  pregnancy  but data  from  a p p l i c a b l e to the  no p r o b l e m s w i t h  were  subjects  running  during  analyzed. pregnancy  lactation  where VO max i n c r e a s e d 20% d u r i n g pregnancy 2 an improvement in endurance performance  indicating  (Dressendorfer,1979).  The  to  pregnancy  due t o t h e m e t a b o l i c  al.,1981)  decrease  other  necessary  et  during  A l l the pregnancies  been  study  training al.,  can  were a e r o b i c a l l y t r a i n e d f o r 10 t o  and t h e newborns were h e a l t h y .  One  fitness  et  free  are only  aerobic  .  running  In t h e l a t e r  work s u g g e s t e d and  that  i t was  i t s intensity  during  s t r e s s i t caused study  the increase  (Hutchinson i n VO  was 2  proportional concluded  to  weight  t o be c o n s t a n t  gain  and  throughout  4  aerobic  gestation.  capacity  was  There  have  been  literature jogging,  on scuba  skiing,  diving,  their  mechanical  suggested  decrease  Spellacy,1983). maternal been  and  in  gestation  their  Women  reported  progressed  due t o  distribution,  and t h e  reserve  who dove ( 5 . 5 %  than  (Jarrett  expected  v s 0% ;  before  Reasons  f o r stopping  and  pre-pregnancy  but  ( 6 % versus  activity  may fetal  the  norm  pregnancy, t h e frequency progressed,  complications Bolton,1980).  levels  and had l i g h t e r  gained  (Clapp  and  were e x t r e m e  higher  Women  less  who during weight  t h o s e who  Dickstein,1984). fatigue,  injury,  t h e p r e g n a n c y , and l a c k o f t i m e .  and t h e  was  newborns t h a n  musculoskeletal  5  which  o f endurance a c t i v i t i e s  t h e 2 8 t h week  discomfort,  normal  condition,  as pregnancy  i n a combination  a t o r near  than  healthy  decreased  stopped  affecting  activity  -uterine  complications  were h i g h e r  delivered earlier,  abdominal  of physical  gestation  circulatory  of the pre-selected b i r t h  participated  ,  to  depth o f d i v e s  women  retrospective  with  I n women who dove d u r i n g  incidence  With a l l  They had a l o w e r a b o r t i o n r a t e and i n c i d e n c e  due  2-4%).  in  involving  cross-country  error.  weight  the  of  as pregnancy  in  in  pregnancy  recall  associated  and f e t a l  abnormalities of  jogging  changes  reported  and a c o m b i n a t i o n  considerable  factors  enlargement,  throughout  of subject's  introduces  decreasing  studies  dance and r u n n i n g .  the accuracy  patterns  have  exercise  aerobic  studies  of  retrospective  fear  lower of  Given  the  problems i n h e r e n t  investigation exercise its  was  throughout  designed  to r e t r o s p e c t i v e to  g e s t a t i o n on  outcome i n h e a l t h y  primiparas.  6  studies,  this  determine  the  effects  of  the course  of pregnancy  and  METHODS Subjects;  Twenty-six  ( a g e s 25 - 3 5 ) w i t h volunteered They  to  were  healthy  no m e d i c a l c o n t r a i n d i c a t i o n s  be s t u d i e d  prospectively  r e c r u i t e d through  family  e d u c a t i o n c l a s s e s , p r e and p o s t n a t a l media:  radio,  subjects  newspaper  were  risks;  subjects,  and  participation  their  in  the  complete the study  and  pattern.  subjects  patterns, heart  gestation.  or  weeks  on  22-24  advised  This  was a  their  This  of  any the  their  d i d not  descriptive  their  activity  included  the  entered the study a t They  pre-pregnancy  physical  r e s p o n s e t o a s u b m a x i m a l t e s t on During the i n i t i a l  pressure  10-14 a  activity assessed a  t e s t i n g session  w e e k s ) and t h e s u b s e q u e n t  7  type  completed  and had t h e i r f i t n e s s  weeks a n d 34-36 w e e k s ) , b l o o d  their  and i n t e n s i t y o f a c t i v i t y .  gestation.  t h e consent form,  c y c l e ergometer. weeks  during  22-24  rate  from  were a s k e d t o keep a l o g o f  frequency, duration,  questionnaire  via  were  The  and  S i x of the subjects  A s s e s s m e n t ; The s u b j e c t s or  protocol  a t t e m p t was made t o m o d i f y  physical activity  Fitness  posters.  t h e s t u d y due t o l a c k o f t i m e and i n t e r e s t ,  no  The  of e x e r c i s e ,  and  : 3 developed medical c o n t r a i n d i c a t i o n s t o  2 left  only;  prenatal  was o b t a i n e d  1 changed g e o g r a p h i c l o c a t i o n .  study  weeks  study.  gestation.  f i t n e s s c l a s s e s , and t h e  consent  physicians  women  exercise  practioners,  advertisement  informed  to  through  made aware o f t h e t e s t i n g  potential  exercise,  primigravid  Caucasian,  sessions  Monark (10-14 (22-24  , w e i g h t , and p r e - t e s t  heart  r a t e s were r e c o r d e d .  determining at  a steady  each of the  25,  50,  75,  during The  per  Fetal  heart  The rate  ended when t h e  minute  was  130  greater  student's  data  bpm  or  than  in  a small  heart  sample  at  as 1.5  "fit" kpm  "unfit"  bpm.  The  size  deemed a p p r o p r i a t e  rpm  by  recorded  direct  ECG.  r a t e reached  f o u r t h workload  or  the  50  was  150  completed.  assessed.  second  with  cycling  r a t e s were  subject's heart  (n=10) i f t h e i r  i n the  second  (n=10) i f t h e i r  and  third  confidence  the  heart  rate  the  two  c y c l e ergometery trimesters  limit  results  was  using  s e t a t 0.05.  further statistical  and  heart  trimester  d i f f e r e n c e between  r a t e response to the  the  involved  workloads f o r 5 to 6 minutes :  post-test period  the  less  130  heart  t test  treatment  a  With was  t r e a t e d as d e s c r i p t i v e  only.  Postpartum in  or  (22-24 w e e k s ) ,  determined  not  (bpm)  r a t e s were n o t  groups i n the  such  the  s u b j e c t s were c l a s s i f i e d  session was  and  test  r a t e response while  watts.The maternal  cycling  testing  beats  heart  c y c l e ergometry  four designated  100  the  The  the  records  data:  data  Lower M a i n l a n d were examined  of m e d i c a t i o n , weight,  The  apgar  obtained  1 in  procedures, at  1 and  newborn.  8  from 6 h o s p i t a l s - 5  Victoria  specifically  surgical scores  and  was  .  The  patients'  f o r : l e n g t h of l a b o u r , p l a c e n t a l weight,  5 minutes,  and  sex  use  newborn of  the  RESULTS The  age  in  each  group  UT=28.70years).The weeks,UT=40.75 measures  lengths  weeks),and  (T=13.92 k g . ,  equivalent.  The  was  similiar of  weight  (T=29.50years,  gestation  (T=40.75  gained versus  pre-pregnancy  UT=13.30 kg) i n t h e two g r o u p s  first  stage of labour  decreased i n  group  (T«=ll h r s 18.0 m i n . , UT=  13 h r s 58.8 m i n . ) .  stage  of labour  group  untrained also  group  of  10  sections  stage of labour  and  sections  untrained  in  i n the untrained  mean h e a r t  and  third  rates  group.  during  trimesters  between t h e two g r o u p s . t h e mean h e a r t (p  <  0.05),  rates  0.05);  between t h e two  second  trimester  133.22  +  indicated  was  groups  There  and  3  were  2  Caesarean  a  tests  1.  i n the second  significant  difference  I n t h e s e c o n d and t h i r d  trimesters  the subjects  (p<0.05),  d i d not change,  UT=147.33 + 5.9 bpm  in  each  levels  trimester,  of  category  i t s mean h e a r t  (p  <  fitness  from the + 9.4 and  group's  147.11 + 5.3 and  bpm  throughout  rate  T=121.78  whereas t h e UT UT=  9  + 9.4, UT=147.11 + 5.3  different  increased  to the t h i r d  12.02 bpm  group  the ergometry  T= 133.22 + 12.0,  between  rates  A difference  The m a t e r n a l d a t a w i t h t h e  were T=121.78  g e s t a t i o n . The T group  heart  The s e c o n d  a r e p r e s e n t e d i n TABLE  respectively,therefore  existed  T  t h a n 80% o f t h e  subjects.  the t r a i n e d  means and r a n g e s o f t h e r e s u l t s  The  the  UT=15.17 m i n . ) . M e d i c a t i o n was a d m i n i s t e r e d t o  trained  Caesarean  was l e s s  (T=70.Omin., UT=90.57min.).  seen i n the t h i r d  (T=7.43 min., 8  i n the trained  were  mean  147.33  +  5.9  bpm.  Based  on  these  Astrand's  nomogram  classified  as being h i g h ,  on  predicted  their  group  A  and t h i r d  Average,  UT=8)  indicated  3 > hours T  good,  respectively).  were  The  were  o r l o w based  Good,  3  Average,  The a c t i v i t y  more a c t i v e  UT=8  l o g b o o k s (T=9,  i naerobic a c t i v i t y  trimester  ,  (T=6;UT=6), b u t  i n the third  trimester  ( S e e a p p e n d i c e s C and D ) .  the trained  m o t h e r s were s l i g h t l y  gms), b u t t h e i r  (T=6A7.A0 gm;UT=812.86 and  i n the trained  distributed  A  i n t h e second  5  placental  gm). The a p g a r  minutes  (T=7.70,UT=7.90;T=9.20,UT=9.33, males  the subjects  average, f a i r ,  participation  (T=3733.00 gms., UT=3679.97  minute  using  (T=5 H i g h , 2 Good, UT=1 Good,  T=l High,  similiar  newborns f r o m  were l o w e r  1968),  responses,  (VO max). The T 2 VO max r a t i n g s , a t 75 w a t t s , i n 2  trimesters  Fair;  subjects  rate  maximum oxygen u p t a k e  p e r weeks,  (T=5;UT=2).  The  A  1 Fair,  Average,  the  (de V r i e s ,  had more above a v e r a g e  the second  heart  were  similiar  r e s p e c t i v e l y ) . T h e r e were  more  evenly  newborns (T:M=8,F=2;UT:M=5,F=5).  newborn d a t a i s summarized i n TABLE  10  weights  scores a t 1  newborns whereas t h e s e x e s were  i n theuntrained  heavier  2.  TABLE 1 Mean M a t e r n a l D a t a T  (n=10)  Age (years)  UT  29.50 (25 - 33)  Gestational  (n«*10)  28.76 (25 - 31)  Period  Length (wks) Weight (kgs)  (range of v a l u e s )  (40.0  40.75 - 41.0)  (38.0  (8.64  13.92 - 20.90)  13.30 (11.82 - 16.36)  gain  40.75 - 42.0)  Labour Stage  l l h r s 18.0 m i n . ( 3 h r s - 15hrs20min.n=9)  Stage  70.0 m i n . 110rain.n=8) (45min.-  (llmin.Stage (4min.Placenta  90.57 m i n . 150min.n=7)  7.43 m i n . 15.17 m i n . 16min.n=7) ( 3 m i n . - 40 min.,n=10)  Weight  (gm) (482 Medication Caesarean  1 3 h r s 58.8 m i n . (4hrs - 48hrs)  647.40 - 820,n=5)  Administered Sections  8/10 2 1 Kjellands rotation and e x t r a c t i o n  11  812.86 (700 - 1050,n=7) 8/10 3  TABLE 2  Mean Newborn D a t a £ r a n g e o f v a l u e s J_  T (n=10)  UT  (n-10)  Apgar 1 minute 5 minute  Weight (gms) Sex  7.70 (5 - 9)  7.90 (5 - 9,  9.20 (8 - 10)  9.33 (9 - 10,  3733.00 (3200 - 4460)  n=9) n=9)  3679.97 (2980 - 5320)  M  8  5  F  2  5  12  DISCUSSION The  literature  has  reported  on t h e e f f e c t s  changes i n t h e l e n g t h  weight  gain.  groups  confirms  Dibblee  and Graham,  The s i m i l i a r previous  observed  lengths here  of  women  Dickstein  was  study,  exercised  to  on  exercise  during  gestation.  study  Graham(1983), subjects  term  the  were  who  heart  as  Capacity  reported  rate  grouped,  classified  (PWC) v a l u e s .  ( S i b l e y et al.,1981;  1976,  1976a)  by  placed  investigation.  gain Clapp  the  in and  fitness whereas,  cardiovascular to  similiar  fitness  to  levels  submaximal  in  subjects  study  13  Physical training  1983; E r k k o l a  an  experimental  group a t t h e b e g i n n i n g o f  investigated the e f f e c t  classifications the other  into  and  primigravid  o f human  Collings et a l . ,  subjects  Dibblee  (1976) who used  The m a j o r i t y  the  This  of  response  ( t r a i n i n g ) or a c o n t r o l (sedentary)  outcome,  with  group i n D i b b l e e and  levels  by a s t e p - t e s t and E r k k o l a  different  shorter reported  The twenty p r i m i g r a v i d  studies  their  gain  (1984)  (1984).  based  Work  i n the unfit  possible to d i f f e r e n t i a t e  this  had  and l o w e r m a t e r n a l w e i g h t  fitness  in  t o terra  i n t h e two g r o u p s w h i c h d i f f e r s  (1983)  who  a l . , 1983;  o f C l a p p and D i c k s t e i n  The m a t e r n a l w e i g h t  body f a t and w e i g h t  Graham's  It  gestations.  et  1976; Pommerance e t a l . ,  t h a t women who e x e r c i s e d  was s i m i l i a r  greater  Erkkola,  those  maternal  o f g e s t a t i o n i n t h e s e two  findings (Collings  with  pregnancy  o f g e s t a t i o n and  lengths  1983;  1974), but c o n f l i c t s who  of exercise during  on  pregnancy  s t u d i e s analyzed  of  and i t s  the e f f e c t  of  their  t r a i n i n g programs on  outcome. in  the  UT  Dibblee  first  and  existed  investigation  we  trimester  found  third  and  studying  a  Guzman  and  for  aerobic  third the  be  T  and  In  in  distinct  and  subjects  between t h e  subjects  to  the  trimester.  adverse  1981),  ),  this  the  second  throughout  the  for  determining experienced  the  gestation  subjects'  (Dibblee or  et the  cardiovascular  al., subjects or  on  Graham  Erkkola  1976,  1976a)  It  is  with  1981). based  aerobic  fitness,  14  walking  testing  aspect and  do  of not  the  was in  not centre during  such  as  (Sibley  et  ( Dressendorfer  these one  known  Cycling  activity,  ,1983),  safe  no  testing protocols  All on  a  configuration  a treadmill  1969;  al.,1982),  i n c r e a s i n g weight, s h i f t s  and  running  et a l . ,  subjects.  body  1975;  and/or  bearing  a f f e c t other  specific  1974)  fitness  the  changes i n  - w h i c h would  1981),  by  in  of  al.,  gestation.  non-weight  and/or  step-test  Hutchinson  ,a  (Ueland  et  aerobic  means  (Rauramo e t  1983;  during  a  ( P e r n o l l et a l . ,  hormonal  al.,  as  interested  (Pommerance  levels  ergometer  classify  1970  fitness  gravity,  those  cardiovascular  ( C o l l i n g s et  by  by  been used  responses - r e s p i r a t o r y  effects  affected  e r g o m e t e r has  establishing  procedure  al.,  differences  groups  subjects  Caplan,  monitoring  the  no  the  the  cycle  Edwards e t a l . ,  of  by  pregnancy,  (1983) c l a s s i f i e d  classified  pregnant  physiological  cycle  but  levels,  trimester.  Exercising  and  Graham  trimester,  groups  fitness  1978;  protocols fitness attempt  to  measure  the  subjects'  flexibility comprise this  which  study  does n o t of  therefore  does  strong  or  delivery  not  Collings  of labour  et a l . , not  A major  second  stage  be  subject's  component  fitness  ligamentous  levels  in  of  the  structures  to  m u s c l e s and  the  their  and,  effect role  of the  i n d i c a t e d d i f f e r e n c e s i n the  two  finding  of  labour  1983;  Pommerance  et  of labour  had  Zaharieva  ( 1 9 7 2 ) and  non-athletes.  stages) perinatal  study  disputed  by  Berg  longer  therefore,  The  than  of  those  T subjects' higher the  subjects'  15  and  of  with  in  the  subjects. the  second  a t h l e t e s compared and  co-workers  (not  labour  level ability  of  and  may  a  powerinto  national have  aerobic to a i d  to  (1984)  separated in  the  Graham,  difference  reported  a c t i v e stage  in  This disagrees  (endurance  labour  fitness  reduction  Dibblee  in elite  1983;  i s involuntary  ( 1 9 6 0 ) however, found  shorter  the  Graham,  in primigravid  that high-performance  the  labour  i s the  et al.,1983;  lengths  and  in  subject's aerobic  been o b s e r v e d  t o be  study. by  the  of  i n the T group.  Erdelyi  athletes' were  stage  this  reported  Dibblee  a l . , 1 9 7 4 ) where no  T h i s was  reported  trained)  of  findings  1981;  This  (Collings  of labour  the  a f f e c t e d by  studies  and,  aerobic  or  in  with  1983).  other  reduced  strength,  o b j e c t i v e measurement  floor  disagrees  level.  who  the  s p e c u l a t i o n as  ( S i b l e y et a l . ,  would  stage  The  or  allow  pelvic  stage  which  length  with  g i v e any  muscle  capacity,  process.  literature  and  the  tight  first  groups  combined  "physical fitness".  condition  The  anaerobic  the  been  fitness birth  process.  Fatigue  and  i t has  can  postpone  p l a y s a major  been d e m o n s t r a t e d the  onset  of  role  the  of  second  l a b o u r was affected  Two  and  f a t i g u e (Brooks  of  this  also quicker the  apparent.  of  surgical  relationship findings Graham who  Collings  a  but  this  this  medication  during  and  co-workers  number  with of  abdominal  of  variable i s  or a f f e c t e d  by  two  groups  fitness the  does  incidence  delivery.  fitness  and  stage  and  (1983) and  Berg  of  stage.  population,  v a r i a b l e s and  1984).  administered  controlled  required  conflicts  higher  but  third  f o r a n a l g e s i a or a f f e c t  between t h e s e  (1983),  found  need  The  management o f  in this  fitness  the p h y s i c a l  d i f f e r e n c e s between t h e  procedures  of  percent.  be  labour  i n the r e d u c t i o n  T group,  c o u l d not  Thus,  i n f l u e n c e the  20  i n the  the  of  Fahey,  of d e a l i n g with  interest,  research design;  were n o t  by  medical  sections,  and  i s reflected  labour  v a r i a b l e s of  caesarean  not  stage  more by  other  the  labour  process  that increased aerobic  Thus a f i t woman i s more c a p a b l e ordeal  i n the  This  supports  the  Dibblee  and  co-workers(1984) deliveries  in  athletes.  The  placental  (Erkkola  1976:  were f o u n d weights study  weight  has  Collings  e t a l . , 1983)  i n the T groups.  reported  in this  f i n d i n g s (Nelson  exercise  decreased  placentas  weighed  been r e p o r t e d  The  UT  p l a c e n t a weight.  i n t h e T g r o u p was 16  two  where l a r g e r  studies placentas  group's l a r g e r p l a c e n t a l  investigation  e t a l . , 1983)  in  i s similar  to  where i n c r e a s e d The  animal maternal  sample s i z e  of  s m a l l e r ( n = 5 ) compared  the to  the  UT  group  placenta  The  w e i g h t and f e t a l  co-workers was  (n=7) .  no  relationship  weight,  as r e p o r t e d  ( 1 9 8 3 ) , was n o t o b s e r v e d  difference  Dickstein  (1984)  in  the  found  between  i n this  newborns'  due  Erkkola  to the higher  hemaglobin the  T  conflicits co-workers 1  minute healthy, effects no  scores. scores  sample s i z e  descriptive,  out nurse  at  The  which  (1983) and C o l l i n g s  and  newborns' had h i g h e r the on  5  the  and t h e a b s e n c e o f any l o n g - t e r m on t h e f e t u s .  T h e r e have  of s i g n i f i c a n t  activity  reported exercise  no a t t e m p t patterns.  6 h o s p i t a l s with  f o r each s u b j e c t ,  recording  equivalent,  of  been  differences i n 5  scores.  w h i c h c a n be made a b o u t  physical  total  scores  w h i c h was a p o s s i b l e r e f l e c t i o n  i n the l i t e r a t u r e  minute apgar  was  were  heavier  T h e r e were no d i f f e r e n c e s i n  of maternal e x e r c i s e  small  group  lighter  and  one m i n u t e a p g a r  and Graham  normal p r e g n a n c i e s ,  reports  The  UT  volume,  and  gestation  blood  (1983) whose f i t o r e x e r c i s e d  apgar  shorter  p l a s m a volume,  Dibblee  minute apgar  be  T o f f s p r i n g t o be  the  there  Clapp  (1976) r e p o r t e d  and  with  since  weights.  t h e T g r o u p newborns t o  i n the T subjects.The  group  by N e l s o n and  study  w h i c h may have been r e l a t e d t o t h e r e p o r t e d periods.  decreased  apgar  subjects  scores, were  here  limits  during  the  pregnancy.  was made t o m o d i f y This  The  study  the subjects'  i n v e s t i g a t i o n was  a different therefore,  conclusions  p h y s i c i a n and  carried caseroom  a lack i n consistency of  and d e l i v e r y p r o c e d u r e s i s a p p a r e n t . classified 17  on  the  basis  of  cardiorespiratory the  other  f i t n e s s and  physiological  Exercise  during  no  attempt  components o f  pregnancy  did  g e s t a t i o n , m a t e r n a l weight  gain,  stage of  decrease  in  labour.  trained  were  subjects.  similiar  during  program  mother o r reduced  fetus. in  increased  The  the  In  In  the  affect  the  second  long-term  i n no  addition  second  active  f i t n e s s and  stage of  18  the  of first  s t a g e of  labour  5 minute apgar  scores  effects  deterimental  the  evaluate  length  of  participation in a  f i t m o t h e r s w h i c h may  cardiorespiratory  during  not  newborn w e i g h t , or  conclusion,  resulted  made t o  fitness.  1 m i n u t e and  i n d i c a t i n g no  pregnancy.  fitness  fatigue  It did  was  stage be  physical  e f f e c t s on of  labour  related  ability  labour.  exercise  to  to  the was their  postpone  REFERENCES A s t r a n d , P.O. and R o d a h l , K . 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G y n e c o l . 61 ( 6 ) , p 705, 1983.  improved  breathing  outcome?  J e n k i n s , R . R . and C i c o n n e , C . Exercise e f f e c t d u r i n g p r e g n a n c y on b r a i n n u c l e i c a c i d s o f f s p r i n g i n r a t s . A r c h . P h y s . M e d . R e h a b . 61, p 124, 1980.  of  J o n e s , R . L . , B o t t i , J . J . . A n d e r s o n , W . M . , and B e n n e t , N . L . Thermoregulation during aerobic exercise p r e g n a n c y . O b s t e t . G y n e c o l . 6 5 , p 340, 1985.  in  Jopke,T. Pregnancy:A time t o e x e r c i s e judgement. S p o r t s m e d i c i n e 11 ( 7 ) , p 139, 1983.  The P h y s i c i a n and  Karasawa,K., Suwa,J., and K i m u r a , S . Voluntary e x e r c i s e d u r i n g p r e g n a n c y and l a c t a t i o n effect on lactational performance in J . N u t r i . S c i . V i t a m i n o l . 27, p 333, 1981.  and i t s mice.  Koh.K.S., Monfared,A.M., M a s d r a i g i s , G . B . e t a l . R-pulse wave timing: A technique for continuous cardiovascular monitoring in obstetrics - Preliminary r e p o r t . A m . J . O b s t e t . G y n e c o l . 135, p 352, 1979 K u n z e l , W . , K a s t e n d i e c k , E . , and Hohman,M. H e a r t r a t e and b l o o d p r e s s u r e r e s p o n s e and m e t a b o l i c in sheep fetus following reduction of uterine flow.Gynecol.Obstet.Invest. 15, p 300, 1983.  changes blood  Longo,L.D., H e w i t t , C.W., L o r i j i n , R.H.W.,and G i l b e r t , R.D. To what extent does maternal exercise affect fetal o x y g e n a t i o n and u t e r i n e b l o o d f l o w ? ( a b s t r a c t ) F e d . P r o c . 37 , p 905,1978. L o t g e r i n g , F.K., G i l b e r t , R.D., and Longo, L.D. Exercise responses i n pregnant sheep: oxygen consumption, uterine blood flow, and blood volume. J.Appl.Physiol.Respirat.Environ.Exercise.Physiol. 55(3), p 834, 1983a.  22  L o t g e r i n g , F.K., G i l b e r t , R.D., and Longo, L.D. Exercise responses i n pregnant sheep: blood gases, temperatures, and fetal cardiovascular system. J.Appl.Physiol.Respirat.Environ.Exercise P h y s i o l . 55(3), p 842,1983b.  M a r s a l , K.G., G e n n s e r , G., and L o f g r e n . O . Effects on fetal breathing movements of maternal c h a l l e n g e s . A c t a O b s t e t . G y n e c o l . S c a n d . 58, p 335, 1979. M o r r i s , N., O s b o r n , S . B . W r i g h t , H . P . , and H a r t , A. Effective u t e r i n e b l o o d - f l o w d u r i n g e x e r c i s e i n normal pre-eclamptic pregnancies.Lancet p 481, S e p t . 8, 1956. t  and  M o t t o l a , M., B a g n a l l , K.M., and McFadden.K.D. The effects of maternal exercise on developing f e t u s e s . B r i t , J . S p o r t s . M e d . 17 ( 2 ) , p 117, 1983.  rat  N a v o t , D . D o n c h i n , Y . , and S a d o v s k y , E . F e t a l response to voluntary maternal h y p e r v e n t i l a t i o n . O b s t e t . G y n e c o l . S c a n d . 6 1 , p 205, 1982.  Acta  f  N e l s o n , P . S . . G i l b e r t , R . D . , and Longo, L.D. F e t a l g r o w t h and p l a c e n t a l d i f f u s i n g c a p a c i t y i n g u i n e a p i g s following l o n g - t e r m m a t e r n a l e x e r c i s e . J . D e v e l o p . P h y s i o l . 5, p 1, 1983. O r r , J . , U n g e r e r , T . , W i l l , J . , W e r n i c k e , K . , and C u r e t , L . E f f e c t s o f e x e r c i s e s t r e s s on c a r o t i e d , u t e r i n e , and i l l i a c blood flow in pregnant and non-pregnant ewes. A m . J . O b s t e t . G y n e c o l . 114 ( 2 ) , p 213, 1972. Parizkova, J . The impact of daily workload during pregnancy and/or postnatal life on the heart microstructure o f r a t male o f f s p r i n g . B a s i c R e s . C a r d i o . 73 ( 5 ) , p 433, 1978. Parizkova, J . Cardiac microstructure i n f e m a l e and male offspring e x e r c i s e d r a t m o t h e r s . A c t a A n a t . 104, p 382, 1979.  of  P a r i z k o v a , J . and P e t r a s e k , R . The impact o f d a i l y work l o a d d u r i n g pregnancy on lipid m e t a b o l i s m i n t h e l i v e r o f o f f s p r i n g . E u r . J . A p p l . P h y s i o l . 39, p 8 1 , 1978. Pernoll,M.L.,Metcalfe,J.,Kovach,P.A.,Watchtel,R.,and Dunham,M.J. Ventilation d u r i n g r e s t and e x e r c i s e i n p r e g n a n c y and p o s t p a r t u m . R e s p i r . P h y s i o l . 25, p 295, 1975.  23  Pernoll,M.L.,Metcalfe,J.,Schlenker,T.L.,Welch,J.E.,and Matsumoto,*J.A. Oxygen c o n s u m p t i o n a t r e s t and d u r i n g e x e r c i s e i n p r e g n a n c y . R e s p i r . P h y s i o l . 25, p 285, 1975  P e r n o l l . M . L . , M e t c a l f e , J . , a n d Paul.M. F e t a l cardiac response to maternal e x e r c i s e . I n : Circulation i n F e t u s and Newborn, e d . L.D.Longo, G a r l a n d P u b l i s h i n g , New Y o r k , 1977. P i j p e r s , L., W l a d i m i r o f f , J . W . , and M c G h i e , J . E f f e c t o f s h o r t - t e r m m a t e r n a l e x e r c i s e on m a t e r n a l and f e t a l cardiovascular dynamics.British J.Obstet.Gynecol. 91, p 1081, 1984. P i a t t , L.D., A r t a l , R . , S e r a e l , J . , S i p o s , L . , and Exercise in pregnancy. II Fetal Am.J.Obstet.Gynecol. 147 ( 5 ) , p 487, 1983.  Kammuala,R.K. responses.  P o k o r n y , J . and R o u s , J . The effect o f m o t h e r ' s work on foetal h e a r t sounds. In Horsky,J. and S t e m b e r a , Z . ( e d s ) : I n t r a u t e r i n g Dangers to the F e t u s E x c e r p t a M e d i c a F o u n d a t i o n 1967, p354. Pommerance, J . J . , G l u c k , L . , a n d L y n c h , V.A. Maternal exercise as a s c r e e n i n g t e s t for uteroplacental i n s u f f i c i e n c y . O b s t e t . G y n e c o l . 44 ( 3 ) , p 383, 1 9 7 4 a . P o m m e r a n c e , J . J . , G l u c k , l . , and L y n c h , V.A. Physical fitness i n pregnancy: i t s effect on pregnancy o u t c o m e . A m . J . O b s t e t . G y n e c o l . 119 ( 7 ) , p 867, 1974b. R a u r a m o , I . , A n d e r s s o n , B . , L a a t i k a i n e n , T . , and P e t t e r s s o n , J . S t r e s s hormones and p l a c e n t a l s t e r i o d s i n p h y s i c a l exercise d u r i n g p r e g n a n c y . B r i t i s h J . O b s t e t . G y n e c o l . 89, p 9 2 1 , 1982. Seitchik,J. Body c o m p o s i t i o n and e n e r g y e x p e n d i t u r e d u r i n g r e s t and work i n p r e g n a n c y . A m . J . O b s t e t . G y n e c o l . 97 ( 5 ) , p 7 0 1 , 1967. Sibley,L..Ruhling,R.0., Cameron-Foster, J . , Christensen,C., and Bolen,T. Swimming and physical fitness during p r e g n a n c y . J . N u r s e - M i d w i f e r y 26 ( 6 ) , p 3, 1981. S m i t h , A . D . , G i l b e r t , R . D . , Lammers,R.J., and L o n g o , L . D . Placental exchange a r e a i n guinea p i g s f o l l o w i n g long-term maternal exercise: a stereological analysis. J . D e v e l o p . P h y s i o l . 5, p 1 1 , 1983. S o i v a , K . , S a l m i , A . , G r o n r o o s , M . , and P e l t o n e n , T . Physical work capacity d u r i n g pregnancy and effect of physical work tests on foetal heart rate. A n n . C h i r . G y n a e c o l . F e n n . 5 3 , p 187, 1964.  24  Stembera,Z.K. and H o d r . J . The "exercise t e s t " a s an e a r l y d i a g n o s t i c a i d for foetal distress.In Horsksy.J. and Stembera,Z ( e d s ) Intrauterine Dangers t o t h e F e t u s . Excerpta Medica Foundation^ 1967, p 349. Terada.M. Effect o f p h y s i c a l a c t i v i t y b e f o r e p r e g n a n c y on f e t u s e s of mice exercised f o r c i b l y during pregnancy.Teratology 10, p 141, 1974. T u r n e r , G., and U n s w o r t h . T . I n t r a u t e r i n e bends? L a n c e t p 905, A p r i l  17,  1982.  U e l a n d , K . Novy, M.J., and M e t c a l f e , J . Cardiorespiratory responses t o p r e g n a n c y and e x e r c i s e i n normal women and patients with heart d i s e a s e . A m . J . O b s t e t . G y n e c o l . 115 ( 1 ) , p 4, 1969. t  U e l a n d . K . , Novy,M.J., P e t e r s o n , E . N . , a n d M e t c a l f e , J . Maternal cardiovascular dynamicstIV The i n f l u e n c e of gestational age on t h e m a t e r n a l c a r d i o v a s c u l a r r e s p o n s e t o p o s t u r e and e x e r c i s e . A m . J . O b s t e t . G y n e c o l . 104 ( 6 ) , p 856, 1969. U e l a n d , K . , Novy,M.J., and M e t c a l f e , J . Hemodynamic responses o f p a t i e n t s with heart disease to p r e g n a n c y and e x e r c i s e . A m . J . O b s t e t . G y n e c o l . 113 ( 1 ) , p 47, 1972. V e i l l e , J - C , H o h i m e r , A.R. , B u r r y , K., S p e r o f f , L . The E f f e c t o e x e r c i s e on u t e r i n e a c t i v i t y i n t h e l a s t e i g h t weeks of pregnancy. Am.J.Obstet.Gynecol. 151 ( 6 ) , p727, 1985. W i l s o n , N . C . and G i s o l f i , C V . Effects of exercising r a t s during 48 ( 1 ) , p 34, 1980.  pregnancy.J.Appl.Physiol.  Zaharieva.E. Olympic p a r t i c i p a t i o n by women - e f f e c t s on c h i l d b i r t h . J.A.M.A. 221 ( 9 ) , p 992, 1972.  25  pregnancy  and  APPENDIX A - REVIEW OF LITERATURE  Introduction  In  the  past  stretch for  exercise  presents  and d e l i v e r y . a  childbearing Popular  dilemma  should  literature  cites  with  outcome.  Reasons  during  pregnancy clinical  their  area gain the  in  of  continuing  women  period.  active  throughout  daily  life  gain,  veins,  exercise decreased  and i n c r e a s e d  and t h e s t r e s s e s  However, t h e r e  on p r e g n a n c y women  pregnancy  concrete  data  on  program  which  throughout  paper reviews t h e s t u d i e s  b o t h a n i m a l and human p o p u l a t i o n s picture of the current  field.  26  i n an  studies  some  and t h e  by a woman who q u e s t i o n s  exercise  of  a r e few p r o s p e c t i v e  have d e m o n s t r a t e d  during  has l i t t l e  and i t s  regular  weight  varicose  exercise  This  of  women who were  with  an  fitness  pregnancy?  Animals s t u d i e s  physician  an o v e r a l l  in  during  a d e c i s i o n when c o n s u l t e d  gestational  preparation  active  on t h e e f f e c t s o f e x e r c i s e  effects  to  exercise  controlling  1983).  fetuses.  of  in  interest  f o rencouraging  include  f o r coping  trials  practicicng  merit  she  cited  (Jopke,  negative  base  The r e c e n t  c o n s t i p a t i o n , and/or  levels  w h i c h were  restricted  no o r p o s i t i v e e f f e c t s on p r e g n a n c y  pregnancy  backache,  was  for physically  age:  gestation  and  pregnancy  and r e l a x a t i o n e x e r c i s e s  labour  energy  during  to the her  i n the  effort  to  of research i n  Animal  Studies  Animal  studies  during  pregnancy.  animals  gestation  examined,  of animal  animals,  exercise  and  that  is  have  shorter  duration  pregnant  offerred  a  fetal  Gisolfi,  1980)  of  while  before size life  literature  training  (Gilbert  others  exercise  - depending  is  was t h a t  had  no l o n g - t e r m  the  mother.  chronic  exercise  bouts  effects.  Some  to exhaustion  will  cause  birthweights,  et a l . ,  1980;  1978  long-term and  1979).  pregnancy - weight  training  occurred  conclusion  e f f e c t s on t h e f e t u s ,  and  W i l s o n and  (Parizikova,  maternal e x e r c i s e ,  27  healthy  e t a l , , 1983)  positive  The g e n e r a l  The  well-tolerated  have f o u n d  when  stages  i n normal,  lower  of  protocols.  long-term  m a t i n g may a f f e c t  cycle.  used,  e t a l . , 1976; M o t t o l a  gestation,  mortality  of prenatal  Exercise  that  variety  animals  to exhaustion  no d e t r i m e n t a l  found  increased  females'  exercising  t h e e f f e c t s on t h e f e t u s f r o m a c u t e  studies  litter  exercise  have shown t h a t  testing  1972; C u r e t  of  and e x p e r i m e n t a l  studies  t r a n s i e n t with  effects  has  on  to the experimental  majority  et a l . ,  literature  gestation  due  (Orr  models f o r t h e e f f e c t s  The  during  conclusions during  provide  gain,  in  the  from t h e animal i n moderation,  gestation  length,  or  Uterine  Blood  Fetal  responses  pregnant  Flow  ewe's  (1972).  At  significant  followed exercise  the  end  increase  associated  maternal  with  i n work of  by  in fetal  pH  and  exercise, decrease  had  higher  the  et  al.  there  was  in fetal  hyperventilation  fetuses  during  Emmanoulides  maternal  maternal  Chronically-stressed  responses  2 alkalosis.  and  pCO  pCO  and  lower  pO  2 values, heart  before rate  normal  and  after  after  e x e r c i s e for a longer  fetuses.  malnutrition (where one  maternal e x e r c i s e ,  There  seen  in  was  the  disadvantage  ewes.  during  associated  decreased  and  hemoglobin assumed  the  were  that  compared  evidence  to  chronically-distressed  fetuses  t i e d ) of  e x e r c i s i n g ewes  e x e r c i s e due  redistribution  of  causes  f o r decreased  fetal  of  circulatory  effects  the  elevated  fetal  maternal The  the  period  an  and  T h e s e f e t u s e s were a t an a d d i t i o n a l  oxygen a v a i l a b l e . with  and  of  u m b i l i c a l a r t e r y was  of n o n - e x e r c i s i n g  animals,  gross  2  the  to  the  reduced  r e g i o n a l blood reserve  of  pregnant  moderate m a t e r n a l and  oxygen  oxygen.  consumption  fetal  The and  flow  study  the  pO 2  gradient during  ( u m b i l i c a l artery - umbilical vein) maternal  moderately decreases  exercise.  severe of  fetal  The  maternal pO  authors  exercise  which  were  may  d i d not  change  concluded  that  induce  transient  varying  and  well-  2 tolerated  by  where t h e r e pre-exercise  the  was  fetuses  with  a rapid return  levels  during  intact  of u t e r i n e blood  recovery.  28  umbilical  circulation flow  (UBF)  to  Orr  et  a l . ( 1 9 7 2 ) f o u n d UBF i n n o n - p r e g n a n t  sheep was n o t i m p a i r e d the  animal  by m a t e r n a l  was h e a l t h y .  was removed by i n c r e a s e d  vascular  plexus  vascular  plexus  i n the  increased  the  s k e l e t a l muscles.  small  sheep  of  the  pregnant sheep,  blood  bones.  during  flow to  the  sheep,  the  blood  flow  In  The i l i a c  oxygen r e q u i r e m e n t s  The s i g n i f i c a n t  increase i n  was b e c a u s e t h e b l o o d  and t h e i n c r e a s e i n UBF d u r i n g  percentage  and  turbinate  t o meet t h e i n c r e a s e d  non-pregnant  heat produced  carotid  i s a heat exchanger.  was  pregnant  exercise to exhaustion, i f  The i n c r e a s e d  exercise  and  flow at  UBF  rest  e x e r c i s e was a  t o t a l UBF t h a n i n  pregnant  in was  greater  sheep.  t h e UBF w o u l d be n e a r maximum v a l u e s  t h e i n c r e a s e w i t h e x e r c i s e w o u l d be a s m a l l e r  of  In  at rest  percentage  o f t o t a l UBF when c o m p a r e d t o t h e i n c r e a s e i n e x e r c i s i n g n o n pregnant  sheep.  conclusions  Orr  disagreed  t h a t a drop i n f e t a l  with blood  Emmanoulides'(1972) pO  indicated  tissue  2 hypoxia.  Orr  indicated  a  Orr's  concluded  t h a t the absence of f e t a l  lack of f e t a l  hypoxia.  Maternal  acidosis  exercise  work d i d n o t c a u s e any h a z a r d o u s e f f e c t s on t h e  in  fetus  b e c a u s e UBF was n o t i m p a i r e d . Later,  i t was c o n f i r m e d  by C u r e t  e t a l . (1976) t h a t  e x e r c i s e d i d not a f f e c t u t e r i n e blood difference untrained  in  a  difference  exercise  response to e x e r c i s e t e s t i n g  p r e g n a n t ewes.  week t r a i n i n g  flow,  Curet  questionned  and t h e r e was no in  trained  testing.  s t r o k e v o l u m e and h e a r t  rate  to  during  Sheep r e s p o n d e d t o t h e e x e r c i s e t e s t 29  and  whether a t h r e e  p e r i o d on t h e t r e a d m i l l was s u f f i c i e n t in  maternal  show the by  increasing differs  cardiac  f r o m humans who  stroke  volume and  Pygmy  goats  increasing that  the  and  postpartum, rest  lower  as  was  with  increased the  heart  arterial increase  rate, by  which  increasing  expected.  The  exercise,  i n cardiac  exercise  was  enough t o  exercise.  by  in  compared  I t was  for  the  proposed  that  the  and  r e s t i n g a-vO  to  resistance  account  exercise  late  significantly  r e s u l t e d from  during The  higher  peripheral vascular  output  pressure  i n pregnancy.  with  not  with  humans,  significantly  p r e g n a n c y and  but  output  like  D h i n s d a e t a l . (1978) f o u n d  r a t e was more  blood  output  output  volume.  increased  cardiac  cardiac  cardiac  lower d u r i n g  increase  i n c r e a s i n g heart  rate.  stroke  r e s t i n g heart  by  increase  increase  their  pregnancy  at  output  increased  its  greater  d i f f e r e n c e and  the  2 amount  i t increased  pregnancy models  and  for  supply,  with  exercise  postpartum.  human  and  blood  fetal  were the  same d u r i n g  Pygmy g o a t s were  flow  suggested  distribution,  oxgenation  studies  late  tissue  during  as  oxygen maternal  exercise. In  the  last  of  the  pygmy g o a t  flow  trimester  during  uterus  exercise  vasconstriction inclined  may  treadmill  h y p o c a p n i a or  of  pregnancy, the suffered  at  a major r e d u c t i o n  (Hohimer  have been due 1.5  hyperthermia.  30  to  nonplacental  et  al.,  to e x e r c i s e  2.0  mph)  or  portions in  1982).  ( walking to  blood The on  an  concommitant  Longo and a s s o c i a t e s sustained" ii  maternal exercise  in significant growth  (1978) concluded t h a t  fetal  d e s c e n d i n g a o r t i c pO  fell  (Emmanoulides  significant ewes  During  maternal  et  al.,  The  the c o n t r o l s ,  with a earlier  There  was  had  f o r c a r b o n monoxide  and d u r i n g  a  from e x e r c i s i n g  The e x e r c i s i n g ewes  lower p l a c e n t a l d i f f u s i n g c a p a c i t y  capacity  fetal  to the  1972).  decrease i n the weight of fetuses  than  intrauterine  exercise,  pCO similiar •-. 2  compared t o t h e c o n t r o l s .  rest,  result  and UBF d e r e a s e d a s s o c i a t e d  2 maternal a r t e r i a l  in  findings  i n p r e g n a n t sheep c o u l d  h y p o x i a and p o s s i b l y c a u s e  retardation.  decrease  " m o d e r a t e t o heavy  exercise  a  during  the d i f f u s i n g  increased.  r a t e s o f u t e r i n e and u m b i l i c a l b l o o d  f l o w and f e t a l  pO 2  d e c r e a s e d i n p r e g n a n t sheep e x e r c i s e d 1980).  During  oxygen  exercise  there  uteroplacental  t i s s u e and t h e f e t u s .  associated  significant  and  respiratory  The  increase  UBF.  The  effected uterine  (Clapp  was a downward s h i f t  d i s s o c i a t i o n curve a l l o w i n g  with  to exhaustion  increases  i n maternal  r a t e was r e l a t e d t o t h e  pre-exercise  c o n d i t i o n of the  ewes  by  t e s t was  temperature  a l k a l o s i s which l e d to a decrease  i n heart  i n the  normal oxygen uptake The e x e r c i s e  ,  in  decrease might  UBF. in have  t h e UBF b e c a u s e t h e w e l l - t r a i n e d ewes had u n c h a n g e d blood  flow  values  during  short  term e x e r c i s e  on  the  treadmill. Recently, in  Lotgering  and c o - w o r k e r s (  p r e g n a n t ewe's UBF d u r i n g 31  1983a) f o u n d a  exercise  and a v e r y  decrease  fast  return  to normal values  during  recovery,  similiar  to f i n d i n g s  with  humans ( M o r r i s e t a l . , 1 9 5 6 ) . The  ewes were a c c u s t o m e d  to  e x e r c i s e s t r e s s by w a l k i n g  t r e a d m i l l at various  speeds  for  10 m i n u t e s ,  questionned find  and  felt  the  suggested  (Emmanoulides levels  decrease to  initial  alkalosis  d e l i v e r y to the  (Orr et a l . ,  effect  the  s u d d e n UBF  changes  duration  The  in  but  maintained  a  w h i c h was  The  adequate before  not  or  exercise due  to  a neural  or  are  hormonal  I t was  was  concluded  relatively  constant  i n v e r s e l y r e l a t e d to  exercise.  UBF  C u r e t e t a l . , 1976;) o r i t d e c r e a s e d  UBF  1972)  with a quick  post-exercise  the  but  e f f e c t on  p r o p o s e d as a n e u r a l  exercise with  1983a).  was  alkalosis.  recovery  humans ( M o r r i s e t a l . , was  to  f u r t h e r d e c r e a s e i n UBF  of maternal  et a l . , during  time  exercise,  during  m a t e r n a l e x e r c i s e e i t h e r had  1972;  had  ( b o t h o c c u r i n e x e r c i s e and  uterus  no  r e t u r n to similiar  the  initial  UBF  or hormonal mechanism  due  1956).  The  resulting  respiratory alkalosis  c o n c e r n f o r the  32  resting to  f u r t h e r d e c r e a s e i n UBF  m a t e r n a l h y p e r t h e r m i a and al.,  (1976)  release  d e c r e a s e i n UBF  to e x e r c i s e .  I n summary, t h e  UBF  The  d e c r e a s e i n UBF  and  to  catecholamine  t o h y p e r t h e r m i a and  the  level  responses  w i t h a d e c r e a s e i n UBF),  attributed  the  sheeps'  excessive  or  m e c h a n i s m due  oxygen  in  test.  hyperthermia  that  associates  t h a t h i s a c c l i m a t i z a t i o n p e r i o d was  that  associated  C u r e t and  w h e t h e r t h r e e weeks were ample t r a i n i n g  prevented  during  the  f o r a week.  differences  Lotgering  on  the  from  (Lotgering  d e c r e a s e i n UBF  was  et  chronic  fetal  t i s s u e hypoxia which could  retardation fetus  was  exercise curve  (Longo e t a l . , 1978). assumed t o be  with  when  (Clapp,  the  and  to i n t r a u t e r i n e  constant  i n the  during  oxygen  u m b i l i c a l blood  to  the  maternal  dissociation  flow  was  reduced  d i d not  affect  1980).  the  pregnant animals to exhaustion  o f f s p r i n g s ' development which could  majority during  of s t u d i e s  involved  gestation.  exercised  One  animals,  significantly the  growth  Oxygen a v a i l a b i l i t y  relatively  downward s h i f t  uterine  Exercising the  lead  d i f f e r e n c e was  majority  to  that  not  training, from  levels,  had  controls,  but  severe  a t t r i b u t e d j u s t t o r e d u c e d UBF.  found t h a t  the  the  offspring  o f f s p r i n g compared t o t h e  not  of s t u d i e s  moderate  expected since  testing,  study did f i n d  at  lighter  exercise  be  The  o f f s p r i n g were n o r m a l  at  birth.  E f f e c t on  Offspring  Terada (1974) s t u d i e d of  training,  development. ran of  (TR)  before Half  from the  Tra-ining before had  g r o u p s o f m i c e t o see and  and 9th  during  the  (TC)  other  to the  m a t i n g was  16th  from the  9th  unknown m e c h a n i s m .  fetal  mating,  to the  16th  after  a d v a n t a g e o u s b e c a u s e t h e TR  T h e r e were no 33  mortality  CE  and day  mating  o r were a c o n t r o l  a l o w e r f e t a l m o r t a l i t y r a t e compared^ t o t h e  t o an  effects  on  before  h a l f e i t h e r ran day,  the  gestation  of the mice t r a i n e d (T)  or were s e d e n t a r y  gestation,  (CE),  four  (CC). group  group  due  differences  between body  TC and CC f e t u s e s .  weights  when t r a i n i n g 16th  weight and  proposed  that the  o f t h e t r a i n e d mice a t t h e s t a r t of  wa'.s due t o a d e c r e a s e d  to  Terada  caloric  occurred.  intake i n their  Exercising  d a y ) was a t t r i b u t e d  phase,  the  body  F e t a l w e i g h t s i n t h e CE  The- h i g h e r m o r t a l i t y and  fetal  w e i g h t s i n t h e CE g r o u p  water  and f o o d c o n s u m p t i o n ,  modifications  growing  to i n t e r f e r r i n g with  were l o w e r .  gestation  d u r i n g mid-pregnancy ( 9 t h  g a i n s i n t h e TR and CE m i c e .  TR l i t t e r s  lower  was c a u s e d and t h e  lower  by t h e d e c r e a s e  uterine  environmental  (eg:decreased UBF).  Comparing m a t e r n a l e x e r c i s e  to c h r o n i c hypoxia i n guinea  Gilbert  found  et  in  a l . , (1979),  g e s t a t i o n d i d not produce  moderate  exercise  any c h a n g e s i n f e t a l  placental  weights,  body  and  brain weights,  heart  , and p l a c e n t a w e i g h t s  pigs  during  body, organ o r  whereas c h r o n i c h y p o x i a decreased and i n c r e a s e d t h e r a t i o o f  fetal brain,  t o body w e i g h t s when compared t o  c o n t r o l r a t i o s . P r e v i o u s work ( T e r a d a , 1974) f o u n d a d e c r e a s e in  fetal  in  the  exercise stress  weight  with maternal exercise,  in  the previous study.  produced  by  1983). was  maternal  (Terada, Based  e x e r c i s e was  of  indication  of  decrease  in  a  body and o r g a n w e i g h t s f o u n d  1974;  Longo e t a l . ,  1978;  on w e i g h t , t h e a u t h o r s f e l t  well-tolerated  20 e x e r c i s i n g  The f i r s t  level  c a p a c i t y , f o u n d w i t h h i g h e r w o r k l o a d s and  changes i n f e t a l  studies  differences  two s t u d i e s were p r o b a b l y due t o a h i g h e r  placental diffusing the  but the  by t h e e x e r c i s i n g  34  other  Nelson et a l . ,  the exercise  animals,  animals aborted or d e l i v e r e d  in  early  level  b u t 15 o f t h e (indicating  the  exercise  did  not  body,  l e v e l was  severe).  induce chronic  organ,  change as  h y p o x i a because the  placenta  - of the  they d i d i n the  A subsequent study w i t h used  on  capacity.  a n i m a l s exposed to c h r o n i c  exercise  and  Placental  fetal  and  i n t e n s i t y increased  and  brain  and  exercise these  levels  organs.  intense  The  smaller  Chandler  compromised alkalosis ewes.  was  about  no  and  as  l e v e l s of  to " r e l a t i v e  to  with  the of more  earlier  compromised  less diffusing  t i s s u e w h i c h was  heart  exercise.  G i l b e r t ' s (1978)  with  the  sparing"  decreased  c o n c l u d e d , was  the  diffusing  relationship  supported  (1981) suggested f e t a l  the  e f f e c t s of  reduced  p l a c e n t a l t r a n s f e r during  hypocapnea w i t h  b e c a u s e an  due  therefore  Bell  Mild  not  to determine  by  capacity later  by  1983.  by on  be  f e t u s , i t was  of f e t a l  and  at higher  not  1980)  r a t i o o f b r a i n and  d i f f u s i n g capacity  placenta,  kilogram  the  l e v e l s supporting  The  Nelson et a l . ,  did  ( G i l b e r t et a l . ,  weights,  w e i g h t s had  w h i c h may  exercise  hypothesis.  per  heart  fetal  hypoxia.  kidney weights decreased  w e i g h t t o body w e i g h t i n c r e a s e d The  -  e x e r c i s i n g animals did  guinea pigs,  placental  pregnancy  weights  d i f f e r e n t l e v e l s of m a t e r n a l e x e r c i s e  effects  a  Exercising during  exercise no  affect  e f f e c t s on the  increase equal  caused  to  fetal  uterine  i n the the  the  and  2  pregnant  development  gases.  in  of  Moderate  uptake  blood  was  maternal  in  mild  exercise  significantly  difference across  decrease 35  UBF  exercise  oxygen  a-vO  oxygenation  the  uterus  flow.  The  significant fetal  and  exercise  maternal than  maternal and  changes  mild  for fetal  glucose  uptake, 3)  and  reduced  significantly on p l a c e n t a l  flow.  increased  umbilical in  utilization  as t h e UBF  decreased,  oxygen t r a n s f e r  glucose  exercise.  of g l y c o g e n o l y s i s glucose  in  maternal  with exercise  placental  glucose  were b a l a n c e d  the  from  umbilical  blood  by  fetal due  to  increased but  effects  the i n c r e a s e i n  transfer  the  and  being  "birth  term  a significant  dissociation  curve,  of maternal  b l o o d , o r 2)  respiratory  authors caused  carbohydrate  exercise  The  t o 1)  due  could  shift  therefore  arterial  fetal  alkalosis  in  blood  hypocapnia could  and  decrease  flow.  therefore, and  fetal  maternal  exercise  respiration  d u r i n g moderate e x e r c i s e  oxygen a f f i n i t y  conclusion, of  alkalosis  oxyhemaglobin  alkalemia  days o f  fetal  of  which i s g r e a t e r than  growth.  were 1)  and  extraction  maternal  levels  mild  moderate  increases  The  respiratory  increasing  In  fetal  were  levels,  after  with  hemoconcentration.  Maternal  the  reduced  blood  maternal  lactate  stimulation  concentration,  were g r e a t e r There  hyperglycemia 2)  hemoblobin  exercise.  concentrations  Reasons  reduce  blood gases  b l o o d g l u c o s e and  lactate  liver,  i n maternal  close  that  short-term  significant metabolism  t o term  i n the normal  36  in  weight  fetal fetal  gross e f f e c t s  s t u d y were b o r n range.  realistic  disturbances  could affect  v i g o u r " more t h a n  lambs i n t h e and  felt  within  on five  in  sheep, wellfetal (5)  Maternal  exercise  growth and Lower  development  levels  placental of  of  's  diffusing  (45  or  60  appearance  of  The  in  in  1983)  and  placental  Parizkova and  fetal  (1978)  postnatal  pregnant during  (EE,CE) or  did  not  on  other  cardiac  muscle  density  was  regular  optimal  fiber  on  i n the  CC  (E)  or  a  a  the  at  the  changes  in  were  an  decrease lab  in  (Smith  volume or  et  decrease  volume.  the  e f f e c t of  prenatal  microstructure.  The  did  (C)  not  i n the  group  Parizkova  workloads during  1)  2)  present  with  The  37  or  exercise  male o f f s p r i n g e i t h e r  EE  to  placental  exercise  (EC.CC).  group.  diffusing  due  f o r the  blood  cardiac  their  was  weights.  low  work i n t h e i r  blood  levels  statement  The  term,  during  in fetal  exercise  fetal  with  morphology  rats either exercised and  decreased  higher  to e x e r c i s e  r a t s to study  exercise  gestation,  and  mechanisms not  placental  used  1983).  weights.  before  capacity  based  et a l . ,  stressful, affecting  mechanisms p r o p o s e d  a decrease  m a t e r n a l and  be  fetuses  aborted  diffusing  exchange s u r f a c e , al.,  fetal  some a d a p t i v e  levels.  fetal  minutes/day)  workloads could  whereby t h e  capacities  on  with G i l b e r t ' s e a r l i e r  and  diffusing  alteration  30  a d i f f e r e n t response  process  placental  or  (Nelson  minutes/day) decreased  increased  had  pigs  effects  whereas d i f f u s i n g c a p a c i t y  capacity,  selection  lower  (15  f i n d i n g s agreed  (1979) t h a t  capacity  detrimental  i n guinea  exercise  weight  exercise  Nelson  produced  highest and  density the  suggested  pregnancy  (E)  exercised  the  of  lowest  that  with  positive  effects the  of e x e r c i s e could  be  e f f e c t s o f e x e r c i s e on  the o f f s p r i n g (EE) group  increased  exercise  compared  density  was  suggested First,  not  regular optimal  t o t h e CC  t h e same as  offspring, t h e EE  but  group.  increase i n p l a c e n t a l blood  the  fetal  changes  were  due  to i n c r e a s e d  glycolysis,  and  l e v e l s of p y r u v i c a c i d , l a c t i c  acids,  thereby  elements  and  repeated  the  no  lipolysis,  increasing modifying  study  were  the  maternal placenta  i t s development.  w i t h m a l e and  Second,  free  fatty  to  these  exposure  Parizkova  sexes.  The  e f f e c t of maternal  metabolism  - lipid  e x e r c i s e on  and  fatty  c h o l e s t e r o l l e v e l s of f r e e f a t t y lipid (1978) days days,  s y n t h e s i s was in  concentration,  acids  (FFA),  cholesterol.  fatty acid concentration  higher  The  38  serum  and  (C).  Petrasek (35-108 At  serum c h o l e s t e r o l l e v e l s  E f e m a l e s had  in their  lipid  c h o l e s t e r o l and  female o f f s p r i n g  ( E ) o r were s e d e n t a r y  t h e E o f f s p r i n g had  F F A ' s and  s e l e c t e d f a c t o r s of  i n v e s t i g a t e d by P a r i z k o v a  exercised  found between  acid  f o u r g r o u p s o f m a l e and  o l d ) who  (1979)  f e m a l e o f f s p r i n g and  d i f f e r e n c e s i n c a r d i a c m i c r o s t r u c t u r e development  the  which  catecholamines,  a c i d , and  fetus'  two  workloads  r e l e a s e of  liver,  CE  development.  to the  daily  if  increased  i t s f u t u r e development.  increased blood  The  flow during  modified  and  the  fetal  change i n d i s t r i b u t i o n of blood heart  and  postnatal  There  e x e r c i s e and  the  execise.  cardiac microstructure with  reasons f o r the changes i n the  the  fetus,  c a r d i a c muscle would i n c r e a s e  continued  their  t r a n s f e r r e d to the  a higher  lipid  35 of and  whereas the E males  had  a lower  the  other  and  90  o r no change i n l i p i d  groups.  Liposynthesis  d a y s , and  i t was  higher  concentration  acids,  and  100  repeated  changed  of  cholesterol,  metabolites  in  Petrasek  the  E  in  fetal  The  blood  synthesis  offsprings'  which  to  may  The  levels  and  from  lipid  have c a u s e d  the i n c r e a s e  development  regardless  was  suggested  concentration lipid The  may  metabolism fat  an  males,  be due  deposits  pregnancy has  that  and  even  stimuli  during  that  concentration  Wilson  and  and/or  during  continued  metabolism  the  that  caused  their  to s t i m u l i  life.  serum may  during  liver  sex  lipid of  hormones. purposes  lipid  -  metabolism  compared  lipid  It  dimorphism  E x e r c i s e was  the i n c r e a s e d  higher  t h e mother  i n f e m a l e s have a v a r i e t y o f  prenatal  a  postnatally.  to the a c t i o n of female  sensitivity  FFA lipid  increased  evidence of a p o s s i b l e  therefore,  because  maternal  females'increased  at  lipid  i n the f e t u s  of p h y s i c a l a c t i v i t y  lactation-  increased  metabolites  lipid  intestine  have c a u s e d  a  fatty  increased  i n the o f f s p r i n g s ' l i v e r s . other  of  livers  concentration o f FFA  35  E m a l e s had  proposed  leading  to  i n E females at  exercise increased  therefore,  compared  i n the s m a l l  and  aerobic  levels,  lower  v a r i e d i n E males.  Pariskova  maternal  blood  was  lower c h o l e s t e r o g e n e s i s  days.  metabolism  concentration  to  the  the suggested  and  fatty  acid  .  Gisolfi  (1980) s t u d i e d  pregnancy,  training  and  through  39  r a t s who  their  pregnancy  exercised  offspring. (TT)  had  before  rats a  who  higher  oxidative the  enzyme  (soleus  other 3 groups.  The  cytochrome r a t s who  oxidase) a c t i v i t y  started  pregnancy  (NT-T) had a h i g h e r o x i d a t i v e  the  group  that  the  control  no  differences  trained control  oxidative,  skeletal  during  g r o u p s was  and  weight studies  between  during  was  gestation,  based on f a t - f r e e w e i g h t rats  The  possible  had  found  contractile of  rats  The  and  adjusted  for  with  human  non-pregnant  women  1972).  the h i g h e s t m o r t a l i t y  causes f o r increased  was  which agreed  (Seitchik,  NT-T  between pregnancy  consumption  on e n e r g y n e e d s o f p r e g n a n t and  T-T  and  found between t h e  no d i f f e r e n c e  r a t s when o x y g e n  the  or  offspring  the c o n t r o l .  i n VO max 2  T h e r e was  gained  (T-NT)  VO max o f t h e 2 l o w e r a t t h e end o f g e s t a t i o n t h a n t h e TT  g r o u p , b u t no d i f f e r e n c e  non-pregnant  glycolytic  muscle  gestation  and C g r o u p s .  than  whereas o t h e r s ( C o r b e t t e t a l . , 1 9 7 9 ) in  of  during  enzyme c a p a c i t y  stopped t r a i n i n g d u r i n g pregnancy  (C),  properties  training  than  The  offspring  i n the f i r s t  mortality  28  of  days.  i n t h e T-T  rats  were 1) unknown e f f e c t s o f s h o c k a v o i d a n c e t e c h n i q u e s u s e d t o force  rats to exercise,  observed The T-T  but  ,not c o n t r o l l e d ,  and/or  r a t s g a i n e d l e s s w e i g h t , b u t had  as t h e o t h e r g r o u p s . differences days,  2) m a t e r n a l c a n n i b a l i s m  W i l s o n and G i s o l f i  3) l o w b i r t h  t h e i r g r o w t h was  was  weight.  t h e same l i t t e r  size  f o u n d no s i g n i f i c a n t  i n t h e w e i g h t o f male o f f s p r i n g  therefore  which  b e t w e e n 45 and  not a f f e c t e d  by  65  maternal  exercise.  Parizkova  (1978)  found male o f f s p r i n g  be l i g h t e r t h a n t h e m a l e o f f s p r i n g 40  of e x e c i s i n g  mothers  of n o n - e x e r c i s i n g  to  mothers.  There  was  no  densities (1980)  difference  in  male  whereas  in capillary  offspring  and  mothers.  W i l s o n and G i s o l f i  between  i n W i l s o n and  Parizkova's  capillary  muscle  or  study (1978)  density  in  cardiac  muscle  Gisolfi's  study  found  offspring  of  and  greater  exercising  (1980) suggested t h e d i f f e r e n c e  t h e two s t u d i e s was t h a t t h e y c o n t r o l l e d  influences.  a  the  genetic  t h e t e c h n i q u e s used t o p r e s e r v e t h e  tissue  specimens.  Exercising  during  weight  development  or  studied  pregnancy  mean  of the diaphragm muscle i n  After  mating,  r a t s continued to run a t a lower rate  alter  the  The t r a i n i n g  to control rats,  mated.  PC r a t s had l a r g e r  The  The  to  was occur  s i z e s between  during PC and PR  have  gestation. rats  was  because o f i t s r o l e  in  movements ( F B M ) .  As an i n d i c a t i o n o f  the  t o human f e t a l  conditions  sensitive  (Marsal,  1979).  i n t h e diaphragm muscle would  severe conditions with  41 \  or  m u s c l e was e x a m i n e d  proposed t h a t changes under  gain,  s i z e s w h i c h may  c o n d i t i o n FBM's were c o n s i d e r e d more similiar  d i d not  who were n o t a c c l i m a t i z e d litter  or  insignificant.  breathing  fetus'  (PR)  b a s e d on w e i g h t  greater weight gain  in litter  diaphragm  fetal  FHR,  their  difference  statistically The  before mating  r a t s ' normal development,  when compared  attributed  Female  rats  t o r u n n i n g on a t r e a d m i l l b e f o r e m a t i n g .  (PC).  1983).  the  acclimatized  sedentary  a l . ,  fetal  were  the  et  on  rats  were  (Mottola  had no e f f e c t  possible  than It only  preferrential  treatment  similiar  suggested  examining  nutritional Another  to the heart,  matermal  sample s i z e .  found  that  pregnant  pressure  during  was  a  in a  In conclusion,  exposure,  simulation  and  comparable.  a l . (1983)  of the (1983).  because  the  d i d not  increased  their  size  and  f e t u s e s (12 t o  effect  of  Sheep  diving  40  during  were s e l e c t e d a s  responses  number  atmospheric  of  to  a  hyperbaric  offspring  were  The s e r i e s o f m a r g i n a l l y - t o l e r a t e d d i v e s by t h e  sheep d i d n o t a f f e c t  explained as  the  lack  health.  from  alterations  development, ' or  the  that  the  Bolton-Klug's to shallower  anatomical  earlier  Boltonhyperbaric  were  effects  t o show i n t h e s m a l l s a m p l e s i z e  were n o t f o u n d i n g r o s s  of c o n c e p t i o n  the fetuses  of e f f e c t s  physiological  during  infrequently  diving  to a i r at  peak d e v e l o p m e n t o f t h e i r  humans  In  Mottola et  changes.  sheep  model  for  with  c h a n g e s w h i c h w o u l d have been e v i d e n t  Bolton-Klug  reversed  changes  may  gestation,  exposure  exercise.  m i l d a e r o b i c e x e r c i s e d u r i n t pregnancy  Exposing  of  (n=5) w h i c h  c a u s e any d e v e l o p m e n t a l  Klug  Mottola signs  d e p r i v a t i o n during maternal  e x e r c i s e was t h e s m a l l s a m p l e s i z e  larger  pregnant  for  o f f e r e d f o r the lack of f e t a l  have m i s s e d s l i g h t  days)  and l i v e r .  a more s e n s i t i v e m u s c l e  (chemical)  reason  brain,  (n=14),  either occured and/or  examinations.  work ( B o l t o n ,  1980)  she  advised  d e p t h s o r no d i v i n g a t a l l a b o u t t h e t i m e  or i n the 1st trimester.  Lotgering et al.(1983b)  examined temperature, 42  u t e r i n e oxygen  consumption,  and  between f e t a l  and m a t e r n a l t e m p e r a t u r e ,  and  during  changed  temperatures \  and  b l o o d gases  response  temperature  changes i n the mother,  the a m n i o t i c f l u i d  and  in fetal  The  was  due  transfer  efficiency  increase  i n f e t a l metabolic rate.  of  the  C  fetal  metabolism There  was  during  to the heat  a  rapid  capacity  w i t h o u t changes i n heat  a c r o s s the p l a c e n t a .  demonstrated  0.5  higher  temperature  the f e t u s ,  difference  at r e s t ,  to d i s s i p a t e heat to the mother.  slow  exercise  The  to the higher r a t e  relatively  of  sheep.  maternal exercise.  were r e l a t e d  requirement  in fetal  The  There  was  decreased  occurrence  of  s h u n t i n g w i t h i n t h e u t e r u s a s p l a c e n t a l VO  no  UBF  major during  preferrential  was  maintained at  2  or  slightly  requirements were  not  oxygen The  control  requirements  fetal  maternal was  hemoconcentration concluded  placenta i n prolonged  exercise  because  maintained and  f o r the  periods  rest.  t o what e x t e n t  l e v e l s were  exercise  animal l i t e r a t u r e  documented  oxygen  of  It  total  was  not  fetal-placental  during  within  during  exercise.  normal  levels  uterine  oxygen  exercise  i n c r e a s e d oxygen e x t r a c t i o n .  t h a t m a t e r n a l e x e r c i s e was  hypoxic event  specified  The  s h o u l d have i n c r e a s e d  oxygentation  consumption  values.  t o t h e same e x t e n t as a t  to assess a c c u r a t e l y  during  The  the  o f t h e f e t u s and  met  possible  above  not a major  due  to  Lotgering  stressful  or  fetus.  has had time  animals forced during  to exercise for  gestation.  One  the e f f e c t s of v o l u n t a r y e x e r c i s e of mice  43  study during  gestation 1981).  and  lactation,  The d a i l y  - was  tallied  divided the  on l a c t a t i o n  activity  during  their  group  growing phase.  after  mating.  gradually  decreased as g e s a t a t i o n  markedly  before  increase  during  delivery.  not  affect  lactation.  of e x e r c i s e  females' a c t i v i t y Jenkins  and  control,  forced  of e x e r c i s e acids.  during  activity  Exercise  motor  brain  level  during  (1980) used t h r e e  gestation  The e x e r c i s e  or  effects,  exercise  the  study  certain  dose f a i l e d  physiologic  nucleic acids  to a l t e r  indicating  -  nucleic  had a l o w e r w e i g h t g a i n  adaptations  The dams  44  nucleic  occured The  to'  poorer  offspring,  on  d i d h a v e some  involvement who  of  exercised  possibly indicating their  c o m p a r e d t o t h o s e who could  on a  engough t o p r o d u c e  selective  voluntarily  they  brain  of the o f f s p r i n g .  v e s t i b u l a r system.  therefore  rats  to exercise,  i n d i c a t e d that maternal exercise  work  of  v o l u n t a r i l y , on a t r e a d w h e e l , d i d  or  exercise,  to  - to study the e f f e c t  t h e d o s e was n o t i n t e n s e  possibly  total  did  on t h e o f f s p r i n g ' s b r a i n  cerebellum  greater  d i d not  pregnancy  groups  p e r f o r m a n c e o f t h e t r e a d m i l l r u n dams'  Rotacone,  exercise  l a c t a t i o n on l a c t a t i o n b e c a u s e t h e  and v o l u n t a r y  therefore  protect  the  Voluntary  t o t a l work t h a n r a t s who were f o r c e d  change  were  l e v e l s were t o o l o w .  R a t s who e x e r c i s e d  acids,  mice  treadwheels) or  I t was n o t p o s s i b l e  during  Ciconne  treadmill.  rotations  l a c t a t i o n b e c a u s e s u c k l i n g t h e young l i m i t e d  f e m a l e s ' f r e e movement.  a  The  a l . ,  p r o g r e s s e d and i t d e c r e a s e d  The  the  effect  et  o f t h e mice - t r e a d w h e e l  i n t o t h e e x e r c i s i n g group (cages w i t h  sedentary  more  (Karasawa  reduce  were  forced  their  to  weight  significantly brain  In  without  nucleic acids  conclusion,  to exhaustion  with  normal  some  during  healthy  Chronic  effects  a n d / o r motor  exercise  on t h e f e t u s concern  pregnant  ,  during  fetuses  ewes e x e r c i s e d  offsprings'  that acute  exercise  o f normal h e a l t h y  did  gestation  whether  found  prenancy  fetuses  their,  performance.  the animal s t u d i e s  bouts  effects.  o b v i o u s e f f e c t s on  not  have  any  pregnancy  long-term  produced  and i t s outcome. suffered  to exhaustion  ,  animals  from but  varied  There  was  hypoxia  in  a l l offspring  were n o r m a l a t b i r t h .  Rat  offspring  may  affect  lipid  studies  cardiac  found  that  microstructure,  metabolism.  One s t u d y  intensity  before  offspring  m o r t a l i t y w h i c h may  design  The  exercising animal these  studies  during  during  provide  studies  physiology different  had  in  a  between  animals with  density,  exercise  pregnancy  led  and  at a  to  have been due t o  high  a  higher  experimental  exercise.  Drawing  direct  forced  to  humans  conclusions  t o humans must be done w i t h  of exercise  period  that  pregnancy  a model from w h i c h t o s t u d y  pregnancy.  literature  duration time  and  during  capillary  found  or the e f f e c t s of maternal  animal  exercise  caution  exercise,  from since  and  the  a n i m a l s does n o t e q u a t e t o t h e same  human.  In  animals  and  e f f e c t s on a human  45  addition, humans  pregnancy.  differences could  result  in in  The  major  subject  d i f f e r e n c e w i t h human s t u d i e s  would  possible  exercise  consequences  voluntarily, of f o r c e d  i s that  thereby  exercise  the pregnant  eliminating and  the  accompanying  stress.  Human  Human  Studies  studies,  statistical of  the  most o f w h i c h a r e a n e c d o t a l  a n a l y s i s , have  animal studies  or too small f o r  n o t shown t h e same r e s u l t s a s many  - shorter  birthweight.  46  gestation,  lower  infant  Physiological  The  Changes d u r i n g  physiological  changes  during  Pregnancy  changes  w i t h pregnancy are  submaximal a e r o b i c  trained  i n d i v i d u a l - increased  volume  and  red  resistance. and  The  pregnancy  anecdotal In  blood  or  poorly  accommodate  the  Respiratory  Changes  Anatomical  changes  the but  thoracic an  cage.  increase  and  volume(20%),  stimulate minute  The  in  the  pregnancy of  the  peripheral training  and  involve the  in  the  uterus  volume(30%), expiratory to  the  respiratory The  by  to  respiratory  presses  depth of the  up  against  the  thorax,  broadening  capacity  higher  in  lead  physiological  to  shunt  of are the and  the  include (5%),  residual  funtional  levels  of  capacity  (15%),  stimulant,  c e n t r e s and  47  the  inspiratory  a decrease The  effect  changes i n pregnancy  a known r e s p i r a t o r y  ventilation.  blood  literature  changes  uterus  decreasing  respiratory  leading  in  during  the  systems,  size  (FRC),(18%).  progesterone,  in  i s counterbalanced  in tidal  decrease  capacity  during  thereby  t h i s decrease  endurance  fetus.  increasing  diaphragm,  occur  physiological  growing  an  to  studies.  cardiovascular  The  decrease  noted  contolled  in  output, increased  volume and  usually  major  respiratory,  cardiac  c h a n g e s w h i c h would are  pregnancy,  system.  cell  exercise  similiar  residual  circulating thought increase dead  to in  space  do  not  of  change u s u a l l y d u r i n g  pregnancy  pregnancy.  d e c r e a s e s PaCO  The  hyperventilation  (29-31mmHg) w h i c h i n c r e a s e s  pH  2 to  the  7.43  sodium At  - 7.46  bicarbonate  term, the  the  pulmonary  The  closing  airways  volume to  i n FRC,  affecting  tidal  tidal  breathing  could  account  significantly  increased,  (CV)  - the  and  lung  c l o s e - does not CV  maybe g r e a t e r  volume.  loss  increased  resistance volume  at  change,  or  possibility  for  r a t e of  the  high  which  the  with  the  FRC,  A l v e o l a r c o l l a p s e may  (32%),  decreased.  but  than the  i n c r e a s i n g the  therefore  occur  during  of hypoxemia,  dyspnea  and  reported  in  Changes  most d r a m a t i c cardiac  increases  (30-50%) from  3 0 t h week,  to  pre-pregnancy  increase  changes i n pregnancy are  output  the  in  the  f e t u s and  red  blood  the  compensatory  women.  Cardiovascular  (BV),  to  mEq/liter).  compliance  decrease  The  (21  o x y g e n u p t a k e has  begin  pregnant  range l e a d i n g  cell  (Q), the  plateaus  end  2  results.  The  ([Hb]) are  lowered  the  first  period  weeks  plasma,  hematocrit  blood  volume  Blood  volume  trimester before  postpartum.  f o r blood  volume i n c r e a s e s as  of  uterus.  volume i s t o meet the  to compensate  same e x t e n t  the  for a short  values  blood  and  in  during  decreasing The  metabolic  i n pregnancy  48  and  large  needs  loss at d e l i v e r y . gestation,  but  therefore a "dilutional  (Hct)  until  hemaglobin  ( to values  of  not  of The to  anemia"  concentration 33-38% and  11-  12mg/100ml, The  respectively).  c a r d i a c output  i n c r e a s e s (30-50%) and  peaks  between  28-32 weeks,  values  the  few  term  last  depends on  occurred  since  position  versus  decreases  as  the  inferior  the  lower  the  The  blood  size  uterus  values in  blood  because of necessary  the  decrease  i n Q at  measurements  in  the  lateral  cardiac  i n c r e a s e s and  output  presses  on  i n c r e a s e i n venous p r e s s u r e  to the  pressure  of the  uterus  a maximum a t term and  peripheral  resistance  especially  increases ten-fold term. but  In t h e  in on  falls  is  to  probably  estrogen  (10X)  acting  flow  i s not  from  the  non-pregnant  becomes v e s s e l - r i c h to the  routinely  i n v a s i v e techniques  on  maximally  dilated  with  1981).  49  blood  term w i t h  therefore  the  pregnancy  p l a c e n t a and  20%  measured  humans  in  to  involved, therefore, i t i s  Uterine at  pre-  state  to o l d e r s t u d i e s ( M o r r i s et a l . ,  to  (Gibbs,  pre-pregnancy  1981).  UBF  dependent,  volume,  delivery.  studies for data.  pressure  The  The  animals be  sitting. uterus  u t e r i n e blood  to r e f e r  The  found  hormones,  gm,  muscle.  to  are  reaches  at  to  t o 60  of the  uterus  the  total  flow  state  i s 30  80%  or  of  vena cava  to s t e r o i d  pregnancy  the  supine  blood  o f t h e women when  smaller decreases  vessels (Gibbs,  Uterine  with  position  vena c a v a .  decrease  secondary  the  the  pre-pregnancy  declines  weeks o f g e s t a t i o n .  e x t r e m i t i e s due  inferior  and  like  a  the  lack  1956)  vessels are blood of  flow  or  thought being  autoregulation  Effects  of Exercise  Studies  and P r e g n a n c y  of exercise  during  p r e g n a n c y have r e p o r t e d  o f p r e g n a n t women t o e x e r c i s e or  serially  expected  gestation.  responses of a healthy  ergometer reported of  through  stress testing  a t one  The s t u d i e s  provide  respiratory  responses,  responses, outcome  work  capacity,  of pregnancy,  categories  responses,  physical training  and e f f e c t s  have  The v a r i a b l e s  i n t o s i x main  cardiovascular  the  bicycle  A few s t u d i e s  maximal r e s p o n s e s t o e x e r c i s e t e s t i n g . c a n be c l a s s i f i e d  instance  p r e g n a n t woman t o a  o r t r e a d m i l l submaximal t e s t .  interest  responses  thermal  effect  on t h e f e t u s o f  on t h e maternal  exercise.  Respiratory  Pernoll  et  a l . (1975a) s t u d i e d  p r e g n a n c y and p o s t p a r t u m submaximal  bicycle  consumption  women  throughout  t o compare oxygen c o n s u m p t i o n  testing.  (VO ) ,  pregnant  at rest  They f o u n d and d u r i n g  that  the  exercise,  during oxygen  increased  2  gradually  as t h e p r e g n a n c y  progressed  with  VO  reaching  peak  2  values  new t e r m .  A t t h e peak, t h e VO  at rest  was 33% above  2  non-pregnant  values,  above n o n - p r e g n a n t  and d u r i n g  values.  exercise  i t was s i g n i f i c a n t l y  The a v e r a g e VO  during  the post-  2  exercise assumed of  periods  increased  the increased  the exercise.  throughout  the pregnancy.  oxygen consumption  Minimal  was due t o t h e  work was i n v o l v e d 50  Pernoll cost  i n t h e movement  and  carrying  since  o f the  cycling  oxygen  cost  e x t r a weight  i s a non-weight would  also  be  gained  bearing  myocardial  during for  late  due t o i n c r e a s e d Q. 2 p r e g n a n c y was g r e a t e r t h a n  explain  why  the  effficiency  during  pregnancy.  In  subsequent  a  exercise, increase  myocardial  study  P e r n o l l and  volume  which (TV).  significantly trimester  was  due  The  carbon  at  rest  (22-26 w e e k s ) .  change  significantly  carbon  dioxide  The  with  than  greater  exercise during  was  lower a t r e s t  the  and  tidal  second did  tidal and  not  volume exercise  signifying  both a t r e s t  and  increased  respiratory quotient  postpartum,  hyperventilation  at r e s t  end  and  significant  production  The  not  declined  rest  a  VO  could  at  (VE),  in  2 amount  work  rates  the  increase  authors  (1975b) f o u n d  exericse.  concentration  pregnancy  alveolar  with  2)  The  muscular  dioxide  of  increase  to a s i g n i f i c a n t l y  and  work  estimated  ventilation  associates  Increased  the  i n e x p i r a t o r y minute v e n t i l a t i o n  exercise,  during  The  work.  of mild  on  1)  p r e g n a n c y and  VO  r e s p i r a t o r y and  pregnancy  activity.  a t t r i b u t e d to  muscles i n h y p e r v e n t i l a t i o n during in  during  relative  exercise  during  pregnancy.  Edwards o f VE, late  et al.(1981) focused VO  in  Pregnant  , VCO , 2 2 pregnancy  subjects  before (38  their  and  after  weeks) and  significantly  work on  r a t e s of  steady-state postpartum  higher  VO  ,  changes exercise,  (3  VE,  months).  and  VCO  2 rest  and  a significantly  greater  51  absolute  increase  i n VE  at 2 from  rest the  to e x e r c i s e first  VE  90  seconds of  increased  recovery were during the  the  After sitting  pre-exercise  rest  c a u s e an  increase  on  the  to  in  pregnancy  and  p o s t p a r t u m maybe due  of  the  extremity  were  efficiency  would  in  postpartum.  to  VCO  the  elicit The  VE  The  veins.  The  on  VE.  increment with  the  to the  6  minute that  blood  slow  pattern  during  during  the  the  vessels  recovery  increases the  and but  rates  refilling  in  VE  during  same w o r k l o a d  and  a v e n t i l a t o r y response greater  Therefore, exercise  ,  muscles of  similiar  therefore,  In  postpartum)  e x e r c i s e was  accelerated  p r e g n a n c y was  than  similiar  and VO s u g g e s t i n g an u n u s u a l r e g u l a t o r y method 2 2 b l o o d f l o w c a r r y i n g deoxyheraaglobin and CO to the 2  regulated  CO  heart.  greater,  and  bicycle for  pressure  venous r e t u r n  pregnancy  than  lower e x t r e m i t y  of  VCO  Edwards s u g g e s t e d  and  lower  the  subjects.  2 postpartum,  (pregnancy  period,  sudden c o n t r a c t i o n o f t h e  l e g s would  postpartum  6 minute b i c y c l e t e s t ,  f o r both c o n d i t i o n s  same.  the  s t a t e ) than  more r a p i d l y i n p r e g n a n c y  rates  the  (steady  where lungs  ventilatory  due  to  increased  flow. 2  Cardiovascular  Some o f  the  circulatory  those  from  volume,total peripheral  Ihrman  physical blood  c h a n g e s i n p r e g n a n c y were the training-  volume,  r e s i s t a n c e (Ihrman,  (1960)  studied  increased  cardiac  52  output,  1960;Gibbs,  circulatory  red  same  blood and  fall  as  cell in  1981).  changes  with  physical  training  i n pregnancy.  exercise,  where  twice  a  pulse  frequency  the  Physical heart  training  r a t e was 140  week f o r 10 weeks.  cardiac  between t h e t r a i n e d and  output  circulatory  that  adjustment  not influenced  three  bouts o f very  since  high  intense  anaerobic  than  aerobic.  fitness  1981), l o n g e r  Mild  than  duration,  exercise  pregnancy.  minute),  there  cardiovascualr of  was response  blood  pressed  increased  Cardiac  the  output  exercise  f o rseveral  that  due  the  sessions eta l . ,  ergometer  were  constant  (200kpm  decline to  the  in  vena  cava  per the  peripheral  o f venous r e t u r n ,  the i n f e r i o r  more  increase  ) on t h e b i c y c l e  (reserve)  53  minutes  intensity.  progressive  peaked  how  not  D u r i n g moderate e x e r c i s e  and o b s t r u c t i o n  against  to the  - p e r h a p s t h e work was  responses  a  other  The p r o g r a m c o n s i s t e d o f  activity  100 kpm p e r m i n u t e  throughout  1969).  the  between t h e 2 0 t h  The s c h e d u l e would  and/or  cardiovascular  uterus  increase  2 t i m e p e r week ( a s i n S i b l e y  produced  pooling  pregnant  by a c i r c u l a t o r y  i n a n o n - p r e g n a n t woman u n l e s s  were more f r e q u e n t  in  i t was n o t s p e c i f i e d  r a t e was e l e v a t e d .  t i m e s p e r 35 m i n u t e s e s s i o n  aerobic  but  "heavy" t o d e s c t i b e  maybe q u e s t i o n a b l e  the heart  3  group,  by heavy e x e r c i s e ,  The t e r m  long  -  untrained  p r e g n a n c y was c h a r a c t e r i z e d  3 0 t h week.  intensity  no d i f f e r e n c e  T h e r e was a s l i g h t  i n the exercised  of  post-exercise  a d j u s t m e n t s were n o t a f f e c t e d w h i c h l e d  conclusion  and  bpm  Ihrman f o u n d  women on t h e b i c y c l e e r g o m e t e r . in  was 35 m i n u t e s  as the  (Ueland  ,  20-24 weeks and was m a i n t a i n e d  until  the  levels  32nd week when Q began t o  between  increased maximum  slightly values  cardiac  nutrition induce  confirmed  needs  were  responses  to  and  since  The  and  work  could  by  cardiorespiratory  women from  the f i r s t  they proposed  which  Ueland  that  on  reserve cardiac  trimester  the  was  bicycle  suggested  both  states.  in  Q was t h e  same  the  in  resulted  output until  on  a t lower workloads  increase  delivery,  cardiac  i n pregnant  or  no and  Adequate increase  in  uptake,  pregnancy  and  woman's h e a r t  women than  reaching  postpartum.  until  t h e 20th  week  and  which  differs  from  Ueland's  o u t p u t which  54  that  mild  o f oxygen  The h i g h e r demands on t h e p r e g n a n t  cardiac  suggest  efficiency  from  The  f o r by t h e  ergometer.  increase  to  the p h y s i o l o g i c a l  l e d the authors to  output per u n i t  increase  responses  i n m e t a b o l i c demands d u r i n g  maximum h e a r t r a t e s  findings  metabolic  a t 29 weeks, was a c c o u n t e d  exercise  the  maintained  that  estrogen  i n an e a r l i e r  in  opinion  i n VO , 2  the given workloads  their  but perhaps  increase  were t h e same i n  increase  postpartum. at  the  women had no d e c r e a s e i n m u s c u l a r  myocardial exercise  to  rate  and r e a c h e d  exercise  fetus,  significant moderate  early  accepted  due  (1970) f o l l o w e d  i n pregnant  increase  pregnant  not  proposed  t h r e e months p o s t p a r t u m ;  uterus  heart  (1966).  exercise  small  non-pregnant  maternal  The  the  of the f e t u s ,  t h e s e changes  Parer  The  to  a t the beginning of gestation  changes  Guzman and C a p l a n to  - 40 weeks.  a t 28 - 32 weeks.  output  hemodynamic  and  38  drop  dropped  to  normal  was  levels  near  term.  cardiac did  output  Ueland  reached that  trimester  not  and s y s t o l i c  Artal  ergometer  al.(1981) maternal  continuous  al.,1979),  expected  compared  light  until  The  norepinephrine the  to r e s t i n g  and  heart  rate  late i n  decreased technique,  during  pregnancy  t h e R time  interval  proposed  concentrations but  redistribution  would be  values.  by Koh  of  these is  et  glucagon,  results  were  catecholamine-  v a l u e s 30  minutes  stopped. which  uterus  i n women a t r i s k  increased  with  with the p o s s i b i l i t y o f premature  the exercise  testing,  55  exercise of  delivery.  s u b j e c t s who e x p e r i e n c e d m i l d i r r e g u l a r  during  first  uterus  f o r 5 minutes,  A l l values returned to baseline  exercise  the  delivery.  exercise  epinephrine,  blood  increasing  concluded  an i n c r e a s e i n h e a r t r a t e  found  and  in  which  blood pressure during c y c l i n g a  heart rate,  after  stimulated  pregnancy  , a t 25 w a t t s  increased  because  mediated.  state  I t was  an i n c r e a s e i n m a t e r n a l  cardiovascular  norepinephrine,  four  found  when e x e r c i s i n g  increased  of  change w i t h t h e  (34-36 weeks) ,  et  labour  state  and d i a s t o l i c  cycle  expected  (a  hyperkinetic did  gestation  hormones, as  and P a r e r ( 1 9 6 9 ) , and n o t due t o b l o o d volume  et al.(1984)  bed-type  t h e changes i n  were due t o o v a r i a n and p l a c e n t a l  but s t a y e d i n a s t a b l e  Pijpers ,  (1970) s u g g e s t e d  peak v a l u e s betwen 30 - 36 weeks.  the  fetus,  Guzman and C a p l a n  but the a c t i v i t y  also  triggering Artal  had  uterine  activity  ceased  when t h e  norepinephrine  levels  were d e c r e a s e d  during  the p o s t - e x e r c i s e  period.  In  a  study  physical found  o f s t r e s s hormones and  exercise  increases  during  Artal  The  increase  supporting  the  in  role  of p r o l a c t i n  exercise  test  minutes p o s t - t e s t .  The  mean  serum  significantly  those  reported  in  1982)  f  during  previously  the  increased  increased  were  pulse  rate,  in  blood  The c a t e c h o l a m i n e versus  significantly  The p r o l a c t i n  levels  prolactin  30 m i n u t e s elevated  uteroplacental exercise  ceased.  flows  compensated cope  blood  were  Morris  due  to  when e x e r c i s e varying  et al.(1956)  during  exercise,  stopped. oxygen  56  at  60 were  elevated  b u t were a t b a s e l i n e that  by  e x e r c i s e d i d not  increased  i n t o maternal c i r c u l a t i o n  decreased  with  were  after  i n the s u b j e c t s  concentrations  Rauramo assummed  levels  Serum  levels.  30 m i n u t e s p o s t - t e s t ,  serum  re-  response  non-pregnancy.  and t h e l e v e l s were s t i l l  oesteriol  levels  the r a t e of p l a c e n t a l s e c r e t i o n of o e s t e r i o l  increased  to  a l .  epinephrine  catecholamines  pregnancy  60 m i n u t e s p o s t - t e s t .  blood  with  of the  than non-pregnant  change  and  catecholamine  and hemodynamics.  not change w i t h  higher  (Rauramo e t  than  plasma  correlated  the  distribution  levels  greater  steriods  e t a l . , 1981.  significantly  did  pregnancy  of norepinephrine  submaximal w o r k l o a d s , by  placental  but blood  availability  the  flow  soon  demonstrated  The a b l i l i t y  but  of  after uterine  flow  was  of the f e t u s depended  on  efficient  development  of  the  placenta.  Pommerance  et  al.  (1974a)  Physical  Fitness  Scores  insufficiency a  f r o m FHR  found  no  (PFS)  and  recordings.  fetuses FHR  had  from A s t r a n s ' s  "positive"  recording  labour  and  indications compromised  and  of  delivery. of  fetal  unbilical  were t e s t e d ,  maximum o x y g e n  p r o t o c o l , g i v i n g the  t e s t s between pre  four  these  and  infants  Seven  and  had  s i x of  on  uptake  PFS.  Five  psot-exercise problems  additional  distress  between  uteroplacental  Subjects  b i c y c l e a t 35-37 weeks g e s t a t i o n and  were p r e d i c t e d  correlation  fetuses the  in had  seven  had  changes  in  circulation.  Temperature  Recently,  Jones  maternal in  four  They  body  exercise,  Work  that and  heat  with  (1985) f o l l o w e d and  aerobic  heat  storage  exercise  storage  concluded  maintained  individual  al.,  temperature  women d u r i n g  found  was  et  that  did  the  advancing  the (heat  content/kg)  throughout  gestation.  not  increase  during  s u b j e c t s ' thermal  balance  pregnancy  due  to  their  exercise prescriptions.  Tests  Early  work  assessment (PWC).  PWC  by in  Dahlstrom pregnancy,  was  a  and  Ihrman  utilized  constant 57  value  (1960),  physical  on  work  throughout  fitness capacity  pregnancy,  decreasing  sharply  a few days a f t e r  delivery.  correlation  between t h e PWC and t h e p r e g n a n t  established  and  stronger over  two  possible  women  grew  different  activity  The  values  PWC  up d u r i n g patterns  toxemia,  adapted  t o t h e work t e s t  et al.(1969).  PWC, a s i n D a h l s t r o m and  PWC.  weight found et  PWC and w e i g h t  al.,1974b).  similiar  to the c o n t r o l  expected  toxemic, age.  pregnant  women's  activity especially increase increases  normal  and had  with  and  system  had  between age and  between  maternal  works,  correlated  pregnant  birthweight  by l a t e r  who  (Pommerance,  women had  PWC  values  women), b u t t h e t o x e m i c  PWC. from  lowest to highest  non-pregnant  were n o t matched pre-pregnancy  f o r women  toxemia  with  blood pressure.  i n blood p r e s s u r e i n toxemic  58  late  because  Soiva f e l t patients  same  physical  in of  was  on t h e  weights.Severe  contraindicator  ,  women o f t h e  f o r weight-based  was a s u g g e s t e d  i n systolic  women  correlation  (non-pregnant  pregnancy,  The c o n t r o l s  war  (1960) o r between  was c o n t r a d i c t e d  r a n k i n g o f PWCs,  normal  were  women.  i n pregnant  were n e g a t i v e l y  The  they  i n hypotensive patients according to  and Ihrman  women had t h e g r e a t e s t The  world  T h e r e was no c o r r e l a t i o n  PWC w h i c h  physically  women, and 2)  the c a r d i o r e s p i r a t o r y  S o i v a found a p o s i t i v e and  o f pregnant  t h a n younger  therefore  1)  therefore  t h e second  were s i m i l i a r  without  Soiva  group  positive  women's age was  were  women c o n c e i v e more c h i l d r e n ,  - r e p r e s e n t e d i n an o l d e r  older  reasons  A  pregnancy the  the  could  great sudden  lead to  premature was  separation  taken  as adequate d u r i n g  to normal l e v e l s  Erkkola  5 minutes  (1976b)  pregnancy,  and  found a  whereas D a l h s t r o m pregnancy. higher (60  The  concluded on  study  Erkkola's  during  group.  (n=51)  Erkkola  whose PWC v a l u e  significantly  shorter  3500  significantly  grams,  of r e l a t i v e  women  had h i g h e r  total  hemaglobin which  The  increased  placenta,  there  found  p l a c e n t a l weight. plasma  plasma  improved  volume,  that  that  than  .  It  pregnant  normal  had  more newborns  over  and f e w e r low  These high blood  PWC  pregnant  volume,  newborns g r e a t e r  and  i t was  influence  healthy  volume was a s s o c i a t e d w i t h circulation,  2 weeks  as a percentage o f  placentas,  higher  l e d to their  59  about  was an i n s i g n i f i c a n t  was g r e a t e r  heavier  per  possible.  t h e pregnancy  spontaneous l a b o u r s ,  values  was  levels  women's PWC's were e x p r e s s e d PWC's.  duration  and Irhraan,  p r e g n a n c y had l i t t l e  i n the t r a i n e d  women  (26 v s 10 w e e k s ) ,  to Dahlstrom  harming  decrease  non-pregnant  training,  PWC was c o n s t a n t i n  work d e m o n s t r a t e d  pressure,  with  a t home v s 35 m i n u t e s  compared  r a t e and b l o o d  pregnant  physical  t o pre-pregnancy  training  returned  p e r week), and g r e a t e r  heart  The  with  change i n p h y s i c a l f i t n e s s  returned  flow  10% s p o n t a n e o u s l y  program was l o n g e r  t o i m p r o v e PWC w i t h o u t that  b e c a u s e t h e FHR  (1960) f o u n d  10 m i n u t e s d a i l y  to d e l i v e r y .  possible  17.6%  3 vs 2 times  a greater  PWC l e v e l s  prior  further  i n Erkkola's  The m y o m e t r i a l  post-exercise.  and Ihrman  minutes plus  therefore  resting  PWC i n c r e a s e d  The t r a i n i n g  frequency  session)  of the placenta.  gas  and  weight.  the  larger  exchange  which  benefited  The  d u r a t i o n o f the pregnancy  factor of  the fetus.  by E r k k o l a e t a l . ,  pregnancy  design  of  eliminated  was n o t v i e w e d  (1976a).  was n o t r e l a t e d the  experiment  They  found  t o t h e PWC,  but  - testing  premature d e l i v e r i e s ,  at  In  w h i c h were t e r m i n a t e d  a  labour was  had l o w e r  this  factor  decreased PWC  and  other  fitness  heart  (1976b)on  Frisch,  1965)  fitness. than  The  the  gestation, tested  The  week medical  premature  Increased  bedrest  p r e m a t u r e l a b o u r and  (1976),  which  authors  rapidly  but  simliar  control  fitness  o f improved p h y s i c a l  (Astrand  and  one s t u d y  (Klepzig  and  correlated  RHV w i t h  women  who were  were  tested  group I I ,  C o n t r o l g r o u p I I was s l i g h t l y  60  The  during  subjects  to the control  group I .  Erkkola's  o f h e a r t volume i n c r e a s i n g  cited  I,  positively  confirming  of the trained  group  were  physical  i n non-pregnant  RHV v a l u e s  the c o n t r o l  (RHV)  as an i n d i c a t o r  that p o s i t i v e l y  a t 38 weeks. the  volume  on t h e r e l a t i o n s h i p  physical training 1970).  1976) .  improving  RHV was u s e d  Rodahl,  38th  threatened  t h e PWC v a l u e s  by E r k k o l a and M a k e l a  based  the  to the  electively.  threatened  affected  due  inactivity.  relative  work  pregnancy.  than  PWC's ( E r k k o l a ,  probably  with  correlated  with  women who  p r e s c r i b e d f o r women w i t h  the duration  number o f p r e g n a n c i e s  a t 40 weeks,  r e t r o s p e c t i v e study,  important  women who developmed  p r o b l e m s were e l i m i n a t e d - and t h e h i g h (27%)  an a n  PWCs  were  physical greater throughout who  were  more f i t  significantly  greater was  i n the  evident  birth  t r a i n e d g r o u p as between RHV  work  pregnancy, until  found  induced  delivery,  toxemia or  maximum  apgar  aerobic  of  and  length  table  subjects  maximum  non-pregnant  No  of  at  previous Pommerance labour  correlation  gestation  or  duration  of  opinion  not  The  the  found  the of  The  no  between 35  subjects  same s t a g e in  parametric  of  predicting were  birth  expressed  were  and  statistical  37  with  by  correlation  of  Erkkola  an  tests  of  length  of  the  61  apgar with  Erkkola. PFS  with  newborn l e n g t h o r  head  view the  duration  (1976a).  similiar The  pregnancies  of to  testing  e l i m i n a t e d premature d e l i v e r i e s  e l i m i n a t e d whose  on  equal  which agreed  outcome o f p r e g n a n c y , by  pregnant  t h a t the p h y s i c a l  pregnancy  d i d not  The  based  represent  t o PFS  weight,  authors  important  and  related  a  fitness  pregnancy.  l e n g t h o f p r e g n a n c y , and  significant  from  t o compare p h y s i c a l  t e s t s would  PWC  of  calculate  obtained  Pommerance assumed  with  The  later  t a b l e s to  values  accurate  from  visible  development  PFSs were i n v e r s e l y r e l a t e d  findings  an  1 minute,  The  1 m i n u t e were n o t  as  baby's head was  labour.  were used  f o r use  i n primlparas,  gestation  at  on  oxygen uptake because they  (PFS)  circumference.  o f PFS  test  influence  Astrand's  capacity.  i n multiparas.  scores  premature  was  scale  significance. labour  scores  subjects.  scores  interval  no  time the  p r e g n a n t women a t  standard  fitness  had  e t a l . ( 1 9 7 4 b ) used  submaximal b i c y c l e levels  PWC  labour,  threatened  Pommerance  the  o r PWC  expected.  weight.  Erkkola's  the  was  and  delivered  after A  42 weeks p l u s a d a y , o r d e v e l o p e d  highly  index  significant  influence, less  pregnancy  a normal  with  previously.  Ihrman's  Erkkola  bicycle.  between ,  1975)  mother.  on m a t e r n a l  Borg's  circulation  test  test  Erkkola.  When p r i m i g r a v i d a e women were t e s t e d  delivery  their  pregnant  women o f t h e same a g e .  (1976b)  found  maximal  PWC,  mentioned Rating  of physical  t h e r e f o r e making i t a  condition  mean p h y s i c a l  PWC  t h a n PER,  condition  was s i m l i a r  10%  38 weeks would n o t  to  by  with reflect  b u t t h e PWC due t o p r e g n a n c y .  t h e v a l u e s were h i g h e r .  found  that  could  be  lactation the  to  2 weeks b e f o r e  Later studies  increased  a  less  according  The  non-  Erkkola  pregnancy, the  non-  predicted  two d a y s b e f o r e and 10 d a y s a f t e r d e l i v e r y 2 i d e n t i c a l (Dressendorfer, 1978), b u t 4 months  delivery  test to  VO  nearly  to  which  i s limited  reliable  pregnant  presumed  t h e s u b j e c t ' s v o l u n t a r y maximal  o f 150 bpm,  at  weight  Perceived Exertion  A submaximal b i c y c l e  PWC  avoids  Erkkola  heart rate  a  confirmed  an o b e s e mother would be  maternal  therefore  Astrand's  (1960) work f o r r e a s o n s  used  that  problems.  supposedly  that  weight  effect  (PER) t o d e t e r m i n e  a  (Erkkola  The A s t r a n d t e s t  had t r a i n i n g  conflicted  on  weight  b u t i t was e x p e c t e d  f i t than  scale  negative c o r r e l a t i o n  and p r e - p r e g n a n c y  Pomraerance's work.  medical  D r e s s e n d o r f e r ' s case  were after study  t h e maximal 0 improved by  u p t a k e and e n d u r a n c e performance 2 during a normal pregnancy and  physical  training  mother o r newborn.  without  A linear  VO  harmful  effects  relationship  between  max and r u n n i n g s p e e d i n n o n - p r e g n a n t s t a t e s was estab2 l i s h e d e x c e p t 2 weeks p o s t p a r t u m when i t a p p e a r e d t h a t t h e 62  subject Most  had  lost  women a r e  postpartum, and  before  not  the  c o u l d not  as  her  be  about  pregnancies its  expected  case running  and  milk  tests,  of her  trimester  run  run  too  slow.  to f o u r  weeks  since  same s t a t e  on  be  running  delivery  of  fitness  by  the  effect. no  et  al.  during  percentage  the  losses.  major  subject's  by  training  Second,  the  subject's heart rate rate,  d i d not  . Third,  the  during  a case  produce  the  study  in  first  decreased,  unreasonable  contraindiations  to  decrease  when m i l e a g e  I t would be  r e p o r t was  three  affected  uptake  pregnancy,  to  First,  fluid  pregnancy oxygen  has  to  in  pregnancy.  the  conclusions  s u b j e c t examined.  (1981)  examine the m e t a b o l i c , running  the  a p p l i e d to the  Hutchinson  led  pregnancy.  c o s t s and  second  Since Dressendorfer's  to  approach  p r o d u c t i o n were n o t  a detraining  that  only  and  maximum  of the  suggested  can  not  i n the  n o n - p r e g n a n t maximum h e a r t  estimated  assume  had  which e l e v a t e d the  serious effects  the  had  t o e x e r c i s e two  t o be  study  high c a l o r i c  treadmill  any  encouraged  and  delivery.  findings  90%  pace s e n s e  subject probably  Dressendorfer's  and  racing  used  the case  respiratory,  and  pregnancy.  The  maximum VO  to perform  study  method  circulatory  metabolic  stress,  to  responses indicated  t h e work t e s t  (a ten  increased  during  2 minute  submaximal  pregnancy.  The  be  during  decreased  from  the  treadmill  authors  substantial  test),  suggested  pregnancy  due  that running  to the  should  increase stress  i n c r e a s e s i n oxygen u p t a k e ,  63  speed  heart  seen rate,  and  v e n t i l a t i o n as t h e pregnancy  oxygen  u p t a k e was p r o p o r t i o n a l  increases not  i n heart  rate  proportional.  constant 70%  et  maintain period  al  their  the study  decreasing  .(1981) initial  exchange r a t i o  capacity  pregnant  physical  was assumed  women  were  fitness level  The c o n t r o l  period  reach  within  over  respectively. of d e l i v e r y  less  were to  be  able a 12  (determined  fetal  heart  were w i t h i n mothers'  rates  clinical  infants and  test  ) without  norms.  Blake  scoring  the  published,  but  able  values  on  effects.  treadmill  test  scores of the trained  9 and 10  The a p g a r  rate  Multistage  were h i g h w i t h 6 o f t h e 7 i n f a n t s  one i n f a n t  efficient  and were a l l  undesirable  The a p g a r  training  A l l the subjects  modified  b e f o r e and a f t e r  minutes, r e s p e c t i v e l y . not  by a  to week  and work  72% o f t h e i r maximum oxygen c o n s u m p t i o n  treadmill  9  g r o u p became  w i t h oxygen c o n s u m p t i o n  t h r e e weeks  Progressive Treadmill  were  but the  61% o f maximum a t 3 months t o  found  - 10% and 20.8%,  were t e s t e d  and  gain,  by p a r t i c i p a t i n g i n a 10 week i n d i v i d u a l i z e d  over  The  and r e s p i r a t o r y  gestation,  (swimming) p r o g r a m .  the  t o the weight  The a e r o b i c  throughout  The i n c r e a s e i n  a t 8 months.  Sibley  to  continued.  scores  i t is.assumed  at  one  scoring and  8  five  of the control  group  a l l infants  were  healthy.  Recently, trained  Collings  et  al.(1983)  compared  pregnant  f o r an a v e r a g e o f 13 weeks on a b i c y c l e  64  women  ergometer a t  submaximal  workloads.  training choice two  (n=12) and  and  the  groups  predicted  subjects  control  remaining  when  interested  The  i t  (n=8)  placed  groups i n i t i a l l y  in by  women were r a n d o m l y a s s i g n e d  became a p p a r e n t  population. maximal VO  were  There  from t h e  the  were no  authors  protocol  their to  the  had  differences  Astrand's  the  an  in  the  between  the  2 groups at The  the  beginning  and  capacity (ANOVA  over  with  the  i n the  post  hoc  untrained trained  fetal  and  heart  rate  heart  exercise  placental fetal  increased heart  fetal  temperature.  rate,  et a l .  outcome o f  been a f f e c t e d which  aerobic  statistical  analysis  found  (4%)  the  trained  capacity  (1/min)  was  significant  capacity  group's f u n c t i o n a l  capacity.  significantly,  a t t r i b u t e d to f e t u s and  could  secondary  three  during The  possible  increased  by not  since  FHR  has  (1983) found pregnancy. the be  small  no  The  65  in  factors:  1)  rate,  2)  release  of  exercise,  t e m p e r a t u r e s may  and/or  influence  a positive correlation  with  c o r r e l a t i o n between t r a i n i n g r e s u l t s of  sample s i z e and  controlled,  exercise  increase  i t s heart  to maternal  fetal  as  fundtional  resting values.  m a t e r n a l and  fetal  and  absolute  t r a n s f e r of maternal c a t e c h o l a m i n e s or  catecholamines  Collings  untrained  over  woke t h e  training  aerobic  trimester  increased  r a t e was  i n the  test)  i n absolute  group's t h i r d  post-exercise,  fetal  The  group's decrease  the  increase  c o n t r o l group of  Scheffe's  (18%)  (ml/kg/min) v e r s u s  3)  study.  functional capacity.  increase  the  was  decrease and  group's  the  the  s u b m a x i m a l b i c y c l e t e s t f o u n d an  group  The  of  s u c h as  the  study  f a c t o r s of  maternal  may  have labour  medication,  inaccurate  determination  presentation.  Maternal  of the onset exercise  of labour,  had  no  effect  and  fetal  on  fetal  growth.  Dibblee  and Graham  ( 1 9 8 3 ) used  (CHFT)  to  16 p r i m i g r a v i d s  group  groupings. physical  The  women  activity.  t h e C a n a d a i n home F i t n e s s T e s t into  " f i t " and  were n o t i n v o l v e d i n  The " f i t "  group  any  "unfit" organized  (CHFT s c o r e s >8) had  a  constant  a b s o l u t e VO max ( 1 / m i n ) and t h e c h a n g e s i n a e r o b i c 2 fitness (VO max i n ml/kg/min) were due t o c h a n g e s i n body 2 mass w i t h p r e g n a n c y . The " u n f i t " g r o u p (CHFT s c o r e s < 8) had an  increasing  decreased  absolute  during  VO m a x ( l / m i n ) d u r i n g e x e r c i s e which 2 p o s t - p a r t u m and a c o n s t a n t a e r o b i c fitness  ( m l / k g / m i n ) w h i c h was a t t r i b u t e d The  increased  the  unfit  gains to  Dibble  the  of a c t i v i t y  Graham  found  a sufficient VO max 2  i n the u n f i t  the  t h e g r o u p s was a h i g h e r  only  demands.  workload  (1/min).  to  for  Greater  group were  compared  attributed  the  f i t group.  significant  difference  a p g a r s c o r e a t one m i n u t e i n  f i t g r o u p ' s newborns a f i n d i n g  al.  similiar  to  Collings  et  (1983).  Effects  In  f a t weight  levels  and  between  body mass p r o v i d e d  group t o i n c r e a s e t h e i r  i n body  lower  to cardiopulmonary  on t h e f e t u s o f m a t e r n a l  the  fetus  literature,  has  the e f f e c t  exercise  of maternal  been documented a s p a r t o f  66  e x e r c i s e on  studies  on  the  maternal  responses to e x e r c i s e have been d i s c u s s e d on  fetal  t e s t i n g or  training,  previously.  responses  only  The  to  and  these r e s u l t s  literature  maternal  that  exercise  focused will  be  reviewed.  One  of  the  exercise  first on  (1961) who test.  studies  fetal  heart  recorded  The  authors  felt  uterine  temporary  additional  found  6  recordings change  of  (4/26),  2)  a n o t h e r was  tested Hon  sample  and  43rd It  1 and  not  caused  minor  The  possible  pregnancies  of  serially.  reflected  in the  step  may  have  putting  FHRs  oxygen  FHR  pattern  post-exercise 1)  no  (6/26).  and In  the  3)  subjects between  from one  to determine since  FHR  remarkable  fluctuated  changing  a  group  serially  small(n=6).  gestation  week  minute  (17/26),  bradycardia  from  c o l l e c t e d between t h e low  have been p r e f e r a b l e  specified  abnormal The  frequency of  Wohlgemuth  uteroplacental  changes  the  and  therefore  the  subjects.  Wohlgemuth's d a t a was  would  the  maternal  exercise  into 3 categories:  s i z e was  weeks o f  tested  on  Hon  a f t e r a three  (UBF),  weekly,  2.  and  e f f e c t s of by  flow  tachycardia,  tested  categories to  26  was  maternal  load  the put  were  (FHR)  the  that  which  were  irregularities, that  blood  mechanism  in  rate  FHRs b e f o r e  decreased  transfer  to evaluate  In  f a c t o r s other  high  (Pernoll level,  risk  and  risk  recordings et a  exercise.  and  pregnancies. from  a  al.,  1977),  larger  sample  p r e g n a n c i e s the  than maternal  67  high  t o have FHR  gestation same r i s k  and  33rd  FHR  may  have  P o k o r n y and  Rous (1967) s t u d i e d  last  weeks o f  four  sounds.  Three  exercise  were 1)  p r e g n a n c y was  different no  were w e l l - a d a p t e d  of  the  exercise,  period,  the  of  sample  the  heart was  and  rates  needed  maternal  exercise.  indicate  whether  It FHR  2)  of  after  increase  steady  the  end  state of  the  i n FHR  which  the  values.  until  FHR A  there  to  mothers  a gradual  by  below n o r m a l  was  assumed a l a r g e r  was  d e p e n d e n t on  the  workload.  FHR  of h e a l t h y  n o r m a l and  and  larger  were  three  an  would  maternal heart  rate,  exercise  and  there  test  i n the  FHR,  to  potentially  was more  the  sample  abnormal pregnancies.  distressed fetuses, variations  reactions  a continuous increase  ( 1 9 6 7 ) used  fetuses  extreme  heart  a t t r i b u t e d to  beginning  period  fetal  1  rate  baseline  Hodr in  hypoxia  in  the  v a r i a t i o n s of a s i n g l e r e a c t i o n to  differences in  the  fell  r e a c t i o n to  and  heart  to d e t e r m i n e whether  r e a c t i o n s or  Stembera  3)  expressed  workload,  to  exercise  different  a n d / o r her  the  returning  exercise  maternal  to  p h y s i c a l work d u r i n g  w h i c h was  t o a maximum a t  but  end  fetal  change,  who  FHR  how  In  a greater to  see  the  distressed potential  influence  tachycardia  of  than  bradycardia.  The  stage of  gestation  should  FHRs a f t e r m a t e r n a l e x e r c i s e gestation gestation when  FHRs  the the  be  i s taken  when i n t e r p r e t i n g  ( P e r n o l l et a l . , 1977). E a r l y i n  post-exercise post-exercise  considered  FHR  FHR  increased,  i s important. 68  decreased,  Pernoll  but  later  illustrating and  in that  associates  found  no  differences  pregnancies, on  an  and  inferior  u t e r i n e blood  cause,  therefore,  interpreted system  80%  of  minute  and  or  decreasing  Stembera  and  after  testing.  times  per  in  week.  pregnant had  were i n e x c e l l e n t  be  cardiovascular and  placental to  FHR  that maternal  did was  not  fetal to  about  142  test  -180  above a v e r a g e health,  and  by  fetal  beats and  bpm  women t r a i n e d  exercise  produce  T h e s e v a l u e s were i n t h e  They  i n the  more s t r e s s e d due  H o d r ' s w h i c h were 140 The  to  hypoxemia,  relation  a submaximal b i c y c l e  bpm.  due  flow.  (1980) f o u n d  tachycardia.  146  cardiac  blood  fetal  risk  cycling  term  stimuli,  oxygen uptake  before  peak v a l u e s o f  fitness,  to autonomic  Goodlin  low  Near t e r m , t a c h y c a r d i a c o u l d  of u t e r i n e blood  (bpm)  near  p o o l i n g of the  f e t u s e s would be  maximum  bradycardia  decreased  a possible increase i n fetal  Older  diversion  from  S i n c e the maternal  to the a u t h o r s ,  tachycardia.  reserve"  Dressendorfer  as  compression,  responsiveness  requirements.  monthly,  mild complications, a f t e r  flow  according  as  "respiratory  at  with  f o r 6 minutes.  vena c a v a  l e g s may  the  those  ergometer  output  and  and  i n FHRs r e c o r d e d  per  reached  same r a n g e before  and  swimming  3  cardiorespiratory  were  non-competitive  swimmers.  FHR  prior  jogging  (1.5  FHR  180  was  to  maternal  m i l e s and -204  bpm  j o g g i n g was  140-150  climbing three f l i g h t s  i n Hauth e t a l .  69  (1982).  bpm  and  of  stairs)  In t h i s  after the  study,  neither  the speed  fitness  levels  start to  or the jogging  o f t h e p a r t i c i p a n t s was n o t d e t e r m i n e d  of the t e s t  evaluate  exercise  period.  the  on f e t a l  well-being.  accelerations  fetal  movement  the  adequate  in  with  compensatory  t e s t (NST)  of  maternal  10 bpm i n a s s o c i a t i o n  mean t i m e s b e f o r e  proposed  humans t h e  maternal  post-exercise  a t the  conclusions  uterine  blood  after during  from  flow  the  remained  (non-exhaustive) e x e r c i s e and/or  fetal state,  two  tachycardia  represented  w h i c h was s u p p o r t e d  later  by  two with  and  t h e f e t u s e s were n o t compromised  Hauth  - 1)  effects  the  The r e a c t i v e NST ( a t l e a s t  ) had s i m i l i a r  exercise.  a non-stress  acute  of at l e a s t  therefore  results  Hauth used  potentially  fetal  jogging,  was n o t c o n t r o l l e d and  2)  fetal Artal  et  maternal e x e r c i s e  in  al.(1984). Fetal the  bradyacardia  third  Dale  trimester  and  decreased exercise, prior heart  was o b s e r v e d (Dale  et a l . ,  associates(1982)  found  for  3  the  first  a treadmill test,  to the subjects rates.  continued  during  Artal  through  to  1982; A r t a l that  the f e t a l  3.5  minutes  and r e t u r n e d  reaching  exercise  ,a  heart of  rates  maternal  to the b a s e l i n e  80% o f t h e i r  e t a l (1984)  e t a l . , 1984).  found  predicted fetal  rate  maximum  bradycardia  symptom-limited  max  VO 2  treadmill labour  at  test. 37.5  One  of their  weeks,  and  subjects agreed  went i n t o to  an  premature  internal  FHR  m o n i t o r i n g d u r i n g a s u b m a x i m a l c y c l e e r g o m e t e r t e s t up t o 65% VO max. The FHR i n c r e a s e d s l o w l y d u r i n g e x e r c i s e f r o m 140 2 bpm p r e t o 150 bpm p o s t - e x e r c i s e . The d i f f e r e n c e i n t h e FHR  70  responses fetal  to  exercise  bradycardia  e x e r c i s e and  exercise.  d e p e n d e n t on  level by  the  fetus, the  Collings  and  relationship when t h e y 70%  2)  1982) per  work  (1985)  subjects  the  aerobic  FHR  to  of by  1)  exercise  capacity  standardize  while  fitness  probably  (Artal the  of  the  et a l . ,  1984)  2 8 t h t o 3 8 t h week  In comparison 1983)  intensity, the  test,  i n n o r m a l and  the  to  types of  c y c l i n g and  others  therefore  exercise  FHR  >180bpm  weeks  C o l l i n g s and found They  too  their  (Hauth e t  al.,  unknown s t r e s s cycling  pregnancies,  gestation, Curet  and  trunk.  d i d count  using  the  a m p l i f i c a t i o n system  of  but  tried  to  from  the  much " n o i s e "  legs  71  to  6 minutes of mild  <35  their  post-exercise  m i l d l y abnormal  post-exercise  age,  consequently  T h e r e were no  P e r n o l l ( 1 9 7 7 ) used that  of  be  associates  gestational  different  .  and  during  could  t e s t s were s e t a c c o r d i n g  weeks i t i n c r e a s e d .  m o n i t o r FHR  exercise  due  a  evidence  FHR  capacity.  exercise  decreased  35  movement  of  no  from  ( C o l l i n g s et a l . ,  subjects  d i d not  serially  post-exercise  activity.  found on  to  mother and level  sympathetic  responses  of hypoxia  Artal  by  s t r e s s and  whether  t o n o r m a l FHR,  fetus.  g e s t a t i o n a l age  duration  to i l l u s t r a t e  after  of  Curet of  subject.  that  level  r a t e s were h i g h e r  maximum  the  i n FHR  r e s p o n s e depended on  o f maximum a e r o b i c  longer  since  of  question  periods  time, r e t u r n  maternal  tested  previous heart  increase  catecholamines released  influenced  to  fetal  the  to  physiological  for brief  status  that  of  was  recovery  the  authors  a normal  mechanism  The  postulated  was  , i f so,  compensatory  l e d the  the  FHR  during  the  FHR  monitor  and  found  The  FHR  Fetal  al.,  was  B r e a t h i n g Movements (FBM),  (1979)  FHR.  n o r m a l w i t h moderate t a c h y c a r d i a .  The  were more s e n s i t i v e FBM  increased  submaximal b i c y c l e passive  test),  movements  hyperventilation  and  paralleled  to maternal maternal  by  Marsal et  challenge  dynamic  d i d n o t change w i t h s t a t i c  ,  and  decreased  hyperoxygenation.  change d u r i n g t h e f i v e FBM  with  i n study  maternal  the maternal  challenges.  pCO  levels  stimulator  of  (  work  and  maternal  FHR The  did  changes  not in  s u p p o r t i n g CO in  as a 2 neonatal  mild  maternal  2 major  work  with The  than  b r e a t h i n g movements e v e n  life.  There  were  exercise  no  (FBM)  relationship fetal  or  FBM  in  a  activity  was  but  levels  o r FBM  betwen body  Piatt  (FB) et  sympathetic  activity  Fetuses with  significantly  after  30  were s t i l l  or  al.  breathing (1983). and  The  mean  minutes  elevated.  increased  from  pre  post-exercise The  five  of stimulus  while a higher l e v e l  would  decrease  to i n d i v i d u a l i z e d  72  and  to the  reasons  level  o b s e r v a t i o n s were due  FM  norepinephrine  were 1) one  the f e t u s a c t s i n d e p e n d e n t l y of the mother,  A  degree  h i g h e r mean p r e  increased significantly  f o r the f i n d i n g s FM  by  epinephrine l e v e l s .  post-exercise,  suggested  fetal  confirmed.  epinephrine levels  increase  study  p o s t - e x e r c i s e had  epinephrine  and  between m a t e r n a l  post-exercise and  correlations  ( w a l k i n g a t 2 mph)  movements  of  direct  may  i t , 2)  therefore varied  a d a p t a t i o n to  changes  in  maternal environment,  the  increase  fetuses and  3) r e d u c t i o n  i n c a t e c h o l a m i n e s w h i c h would  had f o u r  basic  behaviour  w a k e f u l n e s s and t h e s e  (testing  stages  a s i n m a t e r n a l e x e r c i s e , would  o f low h e a r t  reactivity.  variable  Piatt  fetal  rate  variablility,  as  increased  maternal  concluded  that  FM and FBM) seemed sympathetic  maternal a c t i v i t y .  between m a t e r n a l e x e r c i s e  - and FBM i n a m a j o r i t y  o f FBM a s a t e s t  of  maternal  exercise  levels  no  the  weeks) t h a t previously  The f e t a l  activity  associated  with  an  and i n d e p e n d e n t  of  significant  negative  - climbing  of the subjects  data  2  flights  (24 o u t so  The FBM t e s t  was a n a l y z e d . negative  the  The  varied  correlation  of  t o FBM, 6/33 p o s i t i v e c o r r e l a t i o n , and 3/33  climbed and  well-being.  s t u d y - 24/33 w i t h  o f t h e women b e f o r e  pregnancies,  a  of f e t a l  c o r r e l a t i o n - could  women  the  produced  exercise  The p u r p o s e o f t h e s t u d y was t o e s t a b l i s h  results  which  reported  useful i fpost-exercise  with  shaking  were r e v e r s i b l e .  relationship  was  and 5)  mild  activity  (1983)  tested.  weeks  increase  t o be  Jakobovits  validity  a t 36  The c h a n g e s i n FM, FBM, and c a t e c h o l a m i n e  due t o e x e r c i s e  stairs  4)  significantly  biophysical responses.  (measured  33)  FBM,  was a t a mean g e s t a t i o n a l age - 34.6 w e e k s ) ,  fetus,  of  affect  were o r g a n i z e d  periods  levels  be due t o  s t a t e s r e l a t e d t o f e t a l age,  during  its  i n UBF c o u l d  have been due  or during  the s t a i r s  the  ,  time d u r i n g  suggested  gestation, the r i s k  the  t h e women were e v a l u a t e d .  to  test  the  the r a t e a t  level period  of the (35-42  P e r n o l l e t a l . , (1977)  t h e t i m e o f t e s t i n g was i m p o r t a n t  73  fitness  i n FHR  and  Marsal  et a l . ,  (1979) s u p p o r t e d  t h a n FHR. J a k o b i v i t i s  added  be  specified  when c o m p a r i n g  be  read  FHRs.  like  Uterine  activity  weight-bearing during  the  Maternal Fetal  heart  heart  exercise, The  but  motivated, activity  returned  concluded  have used  (cycling)  ,  (Veille  et  as expected, the f i r s t  moderate  subjects  al.,1985).  post-exercise.  15 m i n u t e s  i n the next  15  exercise  post-  minutes.  in  d i d not increase  on  study  a built  has  questionnaires  jogging,  activities  and  a  t o study  highly uterine  i n drawback,  the  especially  9 months g e s t a t i o n .  advertisements  were  mailed  subject's  A pre-selection  t o 208 women,  endurance  retrospective ability  i f over a long  i n n a t i o n a l d i v i n g magazines,  74  of  A  by t h e women who answer an a d v e r t i s e m e n t  Questionnaires  the e f f e c t s of  combination  t h e outcomes o f p r e g n a n c y .  remember e v e n t s r e q u i r e d ,  occurs  non-weight-bearing  Studies  diving,  as  are to  post-exercise.  Researchers  time  i f they  exercise;  to baseline that  FBM,  should  maternal  during  t r a i n e d pregnant  Retrospective  scuba  r a t e was h i g h e r  ( y  after  8 weeks o f g e s t a t i o n  rate increased  authors  and a n a l z y i n g  and  sensitive  t h e week o f g e s t a t i o n  d i d n o t change  (running) last  that  FBM a s more  of  to  period of subjects  f o r subjects.  who r e s p o n d e d  to  and p o s t e r s  in  diving  shops  (Bolton,  within  5 years  of completing  questionnaire fetal  compared  outcome  .  136  women  trimester.  approval not  of  Bolton  found  and  the  vaginal birth in  higher  diver  the  of  stillbirth,  t h e ND g r o u p  results  of  or undesirable  recommended  should  during with  and  and  progressed.  the  pregnancy  complications low b i r t h  of  weight,  s p o n t a n e o u s a b o r t i o n , and more b i r t h  ,but  the  defects  percentage  t h e norms o f t h e the  study  may  of  general not  be  b e c a u s e women who had  outcomes may n o t have  answered  advertisements.  Bolton age  certification  between t h e r i s k  representative of the diving population complications  had a  as t h e pregnancy  t h e D g r o u p was w i t h i n The  first  The f r e q u e n c y  T h e r e were s i g n i f i c a n t l y  population.  the  of  pregnancies  pregnancies.  pregnancy,  than  24  and f a m i l i e s t h a n women who d i d  deaths,  during  group  in  during  of the six pre-selected  - neonatal  D  The d e s c r i p t i v e  o f 208 women dove one  (D) d u r i n g  of  decreased  no r e l a t i o n  defects.  defects  their  the dives  bleeding  the  level  physicians  frequency  pregnancy  pregnant  t o an a v e r a g e d e p t h o f 42.6 f e e t ;  (ND) d u r i n g  depths  had been  o f d i v i n g t o o b s t e t r i c and  thirty-six  women who dove  of their  dive  the extent  dove d e e p e r t h a n 99 f e e t  The  significantly  The s u b j e c t s a scuba c o u r s e .  One h u n d r e d  or more p r e g n a n c i e s the  1980).  be  that  1) e v e r y  informed  pregnancy,  and  woman d i v e r o f  of the p o t e n t i a l 2) t h e p h y s i c i a n  risks should  t h e p r o b l e m s and e n c o u r a g e h e r t o d e c i d e  pregnant depth,  whether duration,  to  dive  and  and c h a r a c t e r  75  what  childbearing of  aquaint  before  limitations  of dives  should  diving her  becoming regarding  be made.  It  was  felt  before  t h a t many women would  dive against medical  p r e g n a n c y was c o n f i r m e d .  officially  discourages  The U n d e r s e a M e d i c a l  diving during  studies are a v a i l a b l e .  Bolton's  p r e g n a n c y were 1) l i m i t  dives  half  the l i m i t s  avoid  strenous  snorkelling  under  further  guidelines f o rdiving during  t o 60 f e e t  and d u r a t i o n t o o n e -  hypoventilation,  optimal  Society  pregnancy u n t i l  o f t h e U.S.Navy n o - d e c o m p r e s s i o n  dives,  advice or  tables,  and c h i l l i n g ,  c o n d i t i o n s a s an  2)  o r 3)  alternative  to  scuba d i v i n g .  I f women s u s p e c t e d (1982) was  suggested  they  were p r e g n a n t  ,  Turner  no d i v i n g below 30 f e e t  preferred.  They  presented  a case  and  Unsworth  o r no d i v i n g a t a l l  study  of  a  pregnant  i woman her feet  who dove 20 t i m e s last  menstrual  or less  dive  rapid",  but  per  minute,  cycle.  (as sugggested  were t o 100 f e e t , problem  were  by B o l t o n ,  dives  1980),  t o 110 f e e t .  three T h e r e was  r a t e was d e s c r i b e d  ascents  were e s t i m a t e d  as  one "very  a t 60 f e e t  The p r e g n a n c y was n o r m a l , b u t t h e newborn had a  Turner  due  to  thalidomide,  the  where  diving.  drug  affecting  the  A  t h e upper  day and t h e l o w e r  root  - arthrogryposis,  and U n s w o r t h i m p l i e d  40th  posterior  after sixty  where t h e a s c e n t the remaining  days  Most o f t h e d i v e s were t o  and one d i v e  number o f a b n o r m a l i t i e s features.  between h e r 4 0 t h and 5 0 t h  limbs  'ganglia  was  76  that  similiar  limbs about  migration  dysgenic  the abnormalities time  course  were a f f e c t e d a b o u t t h e 4 5 t h day due  of c e l l s a  and some  proposed  used  to  reason  as the  to the  form  the  for  the  abnormalities  seen  Arthrogryposis  from  was  abnormalities  d i v i n g between t h e 4 0 t h and 5 0 t h d a y .  supposedly  of c e l l s  forming the a n t e r i o r  Theoretically,  diving  either  the bubble  through  function  because  Jarrett  and  jogging  as t h e i r  Spellacy  pregnancy  reserve  - were  similar  (Karasawa The  abortion  was  occurred  were  the placenta's  secondary  effect  women  enlargement, suggested  decreased  their  Mechanical f a c t o r s changes  decrease  in  in  activity  f i n d i n g s with voluntary  was  suggested  more o f t e n  not  weight  circulatory  levels  exercise  which  in  normal,  population,  mice  cogenital  asymmetry).The  low could  and  dysplaxia,  incidence  sample  abnormalities  of  generally adductus,  The  rate  reported not  life-  right  arm  torticollis, maternal  p r o b a b l y be a t t r i b u t e d t o  of the subjects. data  larger  The a n o m a l i e s  metatarus  hip  fetal  o r 6% was above t h e norms  2-4%.  anomalies  phocomelia,  A  but  women who j o g g e d .  4 o u t 67 s u b j e c t s  (hypospadias,  the  than  whether t h e f e t a l  i n pregnant  a l l classic  complications  lower  to find  threatening  about  fetus  (1983) found  were h i g h e r t h a n e x p e c t e d .  the general  condition  ganglion.  on p l a c e n t a l f u n c t i o n .  the  rate  of a b n o r m a l i t i e s , for  or a  or  e t a l . , 1981).  abnormalities size  formation a f f e c t i n g  a t t r i b u t e d t o reduced  to  root  f a c t o r to the  pregnancies progressed.  and  disease  of i t s effect  - uterine  distribution,  was  i s a detrimental  or the f e t u s ' c i r c u l a t i o n ,  through hypoxia  of  due t o a muscle  facial  and the  fetal healthy  The a u t h o r had some r e s e r v a t i o n s  1) women w i t h poor  77  outcomes may o r  may  not  have  responded,  and  general  conclusion  to  during  run  2) r e c a l l  was  a c c u r a c y was  women who  pregnancy  did  unknown.  were t r a i n e d  not  and  adversely  The  continued  affect  their  pregnancies.  Subjects  who  endurance  activities  skiing  - at  gained of  continued to p a r t i c i p a t e  less  or n e a r weight,  gestation  activities  - running,  lighter  t h a n s u b j e c t s who  before  aerobic  pre-pregnancy had  their  in a  combination  dance,  and  2 8 t h week  was  determinant i n pregnancy  was  t h e c o n t i n u e d and  exercise. been  The  related  subjects,  lighter  sustained  exercise  and  prior  lengths  Dickstein, to  pregnancy gain,  as  i n ; endurance  newborns f o r g e s t a t i o n a l gain  important to note t h a t  term  i n these  weight  participation  to the lower maternal weight  b u t i t was  shorter  (Clapp  i n endurance  a significant  until  ceased p a r t i c i p a t i o n  1984). P a r t i c i p a t i o n no  cross-country  intensities  infants,  of  age of  may  have  exercising  w i t h the d e c r e a s e  i in  the  variables  mentioned  ,  there  was  no  increase  in  morbidity.  The  retropsective  Zaharieva during those shorter  1972;  B e r g e t a l 1983)  pregnancy mentioned in  studies with e l i t e  have f o u n d r e s u l t s previously.  elite  trained  The  athletes  (Erdelyi,1960;Zaharieva, better  who  1972)  m u s c u l a t u r e and  78  athletes trained which  second  was  nervous  prior are  to  1962; and/or  similiar  s t a g e of l a b o u r  compared which  (Erdelyi,  to  was  non-athletes  attributed  systems  to  for  to  their  physical  strain, the  generally  second  perinatal  (Erdelyi,  stage  was  results,  proposed. prolonged  in  uterus,  found  sections,  but  deliveries athletes  tone,  (1983) n o t e d  than  national  diffference  the f i r s t  stage  due t o r i g i d i t y  and  was  an  unusual  parts of the b i r t h  tract.  was  of the lack  of  Erdelyi  had a 50% r e d u c t i o n i n t h e number o f c e s a r i a n Berg  et a l .  found  and h i g h e r p e r c e n t a g e  compared  newborn,  athletes  that  atheletes  muscle  et a l .  f o r the  (1972) n o t e d  i n the soft  athletes  in  reason  t h e Olympic  stronger  flexibility  longer  no  Zaharieva  1962).Berg  . to national  therefore a possible  on c o u r s e o f p r e g n a n c y  an i n c r e a s e  in  abdominal  of high-risk  pregnancies i n  d a t a and l o w e r  birthweight of  influence  of training  history  and l a b o u r .  Conclusion  The  human s t u d i e s  can  be  their  physically  pregnancy  exhausting. rate  at  pregnant level  per  A  a lower  active  that  without  or the fetus pregnant workload  normal  h e a l t h y pregnant  affecting  the  i f the i n t e n s i t y  woman w i l l  or  increase  level  pregnant  more weeks, week  exercising  woman.  levels  The t r a i n i n g  but the frequency  f o ra s i g n i f i c a n t  and n o n - e x e r c i s i n g p r e g n a n t  79  period  to  t o show women.  but  a  non10  3 times  between The  a  fitness  c o u l d be  s h o u l d be a t l e a s t  difference  heart  woman,  compared  of  i s not  r e a c h h e r maximum  than a non-pregnant  her f i t n e s s  women  outcome  woman s h o u l d be a b l e t o m a i n t a i n h e r a e r o b i c  exercising or  suggest  the  duration  of  p r e g n a n c y was  an  important  deliveries subjects 40  question, by  delivered  i n the  apgar  e x e r c i s i n g and  enough  during to  fetal  a number o f  their  studies  the  researchers  eliminated  late  in  gestation  beyond  the  normal g e s t a t i o n  or  as  premature  eliminating period  of  significance,  if  one  weights of  infants  ideal  i n any  study  of  activity  pregnancy,  the  fetus*  development  exercise  trimester  than  the  during  pregnancy  other  factors  s u c h as  activities.  The  significant  studies  in  those  sample  the  the  involved  i n her  80  the  birth  be  in  most  of  trimester,  of  prenatal  this  exercise  weight,  adapted  large  via  monitor  Since  would a l s o  be  or  early  outcomes o f  fetus  to m a t e r n a l  have f o l l o w e d  would  f e t u s more d u r i n g The  s i z e s should  c h a n g e s due  rate  exercise.  first  apgar s c o r e s ,  physical activity  m o t h e r s and  maternal  on  large  i n f a n t at b i r t h  trimester.  e f f e c t the  how  size  f i t n e s s l e v e l s from  first  the  studies  heart  pregnancy  trimester.  indicating  mother's r e g u l a r  Animal  last  by  during  occurs  should  the  affected  the  Further  via fetal  and/or  aerobic  the  have a sample  fetus  exercise and  women.  should  way  s u c h as  maternal  birth  non-exercising  movements,  are  the  the  and  show w h e t h e r t h e  scores  physical  finding  scores  pregnancy  breathing  apgar  any  by  sample s i z e s p r e v e n t e d  exercise  to  but  testing  who  exists,  An  viewed  weeks.  Small  of  not  to  and the  interest care  and  enough t o  show  exercise.  offspring  of  exercising  p r e g n a n t a n i m a l s f o r d i f f e r n c e s i n growth future,  a s more work i s done i n e x e r c i s e d u r i n g  follow-up  on  exercise  during  In  reviewing  number in  a  physical the  their  fetal  should  10 y e a r s  number  and w i t h  of  activity  questions  during  possible  activity  should  pregnancy,  been  women  to  the  about  be answered  within  be some s t a n d a r d  be  drawn  on t h e p r e g n a n c y  published  on t h e e f f e c t s and i t s outcome.  81  i n the  have  workloads or  p r e g n a n t women t o make t h e  studies  a  published  interest  p h y s i o l o g i c a l v a r i a b l e s and p h y s i c a l  among  conclusions  increased  pregnant  pregnancy  There should  used i n t e s t i n g  various  this  of the  be u n d e r t a k e n .  on e x e r c i s e d u r i n g have  In  pregnancy, a  long-term e f f e c t s  development  the l i t e r a t u r e  near f u t u r e .  values of  the i n f a n t s to find  o f t h e p a p e r s on human p r e g n a n c y  the past  area,  and s t r u c t u r e .  comparison activities  enabling of  the  definite physical  APPENDIX Raw  B  Data  Subject  1st 0.5  Mean Heart Rates(bpm) during T e s t at f o u r workloads (kg) Trimester 1.0  1.5  2nd 2.0  A  Cycle Ergometer (see note)  Trimester  3rd  Trimester 2.0  0.5  1.0  1.5  2.0  0.5  1.0  1.5  100  106  125  131  109  122. 5  138 144  100  120  142  *  B  (. 66) n 90  C  -  -  -  -  95  105  125  147. 5  101 115  135  150  D  -  -  -•  -  89  100  120  135  90  110  122  138  E  -  -  -  -  83  87.5  103  123  89  94  110  125  F  81  98  108  134  80  87  110  125  98  120  130  147  G  93  110  133  150  94  110  125  150  110  125  138  144  146  n  (. 66) 115  (1.3) 130  170  97.5  105  142.5  98  110  130  150  121  136. 5  -  87  110  128  145  113  150  99  125  140  150  110  129  147  *  150  105  125  150  *  122  138  150  *  (1.3) 110  n  130  (.66) (1.3) 105.5 127.5  98  n  150  132  147.5  H  n  I  93  107  120  J  -  -  -  K  98  123  143  L  97.5  133  132.5  M  113  135  150  *  109  130  150  *  117  138  150  *  N  -  -  -  -  103  125  150  *  105  125  147  *  0  98  112  133  155  110  129  153  *  130  158  *  *  P  -  -  -  -  105  146  *  *  108  132  156  *  Q  -  -  -  -  125  142  150  *  115  125  150  *  125  138  150  93  110  138  150  -  -  95  110  143  R 102.5 S T  -  -  *  _  113  82  125  150  *  152  *  *  95  110  138  150  *  105  114  138  150  *  110  135  150  *  Note:  The w o r k l o a d s 0.05,  Monark  cycle  ergometer  are  equivalent  "-"  no h e a r t  in  the second  "*"  no  terminated rate  "n"  0.5  equal  1.5,  150,  2.0 kg a t 50rpm on t h e  300, 450, 600 kgm/m, w h i c h  t o 25, 50, 75, 100 w a t t s  rate  data  because  respectively.  the s u b j e c t  started  the study  trimester.  data  at this  workload  because the  a t the p r e v i o u s workload  had a p p r o a c h e d  or reached  150  a t 0.5  kg i n t h e 1 s t adn 2nd  and s u b j e c t trimesters.  83  had  been heart  bpm.  kg i n t h e 1 s t t r i m e s t e r ,  i n t h e 2nd t r i m e s t e r ,  test  when t h e s u b j e c t ' s  due t o c h a n g e s i n t e s t i n g p r o t o c o l  evaluated kg  1.0,  - subject and 0.5  B was n o t kg and  H was n o t e v a l u a t e d  1.5 at  APPENDIX C:PREDICTED MAXIMUM OXYGEN UPTAKES Maximum oxygen u p t a k e (V02max) v a l u e s were p r e d i c t e d f r o m t h e heart r a t e s d u r i n g t h e submaximal c y c l e e r g o m e t r y t e s t s , a t 75 a n d / o r 100 w a t t s i n t h e s e c o n d and t h i r d t r i m e s t e r s , u s i n g A s t r a n d ' s nomogram ( d e V r i e s , 1968). The V02max v a l u e s were rated (low, f a i r , average, good, high) according to A s t r a n d ' s t a b l e o f norms f o r women 20-29, and 30-39. The T group ( s u b j e c t s A - J ) had p r e d i c t e d V02 v a l u e s g r e a t e r than t h e UT group ( s u b j e c t s K-T) a t e a c h w o r k l o a d d u r i n g t h e s e c o n d and t h i r d t r i m e s t e r s .  FITNESS CLASSIFICATION  Second Group  T  Trimester: Workload (watts) 75 100  UT  High  Good  5  2  4  5  75  T  2  Trimester: 75 100  UT  Fair  1  100  Third  Average  1 3  4 4  75 100  84  8  1  1  1  Low  V02(l/min) R a t i n g ( Low, at s e l e c t e d workloads Second  Fair, Average, Good, ( 7 5 w a t t s , 100 w a t t s )  Trimester Workload(watts)  Subject  100  75 High n High High  A B C C E F G H I J  3.0 n 3.0 3.4  3.0 2.5 2.7 2.8  High Good Good High  K L M N 0 P Q R S T  2.4 2.0 2.0 2.0 2.0  Good Average Fair Fair Average  Third A B C D E F G H I J K L M N 0 P Q R S T  * *  ** 2.0 2.4 2.2 2.0  3.4 2.5 2.6 3.1 3.9 3.7 2.5 2.0 2.5 2.7  High Good Good High High High Good Average Good Good  2.5  Good  **  2.0  ** ** ** **  **  Fair Average Average Fair  2.5  *  **  Average  ** ** ** **  Good  **  2.7  Fair  2.7  Good  trimester: 2.4 2.3 2.6 3.2  * 2.7 2.4 2.7 2.0  ** 2.1 2.0 2.0 2.1  ** 1.9 2.0 2.4 2.4 2.0  Average Average Good High  **  2.5 3.0 3.7 2.6 2.7 2.6  Good Good Good Average  ** Average Average Average Average  **  Fair Average Average Average Average  ** **  ** **  ** ** ** ** ** ** **  ** ** ** ** ** ** **  2.5 2.5  **  85  **  Good High High Good High Good  Average Good  **  High)  * The s u b j e c t ' s h e a r t r a t e a t t h i s w o r k l o a d was t o o low t o predict a maximum oxygen u p t a k e f r o m A s t r a n d ' s t a b l e and nomogram.  ** The submaximal c y c l e e r g o m e t r y t e s t had been the previous workload when the subject's approached o r r e a c h e d t h e d e s i g n a t e d maximum t h e r e f o r e no p r e d i c t e d maximum oxygen u p t a k e . "n" S u b j e c t B was trimester, therefore uptake.  n o t t e s t e d a t 75 w a t t s no d a t a f o r p r e d i c t i n g  86  terminated at heart rate o f 150 bpm,  i n the maximum  second oxygen  APPENDIX D - ACTIVITY First  Trimester(if  Subject  * >3hr/wk  LOGBOOKS  available) Activities Type  A  started  B C  * *  D E  started started  F  *  G H I J K  s t a r t e d logbook s t a r t e d logbook no l o g b o o k s t a r t e d logbook no l o g b o o k  L  *  logbook  i n second  logbook logbook  i n second i n second  lhr 90min  *  R S T  * started started  3 2-3  trimester trimester 3-5  i n second i n second  trimester trimester  i n second  trimester  Swimming/tennis /or skating Prenatal fitness  P  Freq/wk  trimester  Swimming  s t a r t e d logbook s t a r t e d logbook no l o g b o o k  A B  Comments Duration  Aerobics Class Weight T r a i n i n g  M N 0  Second  SUMMARIZED  lhr  1-2  lhr  1-2  i n t h e second i n t h e second  Cycling Softball  trimester trimester 2-3 2  Aerobics classes logbook i n second logbook i n second  1-2.4km  lOmiles  lhr 3 trimester trimester  Trimester no a c t i v i t y recorded * Aerobics Classes Walking  lhr 30min  2-3 1 2-3 1  C  *  Weight t r a i n i n g Walking  90min l-2hr  D  *  Prenatal Walking  lhr 1 3 0 - 9 0 m i n 1-2  E  *  Aerobics Classes Swimming Windsurfing  87  fitness  lhr 1  1 1-2 4  l-l/2miles  1km  F  *  G  no  H  *  I J K  L  Swimming Lifecycle a c t i v i t y recorded  24-36rain  P r e n a t a l f i t n e s s 90min Swimming 20-30min Walking 30min no l o g b o o k no a c t i v i t y r e c o r d e d no l o g b o o k * Prenatal  fitness lhr  4-5 1-3  1 1-4 1  *  N  *  0  no  P  *  Badminton Walking  Q  *  Aerobics Running Walking  c l a s s e s 4 0 - 6 0 m i n 1-3 2- 4 30min 3- 4 45min  R  *  Prenatal Walking  fitness  30-45min 30min fitness lhr 45-60min  Prenatal Tennis  basis  2 3  1 2  Jazzercise Tennis  T  Swimming Volleyball  lhr lhr  2-3 1-2  lhr 30min  1-2 1  light-mod.  30rain 1 15-20min. 1  Trimester  A B  no a c t i v i t y r e c o r d e d * Aerobics classes Prenatal fitness  C  *  D E  3-4 irregular  logbook  S  Third  1km  3  M  Walking Cycling  1.5-4.8km  *  lhr lhr  1 2  until until  term term  Prenatal Walking  fitness  lhr lhr  1-2 1-2  to  37th  wk  Prenatal Swimming  fitness  lhr  1- 2 2- 3  to 37th 35-40th  wk wk  3 1-2 1 1  to 37th to 34th 33-37th t o 29nd  wk wk wk wk  lhr Aerobics classes 40-60min Swimming 60-90min Walking lhr Windsurfing  88  Cycling (did F  *  not keep  1-2  logbook  beyond  Swimming  no  H  wk  week) 2-A  1.5-3.0km to term to term  A8-60min A  Lifecycle G  37th  20km 31-32nd  activity.recorded Prenatal Swimming Walking  fitness  90min 20-30min 30-90min  1-2 1 1-3  to to to  3 7 t h wk 3 6 t h wk term  1-2  to  38th  logbook  I  no  J  *  K L  no l o g b o o k no a c t i v i t y  M  -  N 0  no  P  -  Walking  Q  *  Aerobics Walking  classes  R  *  Prenatal Walking  classes  S  —  Jazzercise Tennis Walking  T  —  Prenatal fitness 30min 1 Aerobics classes l h r 1 Volleyball 15-20min 1  Prenatal  fitness  60min  recorded i n third  Walking Prenatal logbook  89  trimester  30min fitness  lhr 20-30min 20-A0min AOmin AOmin lhr lhr  wk  daily  t o term  2  to  term  1-2 3  2A-36th 38-A0th  wk wk  1-3 3-A  25-33rd to term  wk  2-3 1-2  to to  term term  lhr 1-2 t o 3 6 t h wk 3 0 - A 5 m i n 1-2 2 8 - 3 9 t h wk 30-90min i r r e g u l a r basis 27-31st 36-38th 27-31st 3A-38th  wk wk wk wk  

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