Exercise during pregnancy: a practical approach.

Regular exercise has many favorable effects on the cardiovascular system. However, intense physical activity, especially in a competitive fashion, may become hazardous to genetically vulnerable individuals. A competitive athlete is one who participates in an organized team or individual sport that requires regular competition against others as a central component, places a high premium on excellence and achievement, and requires some form of systematic (and usually intense) training. Soccer, basketball, running, cycling, and swimming are some examples of competitive sports with high dynamic activity, whereas gymnastics, weight lifting, and sailing are examples of competitive sports with high static activity. Sudden cardiac death (SCD) in sports and exercise is defined as cardiac arrest occurring during or within 1 hour of exercise or sports-related activity, and genetically transmitted cardiovascular diseases are among the most common pathologies leading to SCD in competitive athletes (1). Sudden death of a competitive athlete has a mass and undesirable effect on the community. Properly diagnosing inherited cardiovascular pathologies, making appropriate recommendations on physical activity in athletic population, and providing close supervision to diseased athletes are the main duties of cardiovascular specialists. The aim of our document is to summarize the various aspects of the most common genetic cardiovascular diseases in athletes and to make recommendations for diseased athletes and athletes with implanted cardiac pacemakers/Implantable Cardioverter Defibrillators (ICDs) based on the current literature. Our general recommendations are summarized in Figure 1 and discussed below in detail. Open in a separate window Figure 1 Athletic activity recommendations for athletes with genetic cardiovascular pathologies and commotio cordis For Athletic activity boxes; Red box: Athletic activity prohibited. Yellow box: Athletic activity allowed selectively according to the level of activity and athlete’s condition. Green box: All athletic activities allowed. ARVC - arrythmogenic right ventricular cardiomyopathy, CAAs - coronary artery anomalies, DCM - dilated cardiomyopathy, HCM - hypertrophic cardiomyopathy, LVNC - left ventricular non compaction, WPW - Wolf Parkinson White syndrome

Physical activity (PA) promotes better cardiometabolic health, physical function, brain health and longevity. In contrast, prolonged sedentary behaviour (SB) is a risk factor for many chronic diseases and poor health....

Assessment of the 12-lead ECG as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 Years of Age): a scientific statement from the American Heart Association and the American College of Cardiology.

BackgroundPrenatal primary nursing care contributes to improving the health outcomes of mothers and unborn babies. Some pregnant women in contexts of vulnerability experience prenatal nursing care in a positive way, while some do not. A better understanding of factors influencing this experience could help improve prenatal nursing care. The aim of this study was to describe factors influencing the prenatal primary nursing care experience of pregnant women in contexts of vulnerability.MethodsThorne’s qualitative interpretative descriptive approach was used. Twenty-four pregnant women in contexts of vulnerability were recruited in local community service centers in Quebec, Canada, using purposive and snowball samplings, to carry out a semi-structured interview. Participants were 16 years old and over, in their second or third trimester, or had given birth in the previous year, and received prenatal nursing care through community health services. Data collection methods included a logbook, sociodemographic questionnaire and semi-structured interview on vulnerable pregnant women’s experience with prenatal primary nursing care. The Qualitative Analysis Guide of Leuven guided the inductive thematic analysis, following a constant comparative iterative process.ResultsThe women’s experience was initially influenced by the fulfillment of their needs and expectations. These stem from their previous or current pregnancy experiences, their motivation to receive prenatal care, their family concerns as well as their contexts of vulnerability. From the pregnant women’s perspective, the main factors that influenced their experience were the nurse’s approach, characteristics and interventions that all impact on their relationship with nurses, as well as the prenatal primary care organization, including the modalities of prenatal care (i.e. schedule, setting, duration, number and frequency of meetings), the continuity and the program’s prenatal care services, such as referral to a nutritionist, social worker or other services.ConclusionsA conceptual framework is proposed to describe relationships among the factors distributed in three dimensions that influence the experience of pregnant women in contexts of vulnerability and to guide nurses in the improvement of prenatal primary care. Considering the complexity of this experience, a person-centered approach is mandatory to promote a positive experience, equity and a better use of services.

One way to prevent complications from childbirth is to do physical activity. The health status of the mother during pregnancy needs to be considered from the beginning of pregnancy, because doing regular and directed physical activity can maintain the health of the mother and fetus during pregnancy. Exercise is one of the physical activities so that pregnant mothers stay healthy and fit. There is still a lack of pregnant women to exercise due to various factors, one of which is a lack of knowledge, so health education is needed to improve their knowledge. This community service was carried out in Padamukti Village, Solokanjeruk, Bandung Regency, with a total of 37 pregnant women. This activity consists of 3 stages, namely preparation, implementation, and evaluation. The health education provided is knowledge about exercise in pregnancy using the Go Pregnancy Exercise (GoPEx) application media. This activity lasted for 90 minutes and was carried out pre- and post-test to assess the difference in the level of knowledge before and after the provision of education. There was a mean difference in knowledge's score between before and after giving the health education by the Go Pregnancy Exercise (GoPEx) Application (p-value 0.05). Pregnant women’s knowledge increases after being given a health education. It is necessary to intensify the socialization of the use of the GoPEx application to increase the physical activity of pregnant women to realize healthy pregnant women.

National data demonstrate that Black women have poorer health status, and greater risk of death from chronic diseases, than their White counterparts. Exercise can help prevent chronic disease, and adult Black women are less likely to engage in exercise than White women. However, few data are available about exercise among pregnant Black women. Pregnant Black women were enrolled in this study at hospital-based prenatal clinics in Baltimore, Maryland. Exercise before and during pregnancy were assessed at the first prenatal visit, along with exposure to stressors, depression, John Henryism Active Coping, and behavioral factors such as smoking. Among the 922 women in the sample, approximately three quarters reported engaging in exercise before pregnancy, and two thirds exercised during pregnancy. Most women engaged in non-strenuous exercise during pregnancy (56%) and exercised for > or = 20 minutes at least three times per week (80%). Exercise participation was significantly associated with higher levels of John Henryism Active Coping and lower levels of depression but was not significantly associated with behavioral factors or exposure to stressors. Prior research, based on older women, may have underestimated exercise participation by young Black women. These results suggest that Black women may decrease exercise participation after pregnancy and as they age. Encouraging Black women to continue to exercise as they age may have promising implications for the prevention of chronic diseases.

Prenatal Care Outcomes in Women with Substance Use Disorders: A Retrospective Cohort Study.

Physical activity during pregnancy, such as pregnancy exercise, has significant benefits for maternal and fetal health. However, participation among pregnant women in exercise programs remains low. This study aims to identify factors influencing this participation in Metro City, Lampung Province. This research employs a quantitative design with a cross-sectional approach. A total of 70 respondents were selected through accidental sampling. Data were collected using a validated and reliable questionnaire. Data analysis was conducted using logistic regression to identify the relationship between independent variables and participation in pregnancy exercise. The findings indicate that knowledge, attitude, family support, accessibility of infrastructure, and interaction with health workers significantly influence pregnant women's participation in pregnancy exercise. Conversely, age, education, occupation, parity, and distance travelled did not show significant effects. This study emphasizes the importance of enhancing knowledge and social support to encourage pregnant women's participation in physical activities. The implications of these findings suggest the need for intervention programs involving health workers and improved infrastructure to support maternal and child health.

Adherence to physical activity among pregnant women in Southern Italy: results of a cross-sectional survey

In the ICD Sports Safety Registry, death, arrhythmia- or shock-related physical injury did not occur in athletes who continue competitive sports after implantable cardioverter-defibrillator (ICD) implantation. However, data from non-competitive ICD recipients is lacking. This report describes arrhythmic events and lead performance in intensive recreational athletes with ICDs enrolled in the European recreational arm of the Registry, and compares their outcome with those of the competitive athletes in the Registry. The Registry recruited 317 competitive athletes ≥ 18 years old, receiving an ICD for primary or secondary prevention (234 US; 83 non-US). In Europe, Israel and Australia only, an additional cohort of 80 'auto-competitive' recreational athletes was also included, engaged in intense physical activity on a regular basis (≥2×/week and/or ≥ 2 h/week) with the explicit aim to improve their physical performance limits. Athletes were followed for a median of 44 and 49 months, respectively. ICD shock data and clinical outcomes were adjudicated by three electrophysiologists. Compared with competitive athletes, recreational athletes were older (median 44 vs. 37 years; p = 0.0004), more frequently men (79% vs. 68%; p = 0.06), with less idiopathic ventricular fibrillation or catecholaminergic polymorphic ventricular tachycardia (1.3% vs. 15.4%), less congenital heart disease (1.3% vs. 6.9%) and more arrhythmogenic right ventricular cardiomyopathy (23.8% vs. 13.6%) ( p < 0.001). They more often had a prophylactic ICD implant (51.4% vs. 26.9%; p < 0.0001) or were given a beta-blocker (95% vs. 65%; p < 0.0001). Left ventricular ejection fraction, ICD rate cut-off and time from implant were similar. Recreational athletes performed fewer hours of sports per week (median 4.5 vs. 6 h; p = 0.0004) and fewer participated in sports with burst-performances ( vs. endurance) as their main sports: 4% vs. 65% ( p < 0.0001). None of the athletes in either group died, required external resuscitation or was injured due to arrhythmia or shock. Freedom from definite or probable lead malfunction was similar (5-year 97% vs. 96%; 10-year 93% vs. 91%). Recreational athletes received fewer total shocks (13.8% vs. 26.5%, p = 0.01) due to fewer inappropriate shocks (2.5% vs. 12%; p = 0.01). The proportion receiving appropriate shocks was similar (12.5% vs. 15.5%, p = 0.51). Recreational athletes received fewer total (6.3% vs. 20.2%; p = 0.003), appropriate (3.8% vs. 11.4%; p = 0.06) and inappropriate (2.5% vs. 9.5%; p = 0.04) shocks during physical activity. Ventricular tachycardia/fibrillation storms during physical activity occurred in 0/80 recreational vs. 7/317 competitive athletes. Appropriate shocks during physical activity were related to underlying disease ( p = 0.004) and competitive versus recreational sports ( p = 0.004), but there was no relation with age, gender, type of indication, beta-blocker use or burst/endurance sports. The proportion of athletes who stopped sports due to shocks was similar (3.8% vs. 7.5%, p = 0.32). Participants in recreational sports had less frequent appropriate and inappropriate shocks during physical activity than participants in competitive sports. Shocks did not cause death or injury. Recreational athletes with ICDs can engage in sports without severe adverse outcomes unless other reasons preclude continuation.

Exercise during pregnancy: A review of patterns and determinants

Background: Perineal tear is the tearing of the pelvic floor muscles. Based on the literature review and previous research, perineal tear often occur in labor, especially in primigravida. Pregnancy exercise is a physical activity that carried out by pregnant women. This study aims to determine the relationship between pregnancy exercise and perineal tear in normal labor at the Pratama Anugrah Clinic in Surabaya. Methods: This study uses an observational analytic method with a retrospective time approach. The number of samples was 34 case groups (perineal tears) and 34 control groups (no perineal tears) in normal delivery using purposive sampling. The instruments used are medical records, written interviews, cameras and checklists. Data analysis used chi square statistical test with a significance level of 0.05. Results: The results showed that there were still many mothers who did not do pregnancy exercise during their pregnancy as many as 43 (63.2%). Mothers who did not practice pregnancy exercise experienced more perineal tears as much as 27 (79.4%), while mothers who did practice pregnancy exercise experience perineal tear in normal labor that is 18 (53%). Result of chi square statistical tests obtained p value 0.006 (p&lt;0.05). Conclusion: Pregnancy exercise minimizes perineal tear in normal delivery.

BackgroundStigma and bias experienced during prenatal care can affect quality of care and, ultimately, the health of pregnant women with obesity and their infants. We sought to 1) better understand the bias and stigma that women with BMIs ≥40 kg/m2 experience while receiving prenatal care, 2) gauge women’s interest in group prenatal education for women with obesity, and 3) gather feedback about their preferred weight-related terminology.MethodsWe conducted and thematically content-analyzed 30 semi-structured interviews of women with BMIs ≥40 kg/m2 who received prenatal care at a university-affiliated teaching hospital in the Midwest region of the United States.ResultsAll women recalled positive experiences during their perinatal care during which they felt listened to and respected by providers. However, many also described a fear of weight-related bias or recalled weight-based discrimination. Women reacted favorably to a proposed group prenatal care option for pregnant women with obesity that focused on nutrition, physical activity, and weight management. Women rated “weight” and “BMI” as the most desirable terms for describing weight, while “large size” and “obesity” were rated least desirable.ConclusionsMany pregnant women with BMIs ≥40 kg/m2 experience bias in the prenatal care setting. Potential steps to mitigate bias towards weight include improving provider awareness of the experiences and perspectives of this population, expanding prenatal care options targeted towards women with high BMIs, including group care, and using patient-preferred weight-related terminology. Through the remainder of this manuscript, wherever possible, the term “high BMI” will be used in place of the term “obesity” to describe women with BMI ≥ 30 kg/m2 in order to respect the preferred terminology of the women we interviewed.

Background Sudden cardiac death (SCD) is uncommon, but accounts for a majority of natural, unexpected sudden death in the young population. Exercise, although clearly health promoting for the vast majority of individuals, is also historically well known as a potential trigger of SCD. Previous studies have reported varying results concerning the comparative risk of SCD in competitive athletes versus non-athletes. Purpose The aim was to study all exercise related SCD in 10–35 years old in Sweden during the 11-year period 2000–2010, regarding the frequency, etiology, prevalence of symptoms, family history and/or ECG-changes; and to estimate the SCD incidence in the young and specifically in competitive athletes and to compare it with data from the previous decade. Methods We have previously identified all cases of SCD in 1–35 years old during 2000–2010 by systematic search in the Swedish Cause of Death Registry and the database of Forensic Medicine (n=552). From this cohort, we identified 514 cases in 10–35-years old, 373 (73%) men, and 141 (27%) women. For each case, information on circumstances at death, pathogenesis, athletic activity, medical history, symptoms, substance use, and heredity was assembled from autopsy-, police- and medical records. Results Exercise-related SCD occurred in 12% (62/514), a majority being men (56/62; 90%). Two thirds were recreational athletes, one-third competitive athletes. In total, 48% had either previous cardiac disease (27%), family history (27%), symptoms (32%), or an abnormal ECG (45%) before death. The most prevalent diagnosis was sudden arrhythmic death syndrome (SADS) (15/62; 24%). Exercise-related SCD was more frequent in men with hypertrophic cardiomyopathy (p=0.0008) and arrhythmogenic right ventricular cardiomyopathy (p=0.001), compared to non-exercise related SCD. The SCD incidence in competitive athletes was 9.4/million per year in men, and 0.6/million per year in women, which was around half the incidence compared to the years 1992–99. The SCD incidence in the general population was 22.3/million per year in men and 9.6/million per year in women. However, the risk of exercise-related SCD was twice as high in competitive athletes compared to recreational athletes. Conclusions 12% of SCD cases in the young Swedish population are exercise-related, with SADS being the most common etiology. The risk of exercise-related SCD is higher for competitive athletes compared to non-athletes. Specifically, exercise seems to trigger SCD in men with ARVC and HCM. About 50% have a pre-mortal risk profile. Importantly, the incidence of SCD in competitive athletes has been approximately halved in the 2000's compared to the 1990's. Theoretically, increased awareness, safety measures and cardiac screening may all have attributed to this positive development. We advocate a uniform evaluation of all exercise-related SCD in young athletes, including optimal histology and genetic analysis at autopsy. Acknowledgement/Funding Grants from Marcus Borgström, Uppsala University, the Swedish Medical Society, and from Norrbotten County Council

One of the physical exercises favored by pregnant women is pregnancy gymnastics. It is a kind of exercise for strengthening and maintaining the elasticity of abdominal wall muscles, ligaments, and basic muscles of pelvis which are related to the process of childbirth. The objective of this research was to find out the effectiveness of physical exercise method between prenatal yoga and pregnancy exercise in primigravida on childbirth duration so that it could provide information which could increase the knowledge of midwives and midwifery students in providing midwifery care for pregnant women in facing the process of childbirth. This quasi experiment study was conducted in July to September 2016. The subjects was 40 pregnant women. The respondents were all primigravida pregnant women of trimester III who had the pregnancy examined in the Practice of Independent Midwife, Medan Johor. T-test was used for statistical analysis. The result of T-test showed that p-value=0.002 which indicated that there was the difference in the effectiveness of physical exercise method between prenatal yoga and pregnancy gymnastics in primigravida on the duration of normal childbirth. Prenatal yoga was more effective than pregnancy gymnastics in shortening the duration of normal childbirth. Keywords: Prenatal yoga, Pregnancy gymnastics, Childbirth