Physical Activity Clinical Trial
Official title:
Randomized Clinical Study of the Effects of Aerobic Water Exercise on Maternal Cardiovascular Adaptation to Pregnancy
Objective: To assess the relationship between maternal cardiovascular capacity and aerobic water exercise during the gestational periods of hemodynamic overload. Study design: randomized clinical trial, with 41 healthy pregnant women assigned to one of two groups: Control and Water exercise. Maternal cardiovascular capacity (maximum oxygen consumption, cardiac output, stroke volume, heart rate and mean arterial pressure), physical performance (relative HR, treadmill speed and self-perceived exertion) and neonatal outcome (gestational age, weight, Apgar index and length of infant's hospitalization) were assessed. Means were evaluated by dependent and independent t-tests, and proportions by the chi-square method (p<0.05). Results: The control variables showed that the groups were homogeneous. Water exercise was associated with maintenance of VO2max, increase in stroke volume and cardiac output, and better performance on stress tests in the third trimester of gestation. No significant difference in neonatal variables was observed. Conclusion: Water exercise maintained cardiovascular capacity and performance under submaximal stress, and did not affect hemodynamic adaptation to gestation or neonatal outcome.
INTRODUCTION
Significant hemodynamic changes take place during the short period of pregnancy, very often
placing a major burden on the maternal cardiovascular system. Normal pregnancy is
characterized by an increase in cardiac output (CO), stroke volume (SV), heart rate (HR) and
blood volume, and decrease in arterial pressure and vascular resistance. Classic studies
have demonstrated an increase of up to 50% in maternal CO during the second and third
trimesters. These circulatory adaptations are responsible for supplying nutrients and oxygen
to the placenta and the fetus.
The physiological changes that follow regular exercise improve training efficiency and
performance, defining the concept of adaptation to exercise or aerobic training. Exercise
causes the heart and lungs to be more efficient by increasing cardiovascular capacity or
resistance. CO, SV and maximum oxygen consumption (VO2max) increase while HR and AP
decrease. The importance of these effects on overall health has been recognized by the most
outstanding medical and scientific groups. Therefore, regular exercise has been widely
promoted and a large number of women decide to begin or continue to exercise during
pregnancy.
This change in women's behavior has become a matter of concern among obstetricians and has
important practical implications - is the maternal body apt to bear the hemodynamic burden
of pregnancy in association with exercise stress? Studies on the effects of exercise on
pregnancy are scarce and show conflicting results, probably due to differences in exercise
frequency, intensity, type, duration, and gestational age at training initiation.
Aiming at standardizing exercise practice and thus promote materno-fetal health, the
American College of Obstetricians and Gynecologists (ACOG) issued, in 1985, guidelines for
exercise during pregnancy. In subsequent reviews, new recommendations were added, and water
exercise during pregnancy was recommended.
Water exercise offers some particular benefits that include the maintenance of body
temperature, control of gestational edema, and increase in diuresis. Moreover, it can be
easily performed up to the end of pregnancy, which favors compliance. These advantages added
to the fact that it has no adverse effect on the fetus explain the preference for this kind
of exercise during pregnancy.
Considering the lack of scientific evidence of the effects of exercise during pregnancy, and
the results obtained in our previous work, the purpose of this study was to assess the
relationship of aerobic water exercise during the gestational periods of greater hemodynamic
burden with maternal cardiovascular capacity and neonatal outcomes.
METHODS
This study is part of a project approved by the Committee of Research Ethics of the Botucatu
Medical School-UNESP on May 10, 1999.
Study design: randomized clinical, without intention to treat. Study subjects: All the
eligible women who volunteered to participate were sequentially enrolled and randomized to
one of two groups according to a computer-generated randomization list of numbers created
with Epi-Info software. Each sequential number corresponded to a sealed opaque envelope
containing the information on the randomization group in order to ensure concealment. Group
1 consisted of 29 women engaged in Water Exercise, and group 2 included 31 pregnant women
not participating in the program (control). Variables: the independent variable studied was
the practice of water exercise. The control variables, which were assessed at baseline,
included age, parity, pre-gestational body mass index (BMI), HR and MAP, smoking,
sedentarism, and gestational age at baseline and at stress testing. The dependent variables
regarding cardiovascular capacity and physical performance at the submaximal stress test
were VO2max; SV; CO; HR and MAP, relative HR treadmill speed and scores obtained with the
scale of Borg. Neonatal variables included gestational age, weight; Apgar index at minute 1
and at minute 5, and length (days) of infant's hospitalization.
Assessment of cardiovascular capacity: performed during prenatal visits at 16-20, 28-33 and
34-39 weeks. Cardiovascular capacity was evaluated by using a treadmill submaximal stress
test, according to the protocol of Balke-Ware & Bruce that requires five minutes on
treadmill at fixed incline and constant individualized speed with AP and HR monitoring.
Assessment of physical performance at stress testing - for this purpose, relative HR,
treadmill speed and the Borg scale scores, obtained during testing, were used. A specific
questionnaire was administered to all subjects in order to quantify stress perception during
testing.
Data processing and analyses - given that the aim of this study was to assess the efficacy
(exploratory and not intention-to-treat) of water exercise during pregnancy, our analysis
included only the subjects who underwent cardiovascular assessment at the three study
moments and missed no more than 2 exercise sessions/month. These data were stored in a
specific database Statistical analysis was performed with SPSS software version 10.0.7.
Means were compared using ANOVA followed by t-tests for independent (between groups) and
dependent (within groups) samples. Data were adequately transformed when necessary.
Proportions were compared by the chi-square test (X2). Statistical significance was set at
5% (p<0.005).
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Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Supportive Care
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