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PARC Services

PARC Services. PARC services support capacity-building, knowledge-sharing and learning opportunities. PARC services include providing: information on physical activity  consultation on physical activity issues assistance in the preparation of workshops and meetings

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PARC Services

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  1. PARC Services • PARC services support capacity-building, knowledge-sharing and • learning opportunities. • PARC services include providing: • information on physical activity  • consultation on physical activity issues • assistance in the preparation of workshops and meetings • review of physical activity-related materials • training for physical activity promoters • managing physical activity programs • PARC Pre-Congress session 2010 International Congress on Physical activity • Visit www.parc.ophea.net • Sign up for our listserv

  2. Special thanks to: Dr. Michelle F. Mottola, Ph.D. FACSM Director, R. Samuel McLaughlin Foundation – Exercise and Pregnancy Laboratory University of Western Ontario London, Ont. N6A 3K7 mmottola@uwo.ca

  3. Purpose of Workshop • To educate & inform women (& men) about the importance of physical activity during and after pregnancy • To increase understanding of PARmed-X for Pregnancy • To increase knowledge of current research in the area of physical activity and pre/post pregnancy • To discuss with others ways to promote anddisseminate this information • To provide an opportunity to ask specific questions, and learn and share with other workshop participants about existing successful programs

  4. Prenatal physical activity • Historical guidelines for exercise during pregnancy • PARmed-X for Pregnancy • Research Evidence • Exercise guidelines • Safety considerations • Community resources

  5. In the Past Prior to 1985 Exercise Guidelines for women did not exist. REST!

  6. In the Past 1985  ACOG (American College of Obstetrics & Gynecology) suggested heart rate should not go over 140 beats per minute 1994  ACOG Ignored heart rate; Replaced with common sense guidelines 2002  ACOG Ignored heart rate; Replaced with exercise on all days of week!

  7. www.csep.ca CSEP & Health Canada (1996; Revised 2002; 2009) PARmed-X for pregnancy (Physical activity readiness, medical prescreening & exercise prescription) - written for physician/midwife or health care professional to increase communication Authors: L.A. Wolfe, Queens & M.F. Mottola, Western Canadian guidelines for active living during pregnancy **Joint SOGC/CSEP Clinical Practice Guideline 2003** Davies et al. 2003; www.csep.ca ** Endorsed by the ACSM – Oct Bulletin 2004 ** Endorsed by the CASM – March 2008 – Position Statement ** Used by PARC (OPHEA) – Goodlife Fitness (CANFitPro) ** Used by Middlesex-London Health Unit + Other Health Units

  8. CSEP & Health Canada (1999) Active Living During Pregnancy Physical activity guidelines for mother & baby. Author: Angela Kochan-Vintinner (Eds. Wolfe & Mottola)

  9. Summary of Canadian Guidelines • Previously sedentary women with healthy pregnancies can safely start an exercise program in the second trimester • Women with low risk pregnancies can continue mild to moderate activity throughout • Mild to moderate aerobic activity within the Canadian guidelines (PARmed-X for Pregnancy) is considered safe • Muscle conditioning activity with necessary precautions is also considered safe (consult with a physical activity specialist )

  10. PARmed-X for Pregnancy • (Physical activity readiness, medical • prescreening & exercise prescription) • Written for physician/midwife or health care professional • Authors: L.A. Wolfe, Queens & M.F. Mottola, Western

  11. 4 page document • current history of pregnant women & occupation • - list of contraindications to exercise • - absolute, relative • - Aerobic conditioning guidelines • F. (frequency) 3- 4 times /week • I. (intensity) target HR zones • T. (time) 15 up to 30 minutes • T. (type) • - Muscle conditioning guidelines & precautions • - Safety considerations & reasons to consult a physician/midwife/health care professional

  12. Heart Rates Mottola et al. 2006 – Med. Sci. Sports Exerc. – new zones VO2peak Prediction and Exercise Prescription for Pregnant Women. 38(8):1389-1395. Target Heart Rate Zones: 20-29 years Fit – 145 – 160 beats/minute Unfit – 129 - 144 beats/minute 30-39 years Fit – 140 – 156 beats/minute Unfit – 128 – 144 beats/minute AgeHeart Rate <20 140-155 20-29 135-150 30-39 130-145 *heart rates if active

  13. New Target Heart Rates Mottola et al. 2006 – Med. Sci. Sports Exerc. – new zones VO2peak Prediction and Exercise Prescription for Pregnant Women. 38(8):1389-1395. New Target Heart Rate Zones Based on Age & Fitness: Age 20-29 yearsTarget Heart Rate Based on Fitness Low 129-144 Active 140-155 Fit 145-160 Age 30-29 yearsTarget Heart Rate Based on Fitness Low 128-144 Active 130-145 Fit 140-156

  14. For Overweight & Obese Pregnant Women? • Current guidelines present THR zones of 60-80% of max aerobic capacity -PARmed-X for Pregnancy • These women may not be capable of exercise at this intensity • The ACSM (2005) suggest overweight and obese women initiate an aerobic exercise program of 20 to 39% of VO2reserve • Must be medically pre-screened • Target heart rate zones based on age: • 20 to 29 years = 102 – 124 bpm; • 30 to 39 years = 101 – 120 bpm Davenport, Charlesworth, Vanderpank, Sopper & Mottola 2008. Appl Physiol Nut Metab 33: 984-89.

  15. Promotion of Physical Activity During Pregnancy • Pregnancy is time when many women change • to a healthier lifestyle improve eating habits quit smoking stop alcohol use moderate caffeine consumption receptive to learning new info want to be good parents and do the best for their baby think about active living

  16. Most common advantages and influences • Most common advantages • Exercise improves mood • Increases energy and stamina • Most common normative influences – (influence of people that have an impact) • Family members and children • Not physicians!

  17. Barriers to obstructing exercise • Physical limitations • Tiredness/fatigue • Time limits • Weight gain

  18. Benefits of Regular Physical Activity • help you and baby gain proper amount of weight • reduce discomforts such as, backaches, leg cramps, constipation, bloating, and swelling • Improve mood, energy level and feelings about appearance • Strengthen muscles and improve blood flow • Improve sleep • Help you have an easier, possibly shorter labour • Help you recover from delivery & return to a healthy weight faster

  19. More benefits • Helps control blood sugar • Improves heart and lung health • Promotes health lifestyle for family & children through role modeling

  20. Needs for Pregnant Women • Benefits of being active during pregnancy • Guidelines available for exercise during pregnancy (www.csep.ca) • Identify barriers to being active and ways to overcome them • Assistance in social support (health care providers, family involvement, transportation, safety issues, facilities, subsidized community programs)

  21. Safety Considerations • Choose moderate activities unlikely to cause injury, such as, walking (most popular), aqua aerobics, swimming, yoga, or a stationary bike • Stop exercising if you feel tired, or are overheated • Drink plenty of water • Wear comfortable clothing that fits well and is supportive • Stop exercising if you feel dizzy, short of breath, pain in your back, swelling, numbness, sick to your stomach, or if your heart is beating too fast or at an uneven rate • Stop exercising if you have vaginal bleeding • Eat a well-balanced diet • Avoid center of gravity shifts • Avoid lying on your back for long periods of time

  22. Other Ways to Promote Active Living • Muscle conditioning activities – check out cupboard!! • Increase steps taken per day – park farther away; take stairs • Rake leaves; cut grass • Gardening • Play with kids!

  23. Prenatal Education • Exercise education should be incorporated into pre and post natal care. • Importance of education and social support. • Include babies & child care in programs • Include PAR Q for Pregnancy in information packages along with brochures on what activities are safe

  24. Community Resources • Where to go for additional information? • Courses/classes • Reading materials

  25. Some new research – the obesity link Pregnancy link to obesity in mother and offspring Risk factors for childhood obesity Obesity prevention better than treatment?? Fetal Imprinting and maternal environment Maternal Lifestyle during pregnancy

  26. Some new research – the obesity link • [Flegal et al. JAMA 2002; 288:1723-7]. • Prevalence of Obesity in the U.S: • 30% of adults above 20 years age are now obese • 60 million people!! • 9 million children or teens are overweight!! • Health issues: • affects all organ systems • risk factor for hypertension • type 2 diabetes • cardiovascular mortality • dementia

  27. Childhood Obesity • increased morbidity • adult obesity • related adverse metabolic and cardiovascular problems • dyslipidemia tracks from childhood into adulthood

  28. Prevalence of Obesity in Canada 2004 59% - OW 23% - OB Katzmarzyk PT. Canadian Medical Association Journal, 2002. Katzmarzyk PT. Obesity, 2008

  29. International National/regional Community Individual factors factors factors factors Public transportation Occupation Genetic Educational policies Market globalization Safety Transportation policies Travel City planning Urbanization policies Leisure Energy expenditure Health policies Industrialization Food availability and accessibility Sports activities Food policies Food Family policies Food intake Media and advertising Media and marketing Cultural policies Body image Income Economic policies Adapted from Ritenbaugh C, Kumanyka S, Morabia A, Jeffrey R, Antipatis V. OITF 1999

  30. Cover page of The Economist, December 13-19th, 2003.

  31. Populations at risk for weight gain: WOMEN • Women in reproductive years • Pregnancy – excessive weight gain • Post partum – excessive weight retention • Menopause • Adolescent females

  32. Obesity/overweight increases risk for Gestational Diabetes (GDM) about 17% (Linne 2004) Maternal Obesity Up to 40% 1 in 6 – obese 1 in 3 - overweight National Geographic 2004

  33. Pregnancy link to Obesity? Among women of childbearing age, one potential pathway for obesity development is excessive pregnancy weight gain and post partum weight retention National Geographic 2004 Siega-Riz et al. 2004. Nut Rev 62:S105-11

  34. Risk factors for GDM….. • No exercise – Watching T.V. (sedentary lifestyle) • Overweight/obesity; • Body Mass Index – Weight/Height2 (BMI>25; >30kg/m2) • GDM in previous pregnancy • History of Large Babies > 9 lbs • Family History of Diabetes • Age • Ethnicity – Aboriginal, Hispanic, South Asian, African

  35. Offspring ….. • Type 1 • Later in life (type 2) • Large babies at risk for obesity which is a risk factor for diabetes Vicious Circle!!!

  36. Risk Factors for Childhood Obesity: • Higher birth weight predicted increased risk of overweight in adolescence • Born to a mother with GDM • Lower birth weight associated with later risk for central obesity • Obese mother/ father • Family life – overeating & sedentary lifestyle

  37. Influence on early post-natal life • Infants who were fed breast milk or who were breast fed longer had lower risk of overweight in adolescence • WHO breast fed at least 6 months Exclusively!! • Parental feeding patterns • Parental activity patterns • Obese mother – obese child

  38. Obesity prevention better than obesity treatment?? • Obesity prevention – begin very early in life? • Obese preschoolers associated with pre-pregnancy BMI of mother • Children of obese mothers twice as likely to be large for gestational age at birth • Large for gestational age babies more likely to be obese preschoolers Whitaker 2004 Pediatrics

  39. Need Obesity prevention better than obesity treatment?? Title? • Prevalence of obesity in children doubled over past 2-3 decades • Appears to be accelerating • Obesity & overweight are risk factors for type 2 diabetes • Type 2 diabetes is no longer an adult disease – happens to younger population including children • Interventions (treatments) aimed at school age kids – TOO LATE!! • PREVENTION!!!! EARLY YEARS??

  40. Impact of maternal & child health on current obesity epidemic • Prevention vs. treatment?? • Intervention times? • before conception • during pregnancy • early years of child’s life

  41. Awareness: Living in Balance • Causes: • input vs output • accelerated body weight gain • genetics; metabolic problems • excessive weight gain during pregnancy & weight retention • fetal programming? EATING HABITS ACTIVITY

  42. Programming evidence: • diabetes during pregnancy • maternal glucose transferred to the fetus • large for gestational age infant • fat cell size and number determined in late pregnancy • risk of offspring for obesity and type 2 diabetes • small for gestational age infants • inadequate maternal nutrition esp. protein • more at risk for central or truncal obesity • fat cell size and patterning early post natal life • problem with cardiovascular risk • Oken & Gillman, 2003 Obesity Res

  43. Fetal Origins of Obesity: • Trouble on both sides of the birth weight spectrum • in utero environment has profound effect on lifelong health • higher birth weight = higher BMI • lower birth weight = higher BMI • Assumption of patterning • Stimulus at critical period of development has lasting effect BMI Birth Weight Oken & Gillman 2003; Catalano 2006

  44. BMI Birth Weight Birth weight/fat deposits • Mismatch • under-nutrition fetal environment • catch-up growth postpartum – rapid weight gain • abdominal obesity • - large babies • - large adults

  45. Fetal • Programming?? • Growing evidence that prenatal environment impacts on chronic disease risk in infant • increased fat mass accompanied by glucose intolerance; insulin resistance; diabetes; CV problems National Geographic 2004

  46. At Birth Overworked pancreas High Insulin Fat Deposits High Sugars Baby Low Blood Sugars Birth Canal

  47. Rat Study (Bayol et al. 2007): Maternal ingestion of “junk food” (heavily processed, hyper-energetic) during pregnancy and lactation may increase junk food preference of the offspring and may increase the propensity for offspring obesity.........

  48. GDM In high-risk groups, GDM is considered a significant initiating factor in the type 2 diabetes/obesity epidemic and thus prevention may lead to decreased rates of type 2 diabetes in successive generations!! (Dyck et al. 2002)

  49. Rat Study (Bayol et al. 2007): If we restore the balance, can obesity and diabetes be prevented in future generations?? EatingHabits Activity

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