Gebelikte Fiziksel Aktivite ve Egzersiz
Özet
Gebelik, bir kadının yaşam tarzı alışkanlıklarının kendisinin ve fetüsün sağlığını önemli ölçüde etkileyebileceği benzersiz bir dönemdir. Sağlıklı gebeliklerde anne adaylarının haftanın çoğu gününde günde 20-30 dakika, haftada en az 150 dakika düşük-orta şiddette egzersiz yapmaları önerilmektedir. Gebelikte fiziksel aktivite ve egzersizin anne, fetal ve neonatal sağlık sonuçları üzerine olumlu birçok etkisi bulunmaktadır. Gebelikte herhangi bir fiziksel aktivite veya egzersiz programına başlamayı veya devam ettirmeyi önermeden önce egzersizden kaçınmayı gerektiren tıbbi bir durum olup olmadığını belirlemek amacı ile kapsamlı klinik değerlendirme yapılmalı, kadının önceki fiziksel aktivite düzeyine göre egzersiz programı planlanmalıdır. Programa, sağlıkla ilgili fiziksel uygunluk parametrelerini (kardiyovasküler dayanıklılık, kassal kuvvet ve endurans, esneklik, vücut kompozisyonu) arttırmayı amaçlayan aerobik, dirençli ve esneklik egzersizlerinin yanı sıra nöromotor egzersizler ve pelvik taban kas kuvvetlendirme egzersizleri dahil edilmelidir. Bu bölümde gebelikte fiziksel aktivite ve egzersiz planlaması ayrıntılı olarak ele alınacaktır.
Pregnancy is a unique time when a woman's lifestyle habits can significantly affect her health and the health of her foetus. In healthy pregnancies, expectant mothers are recommended to exercise at low to moderate intensity for 20-30 minutes per day on most days of the week and at least 150 minutes per week. Physical activity and exercise during pregnancy have many positive effects on maternal, fetal and neonatal health outcomes. Before recommending the initiation or continuation of any physical activity or exercise programme in pregnancy, a comprehensive clinical evaluation should be performed to determine whether there is a medical condition that requires avoidance of exercise, and an exercise programme should be planned according to the woman's previous level of physical activity. The programme should include aerobic, resistance and flexibility exercises aimed at increasing health-related physical fitness parameters (cardiovascular endurance, muscular strength and endurance, flexibility, body composition) as well as neuromotor exercises and pelvic floor muscle strengthening exercises. In this chapter, physical activity and exercise planning in pregnancy will be discussed in detail.
Referanslar
Bagherzadeh R, Gharibi T, Safavi B, et al. Pregnancy; an opportunity to return to a healthy lifestyle: a qualitative study. BMC Pregnancy Childbirth; 2021;21(1): 751. doi:10.1186/s12884-021-04213-6
WHO guidelines on physical activity and sedentary behaviour. Geneva: World Health Organization; 2020. (26.05.2024 tarihinde https://www.ncbi.nlm.nih.gov/books/NBK566047 adresinden ulaşılmıştır).
Guinhouya BC, Duclos M, Enea C, et al. Beneficial effects of maternal physical activity during pregnancy on fetal, newborn, and child health: guidelines for ınterventions during the perinatal period from the french national college of midwives. Journal of Midwifery & Women's Health; 2022;67 Suppl 1: 149-57. doi: 10.1111/jmwh.13424
Borodulin K, Evenson KR, Herring AH. Physical activity patterns during pregnancy through postpartum. BMC Womens Health; 2009;9: 32. doi:10.1186/1472-6874-9-32
Özen Oruk D. Physical activity and exercise during pregnancy in Turkey: a narrative review. Anadolu Kliniği Tıp Bilimleri Dergisi; 2023;28(3): 425-432.
Yıldırım Dİ, Balcı Ş, Günenç O, et al. Effect of physical activity on health-related quality of life and depression anxiety in pregnancy. Cukurova Medical Journal; 2020;45(2): 547-555
Bilgin Z, Yılmaz Esencan T. Perception of physical exercise in Turkish pregnant women and affecting factors. Eur J Physiother. 2022;24(2):97-103
Evenson KR, Moos MK, Carrier K, et al. Perceived barriers to physical activity among pregnant women. Maternal and Child Health Journal; 2009;13(3): 364-375. doi: 10.1007/s10995-008-0359-8
Okafor UB, Goon DT. Physical activity and exercise during pregnancy in Africa: a review of the literature. BMC Pregnancy and Childbirth. 2020;20(1): 732. doi: 10.1186/s12884-020-03439-0
Connell G, Weis CA, Hollman H, et al. Physical activity throughout pregnancy: guideline critical appraisal and implementation tool. The Journal of the Canadian Chiropractic Association; 2021;65(1): 50-58.
Joy EA, Mottola MF, Chambliss H. Integrating exercise is medicine® into the care of pregnant women. Current Sports Medicine Reports; 2013;12(4): 245-247. doi: 10.1249/JSR.0b013e31829a6f7e
American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 10th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2017: 195-202.
Sparks JR, Flanagan EW, Kebbe M, et al. Understanding barriers and facilitators to physical activity engagement to inform a precision prescription approach during pregnancy. American Journal of Lifestyle Medicine; 2022;17(1): 108-122. doi: 10.1177/15598276221108669
Dipietro L, Evenson KR, Bloodgood B, et al. Benefits of physical activity during pregnancy and postpartum: an umbrella review. Medicine & Science in Sports & Exercise; 2019;51(6): 1292-1302. doi: 10.1249/MSS.0000000000001941
Ribeiro MM, Andrade A, Nunes I. Physical exercise in pregnancy: benefits, risks and prescription. Journal of Perinatal Medicine; 2021;50(1): 4-17. doi: 10.1515/jpm-2021-0315
Pereira MA, Rifas-Shiman SL, Kleinman KP, et al. Predictors of change in physical activity during and after pregnancy: Project Viva. American Journal of Preventive Medicine; 2007;32(4): 312-319. doi: 10.1016/j.amepre.2006.12.017
Inge P, Orchard JJ, Purdue R, et al. Exercise after pregnancy. The Australian Journal of General Practice; 2022;51(3): 117-121. doi: 10.31128/AJGP-09-21-6181
Bredin SS, Foulds HJ, Burr JF, et al. Risk assessment for physical activity and exercise clearance: in pregnant women without contraindications. Canadian Family Physician; 2013;59(5): 515-517.
Evenson KR, Barakat R, Brown WJ, et al. Guidelines for physical activity during pregnancy: comparisons from around the world. American Journal of Lifestyle Medicine; 2014;8(2): 102-121. doi: 10.1177/1559827613498204
Brown WJ, Hayman M, Haakstad LAH, et al. Australian guidelines for physical activity in pregnancy and postpartum. Journal of Science and Medicine in Sport; 2022;25(6): 511-519. doi: 10.1016/j.jsams.2022.03.008
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Oliveira C, Imakawa TDS, Moisés ECD. Physical activity during pregnancy: recommendations and assessment tools. Revista Brasileira de Ginecologia e Obstetricia; 2017;39(8): 424-432. doi: 10.1055/s-0037-1604180
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Ertekin YH. Turkish adaptation of the Physical Activity Readiness Questionare for Everyone (PAR-Q+). Family Practice and Palliative Care; 2018;3(1): 52-64. doi:10.22391/fppc.396057
Riebe D, Franklin BA, Thompson PD, et al. Updating ACSM’s recommendations for exercise preparticipation health screening. Medicine & Science in Sports & Exercise; 2015;47(11): 2473–2479.
Magal M, Riebe D. New preparticipation health screening recommendations: what exercise professionals need to know. ACSM’s Health & Fitness Journal; 2016;20(3): 22-27. doi. 10.1249/FIT.0000000000000224
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ACSM-2. Resource Manual for Guidelines for Exercise Testing and Prescription. 7th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014.
Schmidt MD, Freedson PS, Pekow P, et al. Validation of the Kaiser Physical Activity Survey in pregnant women. Medicine and Science in Sports and Exercise; 2006;38(1): 42-50. doi:10.1249/01.mss.0000181301.07516.d6
Tosun OC, Solmaz U, Ekin A, et al. The Turkish version of the Pregnancy Physical Activity Questionnaire: cross-cultural adaptation, reliability, and validity. Journal of Physical Therapy Science; 2015;27(10): 3215-3221.
Üzelpasacı E. Gebeler için Kaiser Fiziksel Aktivite Anketi’nin Türkçe geçerlik ve güvenirliğinin araştırılması (Yüksek Lisans tezi). Ankara: Hacettepe Üniversitesi Sağlık Bilimleri Enstitüsü; 2017.
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Wowdzia JB, Davenport MH. Cardiopulmonary exercise testing during pregnancy. Birth Defects Research; 2021;113(3): 248-264. doi: 10.1002/bdr2.1796
Anderson J, Pudwell J, McAuslan C, et al. Acute fetal response to high-intensity interval training in the second and third trimesters of pregnancy. Applied Physiology, Nutrition, and Metabolism; 2021;46(12): 1552-1558. doi: 10.1139/apnm-2020-1086
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Referanslar
Bagherzadeh R, Gharibi T, Safavi B, et al. Pregnancy; an opportunity to return to a healthy lifestyle: a qualitative study. BMC Pregnancy Childbirth; 2021;21(1): 751. doi:10.1186/s12884-021-04213-6
WHO guidelines on physical activity and sedentary behaviour. Geneva: World Health Organization; 2020. (26.05.2024 tarihinde https://www.ncbi.nlm.nih.gov/books/NBK566047 adresinden ulaşılmıştır).
Guinhouya BC, Duclos M, Enea C, et al. Beneficial effects of maternal physical activity during pregnancy on fetal, newborn, and child health: guidelines for ınterventions during the perinatal period from the french national college of midwives. Journal of Midwifery & Women's Health; 2022;67 Suppl 1: 149-57. doi: 10.1111/jmwh.13424
Borodulin K, Evenson KR, Herring AH. Physical activity patterns during pregnancy through postpartum. BMC Womens Health; 2009;9: 32. doi:10.1186/1472-6874-9-32
Özen Oruk D. Physical activity and exercise during pregnancy in Turkey: a narrative review. Anadolu Kliniği Tıp Bilimleri Dergisi; 2023;28(3): 425-432.
Yıldırım Dİ, Balcı Ş, Günenç O, et al. Effect of physical activity on health-related quality of life and depression anxiety in pregnancy. Cukurova Medical Journal; 2020;45(2): 547-555
Bilgin Z, Yılmaz Esencan T. Perception of physical exercise in Turkish pregnant women and affecting factors. Eur J Physiother. 2022;24(2):97-103
Evenson KR, Moos MK, Carrier K, et al. Perceived barriers to physical activity among pregnant women. Maternal and Child Health Journal; 2009;13(3): 364-375. doi: 10.1007/s10995-008-0359-8
Okafor UB, Goon DT. Physical activity and exercise during pregnancy in Africa: a review of the literature. BMC Pregnancy and Childbirth. 2020;20(1): 732. doi: 10.1186/s12884-020-03439-0
Connell G, Weis CA, Hollman H, et al. Physical activity throughout pregnancy: guideline critical appraisal and implementation tool. The Journal of the Canadian Chiropractic Association; 2021;65(1): 50-58.
Joy EA, Mottola MF, Chambliss H. Integrating exercise is medicine® into the care of pregnant women. Current Sports Medicine Reports; 2013;12(4): 245-247. doi: 10.1249/JSR.0b013e31829a6f7e
American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 10th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2017: 195-202.
Sparks JR, Flanagan EW, Kebbe M, et al. Understanding barriers and facilitators to physical activity engagement to inform a precision prescription approach during pregnancy. American Journal of Lifestyle Medicine; 2022;17(1): 108-122. doi: 10.1177/15598276221108669
Dipietro L, Evenson KR, Bloodgood B, et al. Benefits of physical activity during pregnancy and postpartum: an umbrella review. Medicine & Science in Sports & Exercise; 2019;51(6): 1292-1302. doi: 10.1249/MSS.0000000000001941
Ribeiro MM, Andrade A, Nunes I. Physical exercise in pregnancy: benefits, risks and prescription. Journal of Perinatal Medicine; 2021;50(1): 4-17. doi: 10.1515/jpm-2021-0315
Pereira MA, Rifas-Shiman SL, Kleinman KP, et al. Predictors of change in physical activity during and after pregnancy: Project Viva. American Journal of Preventive Medicine; 2007;32(4): 312-319. doi: 10.1016/j.amepre.2006.12.017
Inge P, Orchard JJ, Purdue R, et al. Exercise after pregnancy. The Australian Journal of General Practice; 2022;51(3): 117-121. doi: 10.31128/AJGP-09-21-6181
Bredin SS, Foulds HJ, Burr JF, et al. Risk assessment for physical activity and exercise clearance: in pregnant women without contraindications. Canadian Family Physician; 2013;59(5): 515-517.
Evenson KR, Barakat R, Brown WJ, et al. Guidelines for physical activity during pregnancy: comparisons from around the world. American Journal of Lifestyle Medicine; 2014;8(2): 102-121. doi: 10.1177/1559827613498204
Brown WJ, Hayman M, Haakstad LAH, et al. Australian guidelines for physical activity in pregnancy and postpartum. Journal of Science and Medicine in Sport; 2022;25(6): 511-519. doi: 10.1016/j.jsams.2022.03.008
ACOG Committee Opinion, Number 804. Physical activity and exercise during pregnancy and the postpartum period. Obstetrics and Gynecology; 2020;135(4): e178-e188. doi:10.1097/AOG.0000000000003772
Oliveira C, Imakawa TDS, Moisés ECD. Physical activity during pregnancy: recommendations and assessment tools. Revista Brasileira de Ginecologia e Obstetricia; 2017;39(8): 424-432. doi: 10.1055/s-0037-1604180
Lee R, Thain S, Tan LK, et al. Asia-Pacific consensus on physical activity and exercise in pregnancy and the postpartum period. BMJ Open Sport & Exercise Medicine; 2021;7(2): e000967. doi: 10.1136/bmjsem-2020-000967
ACOG. Obstetric patient record forms. (26.05.2024 tarihinde https://www.acog.org/clinical-information/obstetric-patient-record-forms adresinden ulaşılmıştır).
CSEP-1. The Get Active Questionnaire for Pregnancy: Breaking down barriers to prenatal exercise. (26.05.2024 tarihinde https://csep.ca/2021/04/18/the-get-active-questionnaire-for-pregnancy-breaking-down-barriers-to-prenatal-exercise adresinden ulaşılmıştır).
CSEP-2. Get Active Questionnaire for Pregnancy. (26.05.2024 tarihinde https://csep.ca/2021/05/27/get-active-questionnaire-for-pregnancy adresinden ulaşılmıştır).
Ertekin YH. Turkish adaptation of the Physical Activity Readiness Questionare for Everyone (PAR-Q+). Family Practice and Palliative Care; 2018;3(1): 52-64. doi:10.22391/fppc.396057
Riebe D, Franklin BA, Thompson PD, et al. Updating ACSM’s recommendations for exercise preparticipation health screening. Medicine & Science in Sports & Exercise; 2015;47(11): 2473–2479.
Magal M, Riebe D. New preparticipation health screening recommendations: what exercise professionals need to know. ACSM’s Health & Fitness Journal; 2016;20(3): 22-27. doi. 10.1249/FIT.0000000000000224
ACSM-1. ACSM risk stratification chart. (26.05.2024 tarihinde https://www.acsm.org/blog-detail/acsm-certified-blog/2019/11/11/acsm-risk-stratification-chart-download adresinden ulaşılmıştır).
ACSM-2. Resource Manual for Guidelines for Exercise Testing and Prescription. 7th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014.
Schmidt MD, Freedson PS, Pekow P, et al. Validation of the Kaiser Physical Activity Survey in pregnant women. Medicine and Science in Sports and Exercise; 2006;38(1): 42-50. doi:10.1249/01.mss.0000181301.07516.d6
Tosun OC, Solmaz U, Ekin A, et al. The Turkish version of the Pregnancy Physical Activity Questionnaire: cross-cultural adaptation, reliability, and validity. Journal of Physical Therapy Science; 2015;27(10): 3215-3221.
Üzelpasacı E. Gebeler için Kaiser Fiziksel Aktivite Anketi’nin Türkçe geçerlik ve güvenirliğinin araştırılması (Yüksek Lisans tezi). Ankara: Hacettepe Üniversitesi Sağlık Bilimleri Enstitüsü; 2017.
Alim A, Imtiaz MH. Wearable sensors for the monitoring of maternal health-a systematic review. Sensors (Basel, Switzerland); 2023;23(5): 2411. doi: 10.3390/s23052411
Wowdzia JB, Davenport MH. Cardiopulmonary exercise testing during pregnancy. Birth Defects Research; 2021;113(3): 248-264. doi: 10.1002/bdr2.1796
Anderson J, Pudwell J, McAuslan C, et al. Acute fetal response to high-intensity interval training in the second and third trimesters of pregnancy. Applied Physiology, Nutrition, and Metabolism; 2021;46(12): 1552-1558. doi: 10.1139/apnm-2020-1086
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