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Semin Neurol 2011; 31(4): 413-422
DOI: 10.1055/s-0031-1293541
© Thieme Medical Publishers

Exercise, Sports Participation, and Musculoskeletal Disorders of Pregnancy and Postpartum

Joanne P. Borg-Stein1 , 2 , 3 , David J. Fogelman1 , 4 , Kathryn E. Ackerman5 , 6 , 7
  • 1Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston
  • 2The Spine Center, Newton-Wellesley Hospital, Newton
  • 3Spaulding Rehabilitation Hospital Wellesley, Boston
  • 4Spaulding Rehabilitation Hospital, Boston
  • 5Department of Medicine, Harvard Medical School, Boston
  • 6Division of Sports Medicine, Children's Hospital Boston, Boston
  • 7Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
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Publication History

Publication Date:
23 November 2011 (online)

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ABSTRACT

The benefits of rigorous physical activity have long been proclaimed by the medical community. However, consensus regarding exercise duration and intensity in pregnancy has been more difficult to achieve. Conservative exercise guidelines for pregnant women were issued broadly in the 1980s due to limited evidence regarding safety. More recent evidence has failed to demonstrate ill effects of physical activity during pregnancy, as any effects on the mother and the fetus have thus far shown to be positive. The physical discomfort experienced by virtually all women during pregnancy, nearly 25% of whom experience at least temporarily disabling symptoms, is often a barrier to participation in an exercise program. An approach to developing an exercise program during pregnancy will be discussed in this article, as well as the potential benefits of such a program for the maternal–fetal unit, and common pregnancy-related musculoskeletal conditions, including a discussion of the anatomy, physiology, diagnosis, and treatment of such disorders.

KEYWORDS

Pregnancy - orthopedic - musculoskeletal - exercise - sports

REFERENCES

  • 1 The ACOG Guidelines for Exercise During Pregnancy and Postpartum .Washington, DC: American College of Obstetricians and Gynecologists, Home Exercise Programs; 1985
  • 2 Borg-Stein J, Dugan S A. Musculoskeletal disorders of pregnancy, delivery and postpartum.  Phys Med Rehabil Clin N Am. 2007;  18 (3) 459-476, ix
    Search in Google Scholar
  • 3 Duncombe D, Wertheim E H, Skouteris H, Paxton S J, Kelly L. Factors related to exercise over the course of pregnancy including women's beliefs about the safety of exercise during pregnancy.  Midwifery. 2009;  25 (4) 430-438
    Search in Google Scholar
  • 4 Hegaard H K, Kjaergaard H, Damm P P, Petersson K, Dykes A K. Experiences of physical activity during pregnancy in Danish nulliparous women with a physically active life before pregnancy. A qualitative study.  BMC Pregnancy Childbirth. 2010;  10 33
    Search in Google Scholar
  • 5 Clapp III J F. Exercise during pregnancy. A clinical update.  Clin Sports Med. 2000;  19 (2) 273-286
    Search in Google Scholar
  • 6 Clapp III J F, Kim H, Burciu B, Lopez B. Beginning regular exercise in early pregnancy: effect on fetoplacental growth.  Am J Obstet Gynecol. 2000;  183 (6) 1484-1488
    Search in Google Scholar
  • 7 Marquez-Sterling S, Perry A C, Kaplan T A, Halberstein R A, Signorile J F. Physical and psychological changes with vigorous exercise in sedentary primigravidae.  Med Sci Sports Exerc. 2000;  32 (1) 58-62
    Search in Google Scholar
  • 8 Kramer M S, McDonald S W. Aerobic exercise for women during pregnancy.  Cochrane Database Syst Rev. 2006;  3 CD000180
    Search in Google Scholar
  • 9 Barakat R, Stirling J R, Lucia A. Does exercise training during pregnancy affect gestational age? A randomised controlled trial.  Br J Sports Med. 2008;  42 (8) 674-678
    Search in Google Scholar
  • 10 Bell R, Palma S. Antenatal exercise and birthweight.  Aust N Z J Obstet Gynaecol. 2000;  40 (1) 70-73
    Search in Google Scholar
  • 11 Clapp III J F, Kim H, Burciu B, Schmidt S, Petry K, Lopez B. Continuing regular exercise during pregnancy: effect of exercise volume on fetoplacental growth.  Am J Obstet Gynecol. 2002;  186 (1) 142-147
    Search in Google Scholar
  • 12 Madsen M, Jørgensen T, Jensen M L et al.. Leisure time physical exercise during pregnancy and the risk of miscarriage: a study within the Danish National Birth Cohort.  BJOG. 2007;  114 (11) 1419-1426
    Search in Google Scholar
  • 13 Chasan-Taber L, Evenson K R, Sternfeld B, Kengeri S. Assessment of recreational physical activity during pregnancy in epidemiologic studies of birthweight and length of gestation: methodologic aspects.  Women Health. 2007;  45 (4) 85-107
    Search in Google Scholar
  • 14 Salvesen K A, Hem E, Sundgot-Borgen J. Fetal wellbeing may be compromised during strenuous exercise among pregnant elite athletes.  Br J Sports Med. 2011;  Epub ahead of print
    Search in Google Scholar
  • 15 Melzer K, Schutz Y, Boulvain M, Kayser B. Physical activity and pregnancy: cardiovascular adaptations, recommendations and pregnancy outcomes.  Sports Med. 2010;  40 (6) 493-507
    Search in Google Scholar
  • 16 Clapp III J F, Kiess W. Effects of pregnancy and exercise on concentrations of the metabolic markers tumor necrosis factor alpha and leptin.  Am J Obstet Gynecol. 2000;  182 (2) 300-306
    Search in Google Scholar
  • 17 Shivakumar G, Brandon A R, Snell P G et al.. Antenatal depression: a rationale for studying exercise.  Depress Anxiety. 2011;  28 (3) 234-242
    Search in Google Scholar
  • 18 ACOG Committee Obstetric Practice . ACOG Committee opinion. Number 267, January 2002: exercise during pregnancy and the postpartum period.  Obstet Gynecol. 2002;  99 (1) 171-173
    Search in Google Scholar
  • 19 Davies G A, Wolfe L A, Mottola M F, MacKinnon C. Society of Obstetricians and gynecologists of Canada, SOGC Clinical Practice Obstetrics Committee . Joint SOGC/CSEP clinical practice guideline: exercise in pregnancy and the postpartum period.  Can J Appl Physiol. 2003;  28 (3) 330-341
    Search in Google Scholar
  • 20 Suzuki S, Murata T, Jiang L, Power G G. Hyperthermia prevents metabolic and cerebral flow responses to hypoxia in the fetal sheep.  J Soc Gynecol Investig. 2000;  7 (1) 45-50
    Search in Google Scholar
  • 21 Sasaki J, Yamaguchi A, Nabeshima Y, Shigemitsu S, Mesaki N, Kubo T. Exercise at high temperature causes maternal hyperthermia and fetal anomalies in rats.  Teratology. 1995;  51 (4) 233-236
    Search in Google Scholar
  • 22 Lindqvist P G, Marsal K, Merlo J, Pirhonen J P. Thermal response to submaximal exercise before, during and after pregnancy: a longitudinal study.  J Matern Fetal Neonatal Med. 2003;  13 (3) 152-156
    Search in Google Scholar
  • 23 Clapp III J F. The changing thermal response to endurance exercise during pregnancy.  Am J Obstet Gynecol. 1991;  165 (6 Pt 1) 1684-1689
    Search in Google Scholar
  • 24 Artal R, O'Toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period.  Br J Sports Med. 2003;  37 (1) 6-12 discussion 12
    Search in Google Scholar
  • 25 Jeffreys R M, Stepanchak W, Lopez B, Hardis J, Clapp III J F. Uterine blood flow during supine rest and exercise after 28 weeks of gestation.  BJOG. 2006;  113 (11) 1239-1247
    Search in Google Scholar
  • 26 Avery N D, Wolfe L A, Amara C E, Davies G A, McGrath M J. Effects of human pregnancy on cardiac autonomic function above and below the ventilatory threshold.  J Appl Physiol. 2001;  90 (1) 321-328
    Search in Google Scholar
  • 27 Lotgering F K, Struijk P C, van Doorn M B, Wallenburg H C. Errors in predicting maximal oxygen consumption in pregnant women.  J Appl Physiol. 1992;  72 (2) 562-567
    Search in Google Scholar
  • 28 Granath A B, Hellgren M S, Gunnarsson R K. Water aerobics reduces sick leave due to low back pain during pregnancy.  J Obstet Gynecol Neonatal Nurs. 2006;  35 (4) 465-471
    Search in Google Scholar
  • 29 Daley A J, Macarthur C, Winter H. The role of exercise in treating postpartum depression: a review of the literature.  J Midwifery Womens Health. 2007;  52 (1) 56-62
    Search in Google Scholar
  • 30 Ko Y L, Yang C L, Chiang L C. Effects of postpartum exercise program on fatigue and depression during “doing-the-month” period.  J Nurs Res. 2008;  16 (3) 177-186
    Search in Google Scholar
  • 31 Quinn T J, Carey G B. Does exercise intensity or diet influence lactic acid accumulation in breast milk?.  Med Sci Sports Exerc. 1999;  31 (1) 105-110
    Search in Google Scholar
  • 32 Chang J, Elam-Evans L D, Berg C J et al.. Pregnancy-related mortality surveillance—United States, 1991–1999.  MMWR Surveill Summ. 2003;  52 (2) 1-8
    Search in Google Scholar
  • 33 Sibai B M. Diagnosis and management of gestational hypertension and preeclampsia.  Obstet Gynecol. 2003;  102 (1) 181-192
    Search in Google Scholar
  • 34 Ness R B, Roberts J M. Heterogeneous causes constituting the single syndrome of preeclampsia: a hypothesis and its implications.  Am J Obstet Gynecol. 1996;  175 (5) 1365-1370
    Search in Google Scholar
  • 35 Vatten L J, Skjaerven R. Is pre-eclampsia more than one disease?.  BJOG. 2004;  111 (4) 298-302
    Search in Google Scholar
  • 36 National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy . Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy.  Am J Obstet Gynecol. 2000;  183 (1) S1-S22
    Search in Google Scholar
  • 37 Sorensen T K, Williams M A, Lee I M, Dashow E E, Thompson M L, Luthy D A. Recreational physical activity during pregnancy and risk of preeclampsia.  Hypertension. 2003;  41 (6) 1273-1280
    Search in Google Scholar
  • 38 Saftlas A F, Logsden-Sackett N, Wang W, Woolson R, Bracken M B. Work, leisure-time physical activity, and risk of preeclampsia and gestational hypertension.  Am J Epidemiol. 2004;  160 (8) 758-765
    Search in Google Scholar
  • 39 Ning Y, Williams M A, Muy-Rivera M, Leisenring W M, Luthy D A. Relationship of maternal plasma leptin and risk of pre-eclampsia: a prospective study.  J Matern Fetal Neonatal Med. 2004;  15 (3) 186-192
    Search in Google Scholar
  • 40 Qiu C, Sorensen T K, Luthy D A, Williams M A. A prospective study of maternal serum C-reactive protein (CRP) concentrations and risk of gestational diabetes mellitus.  Paediatr Perinat Epidemiol. 2004;  18 (5) 377-384
    Search in Google Scholar
  • 41 Williams M A, Farrand A, Mittendorf R et al.. Maternal second trimester serum tumor necrosis factor-alpha-soluble receptor p55 (sTNFp55) and subsequent risk of preeclampsia.  Am J Epidemiol. 1999;  149 (4) 323-329
    Search in Google Scholar
  • 42 Walsh S W, Behr M J, Allen N H. Placental prostacyclin production in normal and toxemic pregnancies.  Am J Obstet Gynecol. 1985;  151 (1) 110-115
    Search in Google Scholar
  • 43 Statement R C. Impact of physical activity during pregnancy and postpartum on chronic disease risk.  Med Sci Sports Exerc. 2006;  38 (5) 989-1006
    Search in Google Scholar
  • 44 Kelly C, Booth G L. Diabetes in Canadian women.  BMC Womens Health. 2004;  4 (Suppl 1) S16
    Search in Google Scholar
  • 45 Jovanovic L, Pettitt D J. Gestational diabetes mellitus.  JAMA. 2001;  286 (20) 2516-2518
    Search in Google Scholar
  • 46 Chu S Y, Callaghan W M, Kim S Y et al.. Maternal obesity and risk of gestational diabetes mellitus.  Diabetes Care. 2007;  30 (8) 2070-2076
    Search in Google Scholar
  • 47 Kim C, Newton K M, Knopp R H. Gestational diabetes and the incidence of type 2 diabetes: a systematic review.  Diabetes Care. 2002;  25 (10) 1862-1868
    Search in Google Scholar
  • 48 Dornhorst A, Rossi M. Risk and prevention of type 2 diabetes in women with gestational diabetes.  Diabetes Care. 1998;  21 (Suppl 2) B43-B49
    Search in Google Scholar
  • 49 Ross G. Gestational diabetes.  Aust Fam Physician. 2006;  35 (6) 392-396
    Search in Google Scholar
  • 50 Dempsey J C, Sorensen T K, Williams M A et al.. Prospective study of gestational diabetes mellitus risk in relation to maternal recreational physical activity before and during pregnancy.  Am J Epidemiol. 2004;  159 (7) 663-670
    Search in Google Scholar
  • 51 Rooney B L, Schauberger C W. Excess pregnancy weight gain and long-term obesity: one decade later.  Obstet Gynecol. 2002;  100 (2) 245-252
    Search in Google Scholar
  • 52 Althuizen E, van Poppel M N, de Vries J H, Seidell J C, van Mechelen W. Postpartum behaviour as predictor of weight change from before pregnancy to one year postpartum.  BMC Public Health. 2011;  11 165
    Search in Google Scholar
  • 53 Snell R S. Clinical Anatomy for Medical Students. Boston: Little Brown and Company; 1973
    Search in Google Scholar
  • 54 Ritchie J R. Orthopedic considerations during pregnancy.  Clin Obstet Gynecol. 2003;  46 (2) 456-466
    Search in Google Scholar
  • 55 Blecher A M, Richmond J C. Transient laxity of an anterior cruciate ligament-reconstructed knee related to pregnancy.  Arthroscopy. 1998;  14 (1) 77-79
    Search in Google Scholar
  • 56 Kristiansson P, Svärdsudd K, von Schoultz B. Serum relaxin, symphyseal pain, and back pain during pregnancy.  Am J Obstet Gynecol. 1996;  175 (5) 1342-1347
    Search in Google Scholar
  • 57 Owens K, Pearson A, Mason G. Symphysis pubis dysfunction—a cause of significant obstetric morbidity.  Eur J Obstet Gynecol Reprod Biol. 2002;  105 (2) 143-146
    Search in Google Scholar
  • 58 Aisaka K, Ikezuki Y, Doi M, Obata S. Evaluation of the cause and treatment of pubic pain during pregnancy.  Obstet Gynecol. 2005;  105 34S-42S
    Search in Google Scholar
  • 59 Schwartz Z, Katz Z, Lancet M. Management of puerperal separation of the symphysis pubis.  Int J Gynaecol Obstet. 1985;  23 (2) 125-128
    Search in Google Scholar
  • 60 Culligan P, Hill S, Heit M. Rupture of the symphysis pubis during vaginal delivery followed by two subsequent uneventful pregnancies.  Obstet Gynecol. 2002;  100 (5 Pt 2) 1114-1117
    Search in Google Scholar
  • 61 Carr C A. Use of a maternity support binder for relief of pregnancy-related back pain.  J Obstet Gynecol Neonatal Nurs. 2003;  32 (4) 495-502
    Search in Google Scholar
  • 62 Ternov N K, Grennert L, Aberg A, Algotsson L, Akeson J. Acupuncture for lower back and pelvic pain in late pregnancy: a retrospective report on 167 consecutive cases.  Pain Med. 2001;  2 (3) 204-207
    Search in Google Scholar
  • 63 LaBan M M, Viola S, Williams D A, Wang A M. Magnetic resonance imaging of the lumbar herniated disc in pregnancy.  Am J Phys Med Rehabil. 1995;  74 (1) 59-61
    Search in Google Scholar
  • 64 Heckman J D, Sassard R. Musculoskeletal considerations in pregnancy.  J Bone Joint Surg Am. 1994;  76 (11) 1720-1730
    Search in Google Scholar
  • 65 Bramlett K W, Killian J T, Nasca R J, Daniel W W. Transient osteoporosis.  Clin Orthop Relat Res. 1987;  222 (222) 197-202
    Search in Google Scholar
  • 66 Beaulieu J G, Razzano C D, Levine R B. Transient osteoporosis of the hip in pregnancy.  Clin Orthop Relat Res. 1976;  (115) 165-168
    Search in Google Scholar
  • 67 Bloem J L. Transient osteoporosis of the hip: MR imaging.  Radiology. 1988;  167 (3) 753-755
    Search in Google Scholar
  • 68 Takatori Y, Kokubo T, Ninomiya S, Nakamura T, Okutsu I, Kamogawa M. Transient osteoporosis of the hip. Magnetic resonance imaging.  Clin Orthop Relat Res. 1991;  271 (271) 190-194
    Search in Google Scholar
  • 69 Arayssi T K, Tawbi H A, Usta I M, Hourani M H. Calcitonin in the treatment of transient osteoporosis of the hip.  Semin Arthritis Rheum. 2003;  32 (6) 388-397
    Search in Google Scholar
  • 70 La Montagna G, Malesci D, Tirri R, Valentini G. Successful neridronate therapy in transient osteoporosis of the hip.  Clin Rheumatol. 2005;  24 (1) 67-69
    Search in Google Scholar
  • 71 Ekman-Ordeberg G, Sälgeback S, Ordeberg G. Carpal tunnel syndrome in pregnancy. A prospective study.  Acta Obstet Gynecol Scand. 1987;  66 (3) 233-235
    Search in Google Scholar
  • 72 Voitk A J, Mueller J C, Farlinger D E, Johnston R U. Carpal tunnel syndrome in pregnancy.  Can Med Assoc J. 1983;  128 (3) 277-281
    Search in Google Scholar
  • 73 Schned E S. DeQuervain tenosynovitis in pregnant and postpartum women.  Obstet Gynecol. 1986;  68 (3) 411-414
    Search in Google Scholar
  • 74 Schumacher Jr H R, Dorwart B B, Korzeniowski O M. Occurrence of De Quervain's tendinitis during pregnancy.  Arch Intern Med. 1985;  145 (11) 2083-2084
    Search in Google Scholar

Joanne P Borg-SteinM.D. 

Spaulding Rehabilitation Hospital Wellesley

125 Nashua Street, Boston, MA 02114

Email: jborgstein@partners.org