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A Perspective on Exercise

A Perspective on Exercise. 20 year perspective and journey Work in the late 1980s. A Perspective on Exercise. My work at Sansum vs. my own two kids / pregnancies Who is at risk? Training throughout pregnancy Just “who” can really exercise? Monitoring in all three trimesters

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A Perspective on Exercise

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  1. A Perspective on Exercise • 20 year perspective and journey • Work in the late 1980s

  2. A Perspective on Exercise • My work at Sansum vs. my own two kids / pregnancies • Who is at risk? • Training throughout pregnancy • Just “who” can really exercise? • Monitoring in all three trimesters • Modifying workloads – applying real exercise standards to the pregnancy population

  3. GDM in the News

  4. GDM in the News • More than 250,000 women who give birth have diabetes • Harms developing baby – but increases risk of diabetes later in life • Costs are 55% higher for delivery in diabetic women

  5. GDM in the News • High BG numbers for fasting, post prandial, or OGTT now pose greater risks • Gaining weight in first trimester are at higher risk of GDM

  6. Theme for this presentation • What’s changed in exercise programming for pregnancy in general over the past 20 plus years? • How can we apply these types of programs to GDM prevention and therapy?

  7. Goals for Exercise • Exercise through entire pregnancy • Manage glucose and stress hormone levels • Develop a safe weight training program with modifications • Stay with low impact aerobic training • Pilates and Yoga are gaining popularity • Post partum exercise – weight loss, depression, improved fitness, life style habits

  8. Goals of Exercise • #1 – Regulate blood sugars – both acute (post exercise), and chronic (lower A1c) • #2 – Regulate body weight gain – good weight vs. excess fat • #3 – Maintain good blood flow – reduce edema, blood pressure increases, etc. • #4 – Maintain or improve lifestyle. Exercise sets the stage for health status of mother and baby

  9. Exercise in the Equation • So how do we integrate exercise into a pregnancy for women at risk for GDM that is safe, effective, and may cause a shift in lifestyle habits that would last after the baby is born?

  10. Recent info on Exercise and Pregnancy Amazon shows a lot of books on the subject – so the information is out there.

  11. Exercise and GDM • Tieu, J. Dietary advice in pregnancy for preventing GDM. Chochrane Database Syst. Rev. 2008. • Low GI diets improved baby birthweights • One trial used combination of standard exercise (?) with diet • However – results in general were inconclusive • deBarros, MC, et al. Resistance exercise and glycemic control in women with GDM. AJOG – 2010 • 21% of exercise vs. 56% required insulin, 80% of EX maintained BG levels throughout trial • Tobias, DK – PA before and during pregnancy and risk of GDM. Diabetes Care. 2010. • Pre pregnancy PA in 34,900 participants – OR = .45 of highest / lowest categories. EX in early pregnancy in 4,400 women was protective OR = .76. PA assoc. with sig. reduction in GDM. • Clapp, JF. Effects of diet and exercise on insulin resistance in pregnancy. Met. Synd. Relat. Dis. 2006 • Decrease in maternal and fetal weight • Lowers insulin resistance, lowers blood glucose

  12. Current Info on Exercise and Diabetes • Exercise must be important – as many web sites are including it as part of the “prevention” formula

  13. Sam’s Club and Prevention • What you get: For $99, buyers of the program get an annual subscription to a web-based program that includes an at-home blood screening test that tracks an individual's cholesterol, blood sugar and hemoglobin levels. • Buyers also get access to a 24/7 nurse line, two health coaching sessions, recommended prevention screenings, schedule and alerts based on age, gender and risks and a physician summary that can be shown to a doctor.

  14. Exercise and GDM Prevention • 1992 case study on the use of exercise and the prevention of GDM • Diagnosed in first pregnancy – exercise to reduce symptoms • Exercise in first trimester of second pregnancy – less weight gain, higher fitness, and no GDM diagnosis at 24 weeks. • Compare first to second pregnancies – clear that exercise had effect on outcome • Eric P. Durak, MSc, Lois Jovanovic, MD, Charles M. Peterson, MD. The Use of Exercise to Prevent Gestational Diabetes Mellitus: A Case Report. Sports Medicine, Training, & Rehab Journal. 3:230, 1992

  15. Exercise and GDM for Today • What do we know about exercise and GDM today?Can we prevent diabetes through exercise?Can we prevent GDM through exercise • http://www.gestationaldiabetes.org/Treatment/exercise.html • http://www.livestrong.com/article/112764-exercise-gestational-diabetes/

  16. Exercise in the Equation • What’s missing? • Comprehensive method of using exercise as part of prevention • Numbers are great – but using exercise systematically can reduce numbers even more • How can we construct the “perfect” exercise program that can improve on the prevention concept? • Who’s qualified to conduct exercise programs for “at risk” diabetic or pre-diabetic pregnant women?

  17. Exercise in the Equation • Current thoughts on exercise for pregnancy • Upper body ergometry is still a standard • Many types to chose in health club setting

  18. Other forms of Exercise • In the Home • Walking program • Swimming • Strength training and stretching • At work • Walking / machine work • With friends • Small group fitness program through pregnancy

  19. An Exercise Prescription • Exercising based on HR and PRE • Exercising multiple times per day • Training for BG control • Time of day to best exercise • Biomechanics and balance issues • Type of aerobic machine • Weight lifting for pregnancy • Functional performance training for two

  20. An Exercise Prescription • Times per week = 3-5 • Work up from 1-2 times at start • May walk 2X per day for BG control • Monitor BG levels post exercise • Training Type • Breathing and imagery training (BG response) • Linear movement patterns (front/ back, side to side) • Light to moderate stretching • Yoga programs • Standing Pilates

  21. Strength through Pregnancy • Weight lifting for pregnancy • Functional performance training for two • Small muscle group exercise • Sets and reps • Rest period • Hydration / rehydration • Tubing, medicine ball, balance • http://www.youtube.com/watch?v=mPzSniJZv4Y&feature=related - Exercise • with Dr. Kathy

  22. Strength in Pregnancy • Modifying range of motion in exercise (squat), and even picking up weights.

  23. Strength in Pregnancy • Use of rubber tubing training • Use of body weight exercises • Wall push ups • Body weight fitness ball squats

  24. Yoga for Pregnancy • One of the best types of exercises for increased oxygen, range of motion, pain reduction, and relaxation

  25. Yoga and Pregnancy • Working on range of motion while keeping a wide stance for balance

  26. Pilates and Pregnancy • Pregnancy exercises for upper body strengthening that do not affect the abdominal area

  27. Pilates and Pregnancy • Post partum core training exercises • Pilates instructor KarenaLineback

  28. Contraindications

  29. Cost of exercise program • 3 pairs of neopreme dumb bells • 5 lb, 8 lb, 10 lb. $50-55.00 • Yoga Mat $25.00 • 3 rubber tubing cords $18.00 • 45-55 CM fitness ball $25.00 • 1-2 exercise videos $20.00 • Good pair of shoes $55.00 • TOTAL $150-200.00

  30. Is exercise part of the “standard of prenatal care”? • Referrals / information from doctors • Oncologists need a listing of qualified instructors from health clubs, Pilates studios, and private practice trainers • Work with physical therapist and pre natal nurses in terms of medical issues

  31. Diet and GDM • What about diet – what is critical in terms of changing metabolism? • Movement to Ornish / vegetarian • ADA general recommendations for diet to manage diabetes • Hidden sugars – substitutes and HFCS

  32. Facebook – diet and pregnancy

  33. Holistic medicine and GDM • Holistic medicine – is there a place for GDM prevention? • Stress reduction techniques • Use of pre-natal supplements • Organic foods

  34. Self care – self management • How about self care – what can women do to improve their odds of prevention? • Daily food logs • Visits to RD in first trimester • Develop a life-long exercise program • Learning to avoid diabetes-related risks

  35. Working with the Exercise Community • What about the diabetes community – how can they incorporate exercise?       Work with local health clubs and YMCAs to provide programs • Computer based outcomes for glucose / body weight / A1c / lipids, etc. • Follow ups after pregnancy

  36. Fitness for the long haul • Long term health consequences of regular exercise • Develop all exercise plans in first trimester • Have initial instruction and supervision as needed • Write down fitness and diabetes outcomes! • Monitoring of BG pre and post exercise – see trends over weeks (see graph next slide)

  37. BG monitoring over time

  38. Future GDM and Wellness Issues • Future thoughts and action plan for exercise and GDM • Health club referrals • Bi-lingual education programs for exercise • Information packet / referral pad in OB-GYN offices

  39. Questions ? ? ? ? ? ? ? ? ? ? ? ? ?

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