DERLEMELER
Sık Sorulan Sorularla Gebelikte Egzersiz
Exercise in Pregnancy via Frequently Asked Questions
Received Date : 08 Nov 2022
Accepted Date : 14 Jun 2023
Available Online : 16 Jun 2023
Ceren ÖRNEKa, Aylin SARIYILDIZa, İlke COŞKUN BENLİDAYIa
aÇukurova Üniversitesi Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon ABD, Adana, Türkiye
Doi: 10.31609/jpmrs.2022-94247 - Makale Dili: TR
J PMR Sci. 2023;26(3):342-7
ÖZET
Gebelik sürecinde kas-iskelet sistemi dâhil olmak üzere birçok sistemde
çeşitli değişiklikler ve adaptasyon mekanizmaları gelişir. Bu adaptasyon
döneminde birçok kas-iskelet problemi ve ağrı yakınması izlenebilir.
Gebelikte uygun süre, şiddet ve türde yapılan egzersizin ise fizyolojik ve
psikolojik açıdan çok sayıda olumlu etkisi bilinmektedir. Travmaya, denge
problemine yol açmayan yürüyüş, sabit bisiklet sürüşü, yüzme gibi aerobik
egzersizler önerilen egzersizlerden bazılarıdır. Gebeler egzersize yönlendirilmeden
önce klinik, obstetrik risk faktörleri açısından mutlaka değerlendirilmelidir.
Ayrıca egzersiz sırasında dikkat etmesi gereken hususlar ve
egzersizi sonlandırması gereken durumlar hakkında bilgilendirilmelidir. Önceki
gebeliklerde preterm doğum öyküsü veya şimdiki gebeliğinde preterm
doğum riskinin bulunması, intrauterin büyüme geriliği, plasenta previa, servikal
yetersizlik, erken membran rüptürü, devam eden 2 ve 3. trimester kanamaları,
gebeliğin indüklediği hipertansiyon veya preeklampsi, ciddi
kardiyovasküler, respiratuar hastalıklar gebelikte egzersizin mutlak kontraendikasyonlarıdır.
Egzersiz esnasında baş ağrısı, göğüs ağrısı, nefes darlığı,
uterin kontraksiyonun başlaması, amniyon sıvısının gelişi veya vajinal kanama
durumlarında egzersiz sonlandırılmalıdır. Bu derlemede, egzersizin
gebelik sürecindeki olumlu etkilerinin, gebelik sırasında önerilen egzersiz
türlerinin, egzersizin kontraendike olduğu klinik durumların ve egzersiz esnasında
dikkat edilecek hususların literatür eşliğinde incelenmesi amaçlanmıştır.
Anahtar Kelimeler: Egzersiz; gebelik; kas-iskelet sistemi
ABSTRACT
Various changes and adaptation mechanisms develop in many
systems, including the musculoskeletal system, in pregnancy. During this
adaptation process, many musculoskeletal problems and pain complaints
can be observed. Appropriate duration, intensity, and type of exercise during
pregnancy are known to have several favorable physiological and psychological
effects. Aerobic exercises such as walking, stationary bike riding,
and swimming that do not cause trauma or balance loss problems are some
of the recommended exercises. Before pregnant women are directed to exercise,
they should be evaluated in terms of clinical and obstetric risk factors.
In addition, they should be informed about the points to be considered
during the exercise and the situations in which they should terminate the exercise.
History of preterm birth in previous pregnancies or risk of preterm
birth in the current pregnancy, intrauterine growth retardation, placenta previa,
cervical insufficiency, premature rupture of membranes, ongoing 2nd
and 3rd trimester bleeding, pregnancy-induced hypertension or preeclampsia,
serious cardiovascular, respiratory diseases are absolute contraindications.
Exercise should be terminated in case of headache, chest pain,
shortness of breath, initiation of uterine contraction, the arrival of amniotic
fluid or vaginal bleeding during exercise. The aim of the current article was
to review the positive effects of exercise during pregnancy, the types of exercise
recommended during pregnancy, the clinical situations in which exercise
is contraindicated, and the points to be considered during exercise.
Keywords: Exercise; pregnancy; musculoskeletal system
REFERENCES
- Ezmerli NM. Exercise in pregnancy. Prim Care Update Ob Gyns. 2000;7:260-5. [Crossref] [PubMed]
- Gregg VH, Ferguson JE 2nd. Exercise in pregnancy. Clin Sports Med. 2017;3:741-52. Erratum in: Clin Sports Med. 2018;37:xiii. [Crossref] [PubMed]
- Köken G, Yılmazer M. [Pregnancy and exercise]. Türkiye Klinikleri Gynecol Obst. 2007;17:385-92. [Link]
- Conder R, Zamani R, Akrami M. The biomechanics of pregnancy: a systematic review. J Funct Morphol Kinesiol. 2019;4:72. [Crossref] [PubMed] [PMC]
- Yoo H, Shin D, Song C. Changes in the spinal curvature, degree of pain, balance ability, and gait ability according to pregnancy period in pregnant and nonpregnant women. J Phys Ther Sci. 2015;27:279-84. [Crossref] [PubMed] [PMC]
- Levendoğlu F. Gebelik ve rehabilitasyon. Beyazova M, Gökçe Kutsal Y, editörler. Fiziksel Tıp ve Rehabilitasyon. 3. Baskı. Ankara: Güneş Tıp Kitapevleri; 2016. p.1425-38.
- Carlson HL, Carlson NL, Pasternak BA, et al. Understanding and managing the back pain of pregnancy. Curr Womens Health Rep. 2003;3:65-71. [PubMed]
- Dunning K, LeMasters G, Levin L, et al. Falls in workers during pregnancy: risk factors, job hazards, and high risk occupations. Am J Ind Med. 2003;44:664-72. [Crossref] [PubMed]
- Betsch M, Wehrle R, Dor L, et al. Spinal posture and pelvic position during pregnancy: a prospective rasterstereographic pilot study. Eur Spine J. 2015;24:1282-8. [Crossref] [PubMed]
- Glinkowski WM, Tomasik P, Walesiak K, et al. Posture and low back pain during pregnancy - 3D study. Ginekol Pol. 2016;87:575-80. [Crossref] [PubMed]
- Dumas GA, Reid JG, Wolfe LA, et al. Exercise, posture, and back pain during pregnancy. Clin Biomech (Bristol, Avon). 1995;10:98-103. [Crossref] [PubMed]
- Physical Activity and Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion, Number 804. Obstet Gynecol. 2020;135:e178-e88. [Crossref] [PubMed]
- Stotland NE, Caughey AB, Breed EM, et al. Risk factors and obstetric complications associated with macrosomia. Int J Gynaecol Obstet. 2004;87:220-6. Erratum in: Int J Gynaecol Obstet. 2005;90:88. [Crossref] [PubMed]
- Borowski LE, Barchi EI, Han JS, et al. Musculoskeletal considerations for exercise and sport: before, during, and after pregnancy. J Am Acad Orthop Surg. 2021;29:e805-814. [Crossref] [PubMed]
- Bung P, Artal R. Gestational diabetes and exercise: a survey. Semin Perinatol. 1996;20:328-33. [Crossref] [PubMed]
- Muktabhant B, Lawrie TA, Lumbiganon P, et al. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database Syst Rev. 2015;2015:CD007145. [Crossref] [PubMed] [PMC]
- Paisley TS, Joy EA, Price RJ Jr. Exercise during pregnancy: a practical approach. Curr Sports Med Rep. 2003;2:325-30. [Crossref] [PubMed]
- Szegda K, Bertone-Johnson ER, Pekow P, et al. Physical activity and depressive symptoms during pregnancy among Latina women: a prospective cohort study. BMC Pregnancy Childbirth. 2018;18:252. [Crossref] [PubMed] [PMC]
- Morris SN, Johnson NR. Exercise during pregnancy: a critical appraisal of the literature. J Reprod Med. 2005;50:181-8. [PubMed]
- Uzun M. [Cardiovascular system and exercise]. J Cardiovascular Nursing. 2016;7:48-53. [Crossref]
- Gökbel H. Acute and chronic adaptations of the respiratory system to physical exercise. Solunum Dergisi. 2012;14:9-11. [Link]
- Davies GA, Wolfe LA, Mottola MF, et al; SOGC Clinical Practice Obstetrics Committee, Canadian Society for Exercise Physiology Board of Directors. Exercise in pregnancy and the postpartum period. J Obstet Gynaecol Can. 2003;25:516-29. English, French. [PubMed]
- ACOG Committee Opinion No. 650: physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol. 2015;126:e135-e42. [Crossref] [PubMed]
- Katz VL. Exercise in water during pregnancy. Clin Obstet Gynecol. 2003;46:432-41. [Crossref] [PubMed]
- 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;37:6-12; discussion 12. [Crossref] [PubMed] [PMC]
- Szymanski LM, Satin AJ. Exercise during pregnancy: fetal responses to current public health guidelines. Obstet Gynecol. 2012;119:603-10. [Crossref] [PubMed] [PMC]
- Mota P, Bø K. ACOG Committee Opinion No. 804: physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol. 2021;137:376. [Crossref] [PubMed]
- McMurray RG, Katz VL, Meyer-Goodwin WE, et al. Thermoregulation of pregnant women during aerobic exercise on land and in the water. Am J Perinatol. 1993;10:178-82. [Crossref] [PubMed]
- Milunsky A, Ulcickas M, Rothman KJ, et al. Maternal heat exposure and neural tube defects. JAMA. 1992;268:882-5. [Crossref] [PubMed]
- Gutke A, Ostgaard HC, Oberg B. Association between muscle function and low back pain in relation to pregnancy. J Rehabil Med. 2008;40:304-11. [Crossref] [PubMed]
- Norén L, Ostgaard S, Johansson G, et al. Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up. Eur Spine J. 2002;11:267-71. [Crossref] [PubMed] [PMC]
- Stuge B, Laerum E, Kirkesola G, et al. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a randomized controlled trial. Spine (Phila Pa 1976). 2004;29:351-9. [Crossref] [PubMed]
- Luo L, Zhou K, Zhang J, et al. Interventions for leg cramps in pregnancy. Cochrane Database Syst Rev. 2020;12CD010655. [Crossref] [PubMed] [PMC]
- Blyton F, Chuter V, Walter KE, et al. Non-drug therapies for lower limb muscle cramps. Cochrane Database Syst Rev. 2012;1:CD008496. Update in: Cochrane Database Syst Rev. 2021;5:CD008496. [PubMed] [PMC]
- Gruszczynska D, Truszczynska-Baszak A. Exercises for pregnant and postpartum women with diastasis recti abdominis-Literature review. Adv Rehabil. 2018;32:27-35. [Crossref]
- Van Geelen H, Ostergard D, Sand P. A review of the impact of pregnancy and childbirth on pelvic floor function as assessed by objective measurement techniques. Int Urogynecol J. 2018;29:327-38. [Crossref] [PubMed]
- Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report. Washington DC: U.S. Department of Health and Human Services; 2008. [Link]
- ACOG Committee Obstetric Practice. ACOG Committee opinion. Number 267, January 2002: exercise during pregnancy and the postpartum period. Obstet Gynecol. 2002;99:171-3. [Crossref] [PubMed]
- Pelliccia A, Sharma S, Gati S, et al; ESC Scientific Document Group. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 2021;42:17-96. Erratum in: Eur Heart J. 2021;42:548-9. [PubMed]
- Price BB, Amini SB, Kappeler K. Exercise in pregnancy: effect on fitness and obstetric outcomes-a randomized trial. Med Sci Sports Exerc. 2012;44:2263-9. [Crossref] [PubMed]
- Jeffreys RM, Stepanchak W, Lopez B, et al. Uterine blood flow during supine rest and exercise after 28 weeks of gestation. BJOG. 2006;113:1239-47. [Crossref] [PubMed]