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551 Presentation

by Alicia Trudeau and Jess Sullivan

Alicia Trudeau

on 22 April 2010

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Transcript of 551 Presentation

Study #20 Meet our Client Risk Factors
Family history (+)
Diabetes (+)
HDL (-)

Natal-Lee Disease Gestational Diabetes Decreased glucose tolerance upon pregnancy Jess Sullivan &
Alicia Trudeau Major Signs and Symptoms Suggestive of
Cardiovascular, Pulmonary or Metabolic Disease
Unusual fatigue with usual activity
Initial Risk Stratification High Risk Recommend medical exam and MD supervised moderate and vigorous GXT
Pre-text Likelihood of CAD = Very Low GXT Rate: 79 bpm

Rhythm: NSR

Axis: NAD

Hypertrophy: None

Infarction: None

ST Changes: None

ECG changes during
exercise and recovery: None
Other Signs or Symptoms Increased thirst
Little weight gain Preeclampsia Contraindications Relative: diabetes GXT Results: Predicted HRmax = 197 bpm
85% of HR max acheived

VO2max = 51.2 ml/kg/min
3.1 L/min

METS = 14.6

Aerobic Capacity = 95th - 99th percentile Signs and Symptoms during GXT General fatigue but no dizziness HR and BP at Rest: HR: 79 bpm
BP: 136/78 mmHg
HR Response
Stage I

Stage II

Stage III

Stage IV





HR Response
BP Response





10 107




79 140/88




Recovery BP Response




170/90 Exercise Absolute: None
Relative: Fatigue
Test Termination
Analysis of Resting ECG Medications Pre-Natal Vitamin
Rx Benefits of Exercise
During Pregnancy Maintain healthy body weight
Maintain personal fitness
Decreased musculoskeletal complaints
Decreased minor discomforts
Improved posture and body mechanics
Reinforced principles of breath awareness and relaxation
Prevention and treatment of problems associated with disease
Stress reduction and enhanced self-image
Possible easing of labor
Special Considerations Weight gain related to pregnancy
Maternal and fetal temperature increases during exercise
Should avoid exercising in the supine position
Avoid jerky, bouncy, or high impact motions Week 1 & 2 Mode Frequency
Duration Jogging
Brisk Walking
Cycling 3-5 days / week Moderate
40-60% HRR
RPE 12-14
Talk test 30-60 minutes Jogging
Swimming Mode Duration Frequency
30-60 minutes Intensity
40-60% HRR
RPE 12-14
Talk test 3-5 days / week Mode Intensity
Swimming 30-60 minutes Frequency
3-5 days / week Duration Moderate
40-60% HRR
RPE 12-14
Talk test Walking
Swimming Intensity
Duration Frequency
3-5 days / week Mode 30-60 minutes Moderate
40-60% HRR
RPE 12-14
Talk test 30-60 minutes Swimming
Duration Mode Moderate
40-60% HRR
RPE 12-14
Talk test Frequency
3-5 days / week Week 3 & 4 Week 7 & 8 Week 11 & 12
Week 5 & 6 Moderate
40-60% HRR
RPE 12-14
Talk test Week 9 & 10 Mode Walking
Swimming 3-5 days / week Frequency
Duration 30-60 minutes Intensity
Exercises to be avoided: Contact sports
Horseback riding
12th Week Caloric Expenditure Lower Limit:
3 days/wk @ 40% VO2R @ 30 min/day
= 621 kcal/week

Upper Limit:
5 days/wk @ 60% VO2R @ 60 min/day
= 2940 kcal/week 12th Week Caloric Expenditure Lower Limit:
3d/wk @ 40% @ 30 min/d
= 621 kcal/wk

Upper Limit:
5d/wk @ 60% @ 60 min/d
= 2940 kcal/wk Strength Training: Type Frequency Intensity Special
Considerations 2-3 days/week Low Resistance
High Repetitions
One or more sets
8-10 different major muscle groups Avoid supine position
& Valsalva maneuver Intensity Machines
Resistance Bands
Free Weights * Phase III: Benefit from Phase III cardiac rehab program

Supervision For:
-gestational diabetes
-borderline preeclampsia
-fetal monitoring
Cardiac Rehab At Home Exercise RX None (for now)
Glucose levels need to be normal levels

Once bg levels and BP are stable (with supervised exercise):
exercise at home would be beneficial
-May not exceed moderate intensity Further Education *Gestational diabetes impact and control
*Preeclampsia effects
possible treatments for high BP such as:
-CCB (Amlodipine, Norvasc)
-Alpha blocker with Beta blocker (Labetetol, Trandate)
*Weight gain during pregnancy
Caloric intake 1st trimester
Caloric intake 2nd and 3rd trimester
Normal weight gain 25 – 35 lbs.
Diet 2000 to 2400 calories a day:
10 Starches
4 Vegetables
4 Fruits
2 Milks
5 to 7 ounces meat
up to 5 fats
Why Swimming? Questions?

American College of Sports Medicine. (2010). ACSM’s resource manual for guidelines for
exercise testing and prescription (6th ed.). Baltimore, MD: Lippincott Williams &
American College of Sports Medicine. (2010). Guidelines for exercise testing and prescription
(8th ed.). Baltimore, MD: Lippincott Williams & Wilkins.
Blackburn, S.T. (2007). Maternal, fetal, & neonatal physiology: A clinical perspective (3rd
ed.). St. Louis, MO: Sauders Elsevier.
Hammer, R.L., Perkins, J., & Parr, R. (200). Exercise during the childbearing year. The
Journal of Perinatal Education, 9(1), 1-13.
Katz, J. (1995). Water fitness during your pregnancy. Champaign, IL: Human Kinetics.
Volpe, S.L., Sabelawski, S.B., & Mohr, C.R. (2007). Fitness nutrition for special dietary
needs. Champaign, IL: Human Kinetics.

HTN complicates 6-8% of all pregnancy
leading cause of maternal mortality Important for providing important nutritional needs for the fetus
Important for decreasing birth defects, especially spina bifida
Additional Testing HELLP
o H hemolysis
o EL elevated liver enzymes
o LP low platelet count
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