Núm. 60 (2015)
Área 17. OTRAS (Actividad Física y Salud) / OTHERS (Physical activity and health)

El ejercicio físico supervisado durante el embarazo mejora la respuesta cardiaca fetal / Supervised Physical Activity During Pregnancy Improves Fetal Cardiac Response. pp. 757-772

Publicado diciembre 17, 2015

Resumen

Objetivo: Valorar la influencia de un programa de ejercicio físico durante  la gestación en la adaptación de la frecuencia cardiaca fetal (FCF). Se espera encontrar una mejor adaptación dela FCFespecialmente en cuanto a recuperaciones más rápidas.

Método: 45 gestantes participantes en un ensayo clínico aleatorizado sin complicaciones ni contraindicaciones para el ejercicio fueron estudiadas durante el tercer trimestre de embarazo. Se midieron las siguientes variables: FCF en reposo, FCF post-ejercicio y tiempo de recuperación dela FCFa los niveles de reposo.

Resultados:La FCFen reposo fue similar en ambos grupos.La FCFpost-ejercicio fue significativamente mayor en el grupo control (GC) que en el grupo ejercicio (GE) en ambas pruebas, al 40% GE=138,5±6,4GE vs 141±7,5 GC (p=0,001), al 60% 141,6±10,8 GE vs 150,3±16,8GC. Lo mismo ocurre en los tiempos de recuperación, al 40% 78,2±95,7GE vs 328,4±315,2GC (p=0,001), al 60% 193,3±257,8 GE vs 542,6±482,9GC (p=0,003).

Conclusión: El ejercicio físico desarrollado durante el embarazo tiene como consecuencia una mejor adaptación dela FCFpost-ejercicio, así como recuperaciones más rápidas.

PALABRAS CLAVE: Embarazo, ejercicio, frecuencia cardiaca fetal, tiempo de recuperación.


ABSTRACT

Objective: To assess the influence of a physical activity program during pregnancy on the adaptation of the fetal heart rate (FHR). Greater adaptations and faster recovery are expected to find.

Methods: 45 pregnant women included in a randomized control trial, all with uncomplicated pregnancies for exercise were studied in their third trimester of pregnancy. Rest FHR, post-exercise FHR and recovery time were assessed.

Results: Rest FHR was similar in both groups. Post-exercise FHR were significantly higher in control group (CG) than in exercise group (EG) in both test, 40% 138,5±6,4EG vs 141±7,5CG (p=0,001), 60% 141,6±10,8EG vs 150,3±16,8CG. The same was found in recovery time, 40% 78,2±95,7EG vs 328,4±315,2CG (p=0,001), al 60% 193,3±257,8EG vs 542,6±482,9CG (p=0,003).

Conclusion: Greater adaptation in post-exercise FHR and faster recovery to rest FHR have been found as a result of a physical activity program carried out during pregnancy.

KEY WORDS: Pregnancy, exercise, fetal heart rate, recovery time.

Citas

Barakat R. El ejercicio físico durante el embarazo. Madrid: Pearson Educación; 2006.

Barakat R, Alonso, G. Rodriguez, M. Rojo, J. El ejercicio físico y los resultados del embarazo. Progresos en Ginecologia y Obstetricia. 2006;49(11):630-8. http://dx.doi.org/10.1016/S0304-5013(06)72664-4

Baciuk EP, Pereira RI, Cecatti JG, Braga AF, Cavalcante SR. Water aerobics in pregnancy: Cardiovascular Response, Labor and Neonatal Outcomes. Reproductive Health. 2008;5:10. http://dx.doi.org/10.1186/1742-4755-5-10

Cavalcante SR, Cecatti JG, Pereira RI, Baciuk EP, Bernardo AL, Silveira C. Water aerobics II: maternal body composition and perinatal outcomes after a program for low risk pregnant women. Reproductive Health. 2009;6:1. http://dx.doi.org/10.1186/1742-4755-6-1

Gavard JA, Artal R. Effect of exercise on pregnancy outcome. Clinical Obstetrics and Gynecology. 2008;51(2):467-80. http://dx.doi.org/10.1097/GRF.0b013e31816feb1d

Juhl M, Olsen J, Andersen PK, Nohr EA, Andersen AM. Physical exercise during pregnancy and fetal growth measures: a study within the Danish National Birth Cohort. American Journal of Obstetrics and Gynecology. 2010;202(1):63 e1-8.

Ferraro ZM, Gaudet L, Adamo KB. The potential impact of physical activity during pregnancy on maternal and neonatal outcomes. Obstetrical & Gynecological Survey. 2012;67(2):99-110. http://dx.doi.org/10.1097/OGX.0b013e318242030e

Kalisiak B, Spitznagle T. What effect does an exercise program for healthy pregnant women have on the mother, fetus, and child? PM & R : The journal of Injury, Function, and Rehabilitation. 2009;1(3):261-6. http://dx.doi.org/10.1016/j.pmrj.2008.12.006

Peláez M. El ejercicio físico durante el embarazo sobre la ganancia excesiva de peso y sus consecuencias. Tesis Doctoral. Universidad Politécnica de Madrid; 2011.

Lotgering FK, Gilbert RD, Longo LD. Maternal and fetal responses to exercise during pregnancy. Physiological Reviews. 1985;65(1):1-36.

Nijhuis IJ, ten Hof J. Development of fetal heart rate and behavior: indirect measures to assess the fetal nervous system. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1999;87(1):1-2. http://dx.doi.org/10.1016/S0301-2115(99)00143-8

May LE, Suminski RR, Langaker MD, Yeh HW, Gustafson KM. Regular Maternal Exercise Dose and Fetal Heart Outcome. Medicine and Science in Sports and Exercise. 2012. Epub 2012/01/06.PubMed PMID: 22217566. http://dx.doi.org/10.1249/MSS.0b013e318247b324

Spinnewijn WE, Lotgering FK, Struijk PC, Wallenburg HC. Fetal heart rate and uterine contractility during maternal exercise at term. American Journal of Obstetrics and Gynecology. 1996;174(1 Pt 1):43-8. http://dx.doi.org/10.1016/S0002-9378(96)70371-X

Gustafson KM, May LE, Yeh HW, Million SK, Allen JJ. Fetal cardiac autonomic control during breathing and non-breathing epochs: The effect of maternal exercise. Early Human Development. 2012. Epub 2012/01/24.PubMed PMID: 22264436. http://dx.doi.org/10.1016/j.earlhumdev.2011.12.017

Manders MA, Sonder GJ, Mulder EJ, Visser GH. The effects of maternal exercise on fetal heart rate and movement patterns. Early Human Development. 1997;48(3):237-47. http://dx.doi.org/10.1016/S0378-3782(96)01858-0

Barakat R, Ruiz, J R., Rodriguez, G., Montejo, R., Lucía, A. Does exercise training during pregnancy influence fetal cardiovascular responses to an exercise stimulus? Insights from a randomized control trial. British Journal of Sports Medicine. 2010;44(10):762-4. http://dx.doi.org/10.1136/bjsm.2009.062547

Veille JC. Maternal and fetal cardiovascular response to exercise during pregnancy. Seminars in Perinatology. 1996;20(4):250-62. http://dx.doi.org/10.1016/S0146-0005(96)80018-8

Barakat R, López, C., Montejo, R. Influencia del ejercicio físico en el tercer trimestre de embarazo sobre el comportamiento circulatorio de la unidad materno-fetal. Revista Andaluza de Medicina del Deporte. 2010;3(2):47-51.

Armitage & Berry. Estadística para la investigación biomédica. (3ª Edición). Madrid: Ed. Harcourt Brace. 1997.

Artal R, O'Toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. British Journal of Sports Medicine. 2003;37(1):6-12. http://dx.doi.org/10.1136/bjsm.37.1.6

Barakat R, Stirling, J R., Zakynthinaki, M. Acute maternal exercise during the third trimester of pregnancy, influence on foetal heart rate. Revista Internacional de Ciencias del Deporte. 2008;4(13):33-43. http://dx.doi.org/10.5232/ricyde2008.01303

Brenner IK, Wolfe LA, Monga M, McGrath MJ. Physical conditioning effects on fetal heart rate responses to graded maternal exercise. Medicine and Science in Sports and Exercise. 1999;31(6):792-9. http://dx.doi.org/10.1097/00005768-199906000-00006

Colberg S. Diabetes y ejercicio físico. Madrid: Tutor; 2003.

Bo K, Sherburn M. Evaluation of female pelvic-floor muscle function and strength. Physical Therapy. 2005;85(3):269-82.

Wolfe LA, Charlesworth SA, Glenn NM, Heenan AP, Davies GA. Effects of pregnancy on maternal work tolerance. Canadian Journal of Applied Physiology = Revue Canadienne de Physiologie Appliquee. 2005;30(2):212-32. http://dx.doi.org/10.1139/h05-116

Riemann MK, Kanstrup Hansen IL. Effects on the foetus of exercise in pregnancy. Scandinavian Journal of Medicine & Science in Sports. 2000;10(1):12-9. http://dx.doi.org/10.1034/j.1600-0838.2000.010001012.x

Heffernan KS, Fahs CA, Shinsako KK, Jae SY, Fernhall B. Heart rate recovery and heart rate complexity following resistance exercise training and detraining in young men. American Journal of Physiology Heart and Circulatory Physiology. 2007;293(5):H3180-6. http://dx.doi.org/10.1152/ajpheart.00648.2007

Singh TP, Rhodes J, Gauvreau K. Determinants of heart rate recovery following exercise in children. Medicine and Science in Sports and Exercise. 2008;40(4):601-5. http://dx.doi.org/10.1249/MSS.0b013e3181621ec4

Ostojic SM, Stojanovic MD, Calleja-Gonzalez J. Ultra short-term heart rate recovery after maximal exercise: relations to aerobic power in sportsmen. The Chinese Journal of Physiology. 2011;54(2):105-10. http://dx.doi.org/10.4077/CJP.2011.AMM018

Clapp JF, 3rd. The effects of maternal exercise on fetal oxygenation and feto-placental growth. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2003;110 Suppl 1:S80-5. http://dx.doi.org/10.1016/S0301-2115(03)00176-3

Collings C, Curet LB. Fetal heart rate response to maternal exercise. American Journal of Obstetrics and Gynecology. 1985;151(4):498-501. http://dx.doi.org/10.1016/0002-9378(85)90277-7

Sorensen KE, Borlum KG. Fetal heart function in response to short-term maternal exercise. British Journal of Obstetrics and Gynaecology. 1986;93(4):310-3.

Rafla NM, Cook JR. The effect of maternal exercise on fetal heart rate. Journal of Obstetrics and Gynaecology : The Journal of the Institute of Obstetrics and Gynaecology. 1999;19(4):381-4. http://dx.doi.org/10.1080/01443619964698

Szymanski LM, Satin AJ. Exercise during pregnancy: fetal responses to current public health guidelines. Obstetrics and Gynecology. 2012;119(3):603-10. http://dx.doi.org/10.1097/AOG.0b013e31824760b5

May LE, Glaros A, Yeh HW, Clapp JF, 3rd, Gustafson KM. Aerobic exercise during pregnancy influences fetal cardiac autonomic control of heart rate and heart rate variability. Early Human Development. 2010;86(4):213-7. http://dx.doi.org/10.1016/j.earlhumdev.2010.03.002

Silveira C, Pereira BG, Cecatti JG, Cavalcante SR, Pereira RI. Fetal cardiotocography before and after water aerobics during pregnancy. Reproductive Health. 2010;7:23. http://dx.doi.org/10.1186/1742-4755-7-23

Kennelly MM, McCaffrey N, McLoughlin P, Lyons S, McKenna P. Fetal heart rate response to strenuous maternal exercise: not a predictor of fetal distress. American Journal of Obstetrics and Gynecology. 2002;187(3):811-6. http://dx.doi.org/10.1067/mob.2002.125892

Melzer K, Schutz Y, Boulvain M, Kayser B. Physical activity and pregnancy: cardiovascular adaptations, recommendations and pregnancy outcomes. Sports Medicine. 2010;40(6):493-507. http://dx.doi.org/10.2165/11532290-000000000-00000