Photo by Serge Melki, Flickr CC

Exercise  during pregnancy provides many benefits to the mother and baby. Fortunately, clinicians and mothers have moved well beyond the view that women should be confined, or cannot initiate activity and be active at any stage of pregnancy. Here are 10 ‘take home messages’ for both clinicians and mums from a recent BMJ podcast with Dr. Browyn Bell.

1. Consider type, frequency and duration; a combination of different types of exercise is important to:

• Reap the different rewards of different types of exercise (pre, during, and post-partum)
• Prepare women for the physical demands of pregnancy and motherhood
• Maintain a healthy bodyweight which decreases likelihood of pregnancy complications

2. There are multiple benefits to exercise during pregnancy such as:

• Prevention of Gestational Diabetes
• Reduction of stress and fatigue

3. Keep core body temperature below 38.5 degrees Celsius (especially in the first trimester)

4. Avoid contact sports, scuba diving, and supine exercises during later pregnancy (listen to the podcast for specifics/details)

5. Consider pre-existing health conditions that may become more pronounced during pregnancy

6. For sedentary pregnant woman who want to start exercising, guidelines are the same as for non-pregnant women (gradual increase in activity)

7. One way to ensure a safe exercise intensity is by maintaining a conversation during exercise

8. Women are encouraged to continue exercise during all stages of pregnancy (even if performance ability is reduced)

9. As always, make healthy food choices

10. Everyone has different (pre-existing and unique) health and physical needs. Common sense activities such as walking are always a good idea. Consult a physician or physiotherapist to develop an individualized approach to exercise.

Follow this link to listen to the complete podcast

Related Articles

Artal, R and O’Toole, M. 2003. 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 . (FREE ONLINE!)

Ruben Barakat, R, Cordero Y, and CoteronJ et al. 2011. Exercise during pregnancy improves maternal glucose screen at 24–28 weeks: a randomised controlled trial. Br J Sports Med Published Online First: 26 September 2011.

Courtesy of Boston Public Library, Flickr CC

ACL injuries, lower limb injuries, neck pain, tendons and ultrasound in sports medicine practice were the chart busters in the 2nd half of 2011. Over 4000 listeners monthly enjoy the 35 BJSM podcasts available now. And we continue to add to the list.

We are very open to your suggestions as to whom to interview – feel free to email, post a message on twitter (include @BJSM_BMJ of course) or call 1 800 BJSM.

That’s all for this blog – take the time to listen to a BJSM podcast and provide feedback via ‘email or your favourite social media site

karim.khan@ubc.ca

@BJSM_BMJ

http://www.facebook.com/BJSM.BMJ

The 5 most popular BJSM Podcasts in 2011 were…

5. Treating tendinopathy with Professor Håkan Alfredson

4. Musculoskeletal ultrasound with Kim Harmon and Sean Martin

3. Managing whiplash with Michele Sterling

2. Biomechanical overload and lower limb injuries with Andrew Franklyn-Miller

…drum roll please for most popular podcast of the year…

1. The JUMP-ACL study with Anthony Beutler

Just a quick alert that Richard Budgett, the Chief Medical Office for the London Olympics, shares his very special insights.

He was an Olympic Gold medal winner in Los Angeles before serving the UK and now the world!

Click here for the podcast

And remember, the IOC, through its Medical Commission, supports the 4 of the 16 issues of British Journal of Sports Medicine (BJSM) annually. See recent editorial about Youth Olympic Games here. The BJSM is the leading clinical source of sports and exercise medicine.

I learned that about 12% of high fit 80+ year olds die annually. Seems a bit unfair. But 27% of low fit 60-69 year olds die annually! No typo. High fit 80-yr olds are HALF AS LIKELY TO DIE as low fit 60-yr olds. Are we talking about 80-yr old Olympians? Nope. High fit is top 40%. Low fit = bottom 20%. Not too hard.

Prof Steve Blair (giving the audience both barrels of evidence, below) provided the data and reminded us that 150 minutes of moderately vigorous activity weekly (walking to and from the fridge) will leave the low fitness group in the dust. Alternatively, 70 minutes of vigorous walking to the fridge will do it. Not a big ask. As he said, the folks who are ‘too busy’ to do this generally have 3-4 hours a day to watch TV. And I guess there’ll be a few who have 10-20 years in the grave to think about it. Sounds non-PC but is actually just a fact.

Prof Dan Lieberman, ‘the Barefoot Professor’ wore black slipper type shoes to remind us not to polarize the debate into ‘barefoot’ vs ‘shod’ running. He highlighted the evolutionary advantage that humans have to run down game in the heat. 9-15 km daily, daily, daily back in the day. He really argued for the benfits of forefoot strike to prevent injuries. He’s doing an interview with the BMJ team tomorrow and there’ll be a session on running shoes/orthoses/etc. with Benno Nigg too. In the meantime see orthotics and patellofemoral pain in the BMJ.

The FIFA research team (F-MARC) including Philippe Tscholl, Mario Bizzini and Jiri Dvorak (photo above) shared the facts that 2010 World Cup football players used medication including NSAIDs and cortisone at a remarkable rate – comparable to that of osteoarthritic octogenarians in a care facility.  A concern. Doctors must do better. No lessons learned from previous World Cups in Germany and France. In a nutshell – FIFA 11+ prevents lower limb injuries and is being rolled out around the world. Football for Health — health messages with players as ambassadors and school children as the target is proving effective and electric. Great uptake – a lesson in implementation which is the theme of January’s BJSM issue (2012). No hyperlink there just yet. BJSM Blog gives you today’s news but not tomorrow’s!

We are hours away from freshening up the podcast page with a suite of interviews. Just need to get the switch at BMA house. We’ll tweet you when it’s ready (@BJSM_BMJ).

And if you add a question for any conference speaker below we’ll try to get it answered. No promises though! Or via Twitter.

PS: Thanks to our terrific team from BMJ for being at UKsem 2011. I am sure you have earned a spot for 2012!

My sense is that the popularity of platelet-rich plasma (PRP) is increasing independent of research in this field. BJSM has covered this with front cover attention:

• Platelet-rich plasma: Debate. Jul 2010, (44)9
• IOC consensus paper on the use of platelet-rich plasma in sports medicine. Dec 2010, (44)15

Of most interest to blog readers will be the Podcast on PRP with Robert Jan de Vos and Adam Weir. These authors have arguably the highest quality study testing PRP to date. We congratulate the Dutch researchers on their quality study design and comprehensive investigations.

Conclusions?

– No clinical benefit in 6 months:

• de Vos, R, Weir, A et al. 2010. Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy. JAMA, 303(2)

-  No ultrasound evidence of benefit:

• de Vos, R, Weir, A et al. 2010. No effects of PRP on ultrasonographic tendon structure and neovascularisation in chronic midportion Achilles tendinopathy. BJSM, Online first November, 2010

- and now no benefit at 12 months:

• de Jonge, S, de Vos, R., Weir, A et al. 2011. One-Year Follow-up of Platelet-Rich Plasma Treatment in Chronic Achilles Tendinopathy: A Double-Blind Randomized Placebo-Controlled Trial. AJSM. August  39.

No benefit at 12 months is not a surprise given previous findings. The proposed mechanism for PRP therapy is accelerated early healing. Nevertheless, these data are important as some evangelical PRP providers may be tempted to discount the 6-month results and argue for a ‘delayed benefit’. This is not the last word on PRP and BJSM Associate Editor Kim Harmon (see: Musculoskeletal ultrasound: taking sports medicine to the next level) has pointed out reasons for this series of Dutch studies having ‘no effect’. BJSM is one of the leading venues for rational debate on PRP and we look forward to adding to your knowledge about the clinical utility of this ‘hot’ therapy that is gaining clinical popularity. Time for a quality randomized trial of PRP versus the Alfredson program for Achilles tendinopathy?

Concussion, concussion, concussion – has dominated the media over the past months. Major injuries to kids, research suggesting long-term problems, even the American Neurology Association updating their guidelines, now Sidney Crosby sits on the sidelines at millions of dollars a day.

BJSM afficionados will be aware but as we get new readers and blog followers daily, I don’t apologize for reminding you of free value in the following links:

The special issue of BJSM that followed the Zurich Concussion Consensus Meeting – this is the meeting that is driving the science – this was the evidence behind all the current change.

Particularly useful is Paul McCrory’s explanation of how to interpret the guidelines – via BJSM’s masterclass podcast.

Here’s the intro that goes with that podcast…

Part 3: You are the expert – you teach concussion to fellows and you can recite the SCAT2 even if you have profound headache and retrograde amnesia. Professor McCrory provides tips from the Consensus Statement that have you on the same page as the 27 experts in Zurich. And maybe you were one of them. Listen anyway, send any additional tips to the BJSM blog (http://blogs.bmj.com/bjsm/) and share the news of this practical podcast.

And then there is consensus statement itself – copublished in about 14 journals – a remarkable achievement in turning knowledge to action or ‘knowledge exchange’

As well as the practical forms to use on the sideline – the unfortunately named ‘SCAT2′ and ‘Pocket SCAT2′

No apologies for plugging the Swedish National Institute for Public Health who have produced an amazing medical tool – evidence based exercise prescription for many, many, medical conditions. If you are in the UK you will be familar with the BNF – this should accompany every BNF and be used more often!

In Australia the equivalent is MIMS and in Canada CPS.  Clinicians should be reaching for this instrument more often than the stethoscope – it would have more impact as an intervention by any measure!
The great thing is that it can be downloaded for free! No excuses!

The link to the downloadable PDF version is in the subject line of this blog. You can read the authors’ brief editorial in this month’s BJSM for free.

We had planned to have the BJSM podcast done by March 1st and we still may – but the issue busted to the home page ahead of schedule so please bear with us if you are looking for the podcast. Lots of great podcasts up on the home page for free (the one with Steven Blair is very relevant) but nothing about this Bible of Physical Activity Prescription yet. I’ll update on the podcast here and via Twitter (@BJSM_BMJ).

The topic of a new BJSM podcast is Ankle sprains and rehabilitation, with human movement specialist Evert Verhagen.

He addresses accurate diagnosis, whether to tape or brace (and when), principles of return to sport, and issues of cost-effectiveness. This podcast is geared to clinicians treating patients after ankle sprain  — and preventing these injuries in the first place. See Evert’s e-learning module at the BMJ [link http://learning.bmj.com.] and his editorial on injury prevention with Professor van Mechelen.

If you haven’t checked out our podcasts, go there now. Feel free to post your comments below.

Do you take care of endurance athletes? Consider the Ironman Sports Medicine Conference in Kona, Hawaii. The 2011 Meeting is in the first week of October (2nd-6th) and it leads up to the World Championship which is on October 8th.

The conference is multidisciplinary and very collegial; all hands are on deck to provide coverage for the event.

Kona has a great vibe and you’ll have fun. The family will love it as you have half-days for academia and the other half day to explore this interesting island (active volcano!), get advice in the run or swim clinic, and actually practice what we preach — do at least 60 minutes of accumulated physical activity for the day!

Bob Sallis is the conference chair and you can listen to him talk about exercise is medicine on a BJSM podcast