WK7 - Infections, Asthma, Cardiac Conditions, Female Athletes Flashcards
(121 cards)
1
Q
What are the common organs affected in athletes?
A
- respiratory system
- skin
- gastrointestinal (some protection in form of gastric juices, enzymes)
Due to exposure to external environment
2
Q
What does ‘itis’ mean?
A
refers to inflammation and infection
3
Q
What does a droplet route of transmission commonly cause?
A
Direct contact
Most common infection route –> speaking, spitting, sneezing
- rhinovirus
- influenza
- measles
- glandular fever (mono)
4
Q
What does direct contact of route of transmission commonly cause?
A
Due to direct contact
Cause from bacteria - skin breach
- staphylococci
- streptococci
5
Q
What do viruses as a route of transmission commonly cause?
A
Due to close contact
- warts (HPV)
- cold sores (HSV) - can be recurring
Anything that decreases area integrity = likely if allergy, sunburn or anything that causes rubbing around mouth
6
Q
What do fungal infections commonly cause?
A
From direct contact!
Tinea
- toes, sweaty feet
- transmitted on wet surfaces
- wet environments
Candida
- moist areas
- armpits
- groin
- breasts
7
Q
Water and food are common places with infections can be transmitted, list some common infections?
A
Bacteria = salmonella, campylobacter (infected chicken/raw egg), E.Coli (waste, from dirty water sources)
Viruses = norovirus, rotavirus, Hep A
8
Q
what are the risks of being in contact with body fluids?
A
Blood - must be removed and cleaned up. Clothing either thrown or kept in bag to be washed
Needle - accidental, IV drugs, tattoos
Sexual contact
sweat
saliva
9
Q
What diseases can be contracted from animal vectors?
A
dengue (aedes aegypti)
ross river
culex annulirostris
aedes vigilax
malaria (not in Aus, but prevent in SEA, and PNG still –> ensure tablets/vax if travelling to countries with these viruses
10
Q
What are the main infectious agents?
A
virus
bacteria
fungi
parasites
11
Q
What are viral infections in sport?
A
- glandular fever (no contact sport if enlarged spleen)
- respiratory virus (fever, myaliga, arthralgia - rest)
- influenza (severe illness)
- human papilloma virus ( warts, stubborn to treat, increase risk of some cancers)
- Herpes Simplex (cold sores, sexual contact, no vaccine)
- molluscum contagiosum (viral skin infection)
- Hep A (faecal/oral, food/water, mild-severe illness, no chronic risks, fever)
- Hep B (body fluids, vomit, yellow skin, tiredness, dark urine, ab pain)
- Hep C (blood, IV drug use, no vacc, improved antiviral therapy)
12
Q
Provide a summary of viral infections in sport.
A
systemic illness = no sport
- fever >37.5
- generalised myalgia and arthralgia
13
Q
What are the common bacterial infections in sport?
A
- pimples
- acne
- abscess (boil) - pus needs to be drained under sterile conditions. Dont need antibiotics unless large area
- Impetigo (superficial infection on skin, antibiotics)
- Cellulitis (red, hot, swolling, tender)
- Otitis Externa - outer ear infection (ear canal, AKA swimmers/tropical ear, use ‘alcohol’ eardrops and topical antibacterial/steroid)
14
Q
Provide summary of treating bacterial infections.
A
localised infections - drain pus
more serious infections - antibiotics
15
Q
What are common fungal infections in sport?
A
Tinea (dermatophyte) - athletes foot, jock rash, underboobs/armpits, anywhere humid/sweaty. Use antifungal cream, dry area, remove wet clothing
Thrush - oral thrush in children, armpits/mouth/knees/back of legs, candida albicans most common, warm moist surfaces
Pityriasis versicolor - whitish areas of fungus, interferes with tanning melanocytes, treat with dandruff shampoo
Nail fungus - onychomycosis, dermatophyte most common, trimming + topical antifungal agents, prolonged oral antifungals
16
Q
How to prevent fungal infections?
A
- wash hands and feet regularly
- wear sweat-absorbing socks/change socks throughout day
- shoes made of material that breathe
- discard old shoes or treat them with disinfectants/antifungal powders
- wear footwear in pool areas and locker rooms
- wear open footwear when possible
- ensure airflow!
17
Q
What are common parasitic infections in sport?
A
Giarida - pools, microscopic protozoan, diarrhea, fatigue, malaise, ab cramps, nausea, weight loss (antibiotics)
18
Q
List prevention methods of infections (always better than cure!).
A
Education!
- hand hygiene
- minimise droplet spread
- quarantine unwell athletes
- don’t share waterbottles
- separate towels/jerseys
- safe sex
- IV drugs
- immunisation
- vaccinations
- traveling
- influenza
19
Q
Where to find vaccination record?
A
- medicare
- medicare card
- HEP b serology
20
Q
List a few sport participation practical tips.
A
- thermometer - quantitative date to athlete
- fever >37.5
- subjective
- generalised muscle/joint pain
- high index of suspicious of infection
- glandular fever - no contact sport
21
Q
What is the prevalence of asthma?
A
- common
- 10-20% children
- 10% adults
- 80% asthmatics get Ex induced asthma
22
Q
What is the pathology of asthma?
A
Bronchospasm - constriction of smooth muscle around airways (wall of bronchioles) –> restricting airflow within bronchioles
Airway swelling - wall of bronchiole increases in size, narrow airway
Increased mucous production - plugs of mucous block bronchioles. Wall significantly swollen, thin wall lumen filled with mucous
23
Q
List the triggers of asthma.
A
Ex - increased breathing rate, dries out air
Cold dry air - mostly likely to have attack in this env
Viral illness
Allergens (dust, mold, pollen, animal dandruff)
24
Q
How to recognise asthma?
A
- shortness of breath
- wheezing when expiring (may move little air to avoid wheezing, severity not indicated by wheezing!)
- dry cough (tight)
Absence of wheeze does not rule out asthma –> cough variant asthma
25
How to recognise severe asthma attack?
- difficulty speaking (no complete sentences, 1 word at time)
- physically and emotionally distressed
- exhausted
- breathing effort (hollowing out collar bones, greater effort)
26
What are the ways of managing asthma?
Reliever (blue puffer)
- acute treatment, bronchodilators (relax smooth muscle), fast acting, can be used pre-sport. SE: shaking hands, increased HR, increased anxiety
Preventer (orange/brown puffer)
- reduce airway sensitivity, dry out mucous, reduce swelling
- used daily
- may require few weeks for results
- not used acutely, will not help on sporting field
- inhaled corticosteroids
27
What are the inhaling techniques for asthma?
If severe 4 puffs into spacer --> 4 breaths in/out, repeat every 4mins until ambulance arrives
No spacer
- shake inhaler
- deep breath in/out to empty lungs
- place puffer in mouth
- fire 1 puff, inhaling slowly/steadily
- hold breath 10s before breathing out
Turbuhaler
-Requires no coordination
-Shake inhaler
-Remove cap
-Keep upright at all times
-Twist base anticlockwise then clockwise until hear click
-Place mouthpiece in mouth
-Deep breath in, hole 10s
With spacer
-Shake inhaler
-Insert inhaler into spacer
-Place spacer mouthpiece in mouth
-Fire 1 puff – breathe in and out normally for 4 breaths through spacer
-repeat
Spacer
= increase dose in lungs
= reduce SE
= easy to use
28
What is the process of severe asthma first aid?
1. sit upright
- reassure / remain with patient
2. give 4 separate puff of BLUE reliever
- shake puffer
- 1 puff into spacer - take 4 breaths - repeat
3. wait 4 mins
- if not better, give 4 more separate puffs, shake, 1 puff, 4 breaths
4. no improvement - call ambulance
- tell operator "asthma attack". Keep giving 4 separate puffs every 4mins
29
What is the prevalence of sudden cardiac arrest (SCA) and death (SCD) in sport?
although sporting activity appears to increase relative risk of SCD, absolute no. of cases is larger in nonsporting population.
Clinical guidance
- athletes with CVD recommended shared-decision making (GP, cardiologist, coach, athlete, family)
30
What is the occurrence of SCA and SCD?
-Estimate of SCD rate range from ~1:100000 to 300000+
-Sport activity and training poses ~2.5x increased risk compared to that in non-athletes and recreational athletes
-3-5x higher incidence in males vs females
-NCAA data indicates black athletes have incidence ratio of 3.2 compared to white counterparts
31
What are the 3 major SCD categories in sport?
- structural cardiac abnormalities (usually genetic)
- electrical cardiac abnormalities
- acquired cardiac abnormalities (trauma / infection)
32
Provide examples of structural cardiac abnormalities.
- hypertrophic cardiomyopathy
- arrhythmogenic right ventricular cardiomyopathy
- congenital coronary artery anomalies
- marfan syndrome
- mitral valve prolapse/aortic stenosis
33
Provide examples of electrical cardiac abnormalities.
- Wolff Parkinson White syndrome
- congenital long QT syndrome
- Brugada syndrome
- catecholaminergic polymorphic ventricular tachycardia
34
Provide examples of acquired cardiac abnormalities.
- infection (myocarditis)
- trauma (commotio cordis)
- toxicity (illicit/performance-enhancing drugs)
- environment (hypo/hyperthermia)
35
What are the potential causes of conditions associated with SC in younger athletes (<35y)?
- 20-30% unknown (even post-mortem, hard to diagnose)
- 30-40% hypertrophic cardiomyopathy
- 7-17% congenital anomalies of coronary arteries (artery comes off wrong place of aorta)
- 5-10% arrthmogenic R ventricular cardiomyopathy (ARVC)
- 5% Marfan's syndrome (genetics, deficiencies in collagen tissue)
- 5% myocarditis (infection/inflammation)
36
What is hypertrophic cardiomyopathy (HCM)?
~30-40% of SCD in young athletes due to HCM or possible HCm/idiopathic L ventricular hypertrophy
- extreme asymmetrical ventricular wall thickening
- prominent in septum
- blood volume out of ventricle reduced
- familial - genetic, autosomal dominant disease
- equal male and female no.
- 10 genes commonly associated with causing HCM
37
What are the symptoms of hypertrophic cardiomyopathy (HCM)?
-Sudden collapse and cardiac death (first symptom in many cases)
-Exertional dyspnea
-Chest pain
-Palpitations
-Syncope/presyncope
*Fainting/feeling faint
38
How to examine HCM?
-History but frequently normal
-ECG --> left ventricular hypertrophy (ST/T wave changes)
- Chest x-ray --> may show enlarged heart but frequently normal
- ECGraph--> left ventricular hypertrophy without dilation >15mm diagnostic
*Normal adaptation for athletes but once past 15mm differentiates the normal vs pathological
* Sluggish on echocardiogram, small ventricle and volume
Investigate using MRI
- visualise myocardial scarring using contrast agents (late enhancing gadolinium)
- significant prognostic relevance
39
What is the clinical recommendation for HCM?
Avoid competitive sport to reduce risk of SCD during/just after exercise
*Restricted outflow due to the scarring
*Abnormal pathways in heart, blocking and arrythmias
40
What is the pathology of arrhythmogenic R ventricular cardiomyopathy (ARVC)?
- fatty infiltration of RV
- fibro-fatty infiltration (scar tissue replacing myofibrils/myocytes)
- fibres replaced by fat/scar tissue
- predispose to severe arrhythmias during Ex - cease sport
40/10k in Italy have it, most common cause of SCD in young
41
What is the prevalence of ARVC?
- predominantly in males
- inherited autosomal dominant pattern
Ex related symptoms
- 80% have symptosm
- dyspnoea
- syncope
- palpitations
- R ventricular outflow tract tachycardia
42
What is Coronary Artery Anomalies (CAAs)?
- Artery coming off wrong place
- congenital
- anomalous aortic origin of coronary artery (AAOCA)
- anomalous origin of coronary artery from pulmonary artery
- interarterial ALCA (L) and ARCA (R) associated with increased SCD risk
- 38-66^ of ALCA/ARCA patients have no pre-existing symptoms (first can result in SCD)
43
What are the mechanisms behind CAAs?
- occlusion (squeezed) or compression of anomalous vessels during exercise
Lead to myocardial ischaemia and subsequent lethal ventricular arrhythmia (ventricular tachycardia/fibrillation
44
What are recommendations for athletes with CAAs?
- WIth ALCA where artery passess between pulmonary artery and aorta --> restriction from all competition sports while waiting for surgical repair
After surgery --> return to intense activities may be considered IF asymptomatic and Ex stress test show no evidence of ischaemia/cardiac arrhythmias
45
What is myocarditis?
inflammation of myocardium,
- most often infection by common virus
In SCD, likely during chronic phase of myocarditis
- had disease, recovered but scarring on heart tissue
- inappropriate firing/no firing
- arrhythmias
46
What happens during the infected/recovered stage of myocarditis?
During
- avoid all aerobic Ex
- withdrawn from sport and training for 6months
Recovered
- when all ventricle function returns to normal/show no signs of arrhythmias
47
What is Marfan's syndrome?
Genetic disorder of connective tissue, autosomal dominant disorder
- mutation to gene that makes fibrillin
- affects heart, lenses, aorta, lungs
Tall and thin, long arms, legs, fingers and toes
- occurs equally in males and females
48
What are the potential cardiac issues with Marfan's syndrome?
1. Aortic root dilation
*Assess and follow up with ECHO
*Beta blockers
*Moving away from high intensity sports to low intensity
*May need aortic/mitral valve replacements
2. Aortic Aneurysm
3. Aortic dissection
*Most often fatal
*Surgical emergency
49
What are the effects of anabolic androgenic steroid use in athletes?
Risk of cardiac disease, 3x among those who use anabolic steroids
Implications on SCD
- affects clotting
- primary cause of cases from coronary arteyr thrombus
- increase levels of coagulation factors both intrinsic/extrinsic pathways
50
What is coronary artery disease (CAD)?
CAD uncommonly related to SCD in young athletes but recognised as problem
- dominant mechanism in older athletes >60% of cases in athletes >35y
- majority of sport-related SCD >35y
51
Pros and cons of mass screening for SCD?
Pros
- may help athletes at risk/reduce risk
Cons
- Dr Barry Maron (US cardiologist) - screening unjustified, hard to detect, complex/expensive. Done in Italy
52
When to screen for SCD?
Med Ax required if...
- syncope, dyspnea, chest pain with exertion
- 1st degree relative with history of SCD
- 1st degree relative with HCM/Marfans'familial cardiomyopathy
53
What is the emergency management/protocol for SCD?
after it happens
- prompt application of AED associated with greater likelihood of survival (or 1.75, 95% confidence interval 1.23-2.5 with p<0.002)
- highest survival to hospital discharge notes in places of recreation 49%
54
List modifiable risk factors for coronary heart disease (CHD).
- Physical inactivity
- diabetes (diet!)
- dyslipidemia
- smoking
- HTN
- obesity
55
What are the normative values for diabetes diagnosis?
HbA1c <6% normal
6-6.4% prediabetes
>6.5% considered diabetes
56
What are the values for dyslipidemia?
total cholesterol <4.5mmol/L
LDL <2mmol/L
hypercholesterolaemia >4.0mmol/L (total >7.5)
HDL >1mol/L
Triglycerides <2.0mmol/L
57
What are the normative values for HTN?
*Normal 120/80 and 129/84mmHg
*High-normal 130/85-139/89
*Hypertension > 140/90mmHg
58
How is BMI categorised?
normal: 18.25-25kg/m^2
overweight: 25-30kg/m^2
obese 1: 30-35kg/m^2
obese 2: 35-40kg/m^2
obese 3: >40kg/m^2
59
What are the absolute CV risk modifications (5y risk stratification)?
- >15% considered high risk of heart, stroke, BV disease in next 5y
- between 10-15% considered moderate risk of CVD in next 5y
- <10% considered low risk of CVD in next 5y
60
What are the CHD risk factors?
risks are cumulative (multiplicative)
- 1 is bad, 2 is substantive, gets worse
- lifestyle predispose
- 1 RF may predispose to other RFs
- improving RF =primary, secondary, tertiary prevention
- improving 1 RF may improve another
61
What are CV symptoms in Ex?
1. Chest pain (angina)
- during or after
- may have underlying CV condition
2. palpitations
- underlying arrhythmia
- fast, slow HR, gaps/skipped beats
3. syncope
- dizziness, lightheadedness, fainting (can be linked)
4. SCD
62
What can be the underlying cause of chest pain?
differential diagnosis = many reasons
MSK (usually if young)
- costochondritis
- thoracic spine-referred
- intercostal muscle between ribs
Cardiac (ischaemic)
Respiratory (pulmonary embolism)
- clots in deep vein of lower limb can break off, travel to vena cava and lodge in arteries
- occlusion of vessels, dead areas of lungs
Gastro intestinal (reflux)
- with spasm can feel like heart attack
63
What are the considerations for ischaemic pain?
1. age- increases with age
2. site- neck, jaw, arms, epigastric
3. type - pressure, constricting, burning
4. aggravation - activity (exertion related bc of higher demand for blood to muscle, heart has to pump harder), meals, cold, stress vs mechanical
5. relieving - rest/GTN (spray/tablet under tongue) --> dilates BVs
6. associations - nausea, sweating, vomiting
64
List the types of tesst for cardiac investigations?
- ECG (ST segment elevation above isoelectric line)
- Serial troponins
- ventilation/perfusion (VQ scan) - exclude pulmonary emoblism
- maximal Ex stress test (MEST)
- myocardial perfusion stress test 9MPS)
- stress ECG
- CT coronary angiogram (CTCA)
- coronary angiogram
65
What are the indications for stress test to occur?
- acute chest pain
- recent acute coronary syndrome/heart attack
- known coronary heart disease
- arrhythmias (palpations)
- symptoms during Ex
- syncope/presyncope (cardiac/fitness/respiratory problem)
- decreased Ex tolerance (amount of Ex they can tolerate gradually decreasing)
66
What are the limitations of a stress test?
- cost
- conservation/fear
- must do it at right time
- chest pain + low pretest probability, CAD - false +ve
- chest pain + high pretest probability, CAD >75% coronary angiogram (may offset a heart attack)
- sensitivity 68%
- specificity 77%
67
What is the purpose of cardiac stress test for chest pain?
- EXT of clinical and risk factor Ax
- determine whether safe to proceed beforehand
- used for risk stratification
- intermediate-risk patients
- no acute ischemic changes
- -ve troponins
68
What is the contraindication of a stress test?
-Recent heart attack <5 days
-Unstable angina – high risk of heart attack
-Severe obstruction/Aortic Stenosis/HOCM
-Left bumble branch block
-Uncontrolled arrythmias
-Severe hypertension
-Significant cardiac failure
69
What is the risk per 10,000 people with stress tests?
2-3 get myocardial infarction
*If look like about to have a heart attack, stop test, rest and send them for angiogram
2-3 get serious arrythmia
1 death
*Due to careful screening for a test
70
What are the indications for terminating a stress test?
- max. effort (max HR possible)
- severe angina, dyspnea
- dizziness
- ST depression >2mm
- ST elevation (indicates infarction)
- significant arrhythmia
- BP = 250mmHg
- significant fall in BP
71
What is myocardial perfusion scanning?
- similar to bone scanning
- radial isotope
- nuclear medicine - technetium isotope
- max Ex stress test
- pharmacological stress test (using drugs instead of physical stress test)
72
What are the reasons for doing pharmacological instead of max stress test?
-Unable to exercise to max HR
-Orthopedic problems
-Deconditioning
-Pulmonary disease
-Peripheral arterial disease
-Resting ECG abnormalities
*Paced rhythm
*Left bundle branch block
*ST depression >1mm
73
What is a resting scan?
- inject dose of radioisotope
- gamma camera
- take images to see where isotope has gone
74
What to look for in a stress test?
monitor ECG, look for arrhythmias
75
What is a stress scan?
- go back under camera
- compare to resting images with stress images
orange = well-perfused
Heart is equally well perfused
Stress = instead of orange, its more blue/purple = narrowing blood flow area
If mainly blue outline of small orange area = poor perfusion, scarring/previous heart attack at rest and stress
Same areas not well perfused/not perfused in stress at rest --> dead muscle, no point re-perfusing
Images present in 3 planes: cross-sectional, sagittal, coronal
76
What is a stress ECG?
- ultrasound of heart
- ECG pics prior to/ immediately after Ex
- how well myocardium contracts
- regional wall motion abnormalities/local
- ejection fraction (LV contract, >50% blood will be ejected)
--> ejection fraction decreases = heart failure (severe decrease) or decreased Ex tolerance
- valve
--> opening/closing velocities
--> exclude significant aortic stenosis and pulmonary HTN
77
How to carry out a stress ECG?
non-pharmacologic
- if able to Ex
- advantage over MP = no radiation involved
pharmacologic
- low ejection fraction
- minimise Ex by increasing HR and BP with drug
- if patient unable to Ex
- if can't get good pics (esp. overweight patients) --> add contrast bubbles to brighten images and get better scans
78
What to look for on stress ECG images?
Normal = light shading across entire surface of heart in image
If centre is more black in centre with slight shading around it = heart doesn't contract well, cavity wont empty as well = can't exercise as well
79
What is cardiac catheterisation?
- catheter put up groin into arterial circulation, fed into heart, in coronary arteries
- release dye in coronary arteries to check for occlusion
80
when/what type of people is cardiac catheterisation performed?
high risk patient with chest pain
- diabetes
- smoking
- cholesterol
- HTN
- obese
+ve stress test (any of above)
81
What is observed in cardiac catheterisations?
- areas of narrowing/completely blocked arteries that cardiologist can open to try and re-perfuse
-return blood flow to occluded area
82
What happens if there are significant lesions shown in cardiac catheterisations?
Angioplasty
*Guide wire through artery, into narrowed area
*Inflate balloon to increase diameter of vessel
Stent
*Placed inside artery
*Recreate normal movement and diameter
*Return blood flow to normal
Coronary bypass grafting
*On outside of heart/artery using vein grafts
Medical therapy
*If areas are not narrow enough
83
What are the benefits of Ex for pregnancy (metabolic considerations)?
General population
*Weight
*Mood
*Diabetes/chronic disease
Elite Athletes
*Higher levels = greater benefit
*Maintain fitness = resume training earlier post-pregnancy
84
What is gestational weight gain?
Weight gained from pregnancy.
- 50% of women have excess GWG
- retain 2-3kg/pregnancy, and do not lose weight (sets up for overweight/obesity)
General Pop
- moderate intensity = lower GWG
Elite athletes
- higher pre-pregnancy and pregnancy PA = Less GWG
85
What are the gestational weight gain guidelines?
Pregnancy BMI kg/m^2 + total gain at term
Underweight
<18.5 + 12.5-18kg
Normal
18.5-25 + 11.5-16kg
Overweight
25-30 + 7-11.5kg
Obese
>30 + 5-9kg
Need to assess benefits of Ex and diet in pregnanyc in light of different cohorts (normal obese), types of Ex
86
For overweight and obese women, dietitian and Ex phys will work with them to have them gain less weight (or no weight depending on their starting BMI) during pregnancy). True or False
TRUE!
87
List some risk factors of exercise related to newborn weight.
small gestational age
- issues relating ot foetal development
- not as physically developed because less nutritents
Wiebe et al 2015 SR
- no significant increase in odds of having baby that is small for gestational age for exercising at a sensible level
88
List some benefits of exercise related to newborn weight
prevent babies from being large for gestational age
- issues relating to gestational diabetes
- prevents overweight babies
Wiebe et al 2015 SR
- significant decrease in odds of having large gestational age baby
89
What is gestational diabetes Mellitus (GDM)?
diabetes developed during pregnancy
90
What is the problem with gestational diabetes?
-10% of pregnant women at risk of developing GDM
-Obstetric complications for both women and baby
-50% of women then go on to develop type 2 DM within 5 years post-partum
Russo et al.
- PA in pregnancy provides a protective effect against development of GDM (reduced risk 0.72)
91
What helps with GDM in general pop and elite athletes?
decrease risk of GDM with regular exercise
92
What are the maternal risks with GDM?
-Developing high BP or pre-eclampsia
-Induced labor
-C-section
-Perineal trauma
-~50% likely develop type 2 diabetes
93
What are the foetal risks of GDM?
- increased risk of large-for-gestational age babies
- birth injury
- admitted to NICU
- more likely to develop metabolic syndrome in childhood and later in life
94
List the benefits of exercise in pregnancy.
- prevent GDM
- preeclampsia (usually 3rd trimester, HTN; risk of seizures/dying)
--> associated with both short and long-term risk for mother and child: inflammation, vascular dysfunction, oxidative stress and vascular disease
- fatigue (no evidence tho)
95
What do studies/systemic reviews say about exercise and pregnancy?
-Exercise only interventions were effective at lowering the odds of developing gestational hypertension
-Exercise only interventions were effective at lowering odds of developing preeclampsia
96
What are the benefits of exercise for those with depression (can be related to pregnancy)?
-Common in pregnancy, increased rate of 22%
-During and post-partum depression
-General population
*Some evidence exercise can be used as prevention and treatment
-Elite athletes
*Similar depression rates
-->Usually develops when they can’t train/perform
*No prevalence data specific to pregnancies
97
What are the benefits of exercise for those with anxiety (can be pregnancy related)?
-Common, 12% per annum
-General population
*Limited data pregnancy
*Pregnancy related anxiety ~14%
-Elite athletes
*~12% have high anxiety
*No prevalence data specific to pregnancy
98
What are the physiological/MSK changes during pregnancy?
- cardiovascular
- respiratory
- MSK
- metabolic
99
How does the CV system change during pregnancy?
Aims to ensure foetal blood supply
- Decreased peripheral resistance afterload reduction
--> Decrease BP
--> Increase risk of low BP, esp after exercise
- Resting HR increases ~15-20bpm
Clinical significance:
*RPE – heartbeat will be 15-20bpm higher than predicted
*Exercising at higher HR than anticipated
^ Athletes should use HR monitor
*Increased SV
--> To deliver more cardiac output for both her and baby’s needs
*Resting cardiac output increases ~50%
*Increases blood volume by ~50% by time of delivery, reduction back to normal by arnd 6 weeks PP
Clinical Significance: Dilutional anaemia --> If plasma increases more than RBCs, low conc of RBC
100
How does posture effect CV system?
IVC compression in supine position
- uterus on top of INF vena cava
- affects venous return (decrease)
- SV and HR decrease
clinical significance: symptomatic HTN
- place wedge under back to decrease pressure on IVC
101
How is respiratory system affected during pregnancy?
Elevated diaphragm
-Decreases residual volume
*Amount you can expand lungs
-Increased sensitivity to CO2
*to avoid acidosis in baby
*increase in tidal volume and minute ventilation
Clinical Implications:
-Dyspnea post exertion
-Dyspnea at rest in late pregnancy
102
How does the MSK system change during pregnancy?
-Weight gain
-Altered center of gravity
*Increased lumbar lordosis, anterior pelvic tilt, flexion of hips
*Alters mechanics
*Lumbopelvic pain
-Ligamentous laxity
*Especially in pelvis for baby to be birthed
*affect all ligaments in body
*Increased risk of ligamentous injury
-Balance affected after trimester 1
Clinical significance
-Increased incidence of LBP
-Increased risk of injuries
-Increased risk of falls (~2-3 times)
103
How does the metabolic system change during pregnancy?
Body temperature
-If body goes past 39 degrees Celsius in trimester 1 (fevers)
*Risk of malformation in baby
*No data that exercise causes malformations
*Teratogenicity (developing defects)
-Sweat at lower temperature
*Cool themselves for better control
*Decreased risk of exposing fetus to higher core temp
104
What is the clinical significance of the metabolic system changing during pregnancy?
-Safe for pregnant women to exercise up to 70% vo2max
-Up to 60 minutes
-Core temp should not exceed 38c
*Dilutional anemia
*Avoid hot humid, use water/aircon
-No data on elite athletes
105
How does pregnancy affect hydration levels?
-Decreased uterine blood flow
*When women exercise around 70% vo2max and above, there is already a decrease in blood flow to placenta
-->Decrease oxygen and nutrients to baby
*Possible small gestational age
*More of a problem when women are dehydrated
-Hypoglycemia
*Fetoplacental unit uses 30-50% of maternal glucose near term (End of pregnancy)
*Does not take much decrease in glucose during exercise to compromise flow of glucose to baby during bout of exercise
106
What is the clinical significance of hydration during pregnancy?
- well-hydrated
- adequate carbohydrates
107
What are the indications for ceasing Ex during pregnancy?
Absolute contraindications (Prevent premature labor)
-Fluid leak/ruptured membranes
-Incompetent cervix
*Cervix that opens up prematurely
-Placenta previa
*Placenta is in front of baby, over cervix
*Placenta will start to bleed as pregnancy progresses
-Signs of pre-term labor
108
Why is it important for modify intensity of Ex during pregnancy?
Eating disorder (underweight) (Using a lot of exercise to keep weight down)
-Obesity
*Water-based, cycling
-Significant medical conditions
*Poorly controlled diabetes/BP
*Any disease that’s not well-controlled
*Intrauterine growth retardation
--> Baby looking small
-Twin pregnancy (28weeks)
*Uterus much larger
*Likely earlier birth
*Maybe light exercise
109
What are the medical reasons for ceasing exercise?
-Chest pain or palpitations
*Cardiovascular incidents possible
-Shortness of breath/dyspnea outside of exercise
*Potential pulmonary embolism
-Severe headaches
*High BP
-Calf pain/swelling
*Deep vein thrombosis (DVTs)
*Pulmonary emboli
*Clots
110
What are obstetric considerations?
-Amniotic fluid leak
-Premature contractions
-Vaginal bleeding
-Decreased fetal movements after exercise sessions
111
What are the traumas from high-risk sports?
- risk to abdomen region
- contact/collision sports
- falls
- equipment
112
Why is trauma risk to abdomen catastrophic?
*abdominal injury in sport ED data <2%
*foetus well protected in early stages, later stages have muscular wall protection
*Main risk is shear forces (acc/deceleration or tissues springing back)
-->Placenta could tear off
-->Large abrupt uterus movement affecting blood vessels
*Fetal trauma data
Usually high speed
Repeated blows
113
What recommendations are made for high-risk sports?
Non- contact
-Throughout pregnancy
Unintended contact
- Tennis/social netball
Risk of fall
-Experienced vs novice
-Don’t recommend pregnant women to take up a new sport
-Requiring treatment/anesthetic risk due to falling/trauma risk
-->Prevent unnecessary drugs and medications during pregnancy
AVOID CONTACT!
114
What are potential physiological risk factors in pregnant women?
Scuba diving!
- decompression sickness
- air embolism
115
What are the two main goals for prescribing Ex to pregnant women?
-All healthy women should remain active throughout pregnancy
-Most recreational and elite athletes voluntarily reduce their training
116
What endurance/aerobic considerations are made for those that are pregnant?
-Aerobic fitness should be maintained
-Safe is 60-80% of vo2peak (unless contraindicated)
*145-160bpm for 20-29 year old
*140-156bpm for 30-39 year old
-Elite should not exceed 90% vo2max
-RPE underestimates HR by about 15bpm
*Use HR not RPE
*Use HR monitors
117
What strength training considerations are made for those that are pregnant?
Light to moderate weights
*No adverse effects
*Strength gains ~40%
Heavy weights (elite)
*No studies
*Avoid Valsalva
*Risks to pelvic floor
--> Due to pregnant abdomen pressing down
--> Could lead to incontinence
118
What flexibility training considerations are made for pregnant individuals?
-Maintain flexibility
-Increased theoretical risk due to increased ligamentous laxity
-Avoid overstretching
119
What are the general principles and guidelines for previously inactive women?
-Encouraged to be active
-Some women adopt more healthy behaviours when they realise they are pregnant
*Good time to adopt healthy habits like exercise
-Commence with low intensity
*Walking, water-based, stationary cycling
-Follow PA guidelines – 150min a week
120
What are the general principles and guidelines for regular exercisers?
- Maintain level of activity
- Moderate intensity 150-300min/week
- Safe to incorporate vigorous intensity
- Muscle strengthening
* 2 sessions/week
* Lightweight/theraband
* Large muscle groups
121
What are the general principles and guidelines for pelvic floor health in women?
-Recommended for all pregnant women
-Should be taught
*Initially prescribed/supervised by specialist physio/midwife/accredited exphys
