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Effects of Human Pregnancy and Aerobic Conditioning on Alveolar Gas Exchange During Exercise

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Effects of Human Pregnancy and Aerobic Conditioning on Alveolar Gas Exchange During Exercise 625 Effects of human pregnancy and aerobic conditioning on alveolar gas exchange during exercise Sonja E. McAuley, Dennis Jensen, Michael J. McGrath, and Larry A. Wolfe Abstract: This study examined the effects of aerobic conditioning during the second and third trimesters of human pregnancy on ventilatory responses to graded cycling. Previously sedentary pregnant women were assigned randomly to an exercise group (n = 14) or a nonexercising control group (n = 14). Data were collected at 15–17 weeks, 25–27 weeks and 34–36 weeks of pregnancy. Testing involved 20 W·min–1 increases in work rate to a heart rate of 170 beats·min–1 and (or) volitional fatigue. Breath-by-breath ventilatory and alveolar gas exchange measurements were compared at rest, a standard submaximal V&O and peak exercise. Within both groups, resting VV& , & , and V /T increased signifi- 2 & & & EA T I & & cantly with advancing gestation. Peak work rate, O2 pulse (VOHR2/), VVEA, respiratory rate, VT/TI, VVOCO2 , 2, and the ventilatory threshold (Tvent) were increased after physical conditioning. Chronic maternal exercise has no significant effect on pregnancy-induced changes in ventilation and (or) alveolar gas exchange at rest or during standard submaximal exercise. Training-induced increases in Tvent and peak oxygen pulse support the efficacy of prenatal fitness programs to improve maternal work capacity. Key words: human gestation, respiration, chronic exercise. Résumé : La présente étude a examiné les effets de l’activité aérobique sur la réponse ventilatoire à un effort gradué sur bicyclette durant les deuxième et troisième trimestres de la grossesse. Des femmes enceintes initialement sédentai- res on été réparties aléatoirement dans un groupe entraîné (n = 14) ou dans un groupe témoin non entraîné (n = 14). Les données ont été recueillies entre les semaines 15–17, 25–27, et 34–36 de la grossesse. L’épreuve a consisté en des augmentations de 20 W·min-1 de l’intensité de l’exercice à une fréquence cardiaque de 170 battements·min-1 et (ou) fa- tigue volontaire. Les mesures cycle à cycle des échanges gazeux alvéolaires et ventilatoires ont été comparées au repos, & & & à une VO2 sous-maximale normale et à l’exercice maximal. Chez les deux groupes, les VVEA, ,etVT/VI ont augmenté significativement avec l’évolution de la gestation. L’intensité maximale, le pouls d’O (V&OF/),laV& ,laV& ,lafré- & & 2 2 C E A For personal use only. quence respiratoire, VT/TI,laVO2 ,laVCO2, et le seuil ventilatoire (Svent) ont augmenté après l’entraînement. L’exercice de longue durée n’a pas d’effet significatif sur les variations induites par la grossesse des échanges gazeux ventilatoires et/ou alvéolaires au repos ou durant un exercice sous-maximal normal. Les augmentations induites par l’entraînement du Svent et du pouls d’O2 maximal confirment l’efficacité des programmes d’exercice prénatal pour améliorer la capa- cité d’adaptation de la mère à l’effort. Mots clés : gestation humaine, respiration, exercice de longue durée. [Traduit par la Rédaction] McAuley et al. 633 Introduction Virtually all maternal physiological control systems are affected by pregnancy and the changes in these systems are Human pregnancy involves critical anatomical and physio- interactive. The ventilatory effects of pregnancy are particu- logical changes that must occur in a specific time sequence larly striking. These include changes in diaphragm and chest to support fetal growth and development while maintaining wall configuration (Crapo 1996), lung volumes and capaci- maternal homeostasis. These changes are mediated by gesta- ties (McAuliffe et al. 2002), and substantial increases in & tional hormones, initiated early in the first trimester, and tidal volume (V ), minute ventilation (V ), alveolar ventila- & T E they may alter maternal exercise tolerance (Wolfe et al. tion (VA), and the ventilatory equivalents for oxygen Can. J. Physiol. Pharmacol. Downloaded from www.nrcresearchpress.com by MCGILL UNIVERSITY on 12/08/11 & & & & 1989; Wolfe et al. 2005). (VVE / O2) and carbon dioxide (VVE / CO2) at rest and during Received 21 September 2004. Published on the NRC Research Press Web site at http://cjpp.nrc.ca on 03 August 2005. Reposted on the web site with correction on 05 August 2005. S.E. McAuley, and D. Jensen.1 School of Physical and Health Education, Queen’s University, Kingston, ON K7L 3N6, Canada. M.J. McGrath. Department of Obstetrics and Gynecology, Queen’s University, Kingston, ON K7L 3N6. Canada. L.A. Wolfe.2 School of Physical and Health Education, and Departments of Physiology and Obstetrics and Gynecology, Queen’s University, Kingston, ON K7l 3N6. Canada. 1Corresponding author (e-mail: [email protected]). 2Deceased. Can. J. Physiol. Pharmacol. 83: 625–633 (2005) doi: 10.1139/Y05-054 © 2005 NRC Canada 626 Can. J. Physiol. Pharmacol. Vol. 83, 2005 exercise (Ohtake and Wolfe 1998; Wolfe et al. 1994). This Experimental design results in a partly compensated respiratory alkalosis with re- Qualified subjects entered the study on a staggered time ductions in arterial carbon dioxide tension (PaCO2 basis and were randomly assigned to either an exercise ~30− 34 mmHg) and plasma bicarbonate concentration, and group (EG) or control group (CG) using a randomized/block increases in arterial pH (7.42–7.49) and arterial oxygen ten- procedure with 4 subjects per block (Popcock 1984). Drop- sion (PaO2 ~100–106 mmHg) (Wolfe et al. 1998). outs for medical reasons or poor compliance from either An important theoretical consequence of the aforemen- group were replaced with the next available qualifying sub- tioned changes is a reduction in maternal ventilatory reserve. & & ject until a total of 14 subjects were accrued for each group. In this regard, values for (VVE / O2) are increased (Wolfe et al. At entry, each subject attended an information session to be- 2003; Ohtake and Wolfe 1998; Wolfe et al. 1994; Pivarnik et & come familiar with the laboratory, study procedures, and cy- al. 1993) and higher peak values are observed for VE at max- cle ergometer testing protocol. imal exercise (Wolfe et al. 2003; Lotgering et al. 1998; The EG participated in a closely monitored prenatal exer- Ohtake and Wolfe 1998; Wolfe et al. 1994) in late gestation. cise program that included both aerobic and moderate mus- Since maximum voluntary ventilation is either unchanged or cular conditioning components, whereas the CG only moderately reduced (Berry et al. 1989), the capacity to in- & performed moderate muscle conditioning exercises designed crease VE in the transition from rest to exercise is reduced. to improve muscular fitness without stressing or causing im- Controlled studies in nonpregnant subjects have reported & & provement in the aerobic energy system. Both conditioning reductions in ventilatory demand (VV/ O ), improvements in E 2 & programs were conducted during the second (TM2) and third ventilatory efficiency, reduced CO output (VCO ), and re- & 2 2 (TM3) pregnancy trimesters. Members of both groups partic- duced VE at a given work rate after physical conditioning ipated in physiological testing between 14 and 17 week ges- (Hoogeveen 2000; Taylor and Jones 1979). It is reasonable tation (entry), at the end of TM2 (25–27 weeks) and TM3 to assume that similar beneficial effects may be experienced (34–36 weeks). Procedures included maternal anthropometric by pregnant women. However, only limited information ex- measurements, assessment of forced vital capacity (FVC), ists regarding the effect of aerobic conditioning on respira- and a graded cycle ergometer test. Qualified medical person- tory and alveolar gas exchange responses to exercise in nel obtained data on pregnancy outcome during labor and human pregnancy (Ohtake and Wolfe 1998; Wolfe et al. delivery and neonatal morphometrics were measured within 1994; Pivarnik et al. 1993). 24 h of delivery. The present study employed a controlled randomized de- sign to examine the effects of a closely monitored prenatal exercise program on maternal aerobic work capacity and Physical conditioning programs measures of ventilation and alveolar gas exchange during As described above, the EG participated in both aerobic standard submaximal exercise in healthy human pregnancy. and muscle conditioning (minimum of 2 days·week–1), We hypothesized that physical conditioning would improve whereas the CG performed only muscle conditioning (mini- For personal use only. aerobic working capacity, increase the ventilatory anaerobic mum 1 day·week–1) in accordance with guidelines from the threshold (Tvent), and attenuate respiratory responses during Society of Obstetricians and Gynaecologists of Canada standard submaximal exercise. (SOGC) and the Canadian Society for Exercise Physiology (Davies et al. 2003; Wolfe and Davies 2003; PARmed-X for Pregnancy 2002; Kochan–Vintinner 1999). For the EG, stair- stepping (Stairmaster 4000CT) was employed as modality Methods for aerobic exercise. Aerobic exercise intensity was prescribed and monitored on an individual basis by an experienced in- Subjects structor using modified pulse rate target zones for pregnant Pregnant subjects were recruited via posted announce- women and Borg’s (1982) rating of perceived exertion ments, newspaper advertisements, and contact with local ob- (RPE) scale (Kochan-Vintinner 1999). Exercise duration was –1 stetricians and health care providers in Kingston, Ontario. increased progressively from 15 to 30 min·session during –1 Prospective subjects were screened for medical contraindica- the TM2 and held constant at 30 min·session during the tions to exercise by the physician or midwife monitoring TM3 (Kochan-Vintinner 1999). Logs of each exercise ses- their pregnancies. A standard form developed in this labora- sion were kept by the instructor and included information on tory for the Canadian Society for Exercise Physiology was attendance, exercise heart rate (HR), RPE, and duration. employed for this purpose (PARmed-X for Pregnancy 2002). This information was averaged for each subject in both TMs Can. J. Physiol. Pharmacol. Downloaded from www.nrcresearchpress.com by MCGILL UNIVERSITY on 12/08/11 Specific exclusion criteria also included the following: regu- to characterize the training stimulus.
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