Simony Lira do Nascimento

Physical exercise during pregnancy: a systematic review.

Purpose of review This review aims to provide an update on the recent evidence concerning exercise during pregnancy including effects for mother and fetus and the types, frequency, intensity, duration and rate of progression of exercise performed. Recent findings Exercises during pregnancy are associated with higher cardiorespiratory fitness, prevention of urinary incontinence and low back pain, reduced symptoms of depression, gestational weight gain control, and for cases of gestational diabetes, reduced number of women who required insulin. There is no association with reduction in birth weight or preterm birth rate. The type of exercise shows no difference on results, and its intensity should be mild or moderate for previous sedentary women and moderate to high for active women. The exercise recommendations still are based on the current guidelines on moderate-intensity, low-impact, aerobic exercise at least three times a week. Yet, new guidelines propose increasing weekly physical-activity expenditure while incorporating vigorous exercise and adding light strength training to the exercise routine of healthy pregnant women. In the case of other chronic diseases like hypertension, there are still few data, and therefore more studies should be performed to assess the safety of the intervention. Summary Physical exercise is beneficial for women during pregnancy and also in the postpartum period; it is not associated with risks for the newborn and can lead to changes in lifestyle that imply long-term benefits.

The effect of an antenatal physical exercise programme on maternal/perinatal outcomes and quality of life in overweight and obese pregnant women: a randomised clinical trial

Please cite this paper as: Nascimento S, Surita F, Parpinelli M, Siani S, Pinto e Silva J. The effect of an antenatal physical exercise programme on maternal/perinatal outcomes and quality of life in overweight and obese pregnant women: a randomised clinical trial. BJOG 2011;118:1455–1463.

Exercise and physical activity in the prevention of pre‐eclampsia: systematic review

Exercise and physical activity have been studied and suggested as a way to reduce or minimize the effects of pre‐eclampsia. Our aim was to evaluate the association between exercise and/or physical activity and occurrence of pre‐eclampsia. We conducted electronic searches without year of publication and language limitations. This was a systematic review designed according to PRISMA. Different databases accessed were as follows: PubMed®; Latin‐American and Caribbean Literature in Health Sciences (LILACS); Scientific Electronic Library On‐line (SciELO); Physiotherapy Evidence Database (PEDro); and ISI web of KnowledgeSM. The Medical Subject Headings (MeSH) were as follows: (“exercise” OR “motor activity” OR “physical activity”) AND (“pre‐eclampsia” OR “eclampsia” OR “hypertension, pregnancy‐induced”). Inclusion criteria were studies conducted in adults who were engaged in some physical activity. The selection and methodological evaluation were carried out by two independent reviewers. Risk assessment was made by the odds ratio (OR) and incidence of pre‐eclampsia in the population who performed physical activity/exercise. A total of 231 articles were found, 214 of which were excluded based on title and full‐text, so that 17 remained. Comparison of six case–control studies showed that physical activity had a protective effect on the development of pre‐eclampsia [OR 0.77, 95% confidence interval (CI) 0.64–0.91, p < 0.01]. The 10 prospective cohort studies showed no significant difference (OR 0.99, 95% CI 0.93–1.05, p= 0.81). The only randomized clinical trial showed a protective effect on the development of pre‐eclampsia in the stretching group (OR 6.34, 95% CI 0.72–55.37, p= 0.09). This systematic review indicates a trend toward a protective effect of physical activity in the prevention of pre‐eclampsia.

Maternal and Perinatal Outcomes of Exercise in Pregnant Women with Chronic Hypertension and/or Previous Preeclampsia: A Randomized Controlled Trial

Objectives. To evaluate the association between physical exercise supervised in pregnant women with chronic hypertension and/or previous preeclampsia and maternal and neonatal outcomes. Method. Randomized controlled trial, which included 116 pregnant women with chronic hypertension and/or previous preeclampsia, considered risk of preeclampsia development. They were divided into two groups: study group that performed physical exercise with a stationary bicycle once a week, for 30 minutes; the intensity was controlled (heart rate 20% above resting values), under professional supervision and a control group that was not engaged in any physical exercise. The data was retrieved from medical charts. Significance level assumed was 5%. Results. Women from study group performed 9.24 ± 7.03 of physical exercise sessions. There were no differences between groups comparing type of delivery and maternal outcomes, including maternal morbidity and hospitalization in intensive unit care, and neonatal outcomes, including birth weight, adequacy of weight to gestational age, prematurity, Apgar scale at first and fifth minutes, hospitalization in intensive unit care, and neonatal morbidity. Conclusions. Physical exercise using a stationary bicycle in pregnant women with chronic hypertension and/or previous preeclampsia, once a week, under professional supervision, did not interfere in the delivery method and did not produce maternal and neonatal risks of the occurrence of morbidity. This trial is registered with ClinicalTrials.gov NCT01395342.

Immediate breast reconstruction with a Latissimus dorsi flap has no detrimental effects on shoulder motion or postsurgical complications up to 1 year after surgery.

Background: Mastectomy negatively affects scapulothoracic and glenohumeral kinematics. Breast reconstructive methods such as the latissimus dorsi flap can result in anatomical modifications that may in theory further affect the shoulder apparatus. The purpose of this study was to examine the effects of latissimus dorsi flap reconstruction on the recovery of shoulder motion and other postsurgical problems during the first year after mastectomy. Methods: This was a prospective cohort study of 104 consecutive mastectomies (47 with immediate latissimus dorsi flaps). Shoulder range of motion was assessed before and at 1, 3, 6, and 12 months after surgery. Pain, tissue adhesion, scar enlargement, and web syndrome were assessed during follow-up. Results: There was a 30 percent decrease of shoulder range of motion 1 month after surgery, with gradual recovery over time. However, mean abduction and flexion capacities did not reach baseline levels and were on average 5 to 10 percent lower than baseline, even after 1 year. Over time, the latissimus dorsi flap was not associated with restriction of flexion or abduction. Scar enlargement (at the first month, p = 0.009) and tissue adhesion (at month 12, p = 0.032) were significantly less common in the latissimus dorsi flap group. Conclusions: The authors’ study clearly suggests that the additional anatomical manipulation required for the latissimus dorsi flap procedure does not further affect shoulder kinematics and is associated with a lower incidence of tissue adhesion. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Association between parity, pre-pregnancy body mass index and gestational weight gain

Abstract Objective: To analyze the relationship between parity, pre-pregnancy body mass index (BMI), and gestational weight gain (GWG). Methods: This observational controlled study was conducted from November 2013 to April 2014, with postpartum women who started antenatal care up to 14 weeks and had full-term births. Data were collected from medical records and antenatal cards. Descriptive and bivariate analyses were performed. The significance level was 5%. Results: Data were collected from 130 primiparous and 160 multiparous women. At the beginning of prenatal care, 54.62% of the primiparous were eutrophic, while the majority of multiparous were overweight or obese (62.51%). Multiparas are two times more likely to be obese at the beginning of their pregnancies, when compared to primiparas. The average pre-pregnancy weight and final pregnancy weight was significantly higher in multiparous, however, the mean GWG was higher among primiparous. Conclusion: We found an inverse correlation between parity and the total GWG, but initial BMI was significantly higher in multiparas. Nevertheless, monitoring of the GWG through actions that promote a healthier lifestyle is needed, regardless of parity and nutritional status, in order to prevent excessive GWG and postpartum weight retention and consequently inadequate pre-pregnancy nutritional status in future pregnancies.

Exercício físico no ganho de peso e resultados perinatais em gestantes com sobrepeso e obesidade: uma revisão sistemática de ensaios clínicos

This study aimed to evaluate the effects of exercise on weight gain and perinatal outcomes among overweight and obese pregnant women, through a systematic review in MEDLINE/PubMed, EMBASE, LILACS, and SciELO. We included ten clinical trials that evaluated the effectiveness of exercise with or without combined diet in the control of gestational weight gain. Three studies were randomized, and methodological quality was assessed using the CONSORT 2010 Checklist, but none met all the criteria. Four studies showed weight gain differences between groups. The majority (60%) of studies showed no differences in perinatal outcomes (mode of delivery, gestational age at birth, birth weight). In conclusion, few studies confirmed the positive effect of exercise in controlling weight gain during pregnancy, thus requiring more research in this direction. Regarding perinatal outcomes, mild to moderate exercise does not appear to be decisive for perinatal outcomes, and is safe for pregnant women with overweight and obesity.This study aimed to evaluate the effects of exercise on weight gain and perinatal outcomes among overweight and obese pregnant women, through a systematic review in MEDLINE/PubMed, EMBASE, LILACS, and SciELO. We included ten clinical trials that evaluated the effectiveness of exercise with or without combined diet in the control of gestational weight gain. Three studies were randomized, and methodological quality was assessed using the CONSORT 2010 Checklist, but none met all the criteria. Four studies showed weight gain differences between groups. The majority (60%) of studies showed no differences in perinatal outcomes (mode of delivery, gestational age at birth, birth weight). In conclusion, few studies confirmed the positive effect of exercise in controlling weight gain during pregnancy, thus requiring more research in this direction. Regarding perinatal outcomes, mild to moderate exercise does not appear to be decisive for perinatal outcomes, and is safe for pregnant women with overweight and obesity.

A Population-Based Study on Gestational Weight Gain according to Body Mass Index in the Southeast of Brazil

Gestational weight gain (GWG) may interfere in perinatal outcomes and also cause future problems throughout woman’s life. The aim of this population-based study is to evaluate the GWG in Campinas city, southeast of Brazil. A total of 1052 women, who delivered in the three major maternity hospitals in Campinas, were interviewed during postpartum period. The general average of GWG was . Of total women, 13.6% were obese and 24.6% were overweight and, in these groups, 55.9% and 53.7%, respectively, exceeded GWG according to the Institute of Medicine recommendations. 6.2% of total women had low body mass index (BMI) and 35.5% in this group had insufficient GWG. Overweight and obese women had a higher risk of excessive GWG and delivery by c-section. The c-section rate was 58.9% and increased according to GWG. Prematurity was more prevalent first in obese and then in low BMI women. Considering the high BMI in women in reproductive age, it is necessary to take effective guidelines about lifestyle and nutritional orientation in order to help women reach adequate GWG. All of them could improve prenatal outcomes and women’s heath as a whole.

Complicações e condutas fisioterapêuticas após cirurgia por câncer de mama: estudo retrospectivo

After breast cancer surgery, women may develop some physical complications. Thus, the aims of this study were to investigate the outcome of these women, who participated in a rehabilitation program for one month, as well to identify along two years the most frequent complications and adopted physical therapy conducts. It was a descriptive and retrospective study with 707 medical records of women treated for breast cancer at the Womens Hospital Professor Doutor Jose Aristodemo Pinotti, Universidade Estadual de Campinas, between January 2006 and December 2007, admitted in the Division of Physical Therapy. Analysis was performed by means, standard deviation, absolute and relative frequencies. By the end of the program, 55% of women were discharged, 17% required additional treatment, and 26% did not join it. The most frequent complications were: pericicatricial adherence (26%), range of motion (ROM) restriction (24%), and scar dehiscence (17%). In the first year after surgery (n=460), the main complaints were: pain (28.5%), heaviness (21.5%), and restriction of shoulder range of motion (16.7%); in the second year (n=168), they were pain (48.2%), heaviness (42.8%), and lymphedema (23.2%). It was concluded that most women were discharged in the end of the program and, over the years, they presented reduction of shoulder range of motion frequency and lymphedema increase. Care of the arm, home exercises, and self-lymphatic drainage were the most adopted conducts.

Postpartum Women’s Perspectives on the Donation of Placentas for Scientific Research in Campinas, Brazil:

Little is known about public perspectives of scientific and therapeutic uses of placentas. Gaps in knowledge potentiate ethical and clinical problems regarding collection and applications. As such, this study sought to assess the perspectives of placenta donation of a sample of women. Postpartum women’s perspectives on placental donation were assessed at the State University of Campinas in the Centro de Atençäo Integral a Saúde da Mulher (CAISM) maternity hospital using a cross-sectional survey (n = 384) and semi-structured interviews (n = 12). Surveys were analyzed quantitatively and interviews were analyzed qualitatively using grounded coding; results were compared. The average age of respondents was 27. Fifty-six percent had more than one child, 45% were Caucasian, 38% were mixed-race, 74% identified with a Christian faith, 52% had high school education or higher, 13% regarded the placenta as spiritually important, 72% felt that knowing what happens to the placenta after birth was somewhat or very important, 78% supported the use of the placenta in research and medicine, 59% reported that consent to collect the placenta was very or somewhat important, 78% preferred their doctor to invite donation, and only 7% preferred the researcher to invite donation. Interviews suggested women appreciate being part of research and that receiving information about studies was important to them. Informed by these results, we argue that women support scientific and therapeutic uses of placentas, want to be included in decision making, and desire information about the placenta. Placentas should not be viewed as “throwaway” organs that are poised for collection without the involvement and permission of women. Women want to be meaningfully included in research processes.