Cardiopulmonary exercise testing during pregnancy

Abstract

The goal of this review is to examine practical considerations when conducting cardiopulmonary exercise testing during pregnancy. In a clinical and research setting, cardiopulmonary exercise testing during pregnancy is valuable in identifying underlying cardiopulmonary conditions, stratifying the risk of adverse pregnancy outcomes, as well as establishing exercise tolerance/limitations. This review encompasses information regarding the unique physiological adaptations that occur throughout gestation (e.g., changes in resting heart rate, blood pressure, glucose, etc.) and how these adaptations impact the interpretation of physiological measurements. There are also key concerns that are unique to pregnant populations that should be considered when participating in exercise (i.e., fetus, ventilation, thermoregulation, urinary incontinence, low back pain, and pelvic girdle pain). This step‐by‐step review of cardiopulmonary exercise testing outlines pregnancy related adjustments to standardized methods (i.e., screening/documentation, pre‐ and post‐test measurements, protocol specifics, modality selection, and fetal monitoring) which should be considered for the safety of both the participant and fetus. Currently, pregnancy specific exercise testing guidelines are lacking. Therefore, we will be discussing the limitations of current recommendations such as a safe cut off for resting heart rate and pregnancy specific test termination criteria.

Glycemic response to acute high‐intensity interval versus moderate‐intensity continuous exercise during pregnancy

“…This has led to concerns of vigorous to near‐maximal exercise intensity causing hypoglycemia (<3.3 mmol/L; Seaquist et al, 2013 ). Hypoglycemia may lead to symptoms of cognitive dysfunction, poor coordination, and in severe cases, loss of consciousness which can increase the risk of trauma to the pregnant individual and fetus (Wowdzia & Davenport, 2021 ).…”

Sport and exercise recommendations for pregnant athletes: a systematic scoping review

“…28 29 Recently, however, interest in the relationship between exercise and pregnancy outcomes in elite athletes has increased, as the systematic reviews and meta-analysis by Wowdzia and Kimber indicate. [30][31][32] The present reviews have investigated or focused on a subset of outcome parameters, which is also reflected in the selection of studies. [32][33][34] An increasing number of elite and competitive amateur female athletes are reaching their career peak during the period of optimal fertility and do not want to postpone having children until they end their athletic careers.…”

“…[30][31][32] The present reviews have investigated or focused on a subset of outcome parameters, which is also reflected in the selection of studies. [32][33][34] An increasing number of elite and competitive amateur female athletes are reaching their career peak during the period of optimal fertility and do not want to postpone having children until they end their athletic careers. This is particularly the case in endurance disciplines where training age plays a relevant role.…”

“…Elite athletes or competitive amateur athletes are often only mentioned in side statements 28 29. Recently, however, interest in the relationship between exercise and pregnancy outcomes in elite athletes has increased, as the systematic reviews and meta-analysis by Wowdzia and Kimber indicate 30–32. The present reviews have investigated or focused on a subset of outcome parameters, which is also reflected in the selection of studies 32–34…”

“… 30–32 The present reviews have investigated or focused on a subset of outcome parameters, which is also reflected in the selection of studies. 32–34 …”