Ejercicio físico y embarazo

Muchas mujeres que realizan un ejercicio físico regular siguen haciéndolo cuando están embarazadas. Sin embargo, las recomendaciones aún vigentes respecto a la realización de ejercicio durante el embarazo que publicó el American College of Obstetrics and Gynecology (ACOG), fueron criticadas como demasiado conservadoras en 1985,48 y siguen siéndolo en la actualización llevada a cabo en 1994.49 Estas recomendaciones afirman que las mujeres embarazadas pueden seguir realizando ejercicios aeróbicos de intensidad leve o moderada durante al menos tres veces por semana. Sin embargo, deben evitar el ejercicio en decúbito supino después del tercer trimestre de la gestación. Las mujeres deben saber que las alteraciones de su morfología (el aumento de peso) pueden modificar su centro de gravedad que quizá originen traumatismos abdominales. También deben saber que corren el riesgo del sobrecalentamiento y que, por lo tanto, han de estar bien hidratadas, llevar la ropa adecuada y prestar atención a cualquier aumento de la temperatura ambiental. Las contraindicaciones del ejercicio físico durante el embarazo son la hipertensión gestacional, la rotura pretérmino de las membranas, el parto prematuro (durante un embarazo previo o en el actual), la incompetencia del cuello uterino, las hemorragias persistentes durante el segundo o tercer trimestres y el retraso del crecimiento fetal intrauterino.

A pesar de las recomendaciones del ACOG, algunos médicos defienden la postura de tener un consentimiento informado ^por parte de la embarazada que quiere hacer ejercicio.50 Esta debe conocer sus riesgos y sus beneficios y, tras discutir con ella estos aspectos, podrá elegir la modalidad de actividad física que sea más adecuada y juiciosa en su caso (tabla 51.2).

En un importante estudio prospectivo realizado en 398 mujeres seguidas durante su embarazo, se observó una correlación entre el aumento de la actividad física y la reducción de los síntomas de malestar propios de la gestación.51 El estudio también señaló que el ejercicio físico no se asociaba a disminución del peso del lactante al nacer ni a unos malos resultados de la maternidad.

Bibliografía

1. Harris SS, Caspersen CJ, DeFriese GH, Estes EH. Physical activity counseling for healthy adults as a primary preventive intervention in the clinical setting: report for the U.S. Preventive Services Task Force. JAMA 1989; 262: 3590-8.

2. Powell KE, Thompson PD, Caspersen CJ, Kendrick JS. Physical activity and the incidence of coronary heart disease. Annu Rev Public Health 1987; 8: 253-87.

3. US Department of Health and Human Services; Centers for Disease Control and Prevention; National Center for Chronic Disease Prevention and Health Promotion; The President’s Council on Physical Fitness and Sports, Physical Activity and Health. A report of the Surgeon General. Atlanta: CDC, 1996.

4. American College of Sports Medicine. Guidelines for exercise testing and prescription. 5th ed. Baltimore: Williams & Wilkins, 1995.

5. Paffenbarger RS Jr, Hyde RT, Wang AL, Hsieh CC. Physical activity, all-cause mortality and longevity of college alumni. N Engl J Med 1986; 314: 605-13.

6. Leon AS, Connett J, Jacobs DR Jr, Rauraman R. Leisure-time physical activity levels and risk of coronary heart disease and death: the Multiple Risk Factor Intervention Trial. JAMA 1987; 258: 2388-95.

7. Ekelund RS, Haskell WL, Johnson JL, et al. Physical fitness as a predictor of cardiovascular mortality in North American men. N Engl J Med 1986; 314: 605-13.

8. Blair SN, Kohl HW, Paffenbarger RS Jr, et al. Physical fitness and all-cause mortality. JAMA 1989; 262: 2395-401.

9. Tanji JL. Sports safety. In: Hudson TW, editor. Clinical preventive medicine. Boston: Little, Brown, 1988: 251-9.

10. US Department of Health and Human Services. The national children and youth fitness study. J Phys Educ Recreat Dance 1985; 1(6): 44-90.

11. Tanji JL. The preparticipation physical examination for sports. Am Fam Physician 1990; 42: 397-402.

12. Paffenbarger RS Jr, Hale WE. Work activity and coronary heart mortality. N Engl J Med 1975; 292: 545-50.

13. Paffenbarger Rs Jr, Laughlin ME, Gima AS, Black RA. Work activity of longshoremen as related to death from coronary heart disease and stroke. N Engl J Med 1970; 282: 1109-14.

14. McCarthy P. Wheezing or breezing through exercise-induced asthma. Phys Sports Med 1989; 17(7): 125-30.

15. Varray AL, Mercier JG, Terral CM, et al. Individualized aerobic and high intensity training for asthmatic children in an exercise readaptation program: is training always helpful for better adaptation to exercise? Chest 1991; 99: 579-86.

16. McFadden ER Jr. Exercise performance in the asthmatic. Am Rev Respir Dis 1984; 129: 584-7.

17. Nickerson BG, Bautista DB, Maney MA, et al. Distance running improves fitness in asthmatic children without pulmonary complications or changes in exercise-induced bron-chospasm. Pediatrics 1983; 71: 147-52.

18. Clark CJ, Cochrane LM. Assessment of work performance in asthma for determination of cardiorespiratory fitness and training capacity. Thorax 1988; 43: 745-9.

19. Haas F, Pineda M, Axen K, et al. Effects of physical fitness on respiratory airflow in exercising asthmatic people. Med Sci Sports Exerc 1985; 17: 585-92.

20. Ludwick SK, Jones JW, Jones TK, et al. Normalization of cardiopulmonary endurance in severely asthmatic children after bicycle ergometry therapy. J Pediatr 1986; 109: 446-51.

21. Ahmed T. Role of heparin for exercise induced asthma. In: Proceedings of American Medical Society for Sports Medicine Annual Meeting. Orlando, AMSSM, 1996: 35-46.

22. Huston TP, Puffer JC, Rodney WM. The athletic heart syndrome. N Engl J Med 1985; 313: 24-32.

23. Bryan G, Ward A, Rippe JM. Athletic heart syndrome. Clin Sports Med 1992; 11:259-72.

24. Tanji JL. Exercise and the hypertensive athlete. Clin Sports Med 1992; 11:291-302.

25. Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. The 5th report of the joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. Bethesda: National Institutes of Health, 1993. NIH Publ. 73: 1088.

26. Tipton CM. Exercise, training and hypertension: an update. Exerc Sport Sci Rev 1991; 19: 447-505.

27. Kaplan NM. The deadly quartet: upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Intern Med 1989; 149: 1514-20.

28. Tanji JL. Hypertension: how exercise helps. Phys Sports Med 1990; 18(7): 77-82.

29. MacDougall JD, Tuxen D, Sale DG, et al. Arterial blood pressure response to heavy resistance exercise. J Appl Physiol 1985; 58: 785-90.

30. Tanji JL. Hypertension: the role of medication. Phys Sports Med 1990; 18(8): 87-91.

31. Reaven GM. Insulin resistance, hyperinsulinemia and hypertriglyceridemia in the etiology and clinical course of hypertension. Am J Med 1991; 90 Suppl 2A: 7A-7S.

32. Eichner ER. Runner’s macrocytosis: a clue to foot strike hemolysis. Am J Med 1985; 78: 321-5.

33. Selly GB, Eichner ER. Endurance swimming, intravascular hemolysis, anemia and iron depletion. Am J Med 1986; 81: 791-4.

34. Krauss BB, Sinclair JW, Castell DO. Gastroesophageal reflux in runners. Ann Intern Med 1990; 112: 429-33.

35. Baska RS, Moses FM, Deuster PA. Cimetidine reduces running-associated gastrointestinal bleeding. Dig Dis Sci 1990; 35: 956-60.

36. Green GA. Gastrointestinal disorders in the athlete. Clin Sports Med 1992;11:453-70.

37. Adolph EF. Physiology of man in the desert. New York: Interscience, 1977.

38. Neufer PD, Young AJ, Sawka MN. Gastric emptying during exercise: effects of heat stress and hypohydration. Eur J Appl Physiol 1989; 58:433-9.

39. Anderson RJ, Reed G, Knochel J. Heatstroke. Adv Intern Med 1983; 28: 115-41.

40. Weiner JS, Home GO. A classification of heat illness. BMJ 1958; 1: 1533-5.

41. Rowell LB. Human cardiovascular adjustments to exercise and thermal stress. Physiol Rev 1974; 54: 75-159.

42. Gisolfi CV, Duchman SM. Guidelines for optimal replacement beverages for different athletic events. Med Sci Sports Exerc 1992; 24: 679-87.

43. Costill DL, Sparks KD. Rapid fluid replacement following thermal dehydration. J Appl Physiol 1973; 34: 299-303.

44. Marbaix O. Le passage pylorique. Cellule 1898; 14: 249-332.

45. Costill DL, Saltin B. Factors limiting gastric emptying during rest and exercise. J Appl Physiol 1974; 37: 679-83.

46. Lamb DR, Brodowicz GR. Optimal use of fluids of varying formulations to minimize exercise-induced disturbances in homeostasis. Sports Med 1986; 3: 247-74.

47. Gisolfi CV, Summers RW, Schedl HP. Intestinal absorption of fluids during rest and exercise: fluid homeostasis during exercise. Carmel, IN: Brown & Benchmark, 1990: 129-75.

48. ACOG Technical Bulletin. Exercise during pregnancy and the postnatal period. Washington, DC: ACOG, 1985.

49. ACOG Technical Bulletin: Exercise during pregnancy and the postpartum period. Washington, DC: ACOG, 1994.

50. Sternfeld B, Quasenberry CP Jr, Eskenazi B, Newman LA. Exercise in pregnancy and pregnancy outcome. Med Sci Sports Exerc 1995; 27: 634-40.

51. ACOG. Guidelines for exercise in pregnancy and the postpartum period. ACOG Technical Bulletin !187. Wash. DC. 1994.