Sunday, January 1, 2017

Factors Associated With Increased Risk of Childhood Obesity

Factors Associated With Increased Risk of Childhood Obesity
Along with the rise in adult obesity there has been a significant increase of obesity in children during the past several decades in the US.  Recent studies have investigated several factors that may impact a child's risk of becoming overweight or obese. This article provides a brief overview of the factors that are associated with this risk.
Excessive Weight Gain During the Prenatal Period
Pregnant women who take in more than the ideal amount of calories during pregnancy provide excess calories to the fetus as well. It's important to counsel pregnant women on healthy weight gain goals and caloric intake for their body size and weight. Women who start pregnancy overweight or obese also increase their risk of having children who develop weight issues during early childhood. It's still unclear what the mechanisms cause this association, but both environmental and genetic factors seem to play a role. Targeting women at risk pre-pregnancy and early pregnancy and providing diet and exercise education and support for them can lead to healthier pregnancies and reduce weight gains that exceed recommendations.
Maternal Smoking
Pregnant women who smoke may increase the risk of their offspring becoming overweight or obese during adolescence and adulthood. Women who quit smoking during the first trimester reduce the risk to her offspring to that of non-smoking pregnant women. The importance of promoting smoking cessation not only for the maternal health but for the future health of her baby can help motivate women to quit.
In addition to the danger of maternal smoking, some research has found that paternal smoking also causes an increased risk of obesity, even if the pregnant mother does not smoke. Smoking cessation programs should be provided to any family members that smoke when there is a pregnant woman in the household.
Low Level of Parental Exercise Activity
Pregnant women who exercise throughout their pregnancy have babies that are less fat, (but not underweight) and some longitudinal studies on the effect of prenatal exercise on offspring suggest children of mothers who exercised were less fat in childhood than those of non-exercising mothers. More studies are needed to determine whether there are genetic influences influencing these results, or they are due to exercising women also eating a healthier diet, gaining less weight during their pregnancy, and including their children in exercise activities.
Maternal impaired glucose metabolism
Gestational diabetes is on the rise in the pregnant population and women who are overweight or obese have a greater risk of GD during pregnancy. Women with a BMI of> 30 kg have a 2-3 fold higher incidence of not only GD, but also other serious conditions such as hypertension and preeclampsia. In addition, women with GD have a higher risk of cesarean section and other birth complication, in part because this condition leads to fetal macrosomia (large for gestational age). There is some discussion about the affect that GD has on the metabolic functioning of children born to women with GD, and the possibility of increased risk of impaired glucose metabolism.
The role of health and fitness professionals in providing pregnant and postpartum women with positive lifestyle counseling is an important component in reducing the incidence of childhood obesity. Offering pregnant women nutritional guidelines that improve her diet and the health of her child, and support to help implement fitness into their lifestyle is key. We can impact the current trend of increasing obesity in children by intervening during pregnancy with nutritional counseling, exercise training and consistent follow up.

Monday, December 19, 2016

Travel Safety Tips During Pregnancy

Many pregnant women have jobs that require frequent air travel, and vacation and holiday plans can also make travel by plane a necessity.  Most healthcare providers advise avoiding plane trips after 35 weeks, and some complications during pregnancy may make air travel contraindicated at any point. But for the majority of pregnant women, travel poses little risk as long as certain precautions are followed.

There is some concern about the radiation risk to the fetus regarding exposure to security metal detectors or full body scanners. Airport security metal detector don’t use ionizing radiation, (the type used in x ray machines but use "nonionizing" radiation-form that does not pose a risk even with routine and/or repeated scanning. As a comparison, the level of radiation from metal detectors is very low-in fact it would take 25,000 trips through an airport scanner to equal one year of normal sun exposure.

The "full-body" x-ray scanner uses a very low-energy and low-intensity radiation, and the energy of the x-ray beam is so low that it does not penetrate the skin-it just forms a picture of the outline of your external torso. Although the risk of passing through these machines is very low, pregnant women can eliminate the risk and worry by choosing to have a “pat down” by TSA instead. Here are a few tips for avoiding x-ray machines and scanners:
-Plan for arriving at the airport with extra time for the pat-down.
-Alert the TSA employees if you’re pregnant or think you may be pregnant.
-If you are concerned about exposure to security machines, you are allowed to choose a TSA pat-down instead of having to pass through the machines.
For more information on the safety of airport x-ray machines and scanners go to:

A very real concern during flights, train, bus or car travel is the formation of blood clots that may occur from long periods of sitting. You can reduce your risk of developing blood clots by getting up and walking every hour, and when sitting avoid crossing your legs. It is helpful to do ankle rolls and foot flexions and squeeze and relax your leg muscles every 15 minutes.

Always pack a protein rich snack and water bottle with your carry on bag, and avoid high sodium foods as they can increase edema. Keeping well hydrated is key, even if it means you will need frequent bathroom breaks, as dehydration can increase the risk of clots as well as swelling in your lower extremities.

You can help make your travel more comfortable by planning ahead and choosing seating that offers more leg room (bulk head seating on planes) and an aisle seat so you are free to get up and move or use the bathroom when needed.  Bring a lumbar support and neck roll (a zip lock gallon bag works great for a lumbar support-zip it nearly shut and blow air in to the bag until inflated to the size your want and quickly zip it shut).  Place the bag behind your back for a great low back support. Also, bring a lightweight blanket (can be used as a back support or neck support when rolled up) and it will keep you warm.

It is always important to dress comfortable when traveling, but it is even more so when pregnant. Avoid tightfitting clothing and shoes that do not provide good support and comfort. If you have to dress up for your work, wear lightweight workout shoes that you can swap out with dress shoes once you reach your destination.

Lastly, check your bag if possible to avoid having to lift a heavy suitcase into the overhead bin.  If you have to carry on, ask for assistance with your bag to keep from injuring your back. Instead of lugging a heavy purse or attaché case, use a small rolling laptop briefcase that can hold all your purse contents, computer, paperwork and other items.

Monday, October 31, 2016

Prenatal Exercise Program Design: Exercise Type

Choosing the type of exercise that is best tolerated during pregnancy depends on the following considerations:

• Which activities the client enjoys or is skilled at performing

• Whether the activity poses any risk to the mother or fetus

• Is she is able to do the activity without being compromised by balance and center of gravity changes

• Can the activity be easily modified as pregnancy progresses

Weight-bearing exercise such as walking, dancing, and running help maintain bone mass and some studies suggest they are more effective for keeping pregnancy weight gain within normal limits. As pregnancy progresses some women may not be able to continue weight-bearing exercise because of back or round ligament pain. If modifications such as wearing a belly support don’t relieve discomfort, switching to non-weight-bearing activities such as swimming, stationary biking, or other types of stationary exercise equipment is recommended.

Absolute and relative contraindicated activities for pregnant women are listed below. Pregnant women should always consult with their healthcare provider before taking part in any exercise program and assess the risk/benefit ratio whenever there is a question about the safety of any activity during pregnancy. Keep in mind that activities such as downhill skiing must be assessed for risks that are not controllable, such as the effect of high altitude on oxygen delivery to the fetus.

 Contraindicated Activities for Pregnant Women


High-altitude sports




Horseback riding


Downhill skiing

Scuba diving

Prenatal Fitness Program Design: Exercise Frequency
In my blog last week I discussed exercise duration, the second of four components used when developing a prenatal fitness program. This week exercise frequency is the focus.The number of days each week that a pregnant woman can safely exercise depends upon several factors. They include:
• Her current level of fitness
• How well she is tolerating pregnancy (ie: any discomfort, lack of weight gain or excessive fatigue)
• The intensity and type and duration of activity she is doing
• How well her body is responding to her exercise routine
Some women find that they can comfortably exercise 5-6 days a week as long as they modify the intensity, duration, and type of activity as needed to maintain a comfortable routine. Three days a week is the minimum needed to achieve cardiovascular benefits and gain improvements in fitness, and many women find that exercising most days is the best way to remain consistent with their program.
Pregnant women should reduce their exercise frequency if they experience signs of overtraining, (see below) and allow for more rest days between exercise sessions.
Signs of Overtraining:
•Lack of weight gain
•Extreme fatigue that doesn’t resolve with rest
•Increase in illness or very slow recovery from illness
•Sustained muscle soreness or pain
•Inability to maintain exercise routine 
•Increased resting heart rate
•Depressed mood 
•Slowed fetal growth 
Want to learn more about how to develop a safe and effective maternal fitness program? The CE correspondence course "Prenatal and Postpartum Exercise Design 2016" is available at:

Thursday, October 27, 2016

Prenatal Exercise Program Design: Exercise Duration

Exercise duration during pregnancy should reflect a woman’s current level of fitness and the type of activity she is doing. If you’re working with someone who’s just starting a prenatal exercise program the duration will be shorter (15-20 minutes) and progress slowly over time to 30-60 minutes. A pregnant woman who is already taking part in a fitness routine can continue with her current duration level, but exercise duration should be modified as needed to enable her to achieve a moderate to somewhat hard level of intensity without discomfort or undue fatigue. 

Some exercise activities, such as swimming, may require a longer duration in order to achieve a moderate to somewhat hard intensity, so close monitori
ng of exercise intensity will help determine whether a longer bout is needed. As pregnancy progresses, pregnant women may find that they are able to tolerate a longer duration, lower intensity exercise bout better than a higher intensity, shorter bout, but avoid taking the intensity below the targeted zone of 12 to 14 on the 20-point scale or 3 to 4 on the 10-point scale.   
In the case where a pregnant woman is having difficulty maintaining her normal exercise duration, try dividing the workout into two shorter sessions during the day. This is a helpful tool for enabling women to continue to exercise when she’s experiencing more fatigue in later pregnancy.

Want to learn more about how to develop a safe and effective maternal fitness program? The CE correspondence course "Prenatal and Postpartum Exercise Design 2016" is available at:

Friday, September 30, 2016

The Increasing Need For Trained Maternal Fitness Instructors
The need for trained maternal fitness professionals has greatly increased as a result of the number of fit women who desire to continue with their exercise routine once they become pregnant. The past several decades has provided a large body of evidence that supports the benefit and safety of prenatal exercise in uncomplicated pregnancies, and ACOG and other fitness and medical health organizations recognize the importance of fitness in a healthy pregnancy. Studies have shown that women who continue or even start an exercise program during pregnancy gain less fat weight, have fewer complications during labor and delivery, and return to their pre-pregnancy weight faster than women who didn't exercise while pregnant.
Knowing what the current evidence based guidelines are for pregnant and postpartum women and being able to work with this population will open up opportunities to create a specialized program that fits their unique needs. Fitness professionals who have training in this field offer skilled support and guidance to pregnant and postpartum women and help them confidently include exercise as part of their lifestyle.  Pregnant women are unsure of what exercises and activities they can continue throughout pregnancy and need guidance on how to monitor their routine for safety. As pregnancy progresses, women need strategies for modifying their exercise program as their body changes to maintain a comfortable and safe routine.