Physical Exercise & Cardiovascular Adaptation Monitoring in Pregnancy
Research type
Research Study
Full title
Physical Exercise & Cardiovascular Adaptation Monitoring in Pregnancy (‘PE-CAMP’)
IRAS ID
239704
Contact name
Michael J Lewis
Contact email
Sponsor organisation
Swansea University
Duration of Study in the UK
2 years, 4 months, 31 days
Research summary
Research Summary
There is general consensus that antenatal physical exercise can benefit pregnant women, helping to avoid excessive weight gain and reducing the risk of pregnancy complications (e.g. hypertensive disorders, gestational diabetes). We have contributed substantially to knowledge of maternal cardiovascular adaptations to antenatal physical activity (APA) but further mechanistic evidence from a larger-scale study is still needed. Also, the impact of APA on foetal cardiac health is not known yet this is likely to have an major influence on future antenatal exercise recommendations. As we also have experience of foetal cardiac evaluation from our earlier work we propose in this study to undertake a combined foeto-maternal assessment of cardiovascular adaptation to APA. Postpartum evaluation of mother and baby will provide further evidence pointing towards the longer-term benefits of APA.
We will 1) implement a bespoke 20-week programme of APA; 2) randomly allocate pregnant women to an APA Group (who follow this programme) or a Control Group (who do no formalised APA); 3) characterise maternal and foetal cardiovascular function using non-invasive methods (ECG, blood pressure, stroke volume and echocardiographic assessment in the mother; ECG and echocardiography in the foetus) during periods of rest, exercise and postural manoeuvre; 4) compare maternal/foetal cardiovascular function in the two groups. Participants will attend three cardiovascular assessment sessions: two during pregnancy (between 18-22 and 32-36 weeks gestation) and once 12 weeks postpartum. We will recruit 300 pregnant women – an ambitious target but one that is important to our goal of providing the first definitive evidence-base of the cardiovascular health value of APA. The project has been awarded a prestigious European Commission Horizon 2020 Marie Skłodowska-Curie Fellowship (Dr Olga Roldan Reoyo).Summary of Results
Introduction The Physical Exercise and Cardiovascular Adaptation Monitoring in Pregnancy study (PECAMP) is a randomised controlled trial aiming to study the influence of supervised physical exercise on the cardiac adaptations occuring in pregnant and postnatal people. The study was conducted from April 2018 to December 2020. Pregnant people interested in participanted were radomised into a standard care group or into a supervised physical exercise intervention group. All participants were asked to attend three assessment appointments (Second and third trimester of pregnancy and 3-month postnatal). During these assessments data from different cardiac parameters was collected (heart rate, stroke volumen, cardiac output, heart rate variability) before, during and after a 10-min exercise bout on a stationary bicycle. Moreover, body composition and upper body strength and flexibility were collected. During the third trimester assessment foetal heart rate was collected. In total 138 pregnant participants were recruited into the study (control= 47, intervention=91). A total of 79 participants completed at least one of the three assessment and therefore included for statistical analysis (control=20, intervention=59).
Preliminary results
Pregnant participants engaging in more moderate to vigorous physical activity before pregnancy and in moderate physical activity during the second trimester had lower maximum heart rate during the exercise stage of the assessment protocol Pregnant participants engaging in vigorous physical activity during the second trimester (mean= 2.19±2.39 mins/week) resulted in higher stroke volume during the exercise stage of the assessment protocol (mean stroke volume = 75.83ml/min, maximum stroke volume = 102.68ml/min).
Pregnant participants engaging in more moderate to vigorous physical activity (moderate physical activity during the thrid trimester = 63.55min/week, vigorous physical activity during the third trimester = 3.33min/week) resulted in higher stroke volume in resting condition (stroke volume at rest = 70.79ml/min) and higher stroke volume in the postnatal period during the exercise stage of the assessment protocol (stroke volume during exercise = 73.59ml/min).Moreover, pregnant participants participanting in the study during the Covid-19 outbreak had to continue the supervised physical activity intervention. Surprisingly this increased their compliance with the exercise intervention, compared to participants attending the exercise intervention prior to the Covid-19 outbreak (compliance non-Covid participants 60.79% vs compliance Covid-19 participants 76.21%).
Preliminary conclusions
Moderate and vigorous physical activity should be encourage in all pregnnacy stages as well as in the pre-pregnancy period if pregnancy is planned, since they have shown enhanced cardiac response before and during exercise. Having a lower heart rate and higher stroke volume can be seen as a positive adaptation of the cardiac system to exercise during pregnancy and the postnatal period. Furthermore, online supervised exercise interventions should be considered as they seem to increase compliance with exercise intervention, although this needs to be taken with caution, since the circumstances around covid lockdown would have positively influence this higher compliance.REC name
Wales REC 6
REC reference
17/WA/0414
Date of REC Opinion
8 Jan 2018
REC opinion
Further Information Favourable Opinion