Maternal Cardiac Adaptations to a Physical Exercise Program during Pregnancy MARI ´ A PERALES 1,2 , ALEJANDRO SANTOS-LOZANO 1,3 , FABIAN SANCHIS-GOMAR 1 , MARI ´ A LUACES 4 , HELIOS PAREJA-GALEANO 1,5 , NURIA GARATACHEA 1,6 , RUBE ´ N BARAKAT 2 , and ALEJANDRO LUCIA 1,5 1 Research Institute Hospital 12 de Octubre (Fi+12_), Madrid, SPAIN; 2 AFIPE Research Group, Faculty of Physical Activity and Sports Sciences INEF, Technical University of Madrid, SPAIN; 3 GIDFYS, Department of Health Sciences, European University Miguel de Cervantes, Valladolid, SPAIN; 4 Department of Cardiology, Cardiovascular Institute, Hospital Clı ´nico San Carlos, Madrid, SPAIN; 5 School of Doctorate Studies and Research, European University, Madrid, SPAIN; and 6 Departamento de Fisiatrı ´a y Enfermerı ´a. Facultad de Ciencias de la Salud y del Deporte. Instituto Agroalimentario de Arago ´n–IA2, Universidad de Zaragoza-CITA, Zaragoza, SPAIN ABSTRACT PERALES, M., A. SANTOS-LOZANO, F. SANCHIS-GOMAR, M. LUACES, H. PAREJA-GALEANO, N. GARATACHEA, R. BARAKAT, and A. LUCIA. Maternal Cardiac Adaptations to a Physical Exercise Program during Pregnancy. Med. Sci. Sports Exerc., Vol. 48, No. 5, pp. 896–906, 2016. Introduction: Scarce evidence exists regarding the effects of regular pregnancy exercise on maternal cardiovascular health. We aimed to study, using a randomized controlled trial design, the effects of pregnancy exercise on echo- cardiographic indicators of hemodynamics, cardiac remodeling, left ventricular (LV) function, and cardiovascular disease (CVD) risk factors. Methods: Two hundred forty-one healthy pregnant women were assigned to a control (standard care) or intervention (exercise) group (initial n = 121/120). The intervention (weeks 9–11 to 38–39) included three supervised sessions per week (55–60 min, with light– moderate intensity aerobic and strength exercises). Results: The main findings were as follows: (i) the proportion of women with excessive weight gain at end pregnancy was lower in the exercise group compared with controls (18% vs 40%, P = 0.005), and (ii) there was a tendency toward lower prevalence of depression at end pregnancy in the former (P = 0.029, threshold P value set at 0.013). No significant exercise training effect was essentially found for echocardiographic variables, CVD risk factors, type/duration of labor, or newborn_s outcomes (weight, height, head circumference, Apgar scores, and umbilical cord pH). Conclusions: Light–moderate intensity supervised exercise is safe for healthy pregnant women and does not impose an additional cardiac overload beyond gestation or affect the main pregnancy outcomes. Such intervention might help decrease, at least partly, the risk of two CVD-associated conditions, excessive weight gain and depression. Key Words: GESTATION, ECHOCARDIOGRAPHY, ANTENATAL DEPRESSION, HYPERTENSION, GESTATIONAL DIABETES MELLITUS, PHYSICAL ACTIVITY T he maternal cardiovascular system has to adapt to the continuous demands of the fetus (11), which leads to gradually increasing levels of blood volume (pre- load) from the first weeks of pregnancy and higher periph- eral resistance (afterload) in the third trimester (29). This results in higher myocardial work and might induce some degree of cardiac remodeling, i.e., myocardial hypertrophy occasionally accompanied by higher left ventricular (LV) rigidity and impaired LV function (37). Although cardio- vascular changes are usually reversible after labor in healthy gravida (20), the pregnancy period may be the origin of cardiovascular diseases (CVD) or aggravate preexisting con- ditions, especially in women with risk factors (obesity, dia- betes, hypertension, smoking, and older age) (22). Another high-risk group is composed of previously healthy women who develop pregnancy-related complications such as gesta- tional diabetes (30), hypertension (22), excessive weight gain (14), or some psychological disorders (15). Physical inac- tivity is an additional CVD risk factor and is actually a common condition during pregnancy (2). Regular levels of light–moderate physical exercise (swim- ming, walking, and toning exercises) during pregnancy im- prove cardiorespiratory fitness compared with following a sedentary lifestyle during this period (19). However, despite some previous efforts to describe the fetal (6) or maternal cardiovascular responses to an acute exercise bout (33), scarce evidence is available on the effects of exercise performed regularly during pregnancy on the maternal cardiovascular system or CVD risk factors using a randomized controlled trial (RCT) design. The purpose of this RCT was to assess the effects of an exercise program performed over pregnancy (from gestational weeks 9–11 to weeks 38–39) on the following: (i) echocardiographic indicators of maternal Address for correspondence: Fabian Sanchis-Gomar, M.D., Ph.D., Research Insti- tute Hospital 12 de Octubre (Fi+12_), Edificio actividades ambulatorias, 6 a planta, Avda. de Co ´rdoba s/n, 28041 Madrid, Spain. E-mail: fabian.sanchis@uv.es. Submitted for publication June 2015. Accepted for publication November 2015. Supplemental digital content is available for this article. Direct URL cita- tions appear in the printed text and are provided in the HTML and PDF versions of this article on the journal_s Web site (www.acsm-msse.org). 0195-9131/16/4805-0896/0 MEDICINE & SCIENCE IN SPORTS & EXERCISE Ò Copyright Ó 2015 by the American College of Sports Medicine DOI: 10.1249/MSS.0000000000000837 896 APPLIED SCIENCES Copyright © 2016 by the American College of Sports Medicine. 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