Exercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from the IOC Expert Group Meeting, Lausanne. Part 3 - Exercise in the postpartum period

This is Part 3 in the series of reviews from the IOC expert committee on exercise and pregnancy in recreational and elite athletes. Part 1 focused on the effects of training during pregnancy and on the management of common pregnancy-related complaints experienced by athletes1; Part 2 addressed maternal and fetal perinatal outcomes.2 In this part, we review the implications of pregnancy and childbirth on return to exercise and on common illnesses and complaints in the postpartum period. The postpartum period can be divided into hospital-based (during hospital stay), immediate postpartum (hospital discharge to 6 weeks postpartum) and later postpartum (6 weeks to 1 year, corresponding sometimes to cessation of breast feeding).3 In the literature, the postpartum period is usually defined as the first 6 weeks after pregnancy, during which time women have not typically been encouraged to exercise, except for strength training of the pelvic floor muscles. However, 6 weeks is an arbitrary time point and, anecdotally, many elite athletes report starting exercise inside that period. For the purpose of the present review, we consider the postpartum period to be up to 12 months following birth

Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1-exercise in women planning pregnancy and those who are pregnant

BACKGROUND Guidelines on physical activity or exercise and pregnancy encourage pregnant women to continue or adopt an active lifestyle during and following pregnancy.1-3 Two systematic reviews of pregnancy-related guidelines on physical activity found similarities between recommendations from different countries, but noted that the guidelines differed in focus.4 5 The guidelines provided variable guidance on prenatal exercise, or on how pregnant women might approach continuing or adopting sport activities.6 However, most guidelines did not include important topics such as prevalence and known risk factors for common pregnancy-related diseases and complaints, and the role of exercise in preventing and treating them. Importantly, the focus of most previous guidelines has been on healthy pregnant women in the general population, in whom there is almost always a decline in physical activity during pregnancy.7 8 Indeed, a high proportion of pregnant women follow neither physical activity nor exercise guidelines, 9 putting them at increased risk of obesity, gestational diabetes mellitus (GDM), and other pregnancy-related diseases and complaints.1 On the other hand, there are enthusiastic exercisers and elite athletes who often meet and exceed general exercise recommendations for pregnant women, but there are no exercise guidelines specifically for these women. Important questions for such women are unanswered in current guidelines: Which activities, exercises and sports can they perform, for how long and at what intensity, without risking their own health and the health of the fetus? How soon can they return to highintensity training and competition after childbirth? The IOC and most National Sports Federations encourage women to participate in all Olympic sport disciplines. The IOC promotes high-level performance, and it is also strongly committed to promoting lifelong health among athletes10-not just during their competitive sporting careers. With an increasing number of elite female athletes competing well into their thirties, many may wish to become pregnant, and some also want to continue to compete after childbirth. With this background, the IOC assembled an international expert committee to review the literature on physical activity and exercise (1) during pregnancy and (2) after childbirth, using rigorous systematic review and search criteria.11 For efficiency, where sex is not specified, the reader should assume that this manuscript about pregnancy and childbirth refers to females (ie, \u27the elite athlete who wishes to train at altitude\u27 is used in preference to \u27the elite female athlete...\u27). AIMS The September 2015 IOC meeting of 16 experts in Lausanne had three aims. They were to: 1. Summarise common conditions, illnesses and complaints that may interfere with strenuous exercise and competition, during pregnancy and after childbirth; 2. Provide recommendations for exercise training during pregnancy and after childbirth, for highlevel regular exercisers and elite athletes; and 3. Identify major gaps in the literature that limit the confidence with which recommendations can be made. METHODS For each section of the document, a search strategy was performed using search terms such as \u27pregnancy\u27 OR \u27pregnant\u27 OR \u27postpartum\u27 AND \u27exercise\u27 OR \u27physical activity\u27 OR\u27leisure activity\u27 OR\u27leisure\u27 OR \u27recreation\u27 OR \u27recreational activity\u27 or \u27physical fitness\u27 OR \u27occupational activity\u27 AND terms related to the condition under study (eg, \u27gestational diabetes\u27). Available databases were searched, with an emphasis on PubMed, EMBASE, Cochrane, PEDro, Web of Science and SPORTDiscus. In addition, existing guidelines with reference lists were scanned. The review of each topic followed the general order: prevalence of the condition in the general pregnant or postpartum population, prevalence in high-level exercisers or elite athletes, risk factors in the general population and in relation to exercise and sport, and effect of preventive and treatment interventions. Level of evidence and grade of recommendations are according to the Cochrane handbook (table 1) for prevention and treatment interventions only. Each member of the working group was assigned to be the lead author of one or more topics and 1-3 others were assigned to review each topic. A first full consensus draft was reviewed before and during the 3-day IOC meeting (27-29 September 2015), and a new version of each topic was submitted to the meeting chairs (KB and KMK) shortly after the meeting. Each topic leader made amendments before sending a new version for comments to the working group

Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 2 - The effect of exercise on the fetus, labour and birth

This is Part 2 of 5 in the series of evidence statements from the IOC expert committee on exercise and pregnancy in recreational and elite athletes. Part 1 focused on the effects of training during pregnancy and on the management of common pregnancy-related symptoms experienced by athletes. In Part 2, we focus on maternal and fetal perinatal outcomes

QUIJOTE scientific results -- XIII. Intensity and polarization study of supernova remnants in the QUIJOTE-MFI wide survey: CTB 80, Cygnus Loop, HB 21, CTA 1, Tycho and HB 9

We use the new QUIJOTE-MFI wide survey (11, 13, 17 and 19 GHz) to produce spectral energy distributions (SEDs), on an angular scale of 1 deg, of the supernova remnants (SNRs) CTB 80, Cygnus Loop, HB 21, CTA 1, Tycho and HB 9. We provide new measurements of the polarized synchrotron radiation in the microwave range. For each SNR, the intensity and polarization SEDs are obtained and modelled by combining QUIJOTE-MFI maps with ancillary data. In intensity, we confirm the curved power law spectra of CTB 80 and HB 21 with a break frequency $\nu_{\rm b}$ at 2.0$^{+1.2}_{-0.5}$ GHz and 5.0$^{+1.2}_{-1.0}$ GHz respectively; and spectral indices respectively below and above the spectral break of $-0.34\pm0.04$ and $-0.86\pm0.5$ for CTB 80, and $-0.24\pm0.07$ and $-0.60\pm0.05$ for HB 21. In addition, we provide upper limits on the Anomalous Microwave Emission (AME), suggesting that the AME contribution is negligible towards these remnants. From a simultaneous intensity and polarization fit, we recover synchrotron spectral indices as flat as $-0.24$, and the whole sample has a mean and scatter of $-0.44\pm0.12$. The polarization fractions have a mean and scatter of $6.1\pm1.9$\%. When combining our results with the measurements from other QUIJOTE studies of SNRs, we find that radio spectral indices are flatter for mature SNRs, and particularly flatter for CTB 80 ($-0.24^{+0.07}_{-0.06}$) and HB 21 ($-0.34^{+0.04}_{-0.03}$). In addition, the evolution of the spectral indices against the SNRs age is modelled with a power-law function, providing an exponent $-0.07\pm0.03$ and amplitude $-0.49\pm0.02$ (normalised at 10 kyr), which are conservative with respect to previous studies of our Galaxy and the Large Magellanic Cloud.Comment: 33 pages, 15 figure, 15 tables. Submitted to MNRAS. QUIJOTE data maps available at https://research.iac.es/proyecto/quijot