Risk assessment for physical activity and exercise clearance In pregnant women without contraindications

Traditionally, exercise was advised with caution or not recommended for pregnant women. Women active before pregnancy were advised by physicians to reduce their habitual exercise levels, while previously inactive women were advised to refrain from initiating exercise programs.1 However, guidelines for exercise during pregnancy have evolved substantially during the past 30 years; recommendations have become less restrictive as evidence-based information becomes more readily available.2 Moreover, an increasing number of pregnant women wish to maintain prepregnancy physical fitness levels during the prenatal period, and others wish to initiate exercise for healthier pregnancies.2,3 The conservative nature of medical advice in the past was intended to safeguard the health of both the mother and the growing fetus.2,3 Advice was intentionally conservative because of concern that exercise might shift oxygenated blood and energy substrates away from the fetus to maternal skeletal muscle, as well as increase core body temperature during vulnerable developmental periods such as embryogenesis. Therefore, it was largely unknown whether exercise increased the risk of congenital abnormalities and caused disturbances in optimal fetal growth.2 There were also maternal concerns that excessive exercise might cause conditions such as chronic fatigue and hypoglycemia, or increase the risk of injury (eg, low back pain, musculoskeletal injury).4,5 A more contemporary view of exercise during pregnancy emphasizes that women and their care providers need to consider the risks of not participating in regular physical activities during the prenatal period.3 Previous work in prenatal exercise did not systematically evaluate the prevalence of adverse exercise-related events. This article provides an executive summary of findings from a systematic review of the risks of physical activity for pregnant women without contraindications.6 It is one in a comprehensive series about the risks of physical activity participation in patients with various medical conditions.7 The overall purpose of these systematic reviews was to provide evidence-based recommendations for tools to simplify exercise clearance and prescription: the new Physical Activity Readiness Questionnaire for Everyone (PAR-Q+)8 and the electronic Physical Activity Readiness Medical Examination (ePARmed-X+).9 The purpose of this summary is to present evidence-based information regarding adverse exercise-related events during uncomplicated pregnancy and discuss this information in relation to the family physician’s task of screening patients for physical activity participation

The Canadian Women’s Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women — Chapter 7: Sex, Gender, and the Social Determinants of Health

Women vs men have major differences in terms of risk-factor profiles, social and environmental factors, clinical presentation, diagnosis, and treatment of cardiovascular disease. Women are more likely than men to experience health issues that are complex and multifactorial, often relating to disparities in access to care, risk-factor prevalence, sex-based biological differences, gender-related factors, and sociocultural factors. Furthermore, awareness of the intersectional nature and relationship of sociocultural determinants of health, including sex and gender factors, that influence access to care and health outcomes for women with cardiovascular disease remains elusive. This review summarizes literature that reports on under-recognized sex- and gender-related risk factors that intersect with psychosocial, economic, and cultural factors in the diagnosis, treatment, and outcomes of women’s cardiovascular health. Résumé: Les profils de facteurs de risque, les facteurs sociaux et environnementaux, le tableau clinique, le diagnostic et le traitement des maladies cardiovasculaires montrent des différences importantes entre les femmes et les hommes. Il est plus probable que les femmes expérimentent des problèmes de santé complexes et multifactoriels, qui sont souvent en relation avec les disparités dans l’accès aux soins, la prévalence des facteurs de risque, les différences biologiques entre les sexes, les facteurs liés au genre et les facteurs socioculturels. De plus, la sensibilisation à la nature et à la relation intersectionnelles des déterminants socioculturels de santé, notamment les facteurs liés au sexe et au genre, qui influencent l’accès aux soins et les résultats cliniques des femmes atteintes d’une maladie cardiovasculaire demeure insaisissable. La présente revue résume la littérature qui porte sur les facteurs de risque liés au sexe et au genre peu reconnus qui se recoupent aux facteurs psychosociaux, économiques et culturels dans le diagnostic, le traitement et les résultats cliniques en lien avec la santé cardiovasculaire des femmes