Physical activity during pregnancy and postpartum period and the effects on perinatal outcomes

Orientador: Fernanda Garanhani de Castro SuritaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Introdução: Tanto o nível de atividade física quanto a prática regular de exercícios físicos durante a gestação são fatores que podem influenciar na evolução da gestação e nos desfechos materno-fetais. Desde a década de 1980, a prática regular de exercício físico durante a gestação e no período pós-parto vem sendo cada vez mais estudada e estimulada por se associar a benefícios para saúde física e psicológica da gestante e por não influenciar adversamente nos desfechos neonatais. Um melhor entendimento dos níveis habituais de atividade física entre gestante e puérperas, os fatores e repercussões relacionados à sua prática ajudariam num melhor delineamento de políticas públicas voltadas para o seu incentivo. Objetivo: Avaliar a prática de atividade física, suas características, fatores relacionados e as repercussões durante a gestação e após o parto. Métodos: Para esta tese de doutorado, foram realizadas diferentes abordagens sobre a prática de atividade física na gestação e puerpério. Primeiramente, foi realizada uma revisão sistemática da literatura, com ensaios clínicos randomizados, publicados entre julho de 2010 e julho de 2012, sobre a prática de exercício na gestação e seus efeitos na saúde materno-fetal, bem como as recomendações existentes a respeito dessa prática. O segundo estudo refere-se a uma revisão sistemática e meta-análise de ensaios clínicos randomizados publicados até Outubro de 2012, que avaliaram a efetividade do exercício físico, combinado ou não com dieta, na perda de peso de mulheres após o parto. Os dois estudos originais apresentados em seguida compartilham a mesma metodologia de estudo do tipo corte transversal, no entanto foram realizados em duas populações distintas. O primeiro na cidade de Campinas ¿ SP, Brasil, onde foi realizado um estudo de base populacional que incluiu 1.279 mulheres em três maternidades, e o segundo na cidade de Kingston ¿ ON, Canadá, onde foram incluídas de 197 mulheres. Os critérios de inclusão para ambos foram: mulheres no puerpério imediato, internadas em maternidades selecionadas, recém-nascido vivo, e gestação única. As participantes foram entrevistadas e responderam às questões sobre dados sociodemográficos, sobre prática de exercícios e atividades físicas cotidianas no período gestacional. Dados da gestação, do parto e do recém-nascido foram extraídos dos prontuários e do cartão de pré-natal. Considerou-se significativo um p-valor <0,05. Resultados: 1) A maioria dos ensaios clínicos recentes confirma a efetividade do exercício como fator de proteção em diversos desfechos maternos e perinatais, como ganho de peso, diabetes gestacional, idade gestacional ao nascimento, peso do recém-nascido, dor lombar, incontinência urinária, depressão pós-parto e qualidade de vida; suportando as atuais recomendações para a prática de exercícios em intensidade moderada por cinco vezes na semana em sessões de 30 minutos ou mais por gestantes que não apresentem contraindicações. 2) Ensaios clínicos randomizados cuja intervenção no estilo de vida incluiu programas de exercício, combinados ou não com dieta, mostraram um efeito significativo na perda de peso por mulheres no pós-parto. Sendo mais efetivos programas que utilizaram frequencímetro cardíaco ou pedômetro, aqueles que combinados à intervenção dietética intensiva. 3) Dados do estudo de corte-transversal mostraram que em Campinas ¿ SP, a prevalência de exercício físico na gestação foi de 20,1%, sendo que metade das mulheres interrompeu sua prática devido à gestação. No início (13,6%) e no final gestação (13,4%) as mulheres tenderam a diminuir ainda mais a prática de exercícios, sendo a maior prevalência observada no segundo trimestre gestacional (17,8%). Menos da metade recebeu algum tipo de orientação sobre exercício físico do médico durante as consultas de pré-natal (47,5%). A caminhada foi o exercício mais frequente, seguido por hidroginástica. Os fatores associados à prática do exercício na gestação foram: maior escolaridade, primiparidade, prática de exercício antes da gestação, e orientação sobre exercício no pré-natal. A prática do exercício físico não se relacionou com os resultados maternos e perinatais. 4) Em Kingston ¿ CA, a prevalência de exercício entre gestantes foi alta em todos os três trimestres da gestação, 75,4%, 69,3% e 60,3%, respectivamente. No entanto observou-se menor prevalecia levando-se em conta o nível recomendado de 150 minutos de exercício por semana, com prevalência máxima de 27,1% no primeiro trimestre, 12,7% no segundo e 7,1% no terceiro. A caminhada foi o tipo mais frequente. O IMC pré-gestacional foi único fator associado à prática de exercício nos três trimestres, quanto maior o IMC menor a chance de praticar exercício. Conclusões: O exercício físico é uma prática associada a benefícios para a saúde da mulher durante a gravidez e significativamente associada a maior perda de peso no pós-parto. No entanto a gestação é uma condição que leva as mulheres a diminuírem o nível de atividade física, e poucas alcançam o nível recomendado de exercício na gestação. A prática de exercícios físicos durante a gestação deve ser mais conhecida e estimulada pelos profissionais da saúde, principalmente para mulheres previamente sedentárias e as com sobrepeso ou obesidadeAbstract: Introduction: The level of physical activity and regular physical exercise during pregnancy are both factors that may be beneficial for maternal and fetal outcomes. Since the 1980s, regular exercise practice during pregnancy and the postpartum period has been increasingly studied and stimulated based on their benefits for physical and psychological mother health and because exercise has not found associated with adverse neonatal outcome. Understanding activity patterns during pregnancy and postpartum and their correlates have significant public health implications. Objective: To evaluate physical activity and to explore to explore associated factors and effects with participation in physical activities during pregnancy and postpartum period. Methods: In this doctoral thesis we have explored a diverse methodological approach about physical activity during pregnancy and postpartum. Firstly, a systematic review of randomized clinical trials, published from July 2010 to July 2012 on the effects of physical exercise during pregnancy on maternal and fetal outcomes and its current recommendations was performed. The second study is a systematic review and meta-analysis of randomized clinical trials published up to 31 October 2012, that examined the effects of exercise interventions, with or without complementary dietary intervention, on weight loss during the postpartum period compared with usual standard of care. The following two presented studies have the same cross-sectional survey methodology. The first one, a population-based study has included 1.279 women in the city of Campinas, Brazil; and the second one and has included 197 women in Kingston, Canada. The inclusion criteria for both studies were: postpartum women, alive newborn and a singleton pregnancy. Each participant was asked to complete a questionnaire in about socio-demographic characteristics, obstetrical history and physical activity patterns throughout pregnancy. Data regarding pregnancy, labour, delivery, and newborn outcomes were retrieved from medical records. Statistical significance is defined as a two sided P value ? 0.05 Results: 1) the most part of the included trials support the effectiveness of physical exercise intervention on maternal and perinatal outcomes, such as gestational weight gain, gestational diabetes, gestational age at birth, newborn weight, low back pain, urinary incontinence, postpartum depression and quality of life. 2) Randomized clinical trial showed that there is benefit from overall lifestyle interventions on weight loss in postpartum women and exercise plus intensive diet and objective targets are the most effective intervention strategies. 3) In Campinas, exercise prevalence during pregnancy was 20.1%, half of the women discontinued their exercise practice due to pregnancy. Pregnant women tend to decrease physical exercises at the beginning (13.6%) and at the end (13.4%) of gestation. The highest prevalence was found at second trimester (17,8%). Less than half received some medical advice about physical exercise during prenatal visits (47.5%). Walking was the most frequent exercise type, followed by water aerobics. Higher educational level, lower parity, been active before pregnancy and medical advice to exercise were associated with physical exercise during pregnancy. Exercise was not associated with maternal and perinatal outcomes. 4) In Kingston, women highly reported to be engaged in exercise during the three trimesters of pregnancy, 75.4%, 69.3% e 60.3%, respectively. However, based on Canadian guidelines of 150 minutes of aerobic exercise per week, the prevalence of active pregnant women decreases, with maximal prevalence of 27.1% in the first trimester, 12.7% in the second, and 7.1% in the third trimester. The most frequent type of exercise was walking. Lower pre-pregnancy Body Mass Index was the unique characteristic associated with been active during the three trimesters of pregnancy Conclusions: Physical exercise is beneficial for women during pregnancy and in the postpartum period lead to greater weight loss. However, there is a decrease on exercise prevalence throughout pregnancy. Thus, prenatal care providers should support women in order to advising them about the target exercise duration recommend in the guidelines, using different strategies, mainly for previous inactive and overweight and obese women who are at risk of sedentary behaviourDoutoradoSaúde Materna e PerinatalDoutora em Ciências da Saúd

A systematic review and meta-analysis of gestational weight gain recommendations and related outcomes in Brazil

Worldwide, different guidelines are used to assess the adequacy of gestational weight gain. This study identified the recommendations for gestational weight gain in Brazilian women. We also determined the proportion of women with adequate weight gain in accordance with these recommendations and the associated perinatal outcomes. A systematic review was performed. A computerized search was conducted utilizing the following databases: PubMed, MEDLINE, Web of Science, Embase, SciELO and Google Scholar. Observational studies of healthy, Brazilian, pregnant women were included. Studies were excluded if they did not provide pregestational weight and gestational weight gain or if they studied women with comorbid conditions. A meta-analysis was performed to evaluate the odds ratio of inadequate (insufficient or excessive) gestational weight gain. Seventeen studies were included in the systematic review and four studies were included in the meta-analysis. The most widely used recommendations were from the Institute of Medicine. Excessive gestational weight gain was associated with fetal macrosomia and high rates of cesarean delivery. Overweight women had a higher risk of excessive gestational weight gain than eutrophic women (OR=2.80, 95%CI=2.22-3.53). There are no standardized recommendations concerning gestational weight gain based on Brazilian population-based data. Many Brazilian women are overweight or obese at the beginning of pregnancy. Overweight pregnant women have a higher risk of excessive gestational weight gain. Excessive gestational weight gain was associated with cesarean delivery and fetal macrosomia

Influência Da Massa Corporal Na Frequência De Linfedema E Outras Complicações Depois De Cirurgia Para Câncer De Mama

This study assessed the influence of pre-operative body mass index (BMI) has upon lymphedema, scar tissue adhesion, pain, and heaviness in the upper limb at two years after surgery for breast cancer. Methods: retrospective analysis of 631 medical records of women who underwent surgery for breast cancer and were referred to the Physiotherapy Program at Prof. Dr. José Aristodemo Pinotti Women's Hospital of the Center for Integral Women's Health Care, CAISM/UNICAMP between January 2006 and December 2007. Results: mean age of women was 56.5 years (±13.7 years) and the most part (55%) were overweight or obese, surgical stages II and III were present in 63% of women studied. Radical mastectomy was the most frequent surgery (54.4%), followed by quadrantectomy (32.1%). In the first year after surgery, there was no significant association between BMI categories and incidence of scar tissue adhesion, pain, heaviness and lymphedema. In the second year, overweight and obese women had higher rates of heaviness in the upper limb and lymphedema. For lymphedema, there was a significant difference among BMI categories (p=0.0268). Obese women are 3.6 times more likely to develop lymphedema in the second year after surgery (odds ratio 3.61 95% CI 1.36 to 9.41). Conclusion: BMI &#8805;25kg/m2 prior to treatment for breast cancer can be considered a risk factor for developing lymphedema in the two years after surgery. There was no association between BMI and the development of other complications.231849

Influencia del índice de masa corporal en la frecuencia de linfedema y otras complicaciones después de la cirugía para el cáncer de mama

Objective: this study assessed the influence of pre-operative body mass index (BMI) has upon lymphedema, scar tissue adhesion, pain, and heaviness in the upper limb at two years after surgery for breast cancer. Methods: retrospective analysis of 631 medical records of women who underwent surgery for breast cancer and were referred to the Physiotherapy Program at Prof. Dr. José Aristodemo Pinotti Women's Hospital of the Center for Integral Women's Health Care, CAISM/UNICAMP between January 2006 and December 2007. Results: mean age of women was 56.5 years (±13.7 years) and the most part (55%) were overweight or obese, surgical stages II and III were present in 63% of women studied. Radical mastectomy was the most frequent surgery (54.4%), followed by quadrantectomy (32.1%). In the first year after surgery, there was no significant association between BMI categories and incidence of scar tissue adhesion, pain, heaviness and lymphedema. In the second year, overweight and obese women had higher rates of heaviness in the upper limb and lymphedema. For lymphedema, there was a significant difference among BMI categories (p=0.0268). Obese women are 3.6 times more likely to develop lymphedema in the second year after surgery (odds ratio 3.61 95% CI 1.36 to 9.41). Conclusion: BMI ?25kg/m2 prior to treatment for breast cancer can be considered a risk factor for developing lymphedema in the two years after surgery. There was no association between BMI and the development of other complications.Avaliou-se a influência do índice de massa corporal (IMC) pré-operatória na ocorrência de linfedema, aderência cicatricial, dor e peso no membro superior nos primeiros dois anos após cirurgia para câncer de mama. O estudo é uma análise retrospectiva, secundária de 631 prontuários de mulheres submetidas à cirurgia para câncer de mama e encaminhadas ao Programa de Fisioterapia do Hospital Professor Dr. José Aristodemo Pinotti do Centro de Atenção Integral à Saúde da Mulher, CAISM /UNICAMP, entre janeiro de 2006 e dezembro de 2007. Eram mulheres com idade média de 56,5 anos (±13,7 anos), a maioria (55%) com sobrepeso ou obesa. Os estádios clínicos II e III foram encontrados em 63% das mulheres. Mastectomia radical foi a cirurgia mais frequente (54,4%), seguida por quadrantectomia (32,1%). No primeiro ano após a cirurgia não houve associação significativa entre as categorias do índice de massa corporal e incidência de aderência cicatricial, dor, peso e linfedema. No segundo ano, mulheres com sobrepeso e obesidade apresentaram maiores taxas de peso no membro superior e linfedema. Para linfedema houve diferença significativa entre as categorias de índice de massa corporal (p=0,0268). Mulheres obesas têm 3,6 vezes mais chance de desenvolver linfedema no segundo ano após a cirurgia (odds ratio 3,61 95% IC 1,36-9,41). Concluiu-se que IMC ?25kg/m2 anterior ao tratamento para câncer de mama pode ser considerado fator de risco para desenvolvimento do linfedema dois anos após a cirurgia. Não houve associação entre IMC e outras complicações.231849

Physical exercise, weight gain, and perinatal outcomes in overweight and obese pregnant women: a systematic review of clinical trials

This study aimed to evaluate the effects of exercise on weight gain and perinatal outcomes among overweight and obese pregnant women, through a systematic review in MEDLINE/PubMed, EMBASE, LILACS, and SciELO. We included ten clinical trials that evaluated the effectiveness of exercise with or without combined diet in the control of gestational weight gain. Three studies were randomized, and methodological quality was assessed using the CONSORT 2010 Checklist, but none met all the criteria. Four studies showed weight gain differences between groups. The majority (60%) of studies showed no differences in perinatal outcomes (mode of delivery, gestational age at birth, birth weight). In conclusion, few studies confirmed the positive effect of exercise in controlling weight gain during pregnancy, thus requiring more research in this direction. Regarding perinatal outcomes, mild to moderate exercise does not appear to be decisive for perinatal outcomes, and is safe for pregnant women with overweight and obesity.Esta revisão objetivou avaliar os efeitos do exercício físico no ganho de peso e nos resultados perinatais de gestantes com sobrepeso e obesidade, através de revisão sistemática da literatura em bases de dados específicas: MEDLINE/PubMed, EMBASE, SciELO e LILACS. Foram incluídos dez ensaios clínicos que avaliaram a efetividade do exercício combinado ou não com dieta no controle do ganho de peso gestacional. Três estudos são randomizados e a qualidade metodológica foi avaliada através do CONSORT 2010 Checklist, porém nenhum deles cumpriu todos os critérios. Quatro estudos obtiveram diferença quanto ao ganho de peso entre os grupos. A maioria dos estudos (60%) não demonstrou diferença quanto aos resultados perinatais (via de parto, idade gestacional ao nascer, peso do recém-nascido). Poucos estudos confirmam o efeito positivo do exercício no controle do ganho de peso gestacional, necessitando mais pesquisas neste sentido. O exercício em intensidade leve a moderada parece não ser determinante nos resultados perinatais, sendo uma prática segura para gestantes com sobrepeso e obesidade.40741

[recommendations For Physical Exercise Practice During Pregnancy: A Critical Review].

Physical exercise is recommended for all healthy pregnant women. Regular practice of exercises during pregnancy can provide many physical and psychological benefits, with no evidence of adverse outcomes for the fetus or the newborn when exercise is performed at mild to moderate intensity. However, few pregnant women engage in this practice and many still have fears and doubts about the safety of exercise. The objective of the present study was to inform the professionals who provide care for Brazilian pregnant women about the current recommendations regarding physical exercise during pregnancy based on the best scientific evidence available. In view of the perception that few systematic models are available about this topic and after performing several studies in this specific area, we assembled practical information of interest to both the professionals and the pregnant women. We also provide recommendations about the indications, contraindications, modalities (aerobics, resistance training, stretching and pelvic floor training), frequency, intensity and duration indicated for each gestational trimester. The review addresses physical exercise recommendation both for low risk pregnant women and for special populations, such as athletes and obese, hypertensive and diabetic subjects. The advantages of an active and healthy lifestyle should be always reinforced during and after gestation since pregnancy is an appropriate period to introduce new habits because pregnant women are usually more motivated to adhere to recommendations. Thus, routine exams, frequent returns and supervision are recommended in order to provide new guidelines that will have long-term beneficial effects for both mother and child.36423-3

Complications and physical therapeutic treatment after breast cancer surgery: a retrospective study

Após cirurgia por câncer de mama, as mulheres estão sujeitas a desenvolver algumas complicações físicas. Os objetivos deste trabalho foram: investigar o desfecho dessas mulheres, que, durante o primeiro mês pós-operatório, foram submetidas a um programa de reabilitação e identificar ao longo de dois anos as complicações mais frequentes e as condutas fisioterapêuticas mais adotadas. Foi um estudo descritivo, retrospectivo, com dados de 707 prontuários de mulheres operadas por câncer de mama no Hospital da Mulher Professor Doutor José Aristodemo Pinotti da Universidade Estadual de Campinas, entre janeiro de 2006 e dezembro de 2007, atendidas pelo Setor de Fisioterapia. A análise foi feita por meio de médias, desvio padrão e frequências absolutas e relativas. Ao final do programa, 55% das mulheres receberam alta, 17% necessitaram de atendimento adicional e 26% não aderiram a ele. As complicações mais frequentes foram: aderência pericicatricial (26%), restrição da amplitude de movimento (24%) e deiscência cicatricial (17%). No primeiro ano após a cirurgia (n=460), foram relatados dor (28,5%), sensação de peso (21,5%) e restrição da amplitude de movimento do ombro (16,7%); já no segundo (n=168), houve dor (48,2%), sensação de peso (42,8%) e linfedema (23,2%). Concluiu-se que, ao final do programa, a maioria das mulheres recebeu alta. Ao longo dos anos, houve redução da frequência de restrição da amplitude de movimento do ombro com aumento de linfedema. Cuidados com o braço, exercícios domiciliares e autodrenagem foram as condutas mais adotadas.After breast cancer surgery, women may develop some physical complications. Thus, the aims of this study were to investigate the outcome of these women, who participated in a rehabilitation program for one month, as well to identify along two years the most frequent complications and adopted physical therapy conducts. It was a descriptive and retrospective study with 707 medical records of women treated for breast cancer at the Women's Hospital Professor Doutor José Aristodemo Pinotti, Universidade Estadual de Campinas, between January 2006 and December 2007, admitted in the Division of Physical Therapy. Analysis was performed by means, standard deviation, absolute and relative frequencies. By the end of the program, 55% of women were discharged, 17% required additional treatment, and 26% did not join it. The most frequent complications were: pericicatricial adherence (26%), range of motion (ROM) restriction (24%), and scar dehiscence (17%). In the first year after surgery (n=460), the main complaints were: pain (28.5%), heaviness (21.5%), and restriction of shoulder range of motion (16.7%); in the second year (n=168), they were pain (48.2%), heaviness (42.8%), and lymphedema (23.2%). It was concluded that most women were discharged in the end of the program and, over the years, they presented reduction of shoulder range of motion frequency and lymphedema increase. Care of the arm, home exercises, and self-lymphatic drainage were the most adopted conducts

Sexual function in women with endometriosis and pelvic floor myofascial pain syndrome

Abstract Objective: To evaluate and compare the sexual function and pelvic floor muscles (PFM) function of women with endometriosis and chronic pelvic pain (CPP) with and without Myofascial Pelvic Pain Syndrome (MPPS). Methods: Cross-sectional study conducted between January 2018 and December 2020. Women with deep endometriosis underwent assessments for trigger points (TP) and PFM function using the PERFECT scale. Electromyographic activity (EMG) and sexual function through Female Sexual Function Index (FSFI) were assessed. Statistical analyses included chi-square and Mann-Whitney tests. Results: There were 46 women. 47% had increased muscle tone and 67% related TP in levator ani muscle (LAM). Weakness in PFM, with P≤2 was noted in 82% and P≥3 in only 17%. Incomplete relaxation of PFM presented in 30%. EMG results were resting 6.0, maximal voluntary isometric contraction (MVIC) 61.9 and Endurance 14.2; FSFI mean total score 24.7. We observed an association between increased muscle tone (P<.001), difficulty in relaxation (P=.019), and lower Endurance on EMG (P=.04) in women with TP in LAM. Participants with TP presented lower total FSFI score (P=.02). TP in the right OIM presented increased muscle tone (P=.01). TP in the left OIM presented lower values to function of PFM by PERFECT (P=.005), and in MVIC (P=.03) on EMG. Conclusion: Trigger points (TP) in pelvic floor muscles (PFM) and obturator internus muscle (OIM) correlates with poorer PFM and sexual function, particularly in left OIM TP cases. Endometriosis and chronic pelvic pain raise muscle tone, weaken muscles, hinder relaxation, elevate resting electrical activity, lower maximum voluntary isometric contraction, and reduce PFM endurance

Physical exercise impact in maternal and perinatal outcomes and quality of life of overweight and obesity pregnant

Orientadores: Fernanda Garanhani de Castro Surita, Mary Ângela ParpinelliDissertação (mestrado) - Universidade Estadual de Campinas. Faculdade de Ciências MédicasObjetivo: avaliar a associação entre a prática do exercício físico no ganho de peso gestacional, resultados maternos, perinatais e a percepção da qualidade de vida de gestantes obesas ou com sobrepeso e revisar de forma sistemática a literatura sobre o assunto. Métodos: inicialmente procedeu-se à revisão sistemática da literatura seguida de ensaio clínico controlado aleatorizado com 82 gestantes acompanhadas em ambulatórios de pré-natal do CAISM/Unicamp no período de agosto de 2008 a março de 2010. Foram incluídas gestantes com sobrepeso ou obesidade, idade gestacional entre 14 e 24 semanas e maiores de 18 anos. As mulheres foram aleatorizadas em dois grupos: um que realizou um programa de exercício físico sob supervisão e recebeu orientação de exercícios domiciliares (grupo-estudo) e o outro que seguiu as rotinas de pré-natal do serviço (grupo-controle). Ambos receberam orientação nutricional padronizada pelo Serviço de Nutrição e Dietética e responderam ao questionário de qualidade de vida WHOQOL-Abreviado, no início do estudo e ao final da gestação. Os resultados da intervenção foram analisados por intenção de tratamento. O nível de significância foi assumido com valor de p inferior a 0,05. Resultados: no grupo de estudo 47% das gestantes ganharam peso acima do adequado contra 52% no controle. Não houve diferença no ganho de peso gestacional entre os grupos. As gestantes com sobrepeso ganharam significativamente menos peso durante toda a gestação (10,0 ± 1,7kg versus 17,9 ± 2,8kg) e após a entrada no estudo (5,9± 4,3kg versus 12,7 ± 0,4kg). A pressão arterial média (PAM) foi semelhante entre os grupos ao longo do tempo. Não houve diferença em relação aos resultados perinatais. Em todos os domínios do WHOQOL - Abreviado o grupo-estudo apresentou escores maiores ao final da gestação do que o grupo-controle, sem diferença significativa. Conclusões: em concordância com dados da literatura o exercício físico é seguro durante a gestação, podendo ou não se associar ao menor ganho de peso e, o programa de exercício realizado beneficiou principalmente as gestantes com sobrepeso, mostrando ser uma prática segura que não interferiu na variação da pressão arterial e nos resultados perinatais, mesmo entre gestantes obesasAbstract: Objective: To systematically review the literature on the effects of exercise on weight gain during pregnancy and perinatal outcomes and to evaluate the association between physical exercise with the maternal, perinatal outcomes and quality of life perception of obese or overweight women. Methods: A randomized controlled clinical trial with 82 pregnant women followed up at the prenatal clinics for the period August 2008 to March 2010. Overweight or obese (BMI ? 26 kg / m²), gestational age between 14 and 24 weeks and from age 18 years were included. They were divided into two random groups: one witch has done na exercise program under supervision and guidance received from home exercises (study group) and another that followed the routines prenatal care service (control group). Both groups received standardized nutritional counseling by the department of nutrition and dietetics and a questionnaire measuring quality of life WHOQOLshort at the beginning of the study and the end of pregnancy. The intervention results were analyzed by intention to treat. A P value less than 0.05 was used to determine statistical significance. Results: In study group 47% of women gained weight above the appropriate against 52% in control. There was no significant difference in gestational weight gain between groups. But the overweight women gained less weight throughout gestation (10.0 ± 1.7kg versus 17.9 ± 2.8 kg) and after entering the study (5.9± 4.3kg versus 12.7 ± 0.4kg). The mean blood pressure was similar between groups over time. In the study group before and after exercise, it was found that the mean blood pressure value was significantly lower in the second trimester of pregnancy. No significant difference in relation to perinatal outcomes. In all domains of WHOQOL-short questionary the study group had higher scores at the end of pregnancy than the control group, but this difference was not significant. Conclusions: The exercise program mainly benefited overweight pregnant women, being a safe practice that did not affect the variation in blood pressure and perinatal outcomes and perception of quality of lifeMestradoCiencias BiomedicasMestre em Tocoginecologi