Actividade física e qualidade de vida na gravidez

Iva Tendais (*)

Bárbara Figueiredo (**)

Jorge Mota (***)

RESUMO

Pouco se conhece acerca da actividade física e qualidade de vida da mulher na gravidez. Este estudo teve como objectivos 1) comparar os padrões de actividade física antes e durante a gravidez, 2) avaliar a percepção da qualidade de vida relacionada com a saúde durante os primeiros seis meses de gestação, e 3) comparar a percepção da qualidade de vida nas mulheres activas e insuficientemente activas considerando as recomendações de saúde pública.

Método: Estudo longitudinal com 59 grávidas seleccionadas em consultórios médicos privados. Às 10-15 semanas foi recolhida informação socio-demográfica e médica, bem como informação sobre a actividade física três meses antes da concepção. Medidas de auto-relato foram administradas entre as 10-15 semanas e as 19-24 semanas de gestação para avaliar o tempo de actividade física (QAFG) (no trabalho, lazer, deslocações) e a qualidade de vida (SF-36).

Resultados: A prevalência de actividade física recomendada é menor durante do que antes da gravidez (16.7% e 17.5% nos 1.º e 2.º trimestres, respectivamente vs. 47.4% antes da gravidez). Com a gravidez, não se verificaram alterações no tempo médio em diferentes tipos de actividade física, mas a actividade física no lazer registou uma diminuição significativa no 1.º trimestre face ao período anterior à concepção. Em comparação com uma amostra normativa de mulheres portuguesas, as grávidas apresentam, nos dois primeiros trimestres de gestação, uma percepção de qualidade da vida mais positiva na generalidade das dimensões do SF-36. No 2.º trimestre, o nível de limitação é significativamente maior nas dimensões físicas, à excepção da Dor Corporal, e nos resultados sumários do Componentes Físico e Mental. As mulheres que no 1.º trimestre atingem os níveis recomendados de actividade física no lazer (≥150 minutos por semana) apresentam melhor estado de saúde geral e estados de humor mais positivos do que as menos activas.

Conclusão: A actividade física no lazer, embora diminua após a concepção, tem um impacto positivo na percepção do estado saúde geral e estados de humor da grávida, o que sugere a sua importância para a saúde da mulher também durante este período da vida.

Palavras-chave: Actividade física, gravidez, qualidade de vida, depressão

 

 

ABSTRACT

Background: Little is know about the impact of pregnancy in health-related quality of life (HRQoL) and in physical activity patterns. The objectives of this study were 1) to compare physical activity patterns before and during pregnancy, 2) to evaluate HRQoL among pregnant women until six months pregnancy and 3) to compare HRQoL between sufficiently and insufficiently active women considering the public health recommendations.

Methods: Longitudinal study with 59 pregnant women (20-39 years of age) recruited in private obstetric clinics. At 10-15 weeks gestation, socio-demographic and medical information was collected, as well as physical activity levels three months prior to conception. Self-report measures were administered at 10-15 weeks and 19-24 weeks gestation to assess work, leisure and transportation-time physical activity and HRQoL.

Results: The prevalence of recommended activity is lower during pregnancy than prepregnancy (16.7% and 17.5% in 1st and 2nd trimesters, respectively, vs. 47.4% prepregnancy). After conception, there were no changes in physical activity time, but leisure-time physical activity showed a decrease from prepregnancy to 1st trimester of gestation. Compared to Portuguese normative data, pregnant women demonstrate a more positive HRQoL on almost every domains of SF-36 in the first two trimesters of pregnancy. In the 2nd trimester of pregnancy, the level of impairment is significantly higher in physical HRQoL, with the exception of Bodily Pain, as well as on the SF-36 physical and mental component summary score. Women meeting recommended levels of leisure physical activity at 10-15 weeks (≥150 minutes per week) reported better general health and more positive mood states compared to less active women.

Conclusions: In spite of the decline observed during pregnancy, leisure-time physical activity has a positive impact in pregnant’s general health status and mood states suggesting its importance for women’s health also during this life period.

Key words: Psysical activity, pregnancy, quality of life, depression

 

Texto completo disponível apenas em PDF.

Full text only available in PDF format.

 

REFERÊNCIAS BIBLIOGRÁFICAS

ACOG Committee Opinion (2002). Exercise during pregnancy and the postpartum period. Number 267, January 2002. American College of Obstetricians and Gynecologists. Int Journal Gynaecol Obstet., 77, 79-81.

(2003). Exercise during pregnancy and the postpartum period. Clin Obstet Gynecol, 46 (2), 496-499.

Atlantis, E., Chow, C., Kirby, A., & Singh, M. F. (2004). An effective exercise-based intervention for improving mental health and quality of life measures: a randomized controlled trial. Preventive Medicine, 39, 424-434.

        [ Links ]

Brown, P., Brown, W., Miller, Y., & Hansen, V. (2001). Perceived constraints and social support for active leisure among mothers with young children. Leisure Science, 23, 131-144.

Brown, W., Stewart, G., & Trost, S. (2003). Life transtions and changing physical activity patterns in young women. American Journal of Preventive Medicine, 25 (2), 140-143.

Campbell, M., & Mottola, M. (2001). Recreational exercise and occupational activity during pregnancy and birth weight: a case-control study. Am J Obstet Gynecol, 184 (3), 403-408.

Caspersen, C., Powell, K., & Christenson, G. (1985). Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep, 100 (2), 126-131.

Chasan-Taber, L., Schmidt, M. D., Pekow, P., Sternfeld, B., Manson, J., & Markenson, G. (2007). Correlates of physical activity among Latina women. Maternal Child Health, 11, 353-363.

Clapp, J. F. 3rd, Kim, H., Burciu, B., Schmidt, S., Petry, K., & Lopez, B. (2002). Continuing regular exercise during pregnancy: effect of exercise volume on feto-placental growth. Am J Obstet Gynecol, 186 (1), 142-147.

Clarke, P., Rousham, E., Groos, H., Halligan, A., & Bosio, P. (2005). Activity patterns and time allocation during pregnancy: a longitudinal study of British women. Ann Hum Biol, 32 (3), 247-258.

Craig, C., Marshall, A., Sjostrom, M., Bauman, A., Booth, M., Ainsworth, B. et al. (2003). International Physical Activity Questionnaire: 12-contry reliability and validity. Medicine and Science in Sports and Exercise, 35 (8), 1381-1395.

Croteau, A., Marcoux, S., & Brisson, C. (2006). Work activity in pregnancy, preventive measures, and the risk of delivering a small-for-gestational-age infant. Am J Public Health, 96 (5), 846-855.

Davies, G., Wolfe, L., Mottola, M., & MacKinnon, C. (2003). Joint SOGC/CSEP clinical practice guide-lines: exercise in pregnancy and the postpartum period. Canadian Journal of Applied Physiology, 28 (3), 330-341.

Dempsey, J. C., Butler, C. L., Sorensen, T. K., Lee, I. M., Thompson, M. L., Miller, R. S. et al. (2004). A case-control study of maternal recreational physical activity and risk of gestational diabetes mellitus. Diabetes Res Clin Pract, 66 (2), 203-215.

Dempsey, J. C., Butler, C. L., Sorensen, T. K., Lee, I. M., Thompson, M. L., Miller, R. S. et al. (2004). Prospective study of gestational diabetes mellitus risk in relation to maternal recreational physical activity before and during pregnancy. Am J Epidemiol, 159 (7), 663-670.

Dye, T. D., Knox, K. L., Artal, R., Aubry, R. H., & Wojtowycz, M. A. (1997). Physical activity, obesity, and diabetes in pregnancy. Am J Epidemiol, 146 (11), 961-965.

Evans, J., Heron, J., Francomb, H., Oke, S., & Golding, J. (2001). Cohort study of depressed mood during pregnancy and after childbirth. BMJ, 323 (7307), 257-260.

Evenson, K., Savitz, D., & Huston, S. (2004). Leisure-time physical activity among pregnant women in the US. Paediatric and Perinatal Epidemiology, 18, 400-407.

Ferreira, P. (2000a). Criação da versão portuguesa do MOS SF-36: Parte I – Adaptação cultural e linguística. Acta Médica Portuguesa, 13, 55-66.

Ferreira, P. (2000b). Criação da versão portuguesa do MOS SF-36: Parte II – Testes de validade. Acta Médica Portuguesa, 13, 119-127.

Figueiredo, B. A., Pacheco, A., & Magarinho, R. (2005). Grávidas adolescentes e grávidas adultas: diferentes circunstâncias de risco? Acta Médica Portuguesa, 18 (2), 97-105.

Gorman, L., O’Hara, M., Figueiredo, B., Hayes, S., Jacque-main, Kammerer, M. et al. (2004). Adaptation of the Structured Clinical Interview for DSM-IV Disorders for assessing depression in women during pregnancy and post-partum across countries and cultures. British Journal of Psychiatry, 184 (s46), 17-23.

Haas, J., Jackson, R., Fuentes-Afflick, E., Stewart, A., Dean, M., Brawarsky, P. et al. (2004). Changes in the health status of women during and after preg-nancy. J Gen Intern Med, 20 (1), 45-51.

Haas, J., Meneses, V., & McCormick, M. (1999). Outcomes and health status of socially disadvantaged women during pregnancy. J Womens Health Gend Based Med, 8 (4), 547-553.

Harkonmaki, K., Rahkonen, O., Martikainen, P., Silven-toinen, K., & Lahelma, E. (2006). Associations of SF-36 mental health functioning and work and family related factors with intentions to retire early among employees. Occup Environ Med, 63 (8), 558-563.

Henriksen, T., Hedegaard, M., Secher, N., & Wilcox, A. (1995). Standing at work and preterm delivery. British Journal of Obstetrics and Gynaecology, 102, 198-206.

Hueston, W., & Kasik-Miller, S. (1998). Changes in functional health status during normal pregnancy. J Fam Pract, 47 (3), 209-212.

Iburg, K., Rasmussen, N., & Avlund, K. (2006). Severity of self-reported diseases and symptoms in Denmark. Popul Health Metr, 18 (4), 3.

Koniak-Griffin, D. (1994). Aerobic exercise, psychological well-being, and physical discomforts during adolescent pregnancy. Res Nurs Health, 17 (4), 253-263.

Larsson, L., & Lindqvist. P. (2005). Low-impact exercise during pregnancy-a study of safety. Acta Obstet Gynecol Scand, 84 (1), 34-38.

Linné, Y., Barkeling, B., & Rössner, S. (2002). Long-term weight development after pregnancy. Obes Rev, 3 (2), 75-83.

Magann, E., Evans, S., Weitz, B., & Newnham, J. (2002). Antepartum, intrapartum, and neonatal significance of exercise on healthy low-risk pregnant working women. Obstet Gynecol, 99 (3), 466-472.

Mamelle, N., Laumon, B., & Lazar, P. (1984). Prematurity and occupational activity during pregnancy. American Journal of Epidemiology, 119, 309-322.

Marquez-Sterling, S., Perry, A., Kaplan, T., Halberstein, R., & Signorile, J. (2000). Physical and psychological changes with vigorous exercise in sedentary primigravidae. Med Sci Sports Exerc, 32 (1), 58-62.

Mckee, M., Cunningham, M., Jankowski, K., & Zayas, L. (2001). Health-related functional status in pregnancy: relationship to depression and social support in a multi-ethnic population. Obstet Gynecol, 97 (6), 988-993.

Myles, P., Viira, D., & Hunt, J. & . (2006). Quality of life at three years after cardiac surgery: relationship with preoperative status and quality of recovery. Anaesth Intensive Care 34 (2), 176-183.

Otchet, F., Carey, M., & Adam, L. (1999). General health and psychological symptom status in pregnancy and the puerperium: what is normal? Obstet Gynecol, 94 (6), 935-941.

Pate, R., Pratt, M., Blair, S., Haskell, W., Macera, C., Bouchard, C. et al. (1995). Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. Journal of the American Medical Association, 273 (5), 402-407.

Poudevigne, M., & O’Connor, P. (2006). A review of physical activity patterns in pregnant women and their relationship to psychological health. Sports Medicine, 36 (1), 19-38.

Ribeiro, J. L. (2005). O importante é a saúde: estudo de adaptação de uma técnica de avaliação do estado de saúde – SF-36. Lisboa: Fundação Merck Sharp & Dohme.

Rössner, S., & Ohlin, A. (1995). Pregnancy as a risk factor for obesity: lessons from the Stockholm Pregnancy and Weight Development Study. Obes Res, 3 Suppl 2, 267s-275s.

Royal College of Obstetricians and Gynaecologists (2006). Exercise in pregnancy. (Statement No. 4, January 2006). Acedido Julho, 9, 2006, de http://www.rcog.org.uk/resources/public/pdf/exercise_pregnancy_rcog_statement4.pdf

Saftlas, A., Logsden-Sackett, N., Wang, W., Woolson, R., & Bracken, M. (2004). Work, leisure-time physical activity, and risk of preeclampsia and gestational hypertension. Am J Epidemiol, 160 (8), 758-765.

Solomon, C. G., Willett, W. C., Carey, V. J., Rich-Edwards, J., Hunter, D. J., Colditz, G. A. et al. (1997). A prospective study of pregravid determinants of gestational diabetes mellitus. JAMA, 278 (13), 1078-1083.

Sorensen, T., Williams, M., Lee, I., Dashow, E., Thompson, M., & Luthy, D. (2003). Recreational physical activity during pregnancy and risk of preeclampsia. Hypertension, 41 (6), 1273-1280.

Spinillo, A., Capuzzo, E., Baltaro, F., Piazza, G., Nicola, S., & Iasci, A. (1996). The effect of work activity in pregnancy on the risk of fetal growth retardation. Acta Obstet Gynecol Scand, 75 (6), 531-536.

Spinillo, A., Capuzzo, E., Colonna, L., Piazzi, G., Nicola, S., & Baltaro, F. (1995). The effect of work activity in pregnancy on the risk of severe preeclampsia. Aust N Z J Obstet Gynaecol, 35 (4), 380-385.

Sternfeld, B., Ainsworth, B., & Quesenberry, C. (1999). Physical activity patterns in a diverse population of women. Prev Med, 28 (3), 313-323.

Tarlov, A., Ware, J., Greenfield, S., Nelson, E., Perrin, E., & Zubkoff, M. (1989). The Medical Outcomes Study: An application of methods of monitoring the results of medical care. Journal of the American Medical Association, 262, 925-930.

Van Raaij, J., Schonk, C., Vermaat-Miedema, S., Peek, M., & Hautvast, J. (1990). Energy cost of physical activity throughout pregnancy and the first year postpartum in Dutch women with sedentary lifestyles. Am J Clin Nutr, 52 (2), 234-239.

Verhoef, M., & Love, E. (1992). Women’s exercise participation: the relevance of social roles compared to non-role related determinants. Canadian Journal of Public Health, 83, 367-370.

Ware, J., & Gandek, B. (1998). Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. Journal of Clinical Epidemiology, 51 (11), 903-912.

Ware, J., & Sherbourne, C. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual frame-work and item selection. Medical Care, 30, 473-483.

 

(*) Universidade Lusíada do Porto, Porto.

(**) Departamento de Psicologia da Universidade do Minho, Braga.

(***) Faculdade de Desporto da Universidade do Porto, Porto.